Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics.

PubMed

Epstein, Arnold M; Jha, Ashish K; Orav, E John; Liebman, Daniel L; Audet, Anne-Marie J; Zezza, Mark A; Guterman, Stuart

2014-01-01

Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. Federal ACO programs for Medicare beneficiaries are now up and running, but little information is available about the baseline characteristics of early entrants. In this descriptive study we present data on the structural and market characteristics of these early ACOs and compare ACOs' patient populations, costs, and quality with those of their non-ACO counterparts at baseline. We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics. Our findings can be useful in interpreting the early results from the federal ACO programs and in establishing a baseline to assess the programs' development.

Physics issues in diffraction limited storage ring design

NASA Astrophysics Data System (ADS)

Fan, Wei; Bai, ZhengHe; Gao, WeiWei; Feng, GuangYao; Li, WeiMin; Wang, Lin; He, DuoHui

2012-05-01

Diffraction limited electron storage ring is considered a promising candidate for future light sources, whose main characteristics are higher brilliance, better transverse coherence and better stability. The challenge of diffraction limited storage ring design is how to achieve the ultra low beam emittance with acceptable nonlinear performance. Effective linear and nonlinear parameter optimization methods based on Artificial Intelligence were developed for the storage ring physical design. As an example of application, partial physical design of HALS (Hefei Advanced Light Source), which is a diffraction limited VUV and soft X-ray light source, was introduced. Severe emittance growth due to the Intra Beam Scattering effect, which is the main obstacle to achieve ultra low emittance, was estimated quantitatively and possible cures were discussed. It is inspiring that better performance of diffraction limited storage ring can be achieved in principle with careful parameter optimization.

CLEARING MAGNET DESIGN FOR APS-U

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abliz, M.; Grimmer, J.; Jaski, Y.

2017-06-25

The Advanced Photon Source is in the process of developing an upgrade (APS-U) of the storage ring. The upgrade will be converting the current double bend achromat (DBA) lattice to a multi-bend achromat (MBA) lattice. In addition, the storage ring will be operated at 6 GeV and 200 mA with regular swap-out injection to keep the stored beam current constant [1]. The swap-out injection will take place with beamline shutters open. For radiation safety to ensure that no electrons can exit the storage ring, a passive method of protecting the beamline and containing the electrons inside the storage ring ismore » proposed. A clearing magnet will be located in all beamline front ends inside the storage ring tunnel. This article will discuss the features and design of the clearing magnet scheme for APS-U.« less

National Synchrotron Light Source II storage ring vacuum systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hseuh, Hsiao-Chaun, E-mail: hseuh@bnl.gov; Hetzel, Charles; Leng, Shuwei

2016-05-15

The National Synchrotron Light Source II, completed in 2014, is a 3-GeV synchrotron radiation (SR) facility at Brookhaven National Laboratory and has been in steady operation since. With a design electron current of 500 mA and subnanometer radians horizontal emittance, this 792-m circumference storage ring is providing the highest flux and brightness x-ray beam for SR users. The majority of the storage ring vacuum chambers are made of extruded aluminium. Chamber sections are interconnected using low-impedance radiofrequency shielded bellows. SR from the bending magnets is intercepted by water-cooled compact photon absorbers resided in the storage ring chambers. This paper presents themore » design of the storage ring vacuum system, the fabrication of vacuum chambers and other hardware, the installation, the commissioning, and the continuing beam conditioning of the vacuum systems.« less

The phase slip factor of the electrostatic cryogenic storage ring CSR

NASA Astrophysics Data System (ADS)

Grieser, Manfred; von Hahn, Robert; Vogel, Stephen; Wolf, Andreas

2017-07-01

To determine the momentum spread of an ion beam from the measured revolution frequency distribution, the knowledge of the phase slip factor of the storage ring is necessary. The slip factor was measured for various working points of the cryogenic storage ring CSR at MPI for Nuclear Physics, Heidelberg and was compared with simulations. The predicted functional relationship of the slip factor and the horizontal tune depends on the different islands of stability, which has been experimentally verified. This behavior of the slip factor is in clear contrast to that of magnetic storage rings.

Online optimization of storage ring nonlinear beam dynamics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, Xiaobiao; Safranek, James

2015-08-01

We propose to optimize the nonlinear beam dynamics of existing and future storage rings with direct online optimization techniques. This approach may have crucial importance for the implementation of diffraction limited storage rings. In this paper considerations and algorithms for the online optimization approach are discussed. We have applied this approach to experimentally improve the dynamic aperture of the SPEAR3 storage ring with the robust conjugate direction search method and the particle swarm optimization method. The dynamic aperture was improved by more than 5 mm within a short period of time. Experimental setup and results are presented.

Large diameter metal ring seal prevents gas leakage at 5000 psi

NASA Technical Reports Server (NTRS)

Middelkoop, J. H.

1966-01-01

Large metal ring seal prevents gas leakage in hydrogen, helium, or nitrogen storage bottles at pressures up to 5,000 psi. The grooved ring seal which contains elastomer O-rings is installed between the mating faces of the access cover and the storage bottle.

National Synchrotron Light Source II storage ring vacuum systems

DOE PAGES

Hseuh, Hsiao-Chaun; Hetzel, Charles; Leng, Shuwei; ...

2016-04-05

The National Synchrotron Light Source II, completed in 2014, is a 3-GeV synchrotron radiation (SR) facility at Brookhaven National Laboratory and has been in steady operation since. With a design electron current of 500 mA and subnanometer radians horizontal emittance, this 792-m circumference storage ring is providing the highest flux and brightness x-ray beam for SR users. Also, the majority of the storage ring vacuum chambers are made of extruded aluminium. Chamber sections are interconnected using low-impedance radiofrequency shielded bellows. SR from the bending magnets is intercepted by water-cooled compact photon absorbers resided in the storage ring chambers. Finally, thismore » paper presents the design of the storage ring vacuum system, the fabrication of vacuum chambers and other hardware, the installation, the commissioning, and the continuing beam conditioning of the vacuum systems.« less

Different Preclimacteric Events in Apple Cultivars with Modified Ripening Physiology

PubMed Central

Singh, Vikram; Weksler, Asya; Friedman, Haya

2017-01-01

“Anna” is an early season apple cultivar exhibiting a fast softening and juiciness loss during storage, in comparison to two mid-late season cultivars “Galaxy” and “GD.” The poor storage capacity of “Anna” was correlated with high lipid oxidation-related autoluminescence, high respiration and ethylene production rates, associated with high expression of MdACO1, 2, 4, 7, and MdACS1. All cultivars at harvest responded to exogenous ethylene by enhancing ethylene production, typical of system-II. The contribution of pre-climacteric events to the poor storage capacity of “Anna” was examined by comparing respiration and ethylene production rates, response to exogenous ethylene, expression of genes responsible for ethylene biosynthesis and response, and developmental regulators in the three cultivars throughout fruit development. In contrast to the “Galaxy” and “GD,” “Anna” showed higher ethylene production and respiration rates during fruit development, and exhibited auto-stimulatory (system II-like) effect in response to exogenous ethylene. The higher ethylene production rate in “Anna” was correlated with higher expression of ethylene biosynthesis genes, MdACS3a MdACO2, 4, and 7 during early fruit development. The expression of negative regulators of ripening (AP2/ERF) and ethylene response pathway, (MdETR1,2 and MdCTR1) was lower in “Anna” in comparison to the other two cultivars throughout development and ripening. Similar pattern of gene expression was found for SQUAMOSA promoter binding protein (SBP)-box genes, including MdCNR and for MdFUL. Taken together, this study provides new understanding on pre-climacteric events in “Anna” that might affect its ripening behavior and physiology following storage. PMID:28928755

Duke storage rink UV/VUV FEL: Status and prospects

DOE Office of Scientific and Technical Information (OSTI.GOV)

Litvinenko, V.N.; Burnham, B.; Madey, J.M.J.

1995-12-31

The 1 GeV Duke storage ring was successfully commissioned with parameters exceeding initial specification. The OK-4 FEL has arrived at the Duke FEL laboratory from the Novosibirsk Institute of Nuclear Physics. The OK-4 installation and commissioning is in progress. In this paper we describe the up-to-date status of the Duke storage ring and the OK-4 FEL. The projected performance of the OK-4 UV/VUV FEL is presented based on the electron beam parameters achieved. Initial plans to operate the OK-4 UV/VUV FEL at the Duke 1 GeV storage ring are outlined. Future plans and prospects of both the OK-4 FEL andmore » the Duke storage ring are discussed.« less

A new storage-ring light source

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chao, Alex

2015-06-01

A recently proposed technique in storage ring accelerators is applied to provide potential high-power sources of photon radiation. The technique is based on the steady-state microbunching (SSMB) mechanism. As examples of this application, one may consider a high-power DUV photon source for research in atomic and molecular physics or a high-power EUV radiation source for industrial lithography. A less challenging proof-of-principle test to produce IR radiation using an existing storage ring is also considered.

Polarization Studies for the eRHIC Electron Storage Ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gianfelice-Wendt, Eliana; Tepikian, S.

A hadron/lepton collider with polarized beams has been under consideration by the scientific community since some years, in the U.S. and Europe. Among the various proposals, those by JLAB and BNL with polarized electron and proton beams are currently under closer study in the U.S. Experimenters call for the simultaneous storage of electron bunches with both spin helicity. In the BNL based Ring-Ring design, electrons are stored at top energy in a ring to be accommodated in the existing RHIC tunnel. The transversely polarized electron beam is injected into the storage ring at variable energies, between 5 and 18 GeV.more » Polarization is brought into the longitudinal direction at the IP by a couple of spin rotators. In this paper results of first studies of the attainable beam polarization level and lifetime in the storage ring at 18 GeV are presented.« less

Inertial energy storage device

DOEpatents

Knight, Jr., Charles E.; Kelly, James J.; Pollard, Roy E.

1978-01-01

The inertial energy storage device of the present invention comprises a composite ring formed of circumferentially wound resin-impregnated filament material, a flanged hollow metal hub concentrically disposed in the ring, and a plurality of discrete filament bandsets coupling the hub to the ring. Each bandset is formed of a pair of parallel bands affixed to the hub in a spaced apart relationship with the axis of rotation of the hub being disposed between the bands and with each band being in the configuration of a hoop extending about the ring along a chordal plane thereof. The bandsets are disposed in an angular relationship with one another so as to encircle the ring at spaced-apart circumferential locations while being disposed in an overlapping relationship on the flanges of the hub. The energy storage device of the present invention has the capability of substantial energy storage due to the relationship of the filament bands to the ring and the flanged hub.

Organizational Attributes Associated With Medicare ACO Quality Performance.

PubMed

Zhu, Xi; Mueller, Keith; Huang, Huang; Ullrich, Fred; Vaughn, Thomas; MacKinney, A Clinton

2018-05-08

To evaluate associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance. We conducted cross-sectional and longitudinal analyses of ACO quality performance using data from the Centers for Medicare and Medicaid Services and additional sources. The sample included 322 and 385 MSSP ACOs that had successfully reported quality measures in 2014 and 2015, respectively. Results show that after adjusting for other organizational factors, rural ACOs' average quality score was comparable to that of ACOs serving other geographic categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher posthospitalization follow-up rates achieved better quality performance. There is no significant difference in average quality performance between rural ACOs and other ACOs after adjusting for structural and service-provision factors. MSSP ACO quality performance is positively associated with hospital-system sponsorship, beneficiary panel size, and posthospitalization follow-up rate. © 2018 National Rural Health Association.

Design of the transfer line from booster to storage ring at 3 GeV

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bayar, C., E-mail: cafer.bayar@cern.ch; Ciftci, A. K., E-mail: abbas.kenan.ciftci@cern.ch

The Synchrotron Booster Ring accelerates the e-beam up to 3 GeV and particles are transported from booster to storage ring by transfer line. In this study, two options are considered, the first one is a long booster which shares the same tunnel with storage ring and the second one is a compact booster. As a result, two transfer line are designed based on booster options. The optical design is constrained by the e-beam Twiss parameters entering and leaving the transfer line. Twiss parameters in the extraction point of booster are used for the entrance of transfer line and are matchedmore » in the exit of transfer line to the injection point of the storage ring.« less

Innovation in the safety net: integrating community health centers through accountable care.

PubMed

Lewis, Valerie A; Colla, Carrie H; Schoenherr, Karen E; Shortell, Stephen M; Fisher, Elliott S

2014-11-01

Safety net primary care providers, including as community health centers, have long been isolated from mainstream health care providers. Current delivery system reforms such as Accountable Care Organizations (ACOs) may either reinforce the isolation of these providers or may spur new integration of safety net providers. This study examines the extent of community health center involvement in ACOs, as well as how and why ACOs are partnering with these safety net primary care providers. Mixed methods study pairing the cross-sectional National Survey of ACOs (conducted 2012 to 2013), followed by in-depth, qualitative interviews with a subset of ACOs that include community health centers (conducted 2013). One hundred and seventy-three ACOs completed the National Survey of ACOs. Executives from 18 ACOs that include health centers participated in in-depth interviews, along with leadership at eight community health centers participating in ACOs. Key survey measures include ACO organizational characteristics, care management and quality improvement capabilities. Qualitative interviews used a semi-structured interview guide. Interviews were recorded and transcribed, then coded for thematic content using NVivo software. Overall, 28% of ACOs include a community health center (CHC). ACOs with CHCs are similar to those without CHCs in organizational structure, care management and quality improvement capabilities. Qualitative results showed two major themes. First, ACOs with CHCs typically represent new relationships or formal partnerships between CHCs and other local health care providers. Second, CHCs are considered valued partners brought into ACOs to expand primary care capacity and expertise. A substantial number of ACOs include CHCs. These results suggest that rather than reinforcing segmentation of safety net providers from the broader delivery system, the ACO model may lead to the integration of safety net primary care providers.

An Inside Look: NSLS-II Storage Ring

ScienceCinema

Fries, Gregory

2018-06-12

Look inside the storage ring of the National Synchrotron Light Source II, under construction at Brookhaven Lab. Exactly 843 magnets now encircle the ring. Their job will be to steer, stabilize, and store electrons racing around at near light speed.

Accountable Care Organizations in California: Market Forces at Work?

PubMed

Whaley, Christopher; Frech, H E; Scheffler, Richard M

2015-08-01

Accountable care organizations (ACOs), one of the most recent and promising health care delivery innovations, encourage care coordination among providers. While ACOs hold promise for decreasing costs by reducing unnecessary procedures, improving resource use as a result of economies of scale and scope, ACOs also raise concerns about provider market power. This study examines the market-level competition factors that are associated with ACO participation and the number of ACOs. Using data from California, we find that higher levels of preexisting managed care leads to higher ACO entry and enrollment growth, while hospital concentration leads to fewer ACOs and lower enrollment. We find interesting results for physician market power - markets with concentrated physician markets have a smaller share of individuals in commercial ACOs but a larger number of commercial ACO organizations. This finding implies smaller ACOs in these markets. Copyright © 2015 by Duke University Press.

Identifying possible asthma-COPD overlap syndrome in patients with a new diagnosis of COPD in primary care.

PubMed

Baarnes, Camilla Boslev; Kjeldgaard, Peter; Nielsen, Mia; Miravitlles, Marc; Ulrik, Charlotte Suppli

2017-01-05

The asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) remains poorly characterised. Our aim was to describe an algorithm for identifying possible ACOS in adults with newly diagnosed COPD in primary care. General practitioners (n=241) consecutively recruited subjects ⩾35 years, with tobacco exposure, at least one respiratory symptom and no previous diagnosis of obstructive lung disease. Possible ACOS was defined as chronic airflow obstruction, i.e., post-bronchodilator (BD) forced expiratory volume 1/forced vital capacity (FEV 1 /FVC) ratio<0.70, combined with wheeze (ACOS wheeze) and/or significant BD reversibility (ACOS BD reversibility). Of 3,875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD, i.e., symptom(s), tobacco exposure and chronic airflow obstruction. Indications for ACOS were found in 264 (38%) of the COPD patients. The prevalence of ACOS wheeze and ACOS BD reversibility was 27% (n=190) and 16% (n=113), respectively (P<0.001), and only 6% (n=39) of the COPD patients fulfilled both criteria for ACOS. Patients with any ACOS were younger (P=0.04), had more dyspnoea (P<0.001), lower FEV 1 %pred (67% vs. 74%; P<0.001) and lower FEV 1 /FVC ratio (P=0.001) compared with COPD-only patients. Comparing subjects fulfilling both criteria for ACOS with those fulfilling criteria for ACOS wheeze only (n=151) and those fulfilling criteria for ACOS BD reversibility only (n=74) revealed no significant differences. Irrespective of the applied ACOS definition, no significant difference in life-time tobacco exposure was found between ACOS- and COPD-only patients. In subjects with a new diagnosis of COPD, the prevalence of ACOS is high. When screening for COPD in general practice among patients with no previous diagnosis of obstructive lung disease, patients with possible ACOS may be identified by self-reported wheeze and/or BD reversibility.

Diffraction-limited storage-ring vacuum technology

PubMed Central

Al-Dmour, Eshraq; Ahlback, Jonny; Einfeld, Dieter; Tavares, Pedro Fernandes; Grabski, Marek

2014-01-01

Some of the characteristics of recent ultralow-emittance storage-ring designs and possibly future diffraction-limited storage rings are a compact lattice combined with small magnet apertures. Such requirements present a challenge for the design and performance of the vacuum system. The vacuum system should provide the required vacuum pressure for machine operation and be able to handle the heat load from synchrotron radiation. Small magnet apertures result in the conductance of the chamber being low, and lumped pumps are ineffective. One way to provide the required vacuum level is by distributed pumping, which can be realised by the use of a non-evaporable getter (NEG) coating of the chamber walls. It may not be possible to use crotch absorbers to absorb the heat from the synchrotron radiation because an antechamber is difficult to realise with such a compact lattice. To solve this, the chamber walls can work as distributed absorbers if they are made of a material with good thermal conductivity, and distributed cooling is used at the location where the synchrotron radiation hits the wall. The vacuum system of the 3 GeV storage ring of MAX IV is used as an example of possible solutions for vacuum technologies for diffraction-limited storage rings. PMID:25177979

Determinants of success in Shared Savings Programs: An analysis of ACO and market characteristics.

PubMed

Ouayogodé, Mariétou H; Colla, Carrie H; Lewis, Valerie A

2017-03-01

Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. To examine ACO and market factors associated with superior financial performance in Medicare ACO programs. We obtained financial performance data from the Centers for Medicare and Medicaid Services (CMS); we derived market-level characteristics from Medicare claims; and we collected ACO characteristics from the National Survey of ACOs for 215 ACOs. We examined the association between ACO financial performance and ACO provider composition, leadership structure, beneficiary characteristics, risk bearing experience, quality and process improvement capabilities, physician performance management, market competition, CMS-assigned financial benchmark, and ACO contract start date. We examined two outcomes from Medicare ACOs' first performance year: savings per Medicare beneficiary and earning shared savings payments (a dichotomous variable). When modeling the ACO ability to save and earn shared savings payments, we estimated positive regression coefficients for a greater proportion of primary care providers in the ACO, more practicing physicians on the governing board, physician leadership, active engagement in reducing hospital re-admissions, a greater proportion of disabled Medicare beneficiaries assigned to the ACO, financial incentives offered to physicians, a larger financial benchmark, and greater ACO market penetration. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments. In the first year, performance is quite heterogeneous, yet organizational structure does not consistently predict performance. Organizations with large financial benchmarks at baseline have greater opportunities to achieve savings. Findings on prior risk bearing suggest that ACOs learn over time under risk-bearing contracts. Given the lack of predictive power for organizational characteristics, CMS should continue to encourage diversity in organizational structures for ACO participants, and provide alternative funding and risk bearing mechanisms to continue to allow a diverse group of organizations to participate. III. Copyright © 2016 Elsevier Inc. All rights reserved.

ONLINE MINIMIZATION OF VERTICAL BEAM SIZES AT APS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, Yipeng

In this paper, online minimization of vertical beam sizes along the APS (Advanced Photon Source) storage ring is presented. A genetic algorithm (GA) was developed and employed for the online optimization in the APS storage ring. A total of 59 families of skew quadrupole magnets were employed as knobs to adjust the coupling and the vertical dispersion in the APS storage ring. Starting from initially zero current skew quadrupoles, small vertical beam sizes along the APS storage ring were achieved in a short optimization time of one hour. The optimization results from this method are briefly compared with the onemore » from LOCO (Linear Optics from Closed Orbits) response matrix correction.« less

The Economics of Medicare Accountable Care Organizations

PubMed Central

Blackstone, Erwin A.; Fuhr, Joseph P.

2016-01-01

Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance.

PubMed

Comfort, Leeann N; Shortell, Stephen M; Rodriguez, Hector P; Colla, Carrie H

2018-01-31

To examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) is associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). Three waves of the National Survey of ACOs and corresponding publicly available Centers for Medicare & Medicaid Services performance data for NSACO respondents participating in the MSSP (N = 204); SK&A Office Based Physicians Database from QuintilesIMS. We compare the performance of three ACO types (physician-led, integrated, and hybrid) for three domains: quality, spending, and likelihood of achieving savings. Sources of performance variation within and between ACO types are compared for each performance measure. There is greater heterogeneity within ACO types than between ACO types. There were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year. There was evidence for higher spending on physician services for physician-led ACOs. ACOs of diverse structures perform comparably on core MSSP quality and spending measures. CMS should maintain its flexibility and continue to support participation of diverse ACOs. Future research to identify modifiable organizational factors that account for performance variation within ACO types may provide insight as to how best to improve ACO performance based on organizational structure and ownership. © Health Research and Educational Trust.

The Economics of Medicare Accountable Care Organizations.

PubMed

Blackstone, Erwin A; Fuhr, Joseph P

2016-02-01

Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. To examine whether the current Medicare ACOs are likely to be successful. Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. The question remains whether Medicare ACOs can achieve the Triple Aim of "improving the experience of care, improving the health of populations, and reducing per capita costs of health care." Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs.

Early Impact of Medicare Accountable Care Organizations on Inpatient Surgical Spending.

PubMed

Nathan, Hari; Thumma, Jyothi R; Ryan, Andrew M; Dimick, Justin B

2018-05-16

To evaluate whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. ACOs have proliferated rapidly and now cover more than 32 million Americans. Medicare Shared Savings Program (MSSP) ACOs have shown modest success in reducing medical spending. Whether they have reduced surgical spending remains unknown. We used 100% Medicare claims from 2010 to 2014 for patients aged 65 to 99 years undergoing 6 common elective surgical procedures [abdominal aortic aneurysm (AAA) repair, colectomy, coronary artery bypass grafting (CABG), hip or knee replacement, or lung resection]. We compared total Medicare payments for 30-day surgical episodes, payments for individual components of care (index hospitalization, readmissions, physician services, and postacute care), and clinical outcomes for patients treated at MSSP ACO hospitals versus matched controls at non-ACO hospitals. We accounted for preexisting trends independent of ACO participation using a difference-in-differences approach. Among 341,675 patients at 427 ACO hospitals and 1,024,090 matched controls at 1531 non-ACO hospitals, patient and hospital characteristics were well-balanced. Average baseline payments were similar at ACO versus non-ACO hospitals. ACO participation was not associated with reductions in total Medicare payments [difference-in-differences estimate=-$72, confidence interval (CI95%): -$228 to +$84] or individual components of payments. ACO participation was also not associated with clinical outcomes. Duration of ACO participation did not affect our estimates. Although Medicare ACOs have had success reducing spending for medical care, they have not had similar success with surgical spending. Given that surgical care accounts for 30% of total health care costs, ACOs and policymakers must pay greater attention to reducing surgical expenditures.

Pushing the MAX IV 3 GeV storage ring brightness and coherence towards the limit of its magnetic lattice

NASA Astrophysics Data System (ADS)

Leemann, S. C.; Wurtz, W. A.

2018-03-01

The MAX IV 3 GeV storage ring is presently being commissioned and crucial parameters such as machine functions, emittance, and stored current have either already been reached or are approaching their design specifications. Once the baseline performance has been achieved, a campaign will be launched to further improve the brightness and coherence of this storage ring for typical X-ray users. During recent years, several such improvements have been designed. Common to these approaches is that they attempt to improve the storage ring performance using existing hardware provided for the baseline design. Such improvements therefore present more short-term upgrades. In this paper, however, we investigate medium-term improvements assuming power supplies can be exchanged in an attempt to push the brightness and coherence of the storage ring to the limit of what can be achieved without exchanging the magnetic lattice itself. We outline optics requirements, the optics optimization process, and summarize achievable parameters and expected performance.

Cabling design of booster and storage ring construction progress of TPS

NASA Astrophysics Data System (ADS)

Wong, Y.-S.; Liu, K.-B.; Liu, C.-Y.; Wang, b.-S.

2017-06-01

The 2012 Taiwan Photon Source (TPS) cable construction project started after 10 months to complete the cable laying and installation of power supply. The circumference of the booster ring (BR) is 496.8 m, whereas that of the storage ring (SR) is 518.4 m. Beam current is set to 500 mA at 3.3 GeV. The paper on grounding systems discusses the design of the ground wire (< 0.2 Ω) with low impedance, power supply of the accelerator and cabling tray. The flow and size of the ground current are carefully evaluated to avoid grounded current from flowing everywhere, which causes interference problems. In the design of the TPS, special shielding will be established to isolate the effects of electromagnetic interference on the magnet and ground current. Booster ring dipoles are connected by a series of 54-magnet bending dipole; the cable size of its stranded wire measures 250 mm2, with a total length of 5000 m. Booster ring and storage ring quadrupoles have 150 magnets; the cable size of their stranded wire is 250 mm2, with a total length of 17000 m. Storage ring dipole consists of 48 magnets; the cable size of its stranded wire is 325 mm2, with a total length of 6000 m. This study discusses the power supply cabling design of the storage ring and booster ring construction progress of TPS. The sections of this paper are divided into discussions of the construction of the control and instrument area, cabling layout of booster ring and storage ring, as well as the installation and commission machine. This study also discusses the use of a high-impedance meter to determine the effect of cabling insulation and TPS power supply machine on energy transfer to ensure the use of safe and correct magnet.

Statistical uncertainty in the Medicare shared savings program.

PubMed

DeLia, Derek; Hoover, Donald; Cantor, Joel C

2012-01-01

Analyze statistical risks facing CMS and Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP). We calculate the probability that shared savings formulas lead to inappropriate payment, payment denial, and/or financial penalties, assuming that ACOs generate real savings in Medicare spending ranging from 0-10%. We also calculate expected payments from CMS to ACOs under these scenarios. The probability of an incorrect outcome is heavily dependent on ACO enrollment size. For example, in the MSSP two-sided model, an ACO with 5,000 enrollees that keeps spending constant faces a 0.24 probability of being inappropriately rewarded for savings and a 0.26 probability of paying an undeserved penalty for increased spending. For an ACO with 50,000 enrollees, both of these probabilities of incorrect outcomes are equal to 0.02. The probability of inappropriate payment denial declines as real ACO savings increase. Still, for ACOs with 5,000 patients, the probability of denial is at least 0.15 even when true savings are 5-7%. Depending on ACO size and the real ACO savings rate, expected ACO payments vary from $115,000 to $35.3 million. Our analysis indicates there may be greater statistical uncertainty in the MSSP than previously recognized. CMS and ACOs will have to consider this uncertainty in their financial, administrative, and care management planning. We also suggest analytic strategies that can be used to refine ACO payment formulas in the longer term to ensure that the MSSP (and other ACO initiatives that will be influenced by it) work as efficiently as possible.

Statistical Uncertainty in the Medicare Shared Savings Program

PubMed Central

DeLia, Derek; Hoover, Donald; Cantor, Joel C.

2012-01-01

Objective Analyze statistical risks facing CMS and Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program (MSSP). Methods We calculate the probability that shared savings formulas lead to inappropriate payment, payment denial, and/or financial penalties, assuming that ACOs generate real savings in Medicare spending ranging from 0–10%. We also calculate expected payments from CMS to ACOs under these scenarios. Results The probability of an incorrect outcome is heavily dependent on ACO enrollment size. For example, in the MSSP two-sided model, an ACO with 5,000 enrollees that keeps spending constant faces a 0.24 probability of being inappropriately rewarded for savings and a 0.26 probability of paying an undeserved penalty for increased spending. For an ACO with 50,000 enrollees, both of these probabilities of incorrect outcomes are equal to 0.02. The probability of inappropriate payment denial declines as real ACO savings increase. Still, for ACOs with 5,000 patients, the probability of denial is at least 0.15 even when true savings are 5–7%. Depending on ACO size and the real ACO savings rate, expected ACO payments vary from $115,000 to $35.3 million. Discussion Our analysis indicates there may be greater statistical uncertainty in the MSSP than previously recognized. CMS and ACOs will have to consider this uncertainty in their financial, administrative, and care management planning. We also suggest analytic strategies that can be used to refine ACO payment formulas in the longer term to ensure that the MSSP (and other ACO initiatives that will be influenced by it) work as efficiently as possible. PMID:24800155

Attention to surgeons and surgical care is largely missing from early medicare accountable care organizations.

PubMed

Dupree, James M; Patel, Kavita; Singer, Sara J; West, Mallory; Wang, Rui; Zinner, Michael J; Weissman, Joel S

2014-06-01

The Affordable Care Act supports the growth of accountable care organizations (ACOs) as a potentially powerful model for health care delivery and payment. The model focuses on primary care. However, surgeons and other specialists have a large role to play in caring for ACOs' patients. No studies have yet investigated the role of surgical care in the ACO model. Using case studies and a survey, we examined the early experience of fifty-nine Medicare-approved ACOs in providing surgical care. We found that ACOs have so far devoted little attention to surgical care. Instead, they have emphasized coordinating care for patients with chronic conditions and reducing unnecessary hospital readmissions and ED visits. In the years to come, ACOs will likely focus more on surgical care. Some ACOs have the ability to affect surgical practice patterns through referral pressures, but local market conditions may limit ACOs' abilities to alter surgeons' behavior. Policy makers, ACO administrators, and surgeons need to be aware of these trends because they have the potential to affect the surgical care provided to ACO patients as well as the success of ACOs themselves. Project HOPE—The People-to-People Health Foundation, Inc.

Primary Care Clinics and Accountable Care Organizations

PubMed Central

Tang, Chiung-Ya; Lin, Yi-Ling; Masri, Maysoun D.

2015-01-01

Background: The Accountable Care Organization (ACO) is one of the new models of health care delivery in the United States. To date, little is known about the characteristics of health care organizations that have joined ACOs. We report on the findings of a survey of primary care clinics, the objective of which was to investigate the opinions of clinic management about participation in ACOs and the characteristics of clinic organizational structure that may contribute to joining ACOs or be willing to do so. Methods: A 27-item survey questionnaire was developed and distributed by mail in 3 annual waves to all Rural Health Clinics (RHCs) in 9 states. Two dependent variables—participation in ACOs and willingness to join ACOs—were created and analyzed using a generalized estimating equation approach. Results: A total of 257 RHCs responded to the survey. A small percentage (5.2%) of the respondent clinics reported that they were participating in ACOs. Rural Health Clinics in isolated areas were 78% less likely to be in ACOs (odds ratio = 0.22, P = .059). Nonprofit RHCs indicated a higher willingness to join an ACO than for-profit RHCs (B = 1.271, P = .054). There is a positive relationship between RHC size and willingness to join an ACO (B = 0.402, P = .010). Conclusion: At this early stage of ACO development, many RHC personnel are unfamiliar with the ACO model. Rural providers’ limited technological and human resources, and the lack of ACO development in rural areas, may delay or prevent their participation in ACOs. PMID:26900587

Determinants of Success in Shared Savings Programs: An Analysis of ACO and Market Characteristics

PubMed Central

Colla, Carrie H.; Lewis, Valerie A.

2016-01-01

Background Medicare’s Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. Objective To examine ACO and market factors associated with superior financial performance in Medicare ACO programs. Methods We obtained financial performance data from the Centers for Medicare and Medicaid Services (CMS); we derived market-level characteristics from Medicare claims; and we collected ACO characteristics from the National Survey of ACOs for 215 ACOs. We examined the association between ACO financial performance and ACO provider composition, leadership structure, beneficiary characteristics, risk bearing experience, quality and process improvement capabilities, physician performance management, market competition, CMS-assigned financial benchmark, and ACO contract start date. We examined two outcomes from Medicare ACOs’ first performance year: savings per Medicare beneficiary and earning shared savings payments (a dichotomous variable). Results When modeling the ACO ability to save and earn shared savings payments, we estimated positive regression coefficients for a greater proportion of primary care providers in the ACO, more practicing physicians on the governing board, physician leadership, active engagement in reducing hospital re-admissions, a greater proportion of disabled Medicare beneficiaries assigned to the ACO, financial incentives offered to physicians, a larger financial benchmark, and greater ACO market penetration. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments. Conclusions In the first year performance is quite heterogeneous, yet organizational structure does not consistently predict performance. Organizations with large financial benchmarks at baseline have greater opportunities to achieve savings. Findings on prior risk bearing suggest that ACOs learn over time under risk-bearing contracts. Implications Given the lack of predictive power for organizational characteristics, CMS should continue to encourage diversity in organizational structures for ACO participants, and provide alternative funding and risk bearing mechanisms to continue to allow a diverse group of organizations to participate. Level of evidence III PMID:27687917

Clinical coordination in accountable care organizations: A qualitative study.

PubMed

Lewis, Valerie A; Schoenherr, Karen; Fraze, Taressa; Cunningham, Aleen

2016-12-06

Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts. We conducted semistructured interviews between July and December 2013. Our sample includes ACOs that began performance contracts in 2012, including Medicare Shared Savings Program and Pioneer participants, stratified across key factors. In total, we conducted interviews with executives from 30 ACOs. Iterative qualitative analysis identified common patterns and themes. ACOs in the first year of performance contracts are commonly focusing on four areas: first, transforming primary care through increased access and team-based care; second, reducing avoidable emergency department use; third, strengthening practice-based care management; and fourth, developing new boundary spanner roles and activities. ACOs were doing little around transforming specialty care, acute and postacute care, or standardizing care across practices during the first 18 months of ACO performance contracts. Results suggest that cost reductions associated with ACOs in the first years of contracts may be related to primary care. Although in the long term many hope ACOs will achieve coordination across a wide array of care settings and providers, in the short term providers under ACO contracts are focused largely on primary care-related strategies. Our work provides a template of the common areas of clinical activity in the first years of ACO contracts, which may be informative to providers considering becoming an ACO. Further research will be needed to understand how these strategies are associated with performance.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Coupled beam motion in a storage ring with crab cavities

DOE PAGES

Huang, Xiaobiao

2016-02-16

We studied the coupled beam motion in a storage ring between the transverse and longitudinal directions introduced by crab cavities. Analytic form of the linear decoupling transformation is derived. Also, the equilibrium bunch distribution in an electron storage ring with a crab cavity is given, including contribution to the eigen-emittance induced by the crab cavity. Furthermore, application to the short pulse generation scheme using crab cavities [1] is considered.

A multiple-orbit time-of-flight mass spectrometer based on a low energy electrostatic storage ring

NASA Astrophysics Data System (ADS)

Sullivan, M. R.; Spanjers, T. L.; Thorn, P. A.; Reddish, T. J.; Hammond, P.

2012-11-01

The results are presented for an electrostatic storage ring, consisting of two hemispherical deflector analyzers (HDA) connected by two separate sets of cylindrical lenses, used as a time-of-flight mass spectrometer. Based on the results of charged particle simulations and formal matrix model, the Ion Storage Ring is capable of operating with multiple stable orbits, for both single and multiply charged ions simultaneously.

RF System Requirements for a Medium-Energy Electron-Ion Collider (MEIC) at JLab

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rimmer, Robert A; Hannon, Fay E; Guo, Jiquan

2015-09-01

JLab is studying options for a medium energy electron-ion collider that could fit on the JLab site and use CEBAF as a full-energy electron injector. A new ion source, linac and booster would be required, together with collider storage rings for the ions and electrons. In order to achieve the maximum luminosity these will be high-current storage rings with many bunches. We present the high-level RF system requirements for the storage rings, ion booster ring and high-energy ion beam cooling system, and describe the technology options under consideration to meet them. We also present options for staging that might reducemore » the initial capital cost while providing a smooth upgrade path to a higher final energy. The technologies under consideration may also be useful for other proposed storage ring colliders or ultimate light sources.« less

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2014-10-01 2014-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2012-10-01 2012-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2013-10-01 2013-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

Avoiding unintended incentives in ACO payment models.

PubMed

Douven, Rudy; McGuire, Thomas G; McWilliams, J Michael

2015-01-01

One goal of the Medicare Shared Savings Program for accountable care organizations (ACOs) is to reduce Medicare spending for ACOs' patients relative to the organizations' spending history. However, we found that current rules for setting ACO spending targets (or benchmarks) diminish ACOs' incentives to generate savings and may even encourage higher instead of lower Medicare spending. Spending in the three years before ACOs enter or renew a contract is weighted unequally in the benchmark calculation, with a high weight of 0.6 given to the year just before a new contract starts. Thus, ACOs have incentives to increase spending in that year to inflate their benchmark for future years and thereby make it easier to obtain shared savings from Medicare in the new contract period. We suggest strategies to improve incentives for ACOs, including changes to the weights used to determine benchmarks and new payment models that base an ACO's spending target not only on its own past performance but also on the performance of other ACOs or Medicare providers. Project HOPE—The People-to-People Health Foundation, Inc.

First national survey of ACOs finds that physicians are playing strong leadership and ownership roles.

PubMed

Colla, Carrie H; Lewis, Valerie A; Shortell, Stephen M; Fisher, Elliott S

2014-06-01

The extent to which physicians lead, own, and govern accountable care organizations (ACOs) is unknown. However, physicians' involvement in ACOs will influence how clinicians and patients perceive the ACO model, how effective these organizations are at improving quality and costs, and how future ACOs will be organized. From October 2012 to May 2013 we fielded the National Survey of Accountable Care Organizations, the first such survey of public and private ACOs. We found that 51 percent of ACOs were physician-led, with another 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. The broad reach of physician leadership has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians. Project HOPE—The People-to-People Health Foundation, Inc.

Ethical challenges for accountable care organizations: a structured review.

PubMed

DeCamp, Matthew; Farber, Neil J; Torke, Alexia M; George, Maura; Berger, Zackary; Keirns, Carla C; Kaldjian, Lauris C

2014-10-01

Accountable care organizations (ACOs) are proliferating as a solution to the cost crisis in American health care, and already involve as many as 31 million patients. ACOs hold clinicians, group practices, and in many circumstances hospitals financially accountable for reducing expenditures and improving their patients' health outcomes. The structure of health care affects the ethical issues arising in the practice of medicine; therefore, like all health care organizational structures, ACOs will experience ethical challenges. No framework exists to assist key ACO stakeholders in identifying or managing these challenges. We conducted a structured review of the medical ACO literature using qualitative content analysis to inform identification of ethical challenges for ACOs. Our analysis found infrequent discussion of ethics as an explicit concern for ACOs. Nonetheless, we identified nine critical ethical challenges, often described in other terms, for ACO stakeholders. Leaders could face challenges regarding fair resource allocation (e.g., about fairly using ACOs' shared savings), protection of professionals' ethical obligations (especially related to the design of financial incentives), and development of fair decision processes (e.g., ensuring that beneficiary representatives on the ACO board truly represent the ACO's patients). Clinicians could perceive threats to their professional autonomy (e.g., through cost control measures), a sense of dual or conflicted responsibility to their patients and the ACO, or competition with other clinicians. For patients, critical ethical challenges will include protecting their autonomy, ensuring privacy and confidentiality, and effectively engaging them with the ACO. ACOs are not inherently more or less "ethical" than other health care payment models, such as fee-for-service or pure capitation. ACOs' nascent development and flexibility in design, however, present a time-sensitive opportunity to ensure their ethical operation, promote their success, and refine their design and implementation by identifying, managing, and conducting research into the ethical issues they might face.

Private sector accountable care organization development: a qualitative study.

PubMed

Scheck McAlearney, Ann; Hilligoss, Brian; Song, Paula H

2017-03-01

To explore accountable care organizations (ACOs) as they develop in the private sector, including their motivation for development, perspectives from consumers regarding these emerging ACOs, and the critical success factors associated with ACO development. Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers. Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study ACOs. We found 3 main motivators for private sector ACO development: 1) opportunity to improve quality and efficiency, 2) potential to improve population health, and 3) belief that payment reform is inevitable. With respect to consumer perspectives, consumers were unaware they received care from an ACO. From the perspectives of ACO stakeholders, these ACOs noted that they prefer to focus on patients' relationships with providers and typically do not emphasize the ACO name or entity. Critical success factors for private sector ACO development included provider engagement, strategic buy-in, prior experience managing risk, IT infrastructure, and leadership, all meant to shift the culture to a focus on value instead of volume. These organizations perceived that pursuing an accountable care strategy allowed them to respond to policy changes anticipated to impact the way healthcare is delivered and reimbursed. Increased understanding of factors that have been important for more mature private sector ACOs may help other healthcare organizations as they strive to enhance value and advance in their ACO journeys.

42 CFR 425.504 - Incorporating reporting requirements related to the Physician Quality Reporting System Incentive...

Code of Federal Regulations, 2014 CFR

2014-10-01

... within an ACO may only participate under their ACO participant TIN as a group practice under the... Reporting System incentive payment, each ACO participant TIN, on behalf of its ACO supplier/provider... available, based on the allowed charges under the Physician Fee Schedule for that TIN. (4) ACO participant...

Effects of CSR Generated from Upstream Bends in a Laser Plasma Storage Ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mitchell, C.; Qiang, J.; Venturini, M.

The recent proposal [1] of a Laser Plasma Storage Ring (LPSR) envisions the use of a laser-plasma (LP) acceleration module to inject an electron beam into a compact 500 MeV storage ring. Electron bunches generated by LP methods are naturally very short (tens of femtoseconds), presenting peak currents on the order of 10 kA or higher. Of obvious concern is the impact of collective effects and in particular Coherent Synchrotron Radiation (CSR) on the beam dynamics in the storage ring. Available simulation codes (e.g. Elegant [2]) usually include transient CSR effects but neglect the contribution of radiation emitted from trailingmore » magnets. In a compact storage ring, with dipole magnets close to each other, cross talking between different magnets could in principle be important.In this note we investigate this effect for the proposed LPSR and show that, in fact, this effect is relatively small. However our analysis also indicates that CSR effects in general would be quite strong and deserve a a careful study.« less

Quality Improvement Strategies in Accountable Care Organization Hospitals.

PubMed

Mora, Arthur M; Walker, Daniel

2016-01-01

Accountable Care Organizations (ACOs) are hoped to lower costs and improve health care quality. However, hospitals remain unsure how to bring about the quality improvement (QI) required to increase financial viability. This success may hinge on the use of sophisticated measurement tracking and the use of multiple QI tools. This study aims to assess the current approaches that ACO hospitals are using to improve quality and to compare their strategies with non-ACO hospitals. The 2013 American Hospital Association's Annual Survey and the Survey of Care Systems and Payment data were merged to identify ACO and non-ACO hospitals. ACO and non-ACO hospital rates of reported use of multiple QI tools and the ability to detect and track readmissions across organizational boundaries were compared. ACO hospitals were significantly less likely to use only 1 QI tool (43.5% vs 65.2%; P < .001) and more likely to use 2 (36.4% vs 28.1%; P < .05), 3 (12.1% vs 6.5%; P < .001), or 4 (8.0% vs 0.2%; P < .001) QI tools. ACO hospitals were significantly more likely to have the capability to detect readmissions (34.1% vs 22.8%; P < .001) and track readmissions (90.5% vs 85.7%; P < .05). Results suggest that ACO hospitals are incorporating more sophisticated measurements and combinations of QI tools than non-ACO hospitals. It remains to be seen whether this leads to accelerated changes across the quality domains in ACO hospitals.

Global Transcriptomic Analysis of Targeted Silencing of Two Paralogous ACC Oxidase Genes in Banana

PubMed Central

Xia, Yan; Kuan, Chi; Chiu, Chien-Hsiang; Chen, Xiao-Jing; Do, Yi-Yin; Huang, Pung-Ling

2016-01-01

Among 18 1-aminocyclopropane-1-carboxylic acid (ACC) oxidase homologous genes existing in the banana genome there are two genes, Mh-ACO1 and Mh-ACO2, that participate in banana fruit ripening. To better understand the physiological functions of Mh-ACO1 and Mh-ACO2, two hairpin-type siRNA expression vectors targeting both the Mh-ACO1 and Mh-ACO2 were constructed and incorporated into the banana genome by Agrobacterium-mediated transformation. The generation of Mh-ACO1 and Mh-ACO2 RNAi transgenic banana plants was confirmed by Southern blot analysis. To gain insights into the functional diversity and complexity between Mh-ACO1 and Mh-ACO2, transcriptome sequencing of banana fruits using the Illumina next-generation sequencer was performed. A total of 32,093,976 reads, assembled into 88,031 unigenes for 123,617 transcripts were obtained. Significantly enriched Gene Oncology (GO) terms and the number of differentially expressed genes (DEGs) with GO annotation were ‘catalytic activity’ (1327, 56.4%), ‘heme binding’ (65, 2.76%), ‘tetrapyrrole binding’ (66, 2.81%), and ‘oxidoreductase activity’ (287, 12.21%). Real-time RT-PCR was further performed with mRNAs from both peel and pulp of banana fruits in Mh-ACO1 and Mh-ACO2 RNAi transgenic plants. The results showed that expression levels of genes related to ethylene signaling in ripening banana fruits were strongly influenced by the expression of genes associated with ethylene biosynthesis. PMID:27681726

Quality of Care Improves for Patients with Diabetes in Medicare Shared Savings Accountable Care Organizations: Organizational Characteristics Associated with Performance.

PubMed

Fraze, Taressa K; Lewis, Valerie A; Tierney, Emily; Colla, Carrie H

2017-12-06

Accountable care organizations (ACOs), a primary care-centric delivery and payment model, aim to promote integrated population health, which may improve care for those with chronic conditions such as diabetes. Research has shown that, overall, the ACO model is effective at reducing costs, but there is substantial variation in how effective different types of ACOs are at impacting costs and improving care delivery. This study examines how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes. Secondary data were analyzed retrospectively to examine Medicare Shared Savings Program (MSSP) ACOs' performance on diabetes metrics in the first 2 years of ACO contracts. Ordinary least squares was used to analyze 162 MSSP ACOs with publicly available performance data and the National Survey of ACOs. ACOs improved performance significantly for patients with diabetes between contract years 1 and 2. In year 1, also having a private payer contract and an increased number of services within the ACO were positively associated with performance, while having a community health center or a hospital were negatively associated with performance. Better performance in year 1 was negatively associated with improved performance in year 2. This study found that ACOs substantively improved diabetes management within initial contract years. ACOs may need different types of support throughout their contracts to ensure continued improvements in performance.

Ring profiler: a new method for estimating tree-ring density for improved estimates of carbon storage

Treesearch

David W. Vahey; C. Tim Scott; J.Y. Zhu; Kenneth E. Skog

2012-01-01

Methods for estimating present and future carbon storage in trees and forests rely on measurements or estimates of tree volume or volume growth multiplied by specific gravity. Wood density can vary by tree ring and height in a tree. If data on density by tree ring could be obtained and linked to tree size and stand characteristics, it would be possible to more...

Storage rings, internal targets and PEP

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spencer, J.E.

Storage rings with internal targets are described, using PEP as an example. The difference between electrons and heavier particles such as protons, antiprotons, and heavy ions is also discussed because it raises possibilities of bypass insertions for more exotic experiments. PEP is compared to other rings in various contexts to verify the assertion that it is an ideal ring for many fundamental and practical applications that can be carried on simultaneously. (LEW)

ELISA - an electrostatic storage ring for low-energy ions

NASA Astrophysics Data System (ADS)

Pape Moeller, Soeren

1997-05-01

The design of a new type of storage ring for low-energy ions using electrostatic deflection and focusing devices is described. Electrostatic bends and quadrupoles are used since they are more efficient than magnetic ones for low-velocity heavy ions. Furthermore, electrostatic devices are more compact and easier to construct than magnetic devices. In comparison to an electromagnetic trap, one important advantage of the elecrostatic ring is the easy access to the circulating beam and its decay products. These and other features, e.g. no magnetic fields, makes such storage devices attractive for many atomic-physics experiments. Also neigboring fields as chemistry and biology might benefit from such an relatively inexpensive device. One important difference between an electrostatic and a magnetic ring is, that the longitudinal energy is not conserved for the electrostatic ring. The actual ring will have a race-track shape as defined by two straight sections each with two quadrupole doublets connected by 180-degrees bends. The bends will consist of 160-degrees spherical deflection plates surrounded by two parallel plate 10-degrees bends. The storage ring ELISA, currently being built, will have a circumference of 6 meters. The first beam tests will take place during summer 1996.

Beam diagnostics at high-intensity storage rings

NASA Astrophysics Data System (ADS)

Plum, Mike

1994-10-01

Beam diagnostics at high-intensity facilities feature their own special set of problems and characteristics, issues peculiar to high-intensity storage rings include beam loss, beam halos, extraction efficiency, beam in the gap, clearing electrodes, and beam-profile measurement. The Los Alamos Proton Storage Ring (PSR) is a nice example of a high-intensity storage ring. I will discuss in some detail three diagnostic systems currently in use at the PSR: the beam-loss-monitor system, the electron-clearing system, and the beam-in-the-gap monitor. Much of our discussion is inspired by the problems we have encountered and the useful things we have learned while commissioning and developing the PSR. Another inspiration is our work on the next-generation neutron-spallation source, also known as the National Center for Neutron Research (NCNR).

Model-independent and fast determination of optical functions in storage rings via multiturn and closed-orbit data

NASA Astrophysics Data System (ADS)

Riemann, Bernard; Grete, Patrick; Weis, Thomas

2011-06-01

Multiturn (or turn-by-turn) data acquisition has proven to be a new source of direct measurements for Twiss parameters in storage rings. On the other hand, closed-orbit measurements are a long-known tool for analyzing closed-orbit perturbations with conventional beam position monitor (BPM) systems and are necessarily available at every storage ring. This paper aims at combining the advantages of multiturn measurements and closed-orbit data. We show that only two multiturn BPMs and four correctors in one localized drift space in the storage ring (diagnostic drift) are sufficient for model-independent and absolute measuring of β and φ functions at all BPMs, including the conventional ones, instead of requiring all BPMs being equipped with multiturn electronics.

Study of Storage Ring Free-Electron Laser Using Experimental and Simulation Approaches

NASA Astrophysics Data System (ADS)

Jia, Botao

2011-12-01

The Duke electron storage ring, first commissioned in November of 1994, has been developed as a dedicated driver for storage ring free-electron lasers (SRFELs) operating in a wide wavelength range from infrared, to visible, to ultraviolet (UV) and vacuum ultraviolet (VUV). The storage ring has a long straight section for various insertion devices and can be operated in a wide energy range (0.25 GeV to 1.15 GeV). Commissioned in 1995, the first free-electron laser (FEL) on the Duke storage ring was the OK-4 FEL, an optical klystron with two planar undulators sandwiching a buncher magnet. In 2005, the OK-5 FEL with two helical undulators was commissioned. Operating four undulators---two OK-4 and two OK-5 undulators, the world's first distributed optical klystron FEL was brought to operation in 2005. Via Compton scattering of FEL photons and electrons in the storage ring, the Duke FEL drives the world's most powerful, nearly monochromatic, and polarized Compton gamma-ray source, the High Intensity Gamma-ray Source (HIgammaS). Today, a variety of configurations of the storage ring FELs at Duke have been used in a wide range of research areas from nuclear physics to biophysics, from chemical and medical research to industrial applications. The capability of accurately measuring the storage ring electron beam energy spread is crucial for understanding the longitudinal beam dynamics and the dynamics of the storage ring FEL. In this dissertation, we have successfully developed a noninvasive, versatile, and accurate method to measure the energy spread using optical klystron radiation. Novel numerical methods based upon the Gauss-Hermite expansion have been developed to treat both spectral broadening and modulation on an equal footing. Through properly configuring the optical klystron, this energy spread measurement method has a large dynamic range. In addition, a model-based scheme has been developed for correcting the electron beam emittance related inhomogeneous spectral broadening effect, to further enhance the accuracy of measuring the electron beam energy spread. Taking advantage of the direct measurement method of the electron beam energy spread, we have developed another novel technique to simultaneously measure the FEL power, electron beam energy spread, and other beam parameters. This allowed us to study the FEL power in a systematic manner for the first time. Based on the experimental findings and results of the theoretical predictions, we have proposed a compact formula to predict the FEL power using only the knowledge of electron beam current, beam energy, and bunch length. As part of the dissertation work, we have developed a self-consistent numerical model to study the storage ring FEL. The simulation program models the electron beam propagation along the storage ring, multi-turn FEL interaction in the undulators, gradual intra-cavity optical power buildup, etc. This simulation code captures the main features of a storage ring FEL at different time and space scales. The simulated FEL gain has been benchmarked against measured gain and calculated gain with good agreement. The simulation package can provide comprehensive information about the FEL gain, optical pulse growth, electron beam properties, etc. In the near future, we plan to further improve the simulation model, by including additional physics effects such as microwave instability, to make it a more useful tool for FEL research.

Using health information technology to manage a patient population in accountable care organizations.

PubMed

Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R

2016-06-20

Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management.

Single-pass BPM system of the Photon Factory storage ring.

PubMed

Honda, T; Katoh, M; Mitsuhashi, T; Ueda, A; Tadano, M; Kobayashi, Y

1998-05-01

At the 2.5 GeV ring of the Photon Factory, a single-pass beam-position monitor (BPM) system is being prepared for the storage ring and the beam transport line. In the storage ring, the injected beam position during the first several turns can be measured with a single injection pulse. The BPM system has an adequate performance, useful for the commissioning of the new low-emittance lattice. Several stripline BPMs are being installed in the beam transport line. The continuous monitoring of the orbit in the beam transport line will be useful for the stabilization of the injection energy as well as the injection beam orbit.

Early Performance of Accountable Care Organizations in Medicare

PubMed Central

McWilliams, J. Michael; Hatfield, Laura A.; Chernew, Michael E.; Landon, Bruce E.; Schwartz, Aaron L.

2016-01-01

BACKGROUND In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs. METHODS Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was −$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P = 0.02), consistent with a 1.4% savings, but only −$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P = 0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P = 0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others. CONCLUSIONS The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups. PMID:27075832

Performance Differences in Year 1 of Pioneer Accountable Care Organizations

PubMed Central

McWilliams, J. Michael; Chernew, Michael E.; Landon, Bruce E.; Schwartz, Aaron L.

2015-01-01

BACKGROUND In 2012, a total of 32 organizations entered the Pioneer accountable care organization (ACO) program, in which providers can share savings with Medicare if spending falls below a financial benchmark. Performance differences associated with characteristics of Pioneer ACOs have not been well described. METHODS In a difference-in-differences analysis of Medicare fee-for-service claims, we compared Medicare spending for beneficiaries attributed to Pioneer ACOs (ACO group) with other beneficiaries (control group) before (2009 through 2011) and after (2012) the start of Pioneer ACO contracts, with adjustment for geographic area and beneficiaries’ sociodemographic and clinical characteristics. We estimated differential changes in spending for several subgroups of ACOs: those with and those without clear financial integration between hospitals and physician groups, those with higher and those with lower baseline spending, and the 13 ACOs that withdrew from the Pioneer program after 2012 and the 19 that did not. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO group and the control group during the precontract period. In 2012, the total adjusted per-beneficiary spending differentially changed in the ACO group as compared with the control group (−$29.2 per quarter, P = 0.007), consistent with a 1.2% savings. Savings were significantly greater for ACOs with baseline spending above the local average, as compared with those with baseline spending below the local average (P = 0.05 for interaction), and for those serving high-spending areas, as compared with those serving low-spending areas (P = 0.04). Savings were similar in ACOs with financial integration between hospitals and physician groups and those without, as well as in ACOs that withdrew from the program and those that did not. CONCLUSIONS Year 1 of the Pioneer ACO program was associated with modest reductions in Medicare spending. Savings were greater for ACOs with higher baseline spending than for those with lower baseline spending and were unrelated to withdrawal from the program. (Funded by the National Institute on Aging and others.) PMID:25875195

Accountable Care Organizations in the United States: market and demographic factors associated with formation.

PubMed

Lewis, Valerie A; Colla, Carrie H; Carluzzo, Kathleen L; Kler, Sarah E; Fisher, Elliott S

2013-12-01

The Accountable Care Organization (ACO) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation. To determine the number of accountable care organizations in the United States, where they are located, and characteristics associated with ACO formation. Cross-sectional study of all ACOs in the United States as of August 2012. We identified ACOs from multiple sources; documented service locations (practices, clinics, hospitals); and linked service locations to local areas, defined as Dartmouth Atlas hospital service areas. We used multivariate analysis to assess what characteristics were associated with local ACO presence. We examined demographic characteristics (2010 American Community Survey) and health care system characteristics (2010 Medicare fee-for-service claims data). We identified 227 ACOs located in 27 percent of local areas. Fifty-five percent of the US population resides in these areas. HSA-level characteristics associated with ACO presence include higher performance on quality, higher Medicare per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location. Much of the US population resides in areas where ACOs have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context. © Health Research and Educational Trust.

REQUIREMENTS AND GUIDELINES FOR NSLS EXPERIMENTAL BEAM LINE VACUUM SYSTEMS-REVISION B.

DOE Office of Scientific and Technical Information (OSTI.GOV)

FOERSTER,C.

Typical beam lines are comprised of an assembly of vacuum valves and shutters referred to as a ''front end'', optical elements to monochromatize, focus and split the photon beam, and an experimental area where a target sample is placed into the photon beam and data from the interaction is detected and recorded. Windows are used to separate sections of beam lines that are not compatible with storage ring ultra high vacuum. Some experimental beam lines share a common vacuum with storage rings. Sections of beam lines are only allowed to vent up to atmospheric pressure using pure nitrogen gas aftermore » a vacuum barrier is established to protect ring vacuum. The front end may only be bled up when there is no current in the machine. This is especially true on the VUV storage ring where for most experiments, windows are not used. For the shorter wavelength, more energetic photons of the x-ray ring, beryllium windows are used at various beam line locations so that the monochromator, mirror box or sample chamber may be used in a helium atmosphere or rough vacuum. The window separates ring vacuum from the environment of the downstream beam line components. The stored beam lifetime in the storage rings and the maintenance of desirable reflection properties of optical surfaces depend upon hydrocarbon-free, ultra-high vacuum systems. Storage ring vacuum systems will operate at pressures of {approximately} 1 x 10{sup {minus}10} Torr without beam and {approximately} 1 x 10{sup {minus}9} Torr with beam. Systems are free of hydrocarbons in the sense that no pumps, valves, etc. containing organics are used. Components are all-metal, chemically cleaned and bakeable. To the extent that beam lines share a common vacuum with the storage ring, the same criteria will hold for beam line components. The design philosophy for NSLS beam lines is to use all-metal, hydrocarbon-free front end components and recommend that experimenters use this approach for common vacuum hardware downstream of front ends. O-ring-sealed valves, if used, are not permitted upstream of the monochromator exit aperture. It will be the responsibility of users to demonstrate that their experiment will not degrade the pressure or quality of the storage ring vacuum. As a matter of operating policy, all beam lines will be monitored for prescribed pressure and the contribution of high mass gases to this pressure each time a beam line has been opened to ring vacuum.« less

Low-emittance tuning of storage rings using normal mode beam position monitor calibration

NASA Astrophysics Data System (ADS)

Wolski, A.; Rubin, D.; Sagan, D.; Shanks, J.

2011-07-01

We describe a new technique for low-emittance tuning of electron and positron storage rings. This technique is based on calibration of the beam position monitors (BPMs) using excitation of the normal modes of the beam motion, and has benefits over conventional methods. It is relatively fast and straightforward to apply, it can be as easily applied to a large ring as to a small ring, and the tuning for low emittance becomes completely insensitive to BPM gain and alignment errors that can be difficult to determine accurately. We discuss the theory behind the technique, present some simulation results illustrating that it is highly effective and robust for low-emittance tuning, and describe the results of some initial experimental tests on the CesrTA storage ring.

Characterization and expression profiles of MaACS and MaACO genes from mulberry (Morus alba L.)*

PubMed Central

Liu, Chang-ying; Lü, Rui-hua; Li, Jun; Zhao, Ai-chun; Wang, Xi-ling; Diane, Umuhoza; Wang, Xiao-hong; Wang, Chuan-hong; Yu, Ya-sheng; Han, Shu-mei; Lu, Cheng; Yu, Mao-de

2014-01-01

1-Aminocyclopropane-1-carboxylic acid synthase (ACS) and 1-aminocyclopropane-1-carboxylic acid oxidase (ACO) are encoded by multigene families and are involved in fruit ripening by catalyzing the production of ethylene throughout the development of fruit. However, there are no reports on ACS or ACO genes in mulberry, partly because of the limited molecular research background. In this study, we have obtained five ACS gene sequences and two ACO gene sequences from Morus Genome Database. Sequence alignment and phylogenetic analysis of MaACO1 and MaACO2 showed that their amino acids are conserved compared with ACO proteins from other species. MaACS1 and MaACS2 are type I, MaACS3 and MaACS4 are type II, and MaACS5 is type III, with different C-terminal sequences. Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) expression analysis showed that the transcripts of MaACS genes were strongly expressed in fruit, and more weakly in other tissues. The expression of MaACO1 and MaACO2 showed different patterns in various mulberry tissues. MaACS and MaACO genes demonstrated two patterns throughout the development of mulberry fruit, and both of them were strongly up-regulated by abscisic acid (ABA) and ethephon. PMID:25001221

A taxonomy of hospitals participating in Medicare accountable care organizations.

PubMed

Bazzoli, Gloria J; Harless, David W; Chukmaitov, Askar S

2017-03-03

Medicare was an early innovator of accountable care organizations (ACOs), establishing the Medicare Shared Savings Program (MSSP) and Pioneer programs in 2012-2013. Existing research has documented that ACOs bring together an array of health providers with hospitals serving as important participants. Hospitals vary markedly in their service structure and organizational capabilities, and thus, one would expect hospital ACO participants to vary in these regards. Our research identifies hospital subgroups that share certain capabilities and competencies. Such research, in conjunction with existing ACO research, provides deeper understanding of the structure and operation of these organizations. Given that Medicare was an initiator of the ACO concept, our findings provide a baseline to track the evolution of ACO hospitals over time. Hierarchical clustering methods are used in separate analyses of MSSP and Pioneer ACO hospitals. Hospitals participating in ACOs with 2012-2013 start dates are identified through multiple sources. Study data come from the Centers for Medicare and Medicaid Services, American Hospital Association, and Health Information and Management Systems Society. Five-cluster solutions were developed separately for the MSSP and Pioneer hospital samples. Both the MSSP and Pioneer taxonomies had several clusters with high levels of health information technology capabilities. Also distinct clusters with strong physician linkages were present. We examined Pioneer ACO hospitals that subsequently left the program and found that they commonly had low levels of ambulatory care services or health information technology. Distinct subgroups of hospitals exist in both the MSSP and Pioneer programs, suggesting that individual hospitals serve different roles within an ACO. Health information technology and physician linkages appear to be particularly important features in ACO hospitals. ACOs need to consider not only geographic and service mix when selecting hospital participants but also their vertical integration features and management competencies.

Long-term Outcomes of One Stage Surgery Using Transanal Colorectal Tube for Acute Colorectal Obstruction of Stage II/III Distal Colon Cancer.

PubMed

Okuda, Yusuke; Yamada, Tomonori; Hirata, Yoshikazu; Shimura, Takaya; Yamaguchi, Ryuzo; Sakamoto, Eiji; Sobue, Satoshi; Nakazawa, Takahiro; Kataoka, Hiromi; Joh, Takashi

2018-06-06

Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO. Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups. Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%; p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658). TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.

Pseudo-single-bunch mode for a 100 MHz storage ring serving soft X-ray timing experiments

NASA Astrophysics Data System (ADS)

Olsson, T.; Leemann, S. C.; Georgiev, G.; Paraskaki, G.

2018-06-01

At many storage rings for synchrotron light production there is demand for serving both high-flux and timing users simultaneously. Today this is most commonly achieved by operating inhomogeneous fill patterns, but this is not preferable for rings that employ passive harmonic cavities to damp instabilities and increase Touschek lifetime. For these rings, inhomogeneous fill patterns could severely reduce the effect of the harmonic cavities. It is therefore of interest to develop methods to serve high-flux and timing users simultaneously without requiring gaps in the fill pattern. One such method is pseudo-single-bunch (PSB), where one bunch in the bunch train is kicked onto another orbit by a fast stripline kicker. The light emitted from the kicked bunch can then be separated by an aperture in the beamline. Due to recent developments in fast kicker design, PSB operation in multibunch mode is within reach for rings that operate with a 100 MHz RF system, such as the MAX IV and Solaris storage rings. This paper describes machine requirements and resulting performance for such a mode at the MAX IV 1.5 GeV storage ring. A solution for serving all beamlines is discussed as well as the consequences of beamline design and operation in the soft X-ray energy range.

A Model Describing Stable Coherent Synchrotron Radiation in Storage Rings

NASA Astrophysics Data System (ADS)

Sannibale, F.; Byrd, J. M.; Loftsdóttir, Á.; Venturini, M.; Abo-Bakr, M.; Feikes, J.; Holldack, K.; Kuske, P.; Wüstefeld, G.; Hübers, H.-W.; Warnock, R.

2004-08-01

We present a model describing high power stable broadband coherent synchrotron radiation (CSR) in the terahertz frequency region in an electron storage ring. The model includes distortion of bunch shape from the synchrotron radiation (SR), which enhances higher frequency coherent emission, and limits to stable emission due to an instability excited by the SR wakefield. It gives a quantitative explanation of several features of the recent observations of CSR at the BESSYII storage ring. We also use this model to optimize the performance of a source for stable CSR emission.

Construction and operation of a support facilities (Building 729) for operation/testing of a prototype accelerator/storage ring (XLS) and machine shop for the National Synchrotron Light Source at Brookhaven National Laboratory, Upton, New York

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-06-01

Proposed action is to construct at BNL a 5,600-ft[sup 2] support building, install and operate a prototypic 200 MeV accelerator and a prototypic 700 MeV storage ring within, and to construct and operate a 15 kV substation to power the building. The accelerator and storage ring would comprise the x-ray lithography source or XLS.

Construction and operation of a support facilities (Building 729) for operation/testing of a prototype accelerator/storage ring (XLS) and machine shop for the National Synchrotron Light Source at Brookhaven National Laboratory, Upton, New York. Environmental assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-06-01

Proposed action is to construct at BNL a 5,600-ft{sup 2} support building, install and operate a prototypic 200 MeV accelerator and a prototypic 700 MeV storage ring within, and to construct and operate a 15 kV substation to power the building. The accelerator and storage ring would comprise the x-ray lithography source or XLS.

High resolution monochromator for the VUV radiation from the DORIS storage ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saile, V.; Gurtler, P.; Koch, E.E.

1976-10-01

The unique properties of the DORIS storage ring at DESY as a synchroton radiation source are exploited for high resolution spectroscopy in the vacuum ultraviolet. We describe a new experimental set up with a 3-m normal incidence monochromator for wavelengths between 3000 A and 300 A (4 < or = h..omega.. < or = 40 eV) using a vertical dispersion plane. The storage ring provides a light flux intense and stable enough for rapid photoelectrical scanning of the spectra with a resolution of 0.03 A in first order. (AIP)

Design Study of an MBA Lattice for the Advanced Photon Source

DOE Office of Scientific and Technical Information (OSTI.GOV)

Decker, Glenn

2014-11-02

Recent interest in ultra-low-emittance designs for storage-ring-based synchrotron light sources has spurred a focused design effort on a multi-bend achromat (MBA) storage ring replacement for the Advanced Photon Source (APS). The APS is relatively large (1104 m circumference) and, as such, an upgrade to a fourth-generation storage ring holds the potential for a two to three order of magnitude enhancement of X-ray brightness due to the approximate inverse cubic scaling of emittance with the number of dipole bend magnets.

ACCELERATORS: Preliminary application of turn-by-turn data analysis to the SSRF storage ring

NASA Astrophysics Data System (ADS)

Chen, Jian-Hui; Zhao, Zhen-Tang

2009-07-01

There is growing interest in utilizing the beam position monitor turn-by-turn (TBT) data to debug accelerators. TBT data can be used to determine the linear optics, coupled optics and nonlinear behaviors of the storage ring lattice. This is not only a useful complement to other methods of determining the linear optics such as LOCO, but also provides a possibility to uncover more hidden phenomena. In this paper, a preliminary application of a β function measurement to the SSRF storage ring is presented.

How to Reach a Thousand-Second in-Plane Polarization Lifetime with 0.97 - GeV / c Deuterons in a Storage Ring

DOE PAGES

Guidoboni, G.; Stephenson, E.; Andrianov, S.; ...

2016-07-28

Here, we observe a deuteron beam polarization lifetime near 1000 s in the horizontal plane of a magnetic storage ring (COSY). This long spin coherence time is maintained through a combination of beam bunching, electron cooling, sextupole field corrections, and the suppression of collective effects through beam current limits. This record lifetime is required for a storage ring search for an intrinsic electric dipole moment on the deuteron at a statistical sensitivity level approaching 10 -29 $e$ cm.

Accountable care organizations: benefits and barriers as perceived by Rural Health Clinic management.

PubMed

Ortiz, Judith; Bushy, Angeline; Zhou, Yue; Zhang, Hong

2013-01-01

Rural Health Clinics (RHCs) have served the primary healthcare needs of the medically underserved in US rural areas for more than 30 years. As a new model of healthcare delivery, the Accountable Care Organization (ACO) offers potential opportunities for addressing the healthcare needs of rural populations, yet little is known about how the ACO model will meet the needs of RHCs. This article reports on the results of a survey, focus groups, and phone interviews with RHC management personnel on the subject of benefits of and barriers to RHC participation in ACOs. Survey research, focus groups, and phone interviews were used to gather and analyze the opinions of RHCs' management about the benefits of and barriers to ACO participation. The study population consisted of all 2011 RHCs in Region 4 (Southeastern USA; as designated by the Department of Health and Human Services). California RHCs were used for comparison. Themes and concepts for the survey questionnaire were developed from recent literature. The survey data were analyzed in two stages: (1) analyses of the characteristics of the RHCs and their responses; and (2) bivariate analyses of several relationships using a variety of statistics including analysis of variance, Pearson's χ² and likelihood χ². Relationships were examined between the RHCs' willingness to join ACOs and the respondent clinic's classification (as provider-based or independent). In addition, willingness to join ACOs among Region 4 RHCs was compared with those in California. Finally, in order to gain a broader understanding of the results of the survey, focus groups and phone interviews were conducted with RHC personnel. It was found that the ACO model is generally unfamiliar to RHCs. Approximately 48% of the survey respondents reported having little knowledge of ACOs; the focus group participants and interviewees likewise reported a lack of knowledge. Among respondents who were knowledgeable about ACOs, the most frequently citied potential benefit of ACOs (58%) was improved patient quality of care, followed by a focus on the patient (54%). More than half of the respondents (53%) cited 'financing' as a deterrent to RHC participating in ACOs. Many (43%) reported that their clinic had inadequate capital to improve their information technology systems. Another 51% cited legal and regulatory barriers. While the ACO model was unfamiliar to many of the RHC study participants, many suggested that ACOs may promote the quality of health care for RHC patients and their communities. If, on the other hand, RHCs are not provided the necessary technical assistance or not valued as ACO partners, ACOs may not improve the services that RHCs provide. As the ACO model evolves, the authors will determine whether it will benefit RHCs and their patients, or how the ACO must be modified to accommodate the unique needs of RHCs.

Accountable Care Organization Implementation Experiences and Rural Participation: Considerations for Nurses.

PubMed

Bagwell, Matt Thomas; Bushy, Angeline; Ortiz, Judith

2017-01-01

Little is known about how accountable care organizations (ACOs) participate with rural health providers. This pilot study examines ACO participation with rural health clinics (RHCs). Telephone interviews with 8 ACO administrators were conducted to determine the early implementation experiences of these organizations, and their participation with rural health providers, such as RHCs, using qualitative content analysis, ACO characteristics, and emerging themes from the ACO executive responses was identified. Three predominant themes emerged: 1) ACOs are growing in size and number and have various organizational structures; 2) there is an expanding emphasis on preventive primary care and chronic disease management for patients; and 3) there is a need for improved information technology integration with clinical services and financial systems. Of 8 participants, 7 reported that their ACO was planning to expand into rural areas and partner with rural providers.

Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

PubMed

Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

2018-05-15

Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

Dielectronic recombination experiments at the storage rings: From the present CSR to the future HIAF

NASA Astrophysics Data System (ADS)

Huang, Z. K.; Wen, W. Q.; Xu, X.; Wang, H. B.; Dou, L. J.; Chuai, X. Y.; Zhu, X. L.; Zhao, D. M.; Li, J.; Ma, X. M.; Mao, L. J.; Yang, J. C.; Yuan, Y. J.; Xu, W. Q.; Xie, L. Y.; Xu, T. H.; Yao, K.; Dong, C. Z.; Zhu, L. F.; Ma, X.

2017-10-01

Dielectronic recombination (DR) experiments of highly charged ions at the storage rings have been developed as a precision spectroscopic tool to investigate the atomic structure as well as nuclear properties of stable and unstable nuclei. The DR experiment on lithium-like argon ions was successfully performed at main Cooler Storage Ring (CSRm) at Heavy Ion Research Facility in Lanzhou (HIRFL) accelerator complex. The DR experiments on heavy highly charged ions and even radioactive ions are currently under preparation at the experimental Cooler Storage Ring (CSRe) at HIRFL. The current status of DR experiments at the CSRm and the preparation of the DR experiments at the CSRe are presented. In addition, an overview of DR experiments by employing an electron cooler and a separated ultra-cold electron target at the upcoming High Intensity heavy ion Accelerator Facility (HIAF) will be given.

Bruno Touschek: From Betatrons to Electron-Positron Colliders

NASA Astrophysics Data System (ADS)

Bernardini, Carlo; Pancheri, Giulia; Pellegrini, Claudio

Bruno Touschek's life as a physicist spanned the period from World War II to the 1970s. He was a key figure in the developments of electron-positron colliders and storage rings, and made important contributions to theoretical high energy physics. Storage rings, initially developed for high energy physics, are being widely used in many countries as synchrotron radiation sources and are a tool for research in physics, chemistry, biology, environmental sciences and cultural heritage studies. We describe Touschek's life in Austria, where he was born, in Germany, where he participated in the construction of a betatron during WWII, and in Italy, where he proposed and led to completion the first electron-positron storage ring in 1960, in Frascati. We highlight how his central European culture influenced his lifestyle and work, and his main contributions to physics, such as the discovery of the Touschek effect and beam instabilities in the larger storage ring ADONE.

Bruno Touschek: From Betatrons to Electron-Positron Colliders

NASA Astrophysics Data System (ADS)

Bernardini, Carlo; Pancheri, Giulia; Pellegrini, Claudio

Bruno Touschek’s life as a physicist spanned the period from World War II to the 1970s. He was a key figure in the developments of electron-positron colliders and storage rings, and made important contributions to theoretical high energy physics. Storage rings, initially developed for high energy physics, are being widely used in many countries as synchrotron radiation sources and are a tool for research in physics, chemistry, biology, environmental sciences and cultural heritage studies. We describe Touschek’s life in Austria, where he was born, in Germany, where he participated in the construction of a betatron during WWII, and in Italy, where he proposed and led to completion the first electron-positron storage ring in 1960, in Frascati. We highlight how his central European culture influenced his lifestyle and work, and his main contributions to physics, such as the discovery of the Touschek effect and beam instabilities in the larger storage ring ADONE.

High-energy accelerator for beams of heavy ions

DOEpatents

Martin, Ronald L.; Arnold, Richard C.

1978-01-01

An apparatus for accelerating heavy ions to high energies and directing the accelerated ions at a target comprises a source of singly ionized heavy ions of an element or compound of greater than 100 atomic mass units, means for accelerating the heavy ions, a storage ring for accumulating the accelerated heavy ions and switching means for switching the heavy ions from the storage ring to strike a target substantially simultaneously from a plurality of directions. In a particular embodiment the heavy ion that is accelerated is singly ionized hydrogen iodide. After acceleration, if the beam is of molecular ions, the ions are dissociated to leave an accelerated singly ionized atomic ion in a beam. Extraction of the beam may be accomplished by stripping all the electrons from the atomic ion to switch the beam from the storage ring by bending it in magnetic field of the storage ring.

Injection envelope matching in storage rings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Minty, M.G.; Spence, W.L.

1995-05-01

The shape and size of the transverse phase space injected into a storage ring can be deduced from turn-by-turn measurements of the transient behavior of the beam envelope in the ring. Envelope oscillations at 2 x the {beta}-tron frequency indicate the presence of a {beta}-mismatch, while envelope oscillations at the {beta}-tron frequency are the signature of a dispersion function mismatch. Experiments in injection optimization using synchrotron radiation imaging of the beam and a fast-gated camera at the SLC damping rings are reported.

Injection envelope matching in storage rings

NASA Astrophysics Data System (ADS)

Minty, M. G.; Spence, W. L.

1995-05-01

The shape and size of the transverse phase space injected into a storage ring can be deduced from turn-by-turn measurements of the transient behavior of the beam envelope in the ring. Envelope oscillations at 2 x the beta-tron frequency indicate the presence of a beta-mismatch, while envelope oscillations at the beta-tron frequency are the signature of a dispersion function mismatch. Experiments in injection optimization using synchrotron radiation imaging of the beam and a fast-gated camera at the SLC damping rings are reported.

Pediatric Accountable Care Organizations: Insight From Early Adopters.

PubMed

Perrin, James M; Zimmerman, Edward; Hertz, Andrew; Johnson, Timothy; Merrill, Tom; Smith, David

2017-02-01

Partly in response to incentives in the Affordable Care Act, there has been major growth in accountable care organizations (ACO) in both the private and public sectors. For several reasons, growth of ACOs in pediatric care has been more modest than for older populations. The American Academy of Pediatrics collaborated with Leavitt Partners, LLC, to carry out a study of pediatric ACOs, including a series of 5 case studies of diverse pediatric models, a scan of Medicaid ACOs, and a summit of leaders in pediatric ACO development. These collaborative activities identified several issues in ACO formation and sustainability in pediatric settings and outlined a number of opportunities for the pediatric community in areas of organization, model change, and market dynamics; payment, financing, and contracting; quality and value; and use of new technologies. These insights can guide future work in pediatric ACO development. Copyright © 2017 by the American Academy of Pediatrics.

A framework for evaluating the formation, implementation, and performance of accountable care organizations.

PubMed

Fisher, Elliott S; Shortell, Stephen M; Kreindler, Sara A; Van Citters, Aricca D; Larson, Bridget K

2012-11-01

The implementation of accountable care organizations (ACOs), a new health care payment and delivery model designed to improve care and lower costs, is proceeding rapidly. We build on our experience tracking early ACOs to identify the major factors-such as contract characteristics; structure, capabilities, and activities; and local context-that would be likely to influence ACO formation, implementation, and performance. We then propose how an ACO evaluation program could be structured to guide policy makers and payers in improving the design of ACO contracts, while providing insights for providers on approaches to care transformation that are most likely to be successful in different contexts. We also propose key activities to support evaluation of ACOs in the near term, including tracking their formation, developing a set of performance measures across all ACOs and payers, aggregating those performance data, conducting qualitative and quantitative research, and coordinating different evaluation activities.

42 CFR 425.504 - Incorporating reporting requirements related to the Physician Quality Reporting System.

Code of Federal Regulations, 2012 CFR

2012-10-01

... under their ACO participant TIN as a group practice under the Physician Quality Reporting System Group... participant TIN, on behalf of its ACO supplier/provider participants who are eligible professionals, will... Physician Fee Schedule for that TIN. (4) ACO participant TINs and individual ACO providers/suppliers who are...

42 CFR 425.504 - Incorporating reporting requirements related to the Physician Quality Reporting System.

Code of Federal Regulations, 2013 CFR

2013-10-01

... under their ACO participant TIN as a group practice under the Physician Quality Reporting System Group... participant TIN, on behalf of its ACO supplier/provider participants who are eligible professionals, will... Physician Fee Schedule for that TIN. (4) ACO participant TINs and individual ACO providers/suppliers who are...

Physician Participation In ACOs Is Lower In Places With Vulnerable Populations Compared To More Affluent Communities

PubMed Central

Yasaitis, Laura C.; Pajerowski, William; Polsky, Daniel; Werner, Rachel M.

2016-01-01

Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physician participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physician participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education—compared to other areas—had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations may not have as great access as other groups to physicians participating in ACOs, which could exacerbate existing disparities in health care quality. PMID:27503961

Status and outlook of the CRYRING@ESR project

NASA Astrophysics Data System (ADS)

Geithner, W.; Andelkovic, Z.; Beck, D.; Bräuning, H.; Bräuning-Demian, A.; Danared, H.; Dimopoulou, C.; Engström, M.; Fedotova, S.; Gorda, O.; Herfurth, F.; Hess, R.; Källberg, A.; Kleffner, C.; Kotovskiy, N.; Kraus, I.; Lestinsky, M.; Litvinov, S.; Nolden, F.; Reiter, A.; Sieber, T.; Steck, M.; Vorobyev, G.

2017-11-01

Once operational, CRYRING@ESR will store and decelerate ions delivered by the experimental storage ring ESR at energies well below those of ESR. In addition to that, CRYRING@ESR has an electron cooler operating with an ultracold electron beam, allowing to provide cooled ion beams for precision experiments. These ions will be delivered to a broad range of experiments presently in preparation; either in-ring or extracted to a dedicated beamline for experiments. An overview and status report of the installation and commissioning of the CRYRING-@ESR storage ring for highly charged ions at the GSI Helmholtzzentrum für Schwerionenforschung is presented. The installation of this storage ring started in 2014 and was completing end of 2016, when this publication was written.

Inverse estimation of the spheroidal particle size distribution using Ant Colony Optimization algorithms in multispectral extinction technique

NASA Astrophysics Data System (ADS)

He, Zhenzong; Qi, Hong; Wang, Yuqing; Ruan, Liming

2014-10-01

Four improved Ant Colony Optimization (ACO) algorithms, i.e. the probability density function based ACO (PDF-ACO) algorithm, the Region ACO (RACO) algorithm, Stochastic ACO (SACO) algorithm and Homogeneous ACO (HACO) algorithm, are employed to estimate the particle size distribution (PSD) of the spheroidal particles. The direct problems are solved by the extended Anomalous Diffraction Approximation (ADA) and the Lambert-Beer law. Three commonly used monomodal distribution functions i.e. the Rosin-Rammer (R-R) distribution function, the normal (N-N) distribution function, and the logarithmic normal (L-N) distribution function are estimated under dependent model. The influence of random measurement errors on the inverse results is also investigated. All the results reveal that the PDF-ACO algorithm is more accurate than the other three ACO algorithms and can be used as an effective technique to investigate the PSD of the spheroidal particles. Furthermore, the Johnson's SB (J-SB) function and the modified beta (M-β) function are employed as the general distribution functions to retrieve the PSD of spheroidal particles using PDF-ACO algorithm. The investigation shows a reasonable agreement between the original distribution function and the general distribution function when only considering the variety of the length of the rotational semi-axis.

Substantial Physician Turnover And Beneficiary 'Churn' In A Large Medicare Pioneer ACO.

PubMed

Hsu, John; Vogeli, Christine; Price, Mary; Brand, Richard; Chernew, Michael E; Mohta, Namita; Chaguturu, Sreekanth K; Weil, Eric; Ferris, Timothy G

2017-04-01

Alternative payment models, such as accountable care organizations (ACOs), attempt to stimulate improvements in care delivery by better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, we found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel). We also found substantial physician turnover: More than half of physicians either joined (41 percent) or left (18 percent) the ACO during the 2012-14 contract period studied. When physicians left the ACO, most of their attributed beneficiaries also left the ACO. Conversely, about half of the growth in the beneficiary population was because of new physicians affiliating with the ACO; the remainder joined after switching physicians. These findings may help explain the muted financial impact ACOs have had overall, and they raise the possibility of future gaming on the part of ACOs to artificially control spending. Policy refinements include coordinated and standardized risk-sharing parameters across payers to prevent any dilution of the payment incentives or confusion from a cacophony of incentives across payers. Project HOPE—The People-to-People Health Foundation, Inc.

Growth of Accountable Care Organizations in California: Number, Characteristics, and State Regulation.

PubMed

Fulton, Brent D; Pegany, Vishaal; Keolanui, Beth; Scheffler, Richard M

2015-08-01

Accountable care organizations (ACOs) result in physician organizations' and hospitals' receiving risk-based payments tied to costs, health care quality, and patient outcomes. This article (1) describes California ACOs within Medicare, the commercial market, and Medi-Cal and the safety net; (2) discusses how ACOs are regulated by the California Department of Managed Health Care and the California Department of Insurance; and (3) analyzes the increase of ACOs in California using data from Cattaneo and Stroud. While ACOs in California are well established within Medicare and the commercial market, they are still emerging within Medi-Cal and the safety net. Notwithstanding, the state has not enacted a law or issued a regulation specific to ACOs; they are regulated under existing statutes and regulations. From August 2012 to February 2014, the number of lives covered by ACOs increased from 514,100 to 915,285, representing 2.4 percent of California's population, including 10.6 percent of California's Medicare fee-for-service beneficiaries and 2.3 percent of California's commercially insured lives. By emphasizing health care quality and patient outcomes, ACOs have the potential to build and improve on California's delegated model. If recent trends continue, ACOs will have a greater influence on health care delivery and financial risk sharing in California. Copyright © 2015 by Duke University Press.

Retinal is formed from apo-carotenoids in Nostoc sp. PCC7120: in vitro characterization of an apo-carotenoid oxygenase

PubMed Central

Scherzinger, Daniel; Ruch, Sandra; Kloer, Daniel P.; Wilde, Annegret; Al-Babili, Salim

2006-01-01

The sensory rhodopsin from Anabaena (Nostoc) sp. PCC7120 is the first cyanobacterial retinylidene protein identified. Here, we report on NosACO (Nostoc apo-carotenoid oxygenase), encoded by the ORF (open reading frame) all4284, as the candidate responsible for the formation of the required chromophore, retinal. In contrast with the enzymes from animals, NosACO converts β-apo-carotenals instead of β-carotene into retinal in vitro. The identity of the enzymatic products was proven by HPLC and gas chromatography–MS. NosACO exhibits a wide substrate specificity with respect to chain lengths and functional end-groups, converting β-apo-carotenals, (3R)-3-hydroxy-β-apo-carotenals and the corresponding alcohols into retinal and (3R)-3-hydroxyretinal respectively. However, kinetic analyses revealed very divergent Km and Vmax values. On the basis of the crystal structure of SynACO (Synechocystis sp. PCC6803 apo-carotenoid oxygenase), a related enzyme showing similar enzymatic activity, we designed a homology model of the native NosACO. The deduced structure explains the absence of β-carotene-cleavage activity and indicates that NosACO is a monotopic membrane protein. Accordingly, NosACO could be readily reconstituted into liposomes. To localize SynACO in vivo, a Synechocystis knock-out strain was generated expressing SynACO as the sole carotenoid oxygenase. Western-blot analyses showed that the main portion of SynACO occurred in a membrane-bound form. PMID:16759173

Regional cost and experience, not size or hospital inclusion, helps predict ACO success.

PubMed

Schulz, John; DeCamp, Matthew; Berkowitz, Scott A

2017-06-01

The Medicare Shared Savings Program (MSSP) continues to expand and now includes 434 accountable care organizations (ACOs) serving more than 7 million beneficiaries. During 2014, 86 of these ACOs earned over $300 million in shared savings payments by promoting higher-quality patient care at a lower cost.Whether organizational characteristics, regional cost of care, or experience in the MSSP are associated with the ability to achieve shared savings remains uncertain.Using financial results from 2013 and 2014, we examined all 339 MSSP ACOs with a 2012, 2013, or 2014 start-date. We used a cross-sectional analysis to examine all ACOs and used a multivariate logistic model to predict probability of achieving shared savings.Experience, as measured by years in the MSSP program, was associated with success and the ability to earn shared savings varied regionally. This variation was strongly associated with differences in regional Medicare fee-for-service per capita costs: ACOs in high cost regions were more likely to earn savings. In the multivariate model, the number of ACO beneficiaries, inclusion of a hospital or involvement of an academic medical center, was not associated with likelihood of earning shared savings, after accounting for regional baseline cost variation.These results suggest ACOs are learning and improving from their experience. Additionally, the results highlight regional differences in ACO success and the strong association with variation in regional per capita costs, which can inform CMS policy to help promote ACO success nationwide.

End-of-Life Care Planning in Accountable Care Organizations: Associations with Organizational Characteristics and Capabilities.

PubMed

Ahluwalia, Sangeeta C; Harris, Benjamin J; Lewis, Valerie A; Colla, Carrie H

2018-06-01

To measure the extent to which accountable care organizations (ACOs) have adopted end-of-life (EOL) care planning processes and characterize those ACOs that have established processes related to EOL. This study uses data from three waves (2012-2015) of the National Survey of ACOs. Respondents were 397 ACOs participating in Medicare, Medicaid, and commercial ACO contracts. This is a cross-sectional survey study using multivariate ordered logit regression models. We measured the extent to which the ACO had adopted EOL care planning processes as well as organizational characteristics, including care management, utilization management, health informatics, and shared decision-making capabilities, palliative care, and patient-centered medical home experience. Twenty-one percent of ACOs had few or no EOL care planning processes, 60 percent had some processes, and 19.6 percent had advanced processes. ACOs with a hospital in their system (OR: 3.07; p = .01), and ACOs with advanced care management (OR: 1.43; p = .02), utilization management (OR: 1.58, p = .00), and shared decision-making capabilities (OR: 16.3, p = .000) were more likely to have EOL care planning processes than those with no hospital or few to no capabilities. There remains considerable room for today's ACOs to increase uptake of EOL care planning, possibly by leveraging existing care management, utilization management, and shared decision-making processes. © Health Research and Educational Trust.

Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies.

PubMed

Trosman, Julia R; Weldon, Christine B; Douglas, Michael P; Deverka, Patricia A; Watkins, John B; Phillips, Kathryn A

2017-01-01

New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Accountable care organization hospitals differ in health IT capabilities.

PubMed

Walker, Daniel M; Mora, Arthur M; Scheck McAlearney, Ann

2016-12-01

The aim of this study was to evaluate health information technology (IT) adoption in hospitals participating in accountable care organizations (ACOs) and compare this adoption to non-ACO hospitals. A cross-sectional sample of US nonfederal, acute care hospitals with data from 3 matched sources: the 2013 American Hospital Association (AHA) Annual Survey, the 2013 AHA Survey of Care Systems and Payments (CSP), and the 2014 AHA Information Technology Supplement. To compare health IT adoption in ACO- and non-ACO hospitals, we created measures of Meaningful Use (MU) Stage 1 and Stage 2 core and menu criteria, patient engagement-oriented health IT, and health information exchange (HIE) participation. Adoption was compared using both naïve and multivariate logit models. Of the 393 ACO hospitals and 810 non-ACO hospitals, a greater percentage of ACO hospitals were capable of meeting MU Stage 1 (50.9% vs 41.6%; P < .01) and Stage 2 (7.6% vs 4.8%; P < .05), having patient engagement health IT (39.8% vs 15.2%; P < .001), and participating in HIE (49.0% vs 30.1%; P < .001). In adjusted models, no difference was found between ACO and non-ACO hospital ability to meet MU Stage 1 or Stage 2, but ACO hospitals were more likely to have patient engagement health IT (odds ratio (OR), 2.20; 95% CI, 1.59-3.04) and be HIE participants (OR, 1.41; 95% CI, 1.03-1.92). ACO-participating hospitals appear to be focused more on adopting health IT that aligns with broader strategic goals rather than those that achieve MU. Aligning adoption with quality and payment reform may be a productive path forward to encourage hospital health IT adoption behavior.

Progression from Asthma to Chronic Obstructive Pulmonary Disease. Is Air Pollution a Risk Factor?

PubMed

To, Teresa; Zhu, Jingqin; Larsen, Kristian; Simatovic, Jacqueline; Feldman, Laura; Ryckman, Kandace; Gershon, Andrea; Lougheed, M Diane; Licskai, Christopher; Chen, Hong; Villeneuve, Paul J; Crighton, Eric; Su, Yushan; Sadatsafavi, Mohsen; Williams, Devon; Carlsten, Christopher

2016-08-15

Individuals with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), have more rapid decline in lung function, more frequent exacerbations, and poorer quality of life than those with asthma or COPD alone. Air pollution exposure is a known risk factor for asthma and COPD; however, its role in ACOS is not as well understood. To determine if individuals with asthma exposed to higher levels of air pollution have an increased risk of ACOS. Individuals who resided in Ontario, Canada, aged 18 years or older in 1996 with incident asthma between 1996 and 2009 who participated in the Canadian Community Health Survey were identified and followed until 2014 to determine the development of ACOS. Data on exposures to fine particulate matter (PM2.5) and ozone (O3) were obtained from fixed monitoring sites. Associations between air pollutants and ACOS were evaluated using Cox regression models. Of the 6,040 adults with incident asthma who completed the Canadian Community Health Survey, 630 were identified as ACOS cases. Compared with those without ACOS, the ACOS population had later onset of asthma, higher proportion of mortality, and more frequent emergency department visits before COPD diagnosis. The adjusted hazard ratios of ACOS and cumulative exposures to PM2.5 (per 10 μg/m(3)) and O3 (per 10 ppb) were 2.78 (95% confidence interval, 1.62-4.78) and 1.31 (95% confidence interval, 0.71-2.39), respectively. Individuals exposed to higher levels of air pollution had nearly threefold greater odds of developing ACOS. Minimizing exposure to high levels of air pollution may decrease the risk of ACOS.

Costs of accountable care organization participation for primary care providers: early stage results.

PubMed

Hofler, Richard A; Ortiz, Judith

2016-07-28

Little is known about the impact of joining an Accountable Care Organization (ACO) on primary care provider organization's costs. The purpose of this study was to determine whether joining an ACO is associated with an increase in a Rural Health Clinic's (RHC's) cost per visit. The analyses focused on cost per visit in 2012 and 2013 for RHCs that joined an ACO in 2012 and cost per visit in 2013 for RHCs that joined an ACO in 2013. The RHCs were located in nine states. Data were obtained from Medicare Cost Reports. The analysis was conducted taking a treatment effects approach where the treatment is joining an ACO. Propensity-score matching was employed to provide multiple single and pooled estimates of the average treatment effect on the treated. Four-hundred thirty four to 544 RHCs (depending on the type of analysis and the variables used) were used in the several analyses. Seven of the RHCs joined an ACO in 2012 and 14 joined an ACO in 2013. The mean cost per visit for RHCs that did not join an ACO rose 4.40 % from 2011 to 2012 whereas the mean cost per visit for RHCs that joined an ACO rose by triple: 13.5 %. All of the pooled estimates of the average treatment effect on the treated from the propensity-score matching showed that joining an ACO was associated with higher mean cost per visit. The range of the estimated mean cost per visit differences was $17.19 (p value = 0.00) to $25.19 (p value = 0.00). This study is one of the first to describe the cost of ACO participation from the perspective of primary care provider organizations. It appears that for at least one type of primary care provider - the RHC - there are substantial costs associated with ACO participation during the first two years.

Clinical characteristics of the asthma-COPD overlap syndrome--a systematic review.

PubMed

Nielsen, Mia; Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

2015-01-01

In recent years, the so-called asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has received much attention, not least because elderly individuals may present characteristics suggesting a diagnosis of both asthma and COPD. At present, ACOS is described clinically as persistent airflow limitation combined with features of both asthma and COPD. The aim of this paper is, therefore, to review the currently available literature focusing on symptoms and clinical characteristics of patients regarded as having ACOS. Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic literature review was performed. A total of 11 studies met the inclusion criteria for the present review. All studies dealing with dyspnea (self-reported or assessed by the Medical Research Council dyspnea scale) reported more dyspnea among patients classified as having ACOS compared to the COPD and asthma groups. In line with this, ACOS patients have more concomitant wheezing and seem to have more cough and sputum production. Compared to COPD-only patients, the ACOS patients were found to have lower FEV1% predicted and FEV1/FVC ratio in spite of lower mean life-time tobacco exposure. Furthermore, studies have revealed that ACOS patients seem to have not only more frequent but also more severe exacerbations. Comorbidity, not least diabetes, has also been reported in a few studies, with a higher prevalence among ACOS patients. However, it should be acknowledged that only a limited number of studies have addressed the various comorbidities in patients with ACOS. The available studies indicate that ACOS patients may have more symptoms and a higher exacerbation rate than patients with asthma and COPD only, and by that, probably a higher overall respiratory-related morbidity. Similar to patients with COPD, ACOS patients seem to have a high occurrence of comorbidity, including diabetes. Further research into the ACOS, not least from well-defined prospective studies, is clearly needed.

Favorable longitudinal change of lung function in patients with asthma-COPD overlap from a COPD cohort.

PubMed

Park, Hye Yun; Lee, Suh-Young; Kang, Danbee; Cho, Juhee; Lee, Hyun; Lim, Seong Yong; Yoon, Ho Il; Ra, Seung Won; Kim, Ki Uk; Oh, Yeon-Mok; Sin, Don D; Lee, Sang-Do; Park, Yong Bum

2018-03-02

The recognition of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) as a distinct phenotype of COPD or asthma has increased. Although ACO has worse clinical features than non-ACO COPD, limited information is available on long-term outcomes of lung function decline for ACO and non-ACO COPD. COPD patients with at least 3 years of follow-up were selected from the Korean Obstructive Lung Disease cohort. ACO was defined based on 3 major criteria: 1) airflow limitation in individuals 40 years of age and older, 2) ≥10 pack-years of smoking history, and 3) a history of asthma or bronchodilator response of > 400 mL in forced expiratory volume in 1 s (FEV 1 ) at baseline; and at least 1 minor criterion: 1) history of atopy or allergic rhinitis, 2) two separated bronchodilator responses of ≥12% and 200 mL in FEV 1 , or 3) peripheral blood eosinophils ≥300 cells/μL. Lung function decline was compared using a linear mixed effects model for longitudinal data with random intercept and random slope. Among 239 patients, 47 were diagnosed with ACO (19.7%). During the follow-up period, change in smoking status, use of inhaled corticosteroids (ICS) and long-acting β2-agonists or ICS and at least 2 exacerbations per year were similar between patients with non-ACO COPD and ACO. Over a median follow-up duration of 5.8 years, patients with non-ACO COPD experienced a faster annual decline in pre-bronchodilator FEV 1 than patients with ACO (- 29.3 ml/year vs. -13.9 ml/year, P = 0.042), which was persistent after adjustment for confounders affecting lung function decline. Patients with ACO showed favorable longitudinal changes in lung function compared to COPD patients over a median follow-up of 5.8 years.

Status of the Frankfurt low energy electrostatic storage ring (FLSR)

NASA Astrophysics Data System (ADS)

King, F.; Kruppi, T.; Müller, J.; Dörner, R.; Schmidt, L. Ph H.; Schmidt-Böcking, H.; Stiebing, K. E.

2015-11-01

Frankfurt low-energy storage ring (FLSR) is an electrostatic storage ring for low-energy ions up to q · 80 keV (q being the ion charge state) at Institut für Kernphysik der Goethe-Universität, Frankfurt am Main, Germany. It has especially been designed to provide a basis for experiments on the dynamics of ionic and molecular collisions in complete kinematics, as well as for high precision and time resolved laser spectroscopy. The ring has ‘racetrack’ geometry with a circumference of 14.23 m. It comprises four experimental/diagnostic sections with regions of enhanced ion density (interaction regions). First beam has successfully been stored in FLSR in summer 2013. Since then the performance of the ring has continuously been improved and an electron target for experiments on dissociative recombination has been installed in one of the experimental sections.

Analysis and correction of linear optics errors, and operational improvements in the Indus-2 storage ring

NASA Astrophysics Data System (ADS)

Husain, Riyasat; Ghodke, A. D.

2017-08-01

Estimation and correction of the optics errors in an operational storage ring is always vital to achieve the design performance. To achieve this task, the most suitable and widely used technique, called linear optics from closed orbit (LOCO) is used in almost all storage ring based synchrotron radiation sources. In this technique, based on the response matrix fit, errors in the quadrupole strengths, beam position monitor (BPM) gains, orbit corrector calibration factors etc. can be obtained. For correction of the optics, suitable changes in the quadrupole strengths can be applied through the driving currents of the quadrupole power supplies to achieve the desired optics. The LOCO code has been used at the Indus-2 storage ring for the first time. The estimation of linear beam optics errors and their correction to minimize the distortion of linear beam dynamical parameters by using the installed number of quadrupole power supplies is discussed. After the optics correction, the performance of the storage ring is improved in terms of better beam injection/accumulation, reduced beam loss during energy ramping, and improvement in beam lifetime. It is also useful in controlling the leakage in the orbit bump required for machine studies or for commissioning of new beamlines.

Unveiling the unicorn: a leader's guide to ACO preparation.

PubMed

Aslin, Paul

2011-01-01

The great uncertainty surrounding healthcare reform provides little incentive for action. However, as healthcare leaders wait for final rules and clarity about accountable care organizations (ACOs), inaction is the inappropriate response. Several central themes emerge from research about beginning the ACO process. Leaders should be able to understand and articulate ACO concepts. They should champion embracing cultural change while partnering with physicians. Inventory of skills and capabilities should take place to understand any deficiencies required to implement an ACO. Finally, a plan should be formed by asking strategic questions on each platform needed to ensure performance and strategic goals are at the forefront of decisions regarding structure and function of an ACO. It takes a visionary leader to accept these challenges.

Low emittance electron storage rings

NASA Astrophysics Data System (ADS)

Levichev, E. B.

2018-01-01

Low-emittance electron (positron) beams are essential for synchrotron light sources, linear collider damping rings, and circular Crab Waist colliders. In this review, the principles and methods of emittance minimization are discussed, prospects for developing relativistic electron storage rings with small beam phase volume are assessed, and problems related to emittance minimization are examined together with their possible solutions. The special features and engineering implementation aspects of various facilities are briefly reviewed.

The final step of the ethylene biosynthesis pathway in turnip tops (Brassica rapa): molecular characterization of the 1-aminocyclopropane-1-carboxylate oxidase BrACO1 throughout zygotic embryogenesis and germination of heterogeneous seeds.

PubMed

Del Carmen Rodríguez-Gacio, María; Nicolás, Carlos; Matilla, Angel Jesús

2004-05-01

In a previous report from the present authors, it was shown that the 1-aminocyclopropane-1-carboxylate (ACC) oxidation may play a crucial role during zygotic embryogenesis of turnip tops seeds. The present study was performed to elucidate the contribution of the silique-wall and seeds in ethylene production during this developmental process. ACC content in the silique wall is only higher than in seeds during the middle phases of zygotic embryogenesis. The ACC-oxidase (ACO) activity peaks in the silique-wall and seeds during the onset of embryogenesis, declining gradually afterwards, being undetectable during desiccation period. Using reverse transcriptase-polymerase chain reaction, one cDNA clone coding for an ACO and called BrACO1, was isolated. The deduced protein for BrACO1 has a molecular weight of 36.8 kDa and a high homology with other crucifer ACOs. The heterologous expression of this cDNA confirmed that BrACO1 is an ACO. The expression of this gene was high during the first phases of silique-wall development, low during the middle phases and undetectable during desiccation. By contrast, BrACO1 transcript was accumulated only in the earliest phases of seed embryogenesis and may participate in the highest ACO activity and ethylene production by seeds at the beginning of embryogenesis. Finally, in this work a correlation between the heterogeneity of Brassica rapa L. cv. Rapa seeds and the ability to oxidize the ACC to ethylene has been demonstrated.

Physicians' Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.

PubMed

Yasaitis, Laura C; Pajerowski, William; Polsky, Daniel; Werner, Rachel M

2016-08-01

Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physicians' participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physicians' participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education-compared to other areas-had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations' access to physicians participating in ACOs may not be as great as access for other groups, which could exacerbate existing disparities in health care quality. Project HOPE—The People-to-People Health Foundation, Inc.

Willingness to participate in accountable care organizations: health care managers' perspective.

PubMed

Wan, Thomas T H; Demachkie Masri, Maysoun; Ortiz, Judith; Lin, Blossom Y J

2014-01-01

This study examines how health care managers responded to the accountable care organization (ACO). The effect of perceived benefits and barriers of the commitment to develop a strategic plan for ACOs and willingness to participate in ACOs is analyzed, using organizational social capital, health information technology uses, health systems integration and size of the health networks, geographic factors, and knowledge about ACOs as predictors. Propensity score matching and analysis are used to adjust the state and regional variations. When the number of perceived benefits is greater than the number of perceived barriers, health care managers are more likely to reveal a stronger commitment to develop a strategic plan for ACO adoption. Health care managers who perceived their organizations as lacking leadership support or commitment, financial incentives, and legal and regulatory support to ACO adoption were less willing to participate in ACOs in the future. Future research should gather more diverse views from a larger sample size of health professionals regarding ACO participation. The perspective of health care managers should be seriously considered in the adoption of an innovative health care delivery system. The transparency on policy formulation should consider multiple views of health care managers.

Structuring payment to medical homes after the affordable care act.

PubMed

Edwards, Samuel T; Abrams, Melinda K; Baron, Richard J; Berenson, Robert A; Rich, Eugene C; Rosenthal, Gary E; Rosenthal, Meredith B; Landon, Bruce E

2014-10-01

The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

The ACO paradox impacting physicians.

PubMed

Bansal, Gunjan; West, Daniel J

2012-01-01

Accountable care organizations (ACOs) would hold care providers jointly accountable for the quality and costs of care, allow consumers the freedom to choose their providers, and involve physicians and consumers in their shared decision-making. Even though the ACO model proposes physician empowerment, it also poses significant financial and change-management challenges for physicians. Furthermore, the "patient-centered" ACOs that have been established to safeguard consumer sovereignty pose the risks of concentrating healthcare markets further and exacerbating the existing disparities in healthcare. We conducted a survey study to understand physicians' perspectives of ACOs by seeking their first-hand feedback. The survey results suggest that there are significant communication gaps between physicians and healthcare administrators; and efficient communication can help improve physician-administrator alignment and help them identify opportunities that would be critical to the success of ACOs.

Are ACOs ready to be accountable for medication use?

PubMed

Dubois, Robert W; Feldman, Marv; Lustig, Adam; Kotzbauer, Greg; Penso, Jerry; Pope, Scott D; Westrich, Kimberly D

2014-01-01

Accountable care organizations (ACOs) have the potential to lower costs and improve quality through incentives and coordinated care. However, the design brings with it many new challenges. One such challenge is the optimal use of pharmaceuticals. Most ACOs have not yet focused on this integral facet of care, even though medications are a critical component to achieving the lower costs and improved quality that are anticipated with this new model. To evaluate whether ACOs are prepared to maximize the value of medications for achieving quality benchmarks and cost offsets. During the fall of 2012, an electronic readiness self-assessment was developed using a portion of the questions and question methodology from the National Survey of Accountable Care Organizations, along with original questions developed by the authors. The assessment was tested and subsequently revised based on feedback from pilot testing with 5 ACO representatives. The revised assessment was distributed via e-mail to a convenience sample (n=175) of ACO members of the American Medical Group Association, Brookings-Dartmouth ACO Learning Network, and Premier Healthcare Alliance. The self-assessment was completed by 46 ACO representatives (26% response rate). ACOs reported high readiness to manage medications in a few areas, such as transmitting prescriptions electronically (70%), being able to integrate medical and pharmacy data into a single database (54%), and having a formulary in place that encourages generic use when appropriate (50%). However, many areas have substantial room for improvement with few ACOs reporting high readiness. Some notable areas include being able to quantify the cost offsets and hence demonstrate the value of appropriate medication use (7%), notifying a physician when a prescription has been filled (9%), having protocols in place to avoid medication duplication and polypharmacy (17%), and having quality metrics in place for a broad diversity of conditions (22%). Developing the capabilities to support, monitor, and ensure appropriate medication use will be critical to achieve optimal patient outcomes and ACO success. The ACOs surveyed have embarked upon an important journey towards this goal, but critical gaps remain before they can become fully accountable. While many of these organizations have begun adopting health information technologies that allow them to maximize the value of medications for achieving quality outcomes and cost offsets, a significant lag was identified in their inability to use these technologies to their full capacities. In order to provide further guidance, the authors have begun documenting case studies for public release that would provide ACOs with examples of how certain medication issues have been addressed by ACOs or relevant organizations. The authors hope that these case studies will help ACOs optimize the value of pharmaceuticals and achieve the "triple aim" of improving care, health, and cost.

Picosecond, tunable, high-brightness hard x-ray inverse Compton source at Duke storage ring

NASA Astrophysics Data System (ADS)

Litvinenko, Vladimir N.; Wu, Ying; Burnham, Bentley; Barnett, Genevieve A.; Madey, John M. J.

1995-09-01

We suggest a state-of-the art x-ray source using a compact electron storage ring with modest energy (less than 1 GeV) and a high power mm-wave as an undulator. A source of this type has x-ray energies and brightness comparable with third generation synchrotron light sources while it can be very compact and fit in a small university or industrial laboratory or hospital. We propose to operate an isochronous mm-wave FEL and a hard x-ray inverse Compton source at the Duke storage ring to test this concept. Resonant FEL conditions for the mm- wave will be provided by the off-axis interaction with an electromagnetic wave. A special optical resonator with holes for the e-beam is proposed for pumping a hard x-ray inverse Compton source with very high brightness. Simulation results of mm-wave FEL operation of the Duke storage ring are discussed. Expected performance of mm-wave FEL and hard x-ray inverse Compton source are presented.

The Storage Ring Proton EDM Experiment

NASA Astrophysics Data System (ADS)

Semertzidis, Yannis; Storage Ring Proton EDM Collaboration

2014-09-01

The storage ring pEDM experiment utilizes an all-electric storage ring to store ~1011 longitudinally polarized protons simultaneously in clock-wise and counter-clock-wise directions for 103 seconds. The radial E-field acts on the proton EDM for the duration of the storage time to precess its spin in the vertical plane. The ring lattice is optimized to reduce intra-beam scattering, increase the statistical sensitivity and reduce the systematic errors of the method. The main systematic error is a net radial B-field integrated around the ring causing an EDM-like vertical spin precession. The counter-rotating beams sense this integrated field and are vertically shifted by an amount, which depends on the strength of the vertical focusing in the ring, thus creating a radial B-field. Modulating the vertical focusing at 10 kHz makes possible the detection of this radial B-field by a SQUID-magnetometer (SQUID-based BPM). For a total number of n SQUID-based BPMs distributed around the ring the effectiveness of the method is limited to the N = n /2 harmonic of the background radial B-field due to the Nyquist sampling theorem limit. This limitation establishes the requirement to reduce the maximum radial B-field to 0.1-1 nT everywhere around the ring by layers of mu-metal and aluminum vacuum tube. The metho's sensitivity is 10-29 e .cm , more than three orders of magnitude better than the present neutron EDM experimental limit, making it sensitive to SUSY-like new physics mass scale up to 300 TeV.

Cloning and expression of 1-aminocyclopropane-1-carboxylate oxidase cDNA induced by thidiazuron during somatic embryogenesis of alfalfa (Medicago sativa).

PubMed

Feng, Bi-Hong; Wu, Bei; Zhang, Chun-Rong; Huang, Xia; Chen, Yun-Feng; Huang, Xue-Lin

2012-01-15

Embryogenic callus (EC) induced from petioles of alfalfa (Medicago sativa L. cv. Jinnan) on B5h medium turned green, compact and non-embryogenic when the kinetin (KN) in the medium was replaced partially or completely by thidiazuron (TDZ). The application of CoCl₂, which is an inhibitor of 1-aminocyclopropane-1-carboxylate oxidase (ACO), counteracted the effect of TDZ. Ethylene has been shown to be involved in the modulation of TDZ-induced morphogenesis responses. However, very little is known about the genes involved in ethylene formation during somatic embryogenesis (SE). To investigate whether ethylene mediated by ACO is involved in the effect of TDZ on inhibition of embryogenic competence of the alfalfa callus. In this study we cloned full-length ACO cDNA from the alfalfa callus, named MsACO, and observed changes in this gene expression during callus formation and induction of SE under treatment with TDZ or TDZ plus CoCl₂. RNA blot analysis showed that during the EC subcultural period, the expression level of MsACO in EC was significantly increased on the 2nd day, rose to the highest level on the 8th day and remained at this high level until the 21st day. However, the ACO expression in the TDZ (0.93 μM)-treated callus was higher than in the EC especially on the 8th day. Moreover the ACO expression level increased with increasing TDZ concentration during the subcultural/maintenance period of the callus. It is worth noting that comparing the treatment with TDZ alone, the treatment with 0.93 μM TDZ plus 50 μM CoCl₂ reduced both of the ACO gene expressions and ACO activity in the treated callus. These results indicate that the effect of TDZ could be counteracted by CoCl₂ either on the ACO gene expression level or ACO activity. Thus, a TDZ inhibitory effect on embryogenic competence of alfalfa callus could be mediated by ACO gene expression. Crown Copyright © 2011. Published by Elsevier GmbH. All rights reserved.

Dose estimates for the 1104 m APS storage ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moe, H.J.

1989-06-01

The estimated dose equivalent rates outside the shielded storage ring, and the estimated annual dose equivalent to members of the public due to direct radiation and skyshine from the ring, have been recalculated. The previous estimates found in LS-84 (MOE 87) and cited in the 1987 Conceptual Design Report of the APS (ANL 87) required revision because of changes in the ring circumference and in the proposed location of the ring with respect to the nearest site boundary. The values assumed for the neutron quality factors were also overestimated (by a factor of 2) in the previous computation, and themore » correct values have been used for this estimate. The methodology used to compute dose and dose rate from the storage ring is the same as that used in LS-90 (MOE 87a). The calculations assumed 80 cm thick walls of ordinary concrete (or the shielding equivalent of this) and a roof thickness of 1 meter of ordinary concrete. The circumference of the ring was increased to 1,104 m, and the closest distance to the boundary was taken as 140 m. The recalculation of the skyshine component used the same methodology as that used in LS-84.« less

Comparison of the QRS Complex, ST-Segment, and T-Wave Among Patients with Left Bundle Branch Block with and without Acute Myocardial Infarction.

PubMed

Dodd, Kenneth W; Elm, Kendra D; Smith, Stephen W

2016-07-01

The modified Sgarbossa criteria have been validated as a rule for diagnosis of acute coronary occlusion (ACO) in left bundle branch block (LBBB). However, no analysis has been done on differences in the QRS complex, T-wave, or ST-segment concordance of < 1 mm in the derivation or validation studies. Furthermore, there was no comparison of patients with acute myocardial infarction (AMI) but without ACO (i.e., non-ST-elevation myocardial infarction [non-STEMI]) to patients with ACO or without AMI (no MI). We compare findings involving the QRS amplitude, ST-segment morphology, ST-concordance < 1 mm, and T-waves in patients with LBBB with ACO, non-STEMI, and no MI. Retrospectively, emergency department patients were identified with LBBB and ischemic symptoms but no MI, with angiographically proven ACO, and with non-STEMI. ACO, non-STEMI, and no MI groups consisted of 33, 24, and 105 patients. The sum of the maximum deflection of the QRS amplitude across all leads (ΣQRS) was smaller in patients with ACO than those without ACO (101.5 mm vs. 132.5 mm; p < 0.0001) and a cutoff of ΣQRS < 90 mm was 92% specific. For ACO, non-concave ST-segment morphology was 91% specific, any ST concordance ≥ 1 mm was 95% specific, and any ST concordance ≥ 0.5 mm was 94% sensitive. For non-STEMI, terminal T-wave concordance, analogous to biphasic T-waves, was moderately sensitive at 79%. We found differences in QRS amplitude, ST-segment morphology, and T-waves between patients with LBBB and ACO, non-STEMI, and no MI. However, none of these criteria outperformed the modified Sgarbossa criteria for diagnosis of ACO in LBBB. Copyright © 2016 Elsevier Inc. All rights reserved.

Perspectives on micropole undulators in synchrotron radiation technology

NASA Astrophysics Data System (ADS)

Tatchyn, Roman; Csonka, Paul; Toor, Arthur

1989-07-01

Micropole undulators promise to advance synchrotron radiation (SR) technology in two distinct ways. The first is in the development of economical, low-energy storage rings, or linacs, as soft x-ray sources, and the second is in the opening up of gamma-ray spectral ranges on high-energy storage rings. In this paper the promise and current status of micropole undulator (MPU) technology are discussed, and a review of some practical obstacles to the implementation of MPU's on present-day storage rings is given. Some successful results of recent performance measurements of micropole undulators on the Lawrence Livermore National Laboratory linac are briefly summarized.

Neural and psychological characteristics of college students with alcoholic parents differ depending on current alcohol use.

PubMed

Brown-Rice, Kathleen A; Scholl, Jamie L; Fercho, Kelene A; Pearson, Kami; Kallsen, Noah A; Davies, Gareth E; Ehli, Erik A; Olson, Seth; Schweinle, Amy; Baugh, Lee A; Forster, Gina L

2018-02-02

A significant proportion of college students are adult children of an alcoholic parent (ACoA), which can confer greater risk of depression, poor self-esteem, alcohol and drug problems, and greater levels of college attrition. However, some ACoA are resilient to these negative outcomes. The goal of this study was to better understand the psychobiological factors that distinguish resilient and vulnerable college-aged ACoAs. To do so, scholastic performance and psychological health were measured in ACoA college students not engaged in hazardous alcohol use (resilient) and those currently engaged in hazardous alcohol use (vulnerable). Neural activity (as measured by functional magnetic resonance imaging) in response to performing working memory and emotion-based tasks were assessed. Furthermore, the frequency of polymorphisms in candidate genes associated with substance use, risk taking and stress reactivity were compared between the two ACoA groups. College ACoAs currently engaged in hazardous alcohol use reported more anxiety, depression and posttraumatic stress symptoms, and increased risky nicotine and marijuana use as compared to ACoAs resistant to problem alcohol use. ACoA college students with current problem alcohol showed greater activity of the middle frontal gyrus and reduced activation of the posterior cingulate in response to visual working memory and emotional processing tasks, which may relate to increased anxiety and problem alcohol and drug behaviors. Furthermore, polymorphisms of cholinergic receptor and the serotonin transporter genes also appear to contribute a role in problem alcohol use in ACoAs. Overall, findings point to several important psychobiological variables that distinguish ACoAs based on their current alcohol use that may be used in the future for early intervention. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluating the Impact of an Accountable Care Organization on Population Health: The Quasi-Experimental Design of the German Gesundes Kinzigtal.

PubMed

Pimperl, Alexander; Schulte, Timo; Mühlbacher, Axel; Rosenmöller, Magdalena; Busse, Reinhard; Groene, Oliver; Rodriguez, Hector P; Hildebrandt, Helmut

2017-06-01

A central goal of accountable care organizations (ACOs) is to improve the health of their accountable population. No evidence currently links ACO development to improved population health. A major challenge to establishing the evidence base for the impact of ACOs on population health is the absence of a theoretically grounded, robust, operationally feasible, and meaningful research design. The authors present an evaluation study design, provide an empirical example, and discuss considerations for generating the evidence base for ACO implementation. A quasi-experimental study design using propensity score matching in combination with small-scale exact matching is implemented. Outcome indicators based on claims data were constructed and analyzed. Population health is measured by using a range of mortality indicators: mortality ratio, age at time of death, years of potential life lost/gained, and survival time. The application is assessed using longitudinal data from Gesundes Kinzigtal, one of the leading population-based ACOs in Germany. The proposed matching approach resulted in a balanced control of observable differences between the intervention (ACO) and control groups. The mortality indicators used indicate positive results. For example, 635.6 fewer years of potential life lost (2005.8 vs. 2641.4; t-test: sig. P < 0.05*) in the ACO intervention group (n = 5411) attributable to the ACO, also after controlling for a potential (indirect) immortal time bias by excluding the first half year after enrollment from the outcome measurement. This empirical example of the impact of a German ACO on population health can be extended to the evaluation of ACOs and other integrated delivery models of care.

Accountable care organization readiness and academic medical centers.

PubMed

Berkowitz, Scott A; Pahira, Jennifer J

2014-09-01

As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

Data Access Based on a Guide Map of the Underwater Wireless Sensor Network

PubMed Central

Wei, Zhengxian; Song, Min; Yin, Guisheng; Wang, Hongbin; Cheng, Albert M. K.

2017-01-01

Underwater wireless sensor networks (UWSNs) represent an area of increasing research interest, as data storage, discovery, and query of UWSNs are always challenging issues. In this paper, a data access based on a guide map (DAGM) method is proposed for UWSNs. In DAGM, the metadata describes the abstracts of data content and the storage location. The center ring is composed of nodes according to the shortest average data query path in the network in order to store the metadata, and the data guide map organizes, diffuses and synchronizes the metadata in the center ring, providing the most time-saving and energy-efficient data query service for the user. For this method, firstly the data is stored in the UWSN. The storage node is determined, the data is transmitted from the sensor node (data generation source) to the storage node, and the metadata is generated for it. Then, the metadata is sent to the center ring node that is the nearest to the storage node and the data guide map organizes the metadata, diffusing and synchronizing it to the other center ring nodes. Finally, when there is query data in any user node, the data guide map will select a center ring node nearest to the user to process the query sentence, and based on the shortest transmission delay and lowest energy consumption, data transmission routing is generated according to the storage location abstract in the metadata. Hence, specific application data transmission from the storage node to the user is completed. The simulation results demonstrate that DAGM has advantages with respect to data access time and network energy consumption. PMID:29039757

Data Access Based on a Guide Map of the Underwater Wireless Sensor Network.

PubMed

Wei, Zhengxian; Song, Min; Yin, Guisheng; Song, Houbing; Wang, Hongbin; Ma, Xuefei; Cheng, Albert M K

2017-10-17

Underwater wireless sensor networks (UWSNs) represent an area of increasing research interest, as data storage, discovery, and query of UWSNs are always challenging issues. In this paper, a data access based on a guide map (DAGM) method is proposed for UWSNs. In DAGM, the metadata describes the abstracts of data content and the storage location. The center ring is composed of nodes according to the shortest average data query path in the network in order to store the metadata, and the data guide map organizes, diffuses and synchronizes the metadata in the center ring, providing the most time-saving and energy-efficient data query service for the user. For this method, firstly the data is stored in the UWSN. The storage node is determined, the data is transmitted from the sensor node (data generation source) to the storage node, and the metadata is generated for it. Then, the metadata is sent to the center ring node that is the nearest to the storage node and the data guide map organizes the metadata, diffusing and synchronizing it to the other center ring nodes. Finally, when there is query data in any user node, the data guide map will select a center ring node nearest to the user to process the query sentence, and based on the shortest transmission delay and lowest energy consumption, data transmission routing is generated according to the storage location abstract in the metadata. Hence, specific application data transmission from the storage node to the user is completed. The simulation results demonstrate that DAGM has advantages with respect to data access time and network energy consumption.

Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program.

PubMed

Hsu, John; Price, Mary; Spirt, Jenna; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Mohta, Namita; Weil, Eric; Ferris, Timothy

2016-03-01

There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012-14. We found that substantial numbers of beneficiaries became part of or left the ACO population during that period. For example, nearly one-third of beneficiaries who entered in 2012 left before 2014. Some of this turnover reflected that of ACO physicians-that is, beneficiaries whose physicians left the ACO were more likely to leave than those whose physicians remained. Some of the turnover also reflected changes in care delivery. For example, beneficiaries who were active in a care management program were less likely to leave the ACO than similar beneficiaries who had not yet started such a program. We recommend policy changes to increase the stability of ACO beneficiary populations, such as permitting lower cost sharing for care received within an ACO and requiring all beneficiaries to identify their primary care physician before being linked to an ACO. Project HOPE—The People-to-People Health Foundation, Inc.

Compact Storage Ring for an X-Ray Source

NASA Astrophysics Data System (ADS)

Ovchinnikova, L.; Shvedunov, V.; Ivanov, K.

2017-12-01

We propose a new design of a compact storage ring for a source of X-ray radiation on the basis of reverse Thomson scattering of laser radiation by electrons with the energy of 35-50 MeV, which has small number of optical elements and a significant clear space for the placement of a beam injection-extraction system and a RF cavity. The original laser cavity layout has been considered. The ring dynamic aperture after correction of chromaticity and a second-order dispersion function is sufficient for the injection and stable circulation of an electron bunch in the ring.

Identification and Characterization of a Novel Alpaca Respiratory Coronavirus Most Closely Related to the Human Coronavirus 229E

PubMed Central

Crossley, Beate M.; Mock, Richard E.; Callison, Scott A.; Hietala, Sharon K.

2012-01-01

In 2007, a novel coronavirus associated with an acute respiratory disease in alpacas (Alpaca Coronavirus, ACoV) was isolated. Full-length genomic sequencing of the ACoV demonstrated the genome to be consistent with other Alphacoronaviruses. A putative additional open-reading frame was identified between the nucleocapsid gene and 3'UTR. The ACoV was genetically most similar to the common human coronavirus (HCoV) 229E with 92.2% nucleotide identity over the entire genome. A comparison of spike gene sequences from ACoV and from HCoV-229E isolates recovered over a span of five decades showed the ACoV to be most similar to viruses isolated in the 1960’s to early 1980’s. The true origin of the ACoV is unknown, however a common ancestor between the ACoV and HCoV-229E appears to have existed prior to the 1960’s, suggesting virus transmission, either as a zoonosis or anthroponosis, has occurred between alpacas and humans. PMID:23235471

A pheromone-rate-based analysis on the convergence time of ACO algorithm.

PubMed

Huang, Han; Wu, Chun-Guo; Hao, Zhi-Feng

2009-08-01

Ant colony optimization (ACO) has widely been applied to solve combinatorial optimization problems in recent years. There are few studies, however, on its convergence time, which reflects how many iteration times ACO algorithms spend in converging to the optimal solution. Based on the absorbing Markov chain model, we analyze the ACO convergence time in this paper. First, we present a general result for the estimation of convergence time to reveal the relationship between convergence time and pheromone rate. This general result is then extended to a two-step analysis of the convergence time, which includes the following: 1) the iteration time that the pheromone rate spends on reaching the objective value and 2) the convergence time that is calculated with the objective pheromone rate in expectation. Furthermore, four brief ACO algorithms are investigated by using the proposed theoretical results as case studies. Finally, the conclusions of the case studies that the pheromone rate and its deviation determine the expected convergence time are numerically verified with the experiment results of four one-ant ACO algorithms and four ten-ant ACO algorithms.

Tailoring Systems Engineering Processes in a Conceptual Design Environment: A Case Study at NASA Marshall Spaceflight Center's ACO

NASA Technical Reports Server (NTRS)

Mulqueen, John; Maples, C. Dauphne; Fabisinski, Leo, III

2012-01-01

This paper provides an overview of Systems Engineering as it is applied in a conceptual design space systems department at the National Aeronautics and Space Administration (NASA) Marshall Spaceflight Center (MSFC) Advanced Concepts Office (ACO). Engineering work performed in the NASA MFSC's ACO is targeted toward the Exploratory Research and Concepts Development life cycle stages, as defined in the International Council on Systems Engineering (INCOSE) System Engineering Handbook. This paper addresses three ACO Systems Engineering tools that correspond to three INCOSE Technical Processes: Stakeholder Requirements Definition, Requirements Analysis, and Integration, as well as one Project Process Risk Management. These processes are used to facilitate, streamline, and manage systems engineering processes tailored for the earliest two life cycle stages, which is the environment in which ACO engineers work. The role of systems engineers and systems engineering as performed in ACO is explored in this paper. The need for tailoring Systems Engineering processes, tools, and products in the ever-changing engineering services ACO provides to its customers is addressed.

Statistical analysis for validating ACO-KNN algorithm as feature selection in sentiment analysis

NASA Astrophysics Data System (ADS)

Ahmad, Siti Rohaidah; Yusop, Nurhafizah Moziyana Mohd; Bakar, Azuraliza Abu; Yaakub, Mohd Ridzwan

2017-10-01

This research paper aims to propose a hybrid of ant colony optimization (ACO) and k-nearest neighbor (KNN) algorithms as feature selections for selecting and choosing relevant features from customer review datasets. Information gain (IG), genetic algorithm (GA), and rough set attribute reduction (RSAR) were used as baseline algorithms in a performance comparison with the proposed algorithm. This paper will also discuss the significance test, which was used to evaluate the performance differences between the ACO-KNN, IG-GA, and IG-RSAR algorithms. This study evaluated the performance of the ACO-KNN algorithm using precision, recall, and F-score, which were validated using the parametric statistical significance tests. The evaluation process has statistically proven that this ACO-KNN algorithm has been significantly improved compared to the baseline algorithms. The evaluation process has statistically proven that this ACO-KNN algorithm has been significantly improved compared to the baseline algorithms. In addition, the experimental results have proven that the ACO-KNN can be used as a feature selection technique in sentiment analysis to obtain quality, optimal feature subset that can represent the actual data in customer review data.

Burton Richter, Storage Rings, and the J/psi Particle

Science.gov Websites

[SLAC's] Technical Director, [Richter] became Director ... from 1984 through 1999. During his tenure, SLAC Limits of Quantum Electro-dynamics, DOE Technical Report, June 1959 Design Considerations for High Energy Electron -- Positron Storage Rings, DOE Technical Report, November 1966 Inclusive Yields of pi+, pi-, K

Accountable Care Organizations: The National Landscape.

PubMed

Shortell, Stephen M; Colla, Carrie H; Lewis, Valerie A; Fisher, Elliott; Kessell, Eric; Ramsay, Patricia

2015-08-01

There are now more than seven hundred accountable care organizations (ACOs) in the United States. This article describes some of their most salient characteristics including the number and types of contracts involved, organizational structures, the scope of services offered, care management capabilities, and the development of a three-category taxonomy that can be used to target technical assistance efforts and to examine performance. The current evidence on the performance of ACOs is reviewed. Since California has the largest number of ACOs (N=67) and a history of providing care under risk-bearing contracts, some additional assessments of quality and patient experience are made between California ACOs and non-ACO provider organizations. Six key issues likely to affect future ACO growth and development are discussed, and some potential "diagnostic" indicators for assessing the likelihood of potential antitrust violations are presented. Copyright © 2015 by Duke University Press.

Ant Colony Optimization With Local Search for Dynamic Traveling Salesman Problems.

PubMed

Mavrovouniotis, Michalis; Muller, Felipe M; Yang, Shengxiang

2016-06-13

For a dynamic traveling salesman problem (DTSP), the weights (or traveling times) between two cities (or nodes) may be subject to changes. Ant colony optimization (ACO) algorithms have proved to be powerful methods to tackle such problems due to their adaptation capabilities. It has been shown that the integration of local search operators can significantly improve the performance of ACO. In this paper, a memetic ACO algorithm, where a local search operator (called unstring and string) is integrated into ACO, is proposed to address DTSPs. The best solution from ACO is passed to the local search operator, which removes and inserts cities in such a way that improves the solution quality. The proposed memetic ACO algorithm is designed to address both symmetric and asymmetric DTSPs. The experimental results show the efficiency of the proposed memetic algorithm for addressing DTSPs in comparison with other state-of-the-art algorithms.

Changes in Post-acute Care in the Medicare Shared Savings Program

PubMed Central

McWilliams, J. Michael; Gilstrap, Lauren G.; Stevenson, David G.; Chernew, Michael E.; Huskamp, Haiden A.; Grabowski, David C.

2017-01-01

Importance Post-acute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit post-acute spending has implications for the importance and design of other payment models that include post-acute care. Objective To assess changes in post-acute spending and utilization associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. Design and Setting Using fee-for-service Medicare claims from 2009–2014, we conducted difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO providers (control group) before vs. after entry into the MSSP. We estimated differential changes separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. Participants Random 20% sample of beneficiaries with 25,544,650 patient-years, 8,395,426 hospital admissions, and 1,595,352 SNF stays from 2009–2014. Exposure Patient attribution to an ACO in the MSSP. Main Outcomes and Measures Post-acute spending, discharge to a facility, length of SNF stays, readmissions, use of highly-rated SNFs, and mortality, adjusted for patient characteristics. Results For the 2012 cohort of ACOs, MSSP participation was associated with an overall reduction in post-acute spending (differential change in 2014 for ACOs vs. control group: −$106/beneficiary or −9.0%; P=0.003) that was driven by differential reductions in inpatient utilization, discharges to facilities rather than home (−0.6 percentage points or −2.7%; P=0.03), and length of SNF stays (−0.60 days/stay or −2.2%; P=0.002). Reductions in SNF use and length of stay were due largely to within-hospital or within-SNF changes in care specifically for ACO patients. MSSP participation was associated with smaller significant reductions in SNF spending in 2014 for the 2013 ACO cohort but not in the 2013 or 2014 cohort’s first year of participation. Estimates were similar for ACOs with and without financial ties to hospitals. MSSP participation was not associated with significant changes in 30-day readmissions, use of highly-rated SNFs, or mortality. Conclusion and Relevance Participation in the MSSP has been associated with significant reductions in post-acute spending without ostensible deterioration in quality. Spending reductions were more consistent with clinicians working within hospitals and SNFs to influence care for ACO patients than with hospital-wide initiatives by ACOs or use of preferred SNFs. PMID:28192556

Do accountable care organizations (ACOs) help or hinder primary care physicians' ability to deliver high-quality care?

PubMed

Berenson, Robert A; Burton, Rachel A; McGrath, Megan

2016-09-01

Many view advanced primary care models such as the patient-centered medical home as foundational for accountable care organizations (ACOs), but it remains unclear how these two delivery reforms are complementary and how they may produce conflict. The objective of this study was to identify how joining an ACO could help or hinder a primary care practice's efforts to deliver high-quality care. This qualitative study involved interviews with a purposive sample of 32 early adopters of advanced primary care and/or ACO models, drawn from across the U.S. and conducted in mid-2014. Interview notes were coded using qualitative data analysis software, permitting topic-specific queries which were then summarized. Respondents perceived many potential benefits of joining an ACO, including care coordination staff, data analytics, and improved communication with other providers. However, respondents were also concerned about added "bureaucratic" requirements, referral restrictions, and a potential inability to recoup investments in practice improvements. Interviewees generally thought joining an ACO could complement a practice's efforts to deliver high-quality care, yet noted some concerns that could undermine these synergies. Both the advantages and disadvantages of joining an ACO seemed exacerbated for small practices, since they are most likely to benefit from additional resources yet are most likely to chafe under added bureaucratic requirements. Our identification of the potential pros and cons of joining an ACO may help providers identify areas to examine when weighing whether to enter into such an arrangement, and may help ACOs identify potential areas for improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

Redesigning Care Delivery with Patient Support Personnel: Learning from Accountable Care Organizations

PubMed Central

Gorbenko, Ksenia O.; Fraze, Taressa; Lewis, Valerie A.

2017-01-01

INTRODUCTION Accountable care organizations (ACOs) are a value-based payment model in the United States rooted in holding groups of healthcare providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, ACOs implement a variety of care delivery changes, including workforce redesign. Patient support personnel (PSP)—non-physician staff such as care coordinators, community health workers, and others—are critical to restructuring care delivery. Little is known about how ACOs are redesigning their patient support personnel in terms of responsibilities, location, and evaluation. METHODS We conducted semi-structured one-hour interviews with 25 executives at 16 distinct ACOs. The interviews were recorded, transcribed, and coded for themes, using a qualitative coding and analysis process. RESULTS ACOs deployed PSP to perform four clusters of responsibilities: care provision, care coordination, logistical help with transportation, and social and emotional support. ACOs deployed these personnel strategically across settings (primary care, inpatient services, emergency department, home care and community) depending on their population needs. Most ACOs used personnel with the same level of training across settings. Few ACOs planned to conduct a comprehensive evaluation of their PSP to optimize their value. DISCUSSION ACO strategies in workforce redesign indicate a shift from a physician-centered to a team-based approach. Employing personnel with varying levels of clinical training to perform different tasks can help further optimize care delivery. More robust evaluation of the deployment of PSP and their performance is needed to demonstrate cost-saving benefits of workforce redesign. PMID:28217305

Mechanical capacitor

NASA Technical Reports Server (NTRS)

Kirk, J. A.; Studer, P. A.; Evans, H. E.

1976-01-01

A new energy storage system (the mechanical capacitor), using a spokeless magnetically levitated composite ring rotor, is described and design formulas for sizing the components are presented. This new system is configured around a permanent magnet (flux biased) suspension which has active servo control in the radial direction and passive control in the axial direction. The storage ring is used as a moving rotor and electronic commutation of the stationary armature coils is proposed. There is no mechanical contact with the rotating spokeless ring; therefore, long life and near zero rundown losses are projected. A 7-kW h system is sized to demonstrate feasibility. A literature review of flywheel energy storage systems is also presented and general formulas are developed for comparing rotor geometries.

MULTI-OBJECTIVE ONLINE OPTIMIZATION OF BEAM LIFETIME AT APS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, Yipeng

In this paper, online optimization of beam lifetime at the APS (Advanced Photon Source) storage ring is presented. A general genetic algorithm (GA) is developed and employed for some online optimizations in the APS storage ring. Sextupole magnets in 40 sectors of the APS storage ring are employed as variables for the online nonlinear beam dynamics optimization. The algorithm employs several optimization objectives and is designed to run with topup mode or beam current decay mode. Up to 50\\% improvement of beam lifetime is demonstrated, without affecting the transverse beam sizes and other relevant parameters. In some cases, the top-upmore » injection efficiency is also improved.« less

National Synchrotron Light Source annual report 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hulbert, S.L.; Lazarz, N.M.

1992-04-01

This report discusses the following research conducted at NSLS: atomic and molecular science; energy dispersive diffraction; lithography, microscopy and tomography; nuclear physics; UV photoemission and surface science; x-ray absorption spectroscopy; x-ray scattering and crystallography; x-ray topography; workshop on surface structure; workshop on electronic and chemical phenomena at surfaces; workshop on imaging; UV FEL machine reviews; VUV machine operations; VUV beamline operations; VUV storage ring parameters; x-ray machine operations; x-ray beamline operations; x-ray storage ring parameters; superconducting x-ray lithography source; SXLS storage ring parameters; the accelerator test facility; proposed UV-FEL user facility at the NSLS; global orbit feedback systems; and NSLSmore » computer system.« less

A method for simultaneous linear optics and coupling correction for storage rings with turn-by-turn beam position monitor data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Xi; Huang, Xiaobiao

2016-05-13

Here, we propose a method to simultaneously correct linear optics errors and linear coupling for storage rings using turn-by-turn (TbT) beam position monitor (BPM) data. The independent component analysis (ICA) method is used to isolate the betatron normal modes from the measured TbT BPM data. The betatron amplitudes and phase advances of the projections of the normal modes on the horizontal and vertical planes are then extracted, which, combined with dispersion measurement, are used to fit the lattice model. The fitting results are used for lattice correction. Finally, the method has been successfully demonstrated on the NSLS-II storage ring.

A method for simultaneous linear optics and coupling correction for storage rings with turn-by-turn beam position monitor data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Xi; Huang, Xiaobiao

2016-08-01

We propose a method to simultaneously correct linear optics errors and linear coupling for storage rings using turn-by-turn (TbT) beam position monitor (BPM) data. The independent component analysis (ICA) method is used to isolate the betatron normal modes from the measured TbT BPM data. The betatron amplitudes and phase advances of the projections of the normal modes on the horizontal and vertical planes are then extracted, which, combined with dispersion measurement, are used to fit the lattice model. Furthermore, the fitting results are used for lattice correction. Our method has been successfully demonstrated on the NSLS-II storage ring.

A method for simultaneous linear optics and coupling correction for storage rings with turn-by-turn beam position monitor data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Xi; Huang, Xiaobiao

2016-08-01

We propose a method to simultaneously correct linear optics errors and linear coupling for storage rings using turn-by-turn (TbT) beam position monitor (BPM) data. The independent component analysis (ICA) method is used to isolate the betatron normal modes from the measured TbT BPM data. The betatron amplitudes and phase advances of the projections of the normal modes on the horizontal and vertical planes are then extracted, which, combined with dispersion measurement, are used to fit the lattice model. The fitting results are used for lattice correction. The method has been successfully demonstrated on the NSLS-II storage ring.

Incidence of Hypocapnia, Hypercapnia, and Acidosis and the Associated Risk of Adverse Events in Preterm Neonates.

PubMed

Brown, Melissa K; Poeltler, Deborah M; Hassen, Kasim O; Lazarus, Danielle V; Brown, Vanessa K; Stout, Jeremiah J; Rich, Wade D; Katheria, Anup C

2018-04-03

Permissive hypercapnia is a lung-protection strategy. We sought to review our current clinical practice for the range of permissive hypercapnia and identify the relationship between P aCO 2 and pH and adverse outcomes. A secondary analysis of a delayed cord-clamping clinical trial was performed on all arterial blood gas tests in the first 72 h in infants < 32 weeks gestational age. All arterial blood gas values were categorized into a clinical range to determine the percent likelihood of occurring in the total sample. The univariate and multivariate relationships of severe adverse events and the time-weighted P aCO 2 , fluctuation of P aCO 2 , maximal and minimal P aCO 2 , base excess, and pH were assessed. 147 infants with birthweight of 1,206 ± 395 g and gestational age of 28 ± 2 weeks were included. Of the 1,316 total samples, < 2% had hypocapnia ( P aCO 2 <30 mm Hg), 47% were normocapnic ( P aCO 2 35-45 mm Hg), 26.5% had mild hypercapnia ( P aCO 2 45-55 mm Hg), 13% had moderate hypercapnia ( P aCO 2 55-65 mm Hg), and 6.5% had severe hypercapnia ( P aCO 2 ≥ 65 mm Hg). There were no adverse events associated with hypocapnia. Subjects with death/severe intraventricular hemorrhage had a higher mean P aCO 2 of 52.3 versus 44.7 (odds ratio [OR] 1.16, 95% CI 1.04-1.29, P = .006), higher variability of P aCO 2 with a standard deviation of 12.6 versus 7.8 (OR 1.15, 95% CI 1.03-1.27, P = .01), and a lower minimum pH of 7.03 versus 7.23 (OR 0, 95% CI 0-0.06, P = .003). There was no significant difference in any variables in subjects who developed other adverse events. The routine targeting of higher than normal P aCO 2 goals may lead to a low incidence of hypocapnia and associated adverse events. Hypercapnia is common, and moderate hypercapnia may increase the risk of neurologic injury and provide little pulmonary benefit. Copyright © 2018 by Daedalus Enterprises.

Characterization of Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: A Qualitative Analysis.

PubMed

Rodrigue, Claudie; Beauchesne, Marie-France; Mallette, Valérie; Lemière, Catherine; Larivée, Pierre; Blais, Lucie

2017-06-01

Approximately 15-20% of patients with chronic obstructive pulmonary disease (COPD) also display characteristics of asthma. In May 2014, the asthma-COPD overlap syndrome (ACOS) was briefly addressed in the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy documents. We evaluated how pulmonologists diagnose and treat ACOS and how they assess its control. Pulmonologists from two university healthcare centers, having ≥ 1 year experience, treating patients with asthma, COPD, or ACOS, were invited to participate in focus groups. Two focus groups (1 hour duration) were convened with seven and five participants, respectively. According to pulmonologists from both institutions, ACOS is a new name for an existing syndrome rather than a new disease. It is characterized by incomplete reversible airflow limitations and changes in forced expiratory volume in one second over time. The pulmonologists noted that its diagnosis must be based on clinical characteristics, pulmonary function test results, and clinical intuition. To diagnose ACOS, pulmonologists must rely on their clinical judgment. They also agreed that the treatment of patients with ACOS should target the features of both asthma and COPD. Pulmonologists from both institutions used asthma control criteria to assess ACOS control. A deeper understanding would enable clinicians to establish specific criteria for the diagnosis, treatment, and follow-up of subjects with ACOS.

Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol).

PubMed

Kang, Jian; Yao, Wanzhen; Cai, Baiqiang; Chen, Ping; Ling, Xia; Shang, Hongyan

2016-12-01

Asthma and chronic obstructive pulmonary disease (COPD) are the frequently occurring chronic airway diseases, and the overlapping syndrome observed in the majority of patients has been recently defined as asthma-COPD overlap syndrome (ACOS) by the Global Initiative for Chronic Obstructive Lung (GOLD, 2014) and Global initiative for Asthma (GINA, 2015). The proportion, features, and clinical practice of ACOS still remain elusive in China. We are conducting this multicenter, cross-sectional, observational study (NCT02600221) to investigate the distributions of chronic obstructive diseases in patients >40 years of age with chronic airflow limitation in China along with determination of the main clinical practice and features of these diseases. The study will also explore the factors that may influence the exacerbations and severity of ACOS in Chinese patients (>40 years of age). A total of 2,000 patients (age, ≥40 years; either sex) who are clinically diagnosed as having asthma, COPD/chronic bronchitis/emphysema, or ACOS for at least 12 months with airflow limitation [post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC): <0.7] will be enrolled from approximately 20 sites in China between December 2015 and December 2016. The proportion of ACOS among patients older than 40 years based on GINA 2015 and GOLD 2014 definitions is the primary variable. Following were the secondary variables: the proportions of COPD and asthma among the patients, distributions of the severity of airflow limitation, distribution of groups according to GOLD 2011 group definition (A, B, C, D), and the distribution of medication by drug class in patients with ACOS, asthma, and COPD. Acute exacerbation history, hospitalization, and severity of ACOS as evaluated using COPD Assessment Test, Asthma Control Questionnaire-5, and Modified British Medical Research Council in patients with ACOS were also assessed. This will be the first study to disseminate scientific knowledge on the current situation, main clinical practice, and features of ACOS, asthma, and COPD conditions in Chinese patients. The insights will be helpful in designing optimal management strategies for ACOS and redefining the healthcare development programs.

NSLS-II storage ring insertion device and front-end commissioning and operation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, G., E-mail: gwang@bnl.gov; Shaftan, T.; Amundsen, C.

The National Synchrotron Light Source II (NSLS-II) is a state of the art 3 GeV third generation light source at Brookhaven National Laboratory. During spring/ summer of 2014, the storage ring was commissioned up to 50 mA without insertion devices. In the fall of 2014, we began commissioning of the project beamlines, which included seven insertion devices on six ID ports. Beamlines IXS, HXN, CSX-1, CSX-2, CHX, SRX, and XPD-1 consist of elliptically polarized undulator (EPU), damping wigglers (DW) and in-vacuum undulators (IVU) covering from VUV to hard x-ray range. In this paper, experience with commissioning and operation is discussed.more » We focus on reaching storage ring performance with IDs, including injection, design emittance, compensation of orbit distortions caused by ID residual field, source point stability, beam alignment and tools for control, monitoring and protection of the ring chambers from ID radiation.« less

Fluorescence decay of naphthalene studied in an electrostatic storage ring, the Mini-Ring

NASA Astrophysics Data System (ADS)

Martin, S.; Matsumoto, J.; Kono, N.; Ji, M.-C.; Brédy, R.; Bernard, J.; Cassimi, A.; Chen, L.

2017-10-01

The cooling of naphthalene cations (C10H8)+ has been studied in a compact electrostatic ion storage ring, the Mini-Ring. A nano second laser pulse of 532 nm (2.33 eV) was used to probe the internal energy distribution every millisecond during the storage time up to 5 ms. The evolution of the internal energy distribution of the stored ions was simulated with a model taking into account the dissociation and the radiative decay processes. Calculated decay curves were fitted to the corresponding laser induced neutral decays. For a laser power of 200 μJ/pulse, a good agreement between experiment and modeling was found using an initial Gaussian energy distribution centered to 5.9 eV and a fluorescence decay rate varying from 200 to 300 s-1 in the energy range from 6 to 7 eV. This fast decay was attributed to the delayed Poincaré fluorescence process.

Colliding or co-rotating ion beams in storage rings for EDM search

NASA Astrophysics Data System (ADS)

Koop, I. A.

2015-11-01

A new approach to search for and measure the electric dipole moment (EDM) of the proton, deuteron and some other light nuclei is presented. The idea of the method is to store two ion beams, circulating with different velocities, in a storage ring with crossed electric and magnetic guiding fields. One beam is polarized and its EDM is measured using the so-called ‘frozen spin’ method. The second beam, which is unpolarized, is used as a co-magnetometer, sensitive to the radial component of the ring’s magnetic field. The particle’s magnetic dipole moment (MDM) couples to the radial magnetic field and mimics the EDM signal. Measuring the relative vertical orbit separation of the two beams, caused by the presence of the radial magnetic field, one can control the unwanted MDM spin precession. Examples of the parameters for EDM storage rings for protons and other species of ions are presented. The use of crossed electric and magnetic fields helps to reduce the size of the ring by a factor of 10-20. We show that the bending radius of such an EDM storage ring could be about 2-3 m. Finally, a new method of increasing the spin coherence time, the so-called ‘spin wheel’, is proposed and its applicability to the EDM search is discussed.

Tree- Rings Link Climate and Carbon Storage in a Northern Mixed Hardwood Forest

NASA Astrophysics Data System (ADS)

Chiriboga, A.

2007-12-01

The terrestrial biosphere is a variable sink for atmospheric carbon dioxide. It is important to understand how carbon storage in trees is affected by natural climate variability to better characterize the sink. Quantifying the sensitivity of forest carbon storage to climate will improve carbon budgets and have implications for forest management practices. Here we explore how climate variability affects the ability of a northern mixed hardwood forest in Michigan to sequester atmospheric carbon dioxide in woody tissues. This site is ideal for studies of carbon sequestration; The University of Michigan Biological Station is an Ameriflux site, and has detailed meteorological and biometric records, as well as CO2 flux data. We have produced an 82- year aspen (Populus grandidentata) tree-ring chronology for this site, and measured ring widths at several heights up the bole. These measurements were used to estimate annual wood volume, which represents carbon allocated to aboveground carbon stores. Standard dendroclimatological techniques are used to identify environmental factors (e.g. temperature or precipitation) that drive tree-ring increment variability in the past century, and therefore annual carbon storage in this forest. Preliminary results show that marker years within the tree- ring chronology correspond with years that have cold spring temperatures. This suggests that trees at this site are temperature sensitive.

Beam Loss Measurements at the Los Alamos Proton Storage Ring

NASA Astrophysics Data System (ADS)

Spickermann, Thomas

2005-06-01

During normal operation the Los Alamos Proton Storage Ring (PSR) accumulates up to 4ṡ1013 protons over 625μs with a repetition rate of 20 Hz, corresponding to a current of 125μA to the Lujan Neutron Science Center. Beam losses in the ring as well as in the extraction beam line and the subsequent activation of material are a limiting factor at these currents. Careful tuning of injection, ring and extraction line is paramount to limiting losses to acceptable levels. Losses are typically not uniform around the ring, but occur in significantly higher levels in certain "hot spots". Here I will report on losses related to the stripper foil which are the dominant source of losses in the ring. First results of a comparison with simulations will also be presented.

Nitrile O-ring Cracking: A Case of Vacuum Flange O-ring Failures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dees, Craig

2016-07-01

A review of recent nitrile O-ring failures in ISO-KF vacuum flange connections in glovebox applications is presented. An investigation of a single “isolated” o-ring failure leads to the discovery of cracked nitrile o-rings in a glovebox atmospheric control unit. The initial cause of the o-ring failure is attributed to ozone degradation. However, additional investigation reveals nitrile o-ring cracking on multiple gloveboxes and general purpose piping, roughly 85% of the nitrile o-rings removed for inspection show evidence of visible cracking after being in service for 18 months or less. The results of material testing and ambient air testing is presented, elevatedmore » ozone levels are not found. The contributing factors of o-ring failure, including nitrile air sensitivity, inadequate storage practices, and poor installation techniques, are discussed. A discussion of nitrile o-ring material properties, the benefits and limitations, and alternate materials are discussed. Considerations for o-ring material selection, purchasing, storage, and installation are presented in the context of lessons learned from the nitrile o-ring cracking investigation. This paper can be presented in 20 minutes and does not require special accommodations or special audio visual devices.« less

Methyl jasmonate-induced defense responses are associated with elevation of 1-aminocyclopropane-1-carboxylate oxidase in Lycopersicon esculentum fruit.

PubMed

Yu, Mengmeng; Shen, Lin; Zhang, Aijun; Sheng, Jiping

2011-10-15

It has been known that methyl jasmonate (MeJA) interacts with ethylene to elicit resistance. In green mature tomato fruits (Lycopersicon esculentum cv. Lichun), 0.02mM MeJA increased the activity of 1-aminocyclopropane-1-carboxylate oxidase (ACO), and consequently influenced the last step of ethylene biosynthesis. Fruits treated with a combination of 0.02 MeJA and 0.02 α-aminoisobutyric acid (AIB, a competitive inhibitor of ACO) exhibited a lower ethylene production comparing to that by 0.02mM MeJA alone. The increased activities of defense enzymes and subsequent control of disease incidence caused by Botrytis cinerea with 0.2mM MeJA treatment was impaired by AIB as well. A close relationship (P<0.05) was found between the activity alterations of ACO and that of chitinase (CHI) and β-1,3-glucanase (GLU). In addition, this study further detected the changes of gene expressions and enzyme kinetics of ACO to different concentrations of MeJA. LeACO1 was found the principal member from the ACO gene family to respond to MeJA. Accumulation of LeACO1/3/4 transcripts followed the concentration pattern of MeJA treatments, where the largest elevations were reached by 0.2mM. For kinetic analysis, K(m) values of ACO stepped up during the experiment and reached the maximums at 0.2mM MeJA with ascending concentrations of treatments. V(max) exhibited a gradual increase from 3h to 24h, and the largest induction appeared with 1.0mM MeJA. The results suggested that ACO is involved in MeJA-induced resistance in tomato, and the concentration influence of MeJA on ACO was attributable to the variation of gene transcripts and enzymatic properties. Copyright © 2011 Elsevier GmbH. All rights reserved.

An analog RF gap voltage regulation system for the Advanced Photon Source storage ring.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Horan, D.

1999-04-13

An analog rf gap voltage regulation system has been designed and built at Argonne National Laboratory to maintain constant total storage ring rf gap voltage, independent of beam loading and cavity tuning effects. The design uses feedback control of the klystron mod-anode voltage to vary the amount of rf power fed to the storage ring cavities. The system consists of two independent feedback loops, each regulating the combined rf gap voltages of eight storage ring cavities by varying the output power of either one or two rf stations, depending on the mode of operation. It provides full operator control andmore » permissive logic to permit feedback control of the rf system output power only if proper conditions are met. The feedback system uses envelope-detected cavity field probe outputs as the feedback signal. Two different methods of combining the individual field probe signals were used to generate a relative DC level representing one-half of the total storage ring rf voltage, an envelope-detected vector sum of the field probe rf signals, and the DC sum of individual field probe envelope detector outputs. The merits of both methods are discussed. The klystron high-voltage power supply (HVPS) units are fitted with an analog interface for external control of the mod-anode voltage level, using a four-quadrant analog multiplier to modulate the HVPS mod-anode voltage regulator set-point in response to feedback system commands.« less

Accountable Care Organizations and Transaction Cost Economics.

PubMed

Mick, Stephen S Farnsworth; Shay, Patrick D

2016-12-01

Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information "impactedness." Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development. © The Author(s) 2016.

Analysis of Methods to Excite Head-Tail Motion Within the Cornell Electron Storage Ring

NASA Astrophysics Data System (ADS)

Gendler, Naomi; Billing, Mike; Shanks, Jim

The main accelerator complex at Cornell consists of two rings around which electrons and positrons move: the synchrotron, where the particles are accelerated to 5 GeV, and the Storage Ring, where the particles circulate a ta Þxed energy, guided by quadrupole and dipole magnets, with a steady energy due to a sinusoidal voltage source. Keeping the beam stable in the Storage Ring is crucial for its lifetime. A long-lasting, invariable beam means more accurate experiments, as well as brighter, more focused X-rays for use in the Cornell High Energy Synchrotron Source (CHESS). The stability of the electron and positron beams in the Cornell Electron Storage Ring (CESR) is important for the development of accelerators and for usage of the beam in X-ray science and accelerator physics. Bunch oscillations tend to enlarge the beam's cross section, making it less stable. We believe that one such oscillation is ``head-tail motion,'' where the bunch rocks back and forth on a pivot located at the central particle. In this project, we write a simulation of the bunch that induces head-tail motion with a vertical driver. We also excite this motion physically in the storage ring, and observe a deÞnite head-tail signal. In the experiment, we saw a deÞnite persistence of the drive-damp signal within a small band around the head-tail frequency, indicating that the head-tail frequency is a natural vertical mode of the bunch that was being excited. The signal seen in the experiment matched the signal seen in the simulation to within an order of magnitude.

Using ant colony optimization on the quadratic assignment problem to achieve low energy cost in geo-distributed data centers

NASA Astrophysics Data System (ADS)

Osei, Richard

There are many problems associated with operating a data center. Some of these problems include data security, system performance, increasing infrastructure complexity, increasing storage utilization, keeping up with data growth, and increasing energy costs. Energy cost differs by location, and at most locations fluctuates over time. The rising cost of energy makes it harder for data centers to function properly and provide a good quality of service. With reduced energy cost, data centers will have longer lasting servers/equipment, higher availability of resources, better quality of service, a greener environment, and reduced service and software costs for consumers. Some of the ways that data centers have tried to using to reduce energy costs include dynamically switching on and off servers based on the number of users and some predefined conditions, the use of environmental monitoring sensors, and the use of dynamic voltage and frequency scaling (DVFS), which enables processors to run at different combinations of frequencies with voltages to reduce energy cost. This thesis presents another method by which energy cost at data centers could be reduced. This method involves the use of Ant Colony Optimization (ACO) on a Quadratic Assignment Problem (QAP) in assigning user request to servers in geo-distributed data centers. In this paper, an effort to reduce data center energy cost involves the use of front portals, which handle users' requests, were used as ants to find cost effective ways to assign users requests to a server in heterogeneous geo-distributed data centers. The simulation results indicate that the ACO for Optimal Server Activation and Task Placement algorithm reduces energy cost on a small and large number of users' requests in a geo-distributed data center and its performance increases as the input data grows. In a simulation with 3 geo-distributed data centers, and user's resource request ranging from 25,000 to 25,000,000, the ACO algorithm was able to reduce energy cost on an average of $.70 per second. The ACO for Optimal Server Activation and Task Placement algorithm has proven to work as an alternative or improvement in reducing energy cost in geo-distributed data centers.

Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort.

PubMed

Cosio, Borja G; Soriano, Joan B; López-Campos, Jose Luis; Calle-Rubio, Myriam; Soler-Cataluna, Juan José; de-Torres, Juan P; Marín, Jose M; Martínez-Gonzalez, Cristina; de Lucas, Pilar; Mir, Isabel; Peces-Barba, Germán; Feu-Collado, Nuria; Solanes, Ingrid; Alfageme, Inmaculada; Casanova, Ciro

2016-01-01

Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult. To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS. Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up (P < .05). The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria. ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Analysis of Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome Defined on the Basis of Bronchodilator Response and Degree of Emphysema.

PubMed

Cosentino, James; Zhao, Huaqing; Hardin, Megan; Hersh, Craig P; Crapo, James; Kim, Victor; Criner, Gerard J

2016-09-01

Despite the increasing recognition of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) as a clinical entity, it remains poorly characterized due to a lack of agreement on its definition and diagnostic criteria. The aim of this study was to use spirometry and computed tomography (CT) to help better define ACOS as well as to classify subjects with ACOS based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) letter grade. We analyzed 10,192 subjects enrolled in the COPDGene Study. Subjects were non-Hispanic white or African American current or former smokers aged 45-80 years with at least a 10-pack-year smoking history. Subjects were categorized as having either ACOS with a bronchodilator response or chronic obstructive pulmonary disease with emphysema on the basis of spirometry, high-resolution CT, and a history of asthma or hay fever. Subjects with ACOS were younger (60.6 vs. 65.9 years old; P < 0.0001), more likely to be African American (26.8% vs. 14.4%; P < 0.0001), had a higher body mass index (29.6 vs. 25.1 kg/m(2); P < 0.0001), and were more likely to be current smokers (50.9% vs. 20.7%; P < 0.0001). The majority of subjects with ACOS were categorized as GOLD grade B. Despite less severe spirometry and CT findings in subjects with ACOS, there was no significant difference in severe or frequent exacerbations. Bronchodilator responsiveness and degree of emphysema can help define ACOS. When defined on the basis of bronchodilator responsiveness and degree of emphysema, patients with ACOS represent a unique and high-risk group with distinct clinical features.

Surgeon Participation in Early Accountable Care Organizations.

PubMed

Resnick, Matthew J; Graves, Amy J; Buntin, Melinda B; Richards, Michael R; Penson, David F

2018-03-01

We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation. Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs. Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015. We fit multivariable logistic regression models to characterize key drivers of ACO participation, and more specifically, the interaction between ACO affiliation and organizational structure. Of 125,425 US surgeons, 27,956 (22.3%) participated in at least 1 ACO program in 2015. We observed heterogeneity in participation by subspecialty, with trauma and transplant reporting the highest rate of ACO enrollment (36% for both) and plastic surgeons reporting the lowest (12.9%) followed by ophthalmology (16.0%) and hand (18.6%). Surgeons in group practices and integrated systems were more likely to participate relative to those practicing independently (aOR 1.57, 95% CI 1.50, 1.64; aOR 4.87, 95% CI 4.68, 5.07, respectively). We observed a statistically significant interaction (P <0.001) between surgical specialty and practice organization. Model-derived predicted probabilities revealed that, within each specialty, surgeons in integrated health systems had the highest predicted probabilities of ACO and those practicing independently generally had the lowest. We observed considerable variation in ACO enrollment among US surgeons, mediated at least in part by differences in practice organization. These data underscore the need for development of frameworks to characterize the strategic advantages and disadvantages associated with APM participation.

Aligning for accountable care: Strategic practices for change in accountable care organizations.

PubMed

Hilligoss, Brian; Song, Paula H; McAlearney, Ann Scheck

Alignment within accountable care organizations (ACOs) is crucial if these new entities are to achieve their lofty goals. However, the concept of alignment remains underexamined, and we know little about the work entailed in creating alignment. The aim of this study was to develop the concept of aligning by identifying and describing the strategic practices administrators use to align the structures, processes, and behaviors of their organizations and individual providers in pursuit of accountable care. We conducted 2-year qualitative case studies of four ACOs that have assumed full risk for the costs and quality of care for defined populations. Five strategic aligning practices were used by all four ACOs. Informing both aligns providers' understandings with the goals and value proposition of the ACO and aligns the providers' attention with the drivers of performance. Involving both aligns ACO leaders' understandings with the realities facing providers and aligns the policies of the ACO with the needs of providers. Enhancing both aligns the operations of individual provider practices with the operations of the ACO and aligns the trust of providers with the ACO. Motivating aligns what providers value with the goals of the ACO. Finally, evolving is a metapractice of learning and adapting that guides the execution of the other four practices. Our findings suggest that there are second-order cognitive (e.g., understandings and attention) and cultural (e.g., trust and values) levels of alignment, as well as a first-order operational level (organizational structures, processes, and incentives). A well-aligned organization may require ongoing repositioning at each of these levels, as well as attention to both cooperative and coordinative dimensions of alignment. Implications for research and practice are discussed.

Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations.

PubMed

T H Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

2014-01-01

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures - 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations

PubMed Central

T.H.Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

2014-01-01

Purpose The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. Methodology/Approach A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures – 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. Findings RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. Research limitations/implications The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Originality/Value of Paper Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States. PMID:25541569

Socioeconomic impact of asthma, chronic obstructive pulmonary disease and asthma-COPD overlap syndrome.

PubMed

Kim, Jinhee; Kim, Young Sam; Kim, Kyungjoo; Oh, Yeon-Mok; Yoo, Kwang Ha; Rhee, Chin Kook; Lee, Jin Hwa

2017-06-01

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is defined as having both features of asthma and COPD, which are airway hyper-responsiveness and incompletely reversible airway obstruction. However, socioeconomic impact of ACOS have not been well appreciated. Adults with available wheezing history and acceptable spirometry were selected from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) in 2007-2009. Their data were merged with the Korean National Health Insurance claim data. 'Asthma group' was defined as having self-reported wheezing history and FEV 1 /FVC ≥0.7, 'COPD group' was defined as having FEV 1 /FVC <0.7 and no wheezing, 'ACOS group' was defined as having both wheezing and FEV 1 /FVC <0.7, and 'no airway disease (NAD) group' was defined as having no wheezing and FEV 1 /FVC ≥0.7. Among a total of 11,656 subjects, ACOS comprise 2.2%; COPD, 8.4%; asthma, 5.8% and NAD, 83.6%. Total length of healthcare utilization and medical costs of ACOS group was the top among four groups (P<0.001), though inpatient medical cost was the highest in COPD group (P=0.025). Multiple linear regression analyses showed that ACOS group (β=12.63, P<0.001) and asthma group (β=6.14, P<0.001) were significantly associated with longer duration of healthcare utilization and ACOS group (β=350,475.88, P=0.008) and asthma group (β=386,876.81, P<0.001) were associated with higher medical costs. This study demonstrated that ACOS independently influences healthcare utilization after adjusting several factors. In order to utilize limited medical resources efficiently, it may be necessary to find and manage ACOS patients.

Transforming healthcare delivery: Why and how accountable care organizations must evolve.

PubMed

Chen, Christopher T; Ackerly, D Clay; Gottlieb, Gary

2016-09-01

Accountable care organizations (ACOs) have shown promise in reducing healthcare spending growth, but have proven to be financially unsustainable for many healthcare organizations. Even ACOs with shared savings have experienced overall losses because the shared savings bonuses have not covered the costs of delivering population health. As physicians and former ACO leaders, we believe in the concept of accountable care, but ACOs need to evolve if they are to have a viable future. We propose the novel possibility of allowing ACOs to bill fee-for-service for their population health interventions, a concept we call population health billing. Journal of Hospital Medicine 2016;11:658-661. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Beam vacuum system of Brookhaven`s muon storage ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hseuth, H.C.; Snydstrup, L.; Mapes, M.

1995-11-01

A storage ring with a circumference of 45 m is being built at Brookhaven to measure the g-2 value of the muons to an accuracy of 0.35 ppm.. The beam vacuum system of the storage ring will operate at 10{sup -7} Torr and has to be completely non-magnetic. It consists of twelve sector chambers. The chambers are constructed of aluminum and are approximately 3.5 m in length with a rectangular cross-section of 16.5 cm high by 45 cm at the widest point. The design features, fabrication techniques and cleaning methods for these chambers are described. The beam vacuum system willmore » be pumped by forty eight non-magnetic distributed ion pumps with a total pumping speed of over 2000 {ell}/sec. Monte Carlo simulations of the pressure distribution in the muon storage region are presented.« less

42 CFR 425.700 - General rules.

Code of Federal Regulations, 2014 CFR

2014-10-01

... privacy of individually identifiable health information and comply with the terms of the data use...) MEDICARE PROGRAM (CONTINUED) MEDICARE SHARED SAVINGS PROGRAM Data Sharing With ACOs § 425.700 General rules. (a) CMS shares aggregate reports with the ACO. (b) CMS shares beneficiary identifiable data with ACOs...

42 CFR 425.304 - Other program requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... interests in the judgment of the referring party. (d) Required reporting of NPIs and TINs. (1) The ACO must... times as specified by CMS the list of each ACO participant's TIN and ACO providers/supplier's NPI that... any changes to the list of NPIs and TINs. ...

42 CFR 425.304 - Other program requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... interests in the judgment of the referring party. (d) Required reporting of NPIs and TINs. (1) The ACO must... times as specified by CMS the list of each ACO participant's TIN and ACO providers/supplier's NPI that... any changes to the list of NPIs and TINs. ...

42 CFR 425.304 - Other program requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... interests in the judgment of the referring party. (d) Required reporting of NPIs and TINs. (1) The ACO must... times as specified by CMS the list of each ACO participant's TIN and ACO providers/supplier's NPI that... any changes to the list of NPIs and TINs. ...

Roles for specialty societies and vascular surgeons in accountable care organizations

PubMed Central

Goodney, Philip P.; Fisher, Elliott S.; Cambria, Richard P.

2012-01-01

With the passage of the Affordable Care Act, accountable care organizations (ACOs) represent a new paradigm in healthcare payment reform. Designed to limit growth in spending while preserving quality, these organizations aim to incant physicians to lower costs by returning a portion of the savings realized by cost-effective, evidence-based care back to the ACO. In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a “seat at the table” will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs. PMID:22370029

An Early Assessment of Accountable Care Organizations Efforts to Engage Patients and Their Families

PubMed Central

Shortell, Stephen M.; Sehgal, Neil; Bibi, Salma; Ramsay, Patricia P.; Neuhauser, Linda; Colla, Carrie H.; Lewis, Valerie A.

2017-01-01

Accountable Care Organizations (ACOs) have incentives to meet quality and expenditure targets and share in resulting savings. Achieving these goals will require ACOs to engage more actively with patients and their families. The extent to which ACOs do so is currently unknown. Using mixed-methods including a national survey, phone interviews and site-visits; we examine the extent to which ACOs actively engage patients and their families, explore challenges involved; and consider approaches for dealing with those challenges. Results indicate that greater ACO use of patient activation and engagement (PAE) activities at the point-of-care may influence more positive leadership perceptions of the impact of PAE investments on ACO costs, quality, and outcomes of care. We identify a number of important practices associated with greater PAE, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training and use of inter-disciplinary care teams, and frequent monitoring and reporting on progress. PMID:26038349

Corrections for a constant radial magnetic field in the muon \\varvec{g}-2 and electric-dipole-moment experiments in storage rings

NASA Astrophysics Data System (ADS)

Silenko, Alexander J.

2017-10-01

We calculate the corrections for constant radial magnetic field in muon {g}-2 and electric-dipole-moment experiments in storage rings. While the correction is negligible for the current generation of {g}-2 experiments, it affects the upcoming muon electric-dipole-moment experiment at Fermilab.

Loss-free method of charging accumulator rings

DOEpatents

Maschke, Alfred W.

1979-01-01

A method for the production of high current pulses of heavy ions having an atomic weight greater than 100. Also a linear accelerator based apparatus for carrying out said method. Pulses formed by the method of the subject invention are suitable for storage in a storage ring. The accumulated pulses may be used in inertial fusion apparatus.

National Synchrotron Light Source annual report 1991. Volume 1, October 1, 1990--September 30, 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hulbert, S.L.; Lazarz, N.M.

1992-04-01

This report discusses the following research conducted at NSLS: atomic and molecular science; energy dispersive diffraction; lithography, microscopy and tomography; nuclear physics; UV photoemission and surface science; x-ray absorption spectroscopy; x-ray scattering and crystallography; x-ray topography; workshop on surface structure; workshop on electronic and chemical phenomena at surfaces; workshop on imaging; UV FEL machine reviews; VUV machine operations; VUV beamline operations; VUV storage ring parameters; x-ray machine operations; x-ray beamline operations; x-ray storage ring parameters; superconducting x-ray lithography source; SXLS storage ring parameters; the accelerator test facility; proposed UV-FEL user facility at the NSLS; global orbit feedback systems; and NSLSmore » computer system.« less

Low emittance lattice for the storage ring of the Turkish Light Source Facility TURKAY

NASA Astrophysics Data System (ADS)

Nergiz, Z.; Aksoy, A.

2015-06-01

The TAC (Turkish Accelerator Center) project aims to build an accelerator center in Turkey. The first stage of the project is to construct an Infra-Red Free Electron Laser (IR-FEL) facility. The second stage is to build a synchrotron radiation facility named TURKAY, which is a third generation synchrotron radiation light source that aims to achieve a high brilliance photon beam from a low emittance electron beam at 3 GeV. The electron beam parameters are highly dependent on the magnetic lattice of the storage ring. In this paper a low emittance storage ring for TURKAY is proposed and the beam dynamic properties of the magnetic lattice are investigated. Supported by Turkish Republic Ministry of Development (DPT2006K120470)

The aconitate hydratase family from Citrus

PubMed Central

2010-01-01

Background Research on citrus fruit ripening has received considerable attention because of the importance of citrus fruits for the human diet. Organic acids are among the main determinants of taste and organoleptic quality of fruits and hence the control of fruit acidity loss has a strong economical relevance. In citrus, organic acids accumulate in the juice sac cells of developing fruits and are catabolized thereafter during ripening. Aconitase, that transforms citrate to isocitrate, is the first step of citric acid catabolism and a major component of the citrate utilization machinery. In this work, the citrus aconitase gene family was first characterized and a phylogenetic analysis was then carried out in order to understand the evolutionary history of this family in plants. Gene expression analyses of the citrus aconitase family were subsequently performed in several acidic and acidless genotypes to elucidate their involvement in acid homeostasis. Results Analysis of 460,000 citrus ESTs, followed by sequencing of complete cDNA clones, identified in citrus 3 transcription units coding for putatively active aconitate hydratase proteins, named as CcAco1, CcAco2 and CcAco3. A phylogenetic study carried on the Aco family in 14 plant species, shows the presence of 5 Aco subfamilies, and that the ancestor of monocot and dicot species shared at least one Aco gene. Real-time RT-PCR expression analyses of the three aconitase citrus genes were performed in pulp tissues along fruit development in acidic and acidless citrus varieties such as mandarins, oranges and lemons. While CcAco3 expression was always low, CcAco1 and CcAco2 genes were generally induced during the rapid phase of fruit growth along with the maximum in acidity and the beginning of the acid reduction. Two exceptions to this general pattern were found: 1) Clemenules mandarin failed inducing CcAco2 although acid levels were rapidly reduced; and 2) the acidless "Sucreña" orange showed unusually high levels of expression of both aconitases, an observation correlating with the acidless phenotype. However, in the acidless "Dulce" lemon aconitase expression was normal suggesting that the acidless trait in this variety is not dependent upon aconitases. Conclusions Phylogenetic studies showed the occurrence of five different subfamilies of aconitate hydratase in plants and sequence analyses indentified three active genes in citrus. The pattern of expression of two of these genes, CcAco1 and CcAco2, was normally associated with the timing of acid content reduction in most genotypes. Two exceptions to this general observation suggest the occurrence of additional regulatory steps of citrate homeostasis in citrus. PMID:20958971

Metabolic engineering of tomato fruit organic acid content guided by biochemical analysis of an introgression line.

PubMed

Morgan, Megan J; Osorio, Sonia; Gehl, Bernadette; Baxter, Charles J; Kruger, Nicholas J; Ratcliffe, R George; Fernie, Alisdair R; Sweetlove, Lee J

2013-01-01

Organic acid content is regarded as one of the most important quality traits of fresh tomato (Solanum lycopersicum). However, the complexity of carboxylic acid metabolism and storage means that it is difficult to predict the best way to engineer altered carboxylic acid levels. Here, we used a biochemical analysis of a tomato introgression line with increased levels of fruit citrate and malate at breaker stage to identify a metabolic engineering target that was subsequently tested in transgenic plants. Increased carboxylic acid levels in introgression line 2-5 were not accompanied by changes in the pattern of carbohydrate oxidation by pericarp discs or the catalytic capacity of tricarboxylic acid cycle enzymes measured in isolated mitochondria. However, there was a significant decrease in the maximum catalytic activity of aconitase in total tissue extracts, suggesting that a cytosolic isoform of aconitase was affected. To test the role of cytosolic aconitase in controlling fruit citrate levels, we analyzed fruit of transgenic lines expressing an antisense construct against SlAco3b, one of the two tomato genes encoding aconitase. A green fluorescent protein fusion of SlAco3b was dual targeted to cytosol and mitochondria, while the other aconitase, SlAco3a, was exclusively mitochondrial when transiently expressed in tobacco (Nicotiana tabacum) leaves. Both aconitase transcripts were decreased in fruit from transgenic lines, and aconitase activity was reduced by about 30% in the transgenic lines. Other measured enzymes of carboxylic acid metabolism were not significantly altered. Both citrate and malate levels were increased in ripe fruit of the transgenic plants, and as a consequence, total carboxylic acid content was increased by 50% at maturity.

Metabolic Engineering of Tomato Fruit Organic Acid Content Guided by Biochemical Analysis of an Introgression Line1[W][OA

PubMed Central

Morgan, Megan J.; Osorio, Sonia; Gehl, Bernadette; Baxter, Charles J.; Kruger, Nicholas J.; Ratcliffe, R. George; Fernie, Alisdair R.; Sweetlove, Lee J.

2013-01-01

Organic acid content is regarded as one of the most important quality traits of fresh tomato (Solanum lycopersicum). However, the complexity of carboxylic acid metabolism and storage means that it is difficult to predict the best way to engineer altered carboxylic acid levels. Here, we used a biochemical analysis of a tomato introgression line with increased levels of fruit citrate and malate at breaker stage to identify a metabolic engineering target that was subsequently tested in transgenic plants. Increased carboxylic acid levels in introgression line 2-5 were not accompanied by changes in the pattern of carbohydrate oxidation by pericarp discs or the catalytic capacity of tricarboxylic acid cycle enzymes measured in isolated mitochondria. However, there was a significant decrease in the maximum catalytic activity of aconitase in total tissue extracts, suggesting that a cytosolic isoform of aconitase was affected. To test the role of cytosolic aconitase in controlling fruit citrate levels, we analyzed fruit of transgenic lines expressing an antisense construct against SlAco3b, one of the two tomato genes encoding aconitase. A green fluorescent protein fusion of SlAco3b was dual targeted to cytosol and mitochondria, while the other aconitase, SlAco3a, was exclusively mitochondrial when transiently expressed in tobacco (Nicotiana tabacum) leaves. Both aconitase transcripts were decreased in fruit from transgenic lines, and aconitase activity was reduced by about 30% in the transgenic lines. Other measured enzymes of carboxylic acid metabolism were not significantly altered. Both citrate and malate levels were increased in ripe fruit of the transgenic plants, and as a consequence, total carboxylic acid content was increased by 50% at maturity. PMID:23166354

PEGASYS---A proposed internal target facility for the PEP storage ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Biber, K.

A proposal for an integral gas-jet target and forward spectrometer for the PEP storage ring is described. The beam structure, allowable, luminosity (L = 10/sup 33/ cm/sup /minus/2/s/sup /minus/1/ for H/sub 2/, D/sub 2/) and energy (E/sub e/ less than or equal to 15 GeV) make the ring ideal for multiparticle coincidence studies in the scaling regime, and where perturbative QCD may be an apt description of some exclusive and semi-inclusive reactions. 14 refs., 7 figs.

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and ACO...

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and ACO...

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and ACO...

42 CFR 425.306 - Participation agreement and exclusivity of ACO participant TINs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... participant TINs. 425.306 Section 425.306 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... participant TINs. (a) For purposes of the Shared Savings Program, each ACO participant TIN is required to commit to a participation agreement with CMS. (b) Each ACO participant TIN upon which beneficiary...

42 CFR 425.306 - Participation agreement and exclusivity of ACO participant TINs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... participant TINs. 425.306 Section 425.306 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... participant TINs. (a) For purposes of the Shared Savings Program, each ACO participant TIN is required to commit to a participation agreement with CMS. (b) Each ACO participant TIN upon which beneficiary...

42 CFR 425.306 - Participation agreement and exclusivity of ACO participant TINs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... participant TINs. 425.306 Section 425.306 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... participant TINs. (a) For purposes of the Shared Savings Program, each ACO participant TIN is required to commit to a participation agreement with CMS. (b) Each ACO participant TIN upon which beneficiary...

42 CFR 425.302 - Program requirements for data submission and certifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Program requirements for data submission and... of his or her knowledge information and belief. (3) Annual certification. At the end of each... her knowledge, information, and belief— (i) That the ACO, its ACO participants, its ACO providers...

42 CFR 425.302 - Program requirements for data submission and certifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Program requirements for data submission and... of his or her knowledge information and belief. (3) Annual certification. At the end of each... her knowledge, information, and belief— (i) That the ACO, its ACO participants, its ACO providers...

42 CFR 425.302 - Program requirements for data submission and certifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Program requirements for data submission and... of his or her knowledge information and belief. (3) Annual certification. At the end of each... her knowledge, information, and belief— (i) That the ACO, its ACO participants, its ACO providers...

Cost-outcomes focus is essential for ACO success.

PubMed

Greenspun, Harry; Bercik, William

2013-02-01

To succeed under value-based payment, accountable care organizations (ACOs) must be able to link, analyze, and compare clinical and administrative data from across their constituent organizations. ACOs require a precise costing methodology, such as activity-based costing, to be able to manage costs effectively and gain critical insight into which service lines are delivering value from a clinical and financial standpoint. To support informed strategic decision-making, ACOs also require ready access to integrated patient encounter data to be able to perform the sophisticated modeling of predictive analytics.

Analysis of parameter estimation and optimization application of ant colony algorithm in vehicle routing problem

NASA Astrophysics Data System (ADS)

Xu, Quan-Li; Cao, Yu-Wei; Yang, Kun

2018-03-01

Ant Colony Optimization (ACO) is the most widely used artificial intelligence algorithm at present. This study introduced the principle and mathematical model of ACO algorithm in solving Vehicle Routing Problem (VRP), and designed a vehicle routing optimization model based on ACO, then the vehicle routing optimization simulation system was developed by using c ++ programming language, and the sensitivity analyses, estimations and improvements of the three key parameters of ACO were carried out. The results indicated that the ACO algorithm designed in this paper can efficiently solve rational planning and optimization of VRP, and the different values of the key parameters have significant influence on the performance and optimization effects of the algorithm, and the improved algorithm is not easy to locally converge prematurely and has good robustness.

The KACST Heavy-Ion Electrostatic Storage Ring

NASA Astrophysics Data System (ADS)

Almuqhim, A. A.; Alshammari, S. M.; El Ghazaly, M. O. A.; Papash, A. I.; Welsch, C. P.

2011-10-01

A novel Electrostatic Storage Ring (ESR) for beams at energies up to 30keV/q is now being constructed at the National Centre for Mathematics and Physics (NCMP), King Abdul-Aziz City for Science and Technology (KACST). The ring is designed to be the core of a highly flexible experimental platform that will combine a large package of complementary beam techniques for atomic and molecular physics and related fields. The lattice design had to cover the different experimental techniques that the ring will be equipped with, such as e.g. Electron-Ion, Laser-Ion, Ion-Ion or Ion-Neutral beams, in both crossed and merged-beam configurations. The development of such an ESR is realized in a staged approach, in which a simple and early-run adaptation of the ring is built first, and then this basic version is upgraded to a higher symmetry of the ultimate version of the ring. Here, we report a general overview of this technical development with a focus on the layout of the first built stage of the ring.

Characterizing the population of Asteroids in Cometary Orbits (ACOs)

NASA Astrophysics Data System (ADS)

Tancredi, Gonzalo; Licandro, Javier; Alí-Lagoa, Victor; Martino, Silvia; Vieira Monteiro, Filipe; Silva, Jose Sergio; Lazzaro, Daniela

2015-08-01

The classification criterion between asteroids and comets has evolved in recent decades, but the main phenomenological distinction remains unchanged: comets are active objects as they present gas and dust ejection from the surface at some point of their orbits, while asteroids are inert objects as they do not show any kind of large scale gas and dust ejection.To identify the transitional objects several classification schemes based on the orbital elements have been used. They are usually based on the Tisserand’s parameter (TJ). Tancredi (2014) presents a much more restrictive criterion to identify ACOs that ensured that the objects have a dynamical evolution similar to the population of periodic comets. After applying the criteriaa to the sample of over half a million asteroids already discovered, we obtain 316 ACOs that are further classified in subclasses similar to the cometary classification: 203 objects belong to the Jupiter Family group; 72 objects are classified as Centaurs; and 56 objects have Halley Type Orbits (also known as Damocloids). These are the best-known extinct/dormant comets candidates from a dynamical point of view.We study the physical properties of this sample of ACOs. Two results will be presented:- We look for the ACOs detected by the NASA’s WISE and by fitting a thermal model to their observations, we derive: the effective diameter, beaming parameter and the visible geometric albedo, using the method described in Al-Lagoa et al (2013). We obtain these parameters for 37 of 203 ACOs in JFC orbits and 13 of 56 Damocloids. We also compute the Cumulative Size Distribution (CSDs) of these populations and compare them with the CSDs of JF Comets and Centaurs.- We have been monitoring the observable ACOs since 12/2014 up to 06/2015. Every other month we select all the ACOs with elongations >90deg and estimated magnitudes V<21. We try to observe them with the 1m IMPACTON telescope of the Observatório Astronômico do Sertão de Itaparica (OASI). By comparing the photometric profiles of the ACOs with background stars, we try to detect some hint of cometary activity. Over 20 ACOs have been observed in the six months.

Asthma-chronic obstructive pulmonary disease overlap syndrome in the urban Chinese population: prevalence and disease burden using the 2010, 2012, and 2013 China National Health and Wellness Surveys.

PubMed

Ding, Bo; DiBonaventura, Marco; Karlsson, Niklas; Ling, Xia

2016-01-01

Research has suggested a significant burden for patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). However, few studies have studied this population in the People's Republic of China, a region in the midst of rapid epidemiological change with respect to respiratory disease. The aim of this study was to assess the prevalence of ACOS and its association with patient outcomes in urban China. Data from the 2010, 2012, and 2013 China National Health and Wellness Survey, an Internet-based survey of adults in urban China, were used (N=59,935). Respondents were categorized into one of four groups based on self-reported physician diagnoses: ACOS, asthma only, COPD only, or control (ie, no asthma or COPD). A propensity score matching procedure was conducted to cull the control group into a subgroup (ie, matched controls) who resembled patients with ACOS, asthma only, and COPD only. These four groups (ACOS, asthma only, COPD only, matched controls) were then compared with respect to health status (Short Form-12 version 2/Short Form-36 version 2), work productivity, and health care resource use using generalized linear models. Patients with ACOS (N=366) comprised 0.61% of the adult population, 30.73% of the asthma population, and 18.60% of the COPD population in the People's Republic of China. Patients with ACOS reported significantly worse health status (eg, health utilities =0.63, 0.66, 0.63, and 0.69 for ACOS, COPD only, asthma only, and matched controls, respectively) and significantly greater work impairment (eg, overall work impairment =43.65%, 35.19%, 48.55%, and 29.80%, respectively) and health care resource use (eg, physician visits in the past 6 months =5.13, 3.84, 4.65, and 2.39, respectively) compared with matched controls and patients with COPD only. Few significant differences were observed between patients with ACOS and asthma only. Patients with ACOS have a greater comorbidity burden and significantly worse health outcomes compared with COPD only patients and matched controls. Better management of these patients may help to improve their outcomes.

BEAM DIAGNOSTICS USING BPM SIGNALS FROM INJECTED AND STORED BEAMS IN A STORAGE RING

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, G.M.; Shaftan; T.

2011-03-28

Many modern light sources are operating in top-off injection mode or are being upgraded to top-off injection mode. The storage ring always has the stored beam and injected beam for top-off injection mode. So the BPM data is the mixture of both beam positions and the injected beam position cannot be measured directly. We propose to use dedicated wide band BPM electronics in the NSLS II storage ring to retrieve the injected beam trajectory with the singular value decomposition (SVD) method. The beam position monitor (BPM) has the capability to measure bunch-by-bunch beam position. Similar electronics can be used tomore » measure the bunch-by-bunch beam current which is necessary to get the injection beam position. The measurement precision of current needs to be evaluated since button BPM sum signal has position dependence. The injected beam trajectory can be measured and monitored all the time without dumping the stored beam. We can adjust and optimize the injected beam trajectory to maximize the injection efficiency. We can also measure the storage ring acceptance by mapping the injected beam trajectory.« less

First storage of ion beams in the Double Electrostatic Ion-Ring Experiment: DESIREE.

PubMed

Schmidt, H T; Thomas, R D; Gatchell, M; Rosén, S; Reinhed, P; Löfgren, P; Brännholm, L; Blom, M; Björkhage, M; Bäckström, E; Alexander, J D; Leontein, S; Hanstorp, D; Zettergren, H; Liljeby, L; Källberg, A; Simonsson, A; Hellberg, F; Mannervik, S; Larsson, M; Geppert, W D; Rensfelt, K G; Danared, H; Paál, A; Masuda, M; Halldén, P; Andler, G; Stockett, M H; Chen, T; Källersjö, G; Weimer, J; Hansen, K; Hartman, H; Cederquist, H

2013-05-01

We report on the first storage of ion beams in the Double ElectroStatic Ion Ring ExpEriment, DESIREE, at Stockholm University. We have produced beams of atomic carbon anions and small carbon anion molecules (C(n)(-), n = 1, 2, 3, 4) in a sputter ion source. The ion beams were accelerated to 10 keV kinetic energy and stored in an electrostatic ion storage ring enclosed in a vacuum chamber at 13 K. For 10 keV C2 (-) molecular anions we measure the residual-gas limited beam storage lifetime to be 448 s ± 18 s with two independent detector systems. Using the measured storage lifetimes we estimate that the residual gas pressure is in the 10(-14) mbar range. When high current ion beams are injected, the number of stored particles does not follow a single exponential decay law as would be expected for stored particles lost solely due to electron detachment in collision with the residual-gas. Instead, we observe a faster initial decay rate, which we ascribe to the effect of the space charge of the ion beam on the storage capacity.

An agent-based simulation model to study accountable care organizations.

PubMed

Liu, Pai; Wu, Shinyi

2016-03-01

Creating accountable care organizations (ACOs) has been widely discussed as a strategy to control rapidly rising healthcare costs and improve quality of care; however, building an effective ACO is a complex process involving multiple stakeholders (payers, providers, patients) with their own interests. Also, implementation of an ACO is costly in terms of time and money. Immature design could cause safety hazards. Therefore, there is a need for analytical model-based decision-support tools that can predict the outcomes of different strategies to facilitate ACO design and implementation. In this study, an agent-based simulation model was developed to study ACOs that considers payers, healthcare providers, and patients as agents under the shared saving payment model of care for congestive heart failure (CHF), one of the most expensive causes of sometimes preventable hospitalizations. The agent-based simulation model has identified the critical determinants for the payment model design that can motivate provider behavior changes to achieve maximum financial and quality outcomes of an ACO. The results show nonlinear provider behavior change patterns corresponding to changes in payment model designs. The outcomes vary by providers with different quality or financial priorities, and are most sensitive to the cost-effectiveness of CHF interventions that an ACO implements. This study demonstrates an increasingly important method to construct a healthcare system analytics model that can help inform health policy and healthcare management decisions. The study also points out that the likely success of an ACO is interdependent with payment model design, provider characteristics, and cost and effectiveness of healthcare interventions.

Preventive care quality of Medicare Accountable Care Organizations: Associations of organizational characteristics with performance

PubMed Central

Albright, Benjamin B.; Lewis, Valerie A.; Ross, Joseph S.; Colla, Carrie H.

2015-01-01

Background Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for eight measures of preventive care quality. Objectives To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. Design Cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Results Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified two underlying factors among eight measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. Conclusions ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration. PMID:26759974

Aconitase post-translational modification as a key in linkage between Krebs cycle, iron homeostasis, redox signaling, and metabolism of reactive oxygen species.

PubMed

Lushchak, Oleh V; Piroddi, Marta; Galli, Francesco; Lushchak, Volodymyr I

2014-01-01

Aconitase, an enzyme possessing an iron-sulfur cluster that is sensitive to oxidation, is involved in the regulation of cellular metabolism. There are two isoenzymes of aconitase (Aco)--mitochondrial (mAco) and cytosolic (cAco) ones. The primary role of mAdco is believed to be to control cellular ATP production via regulation of intermediate flux in the Krebs cycle. The cytosolic Aco in its reduced form operates as an enzyme, whereas in the oxidized form it is involved in the control of iron homeostasis as iron regulatory protein 1 (IRP1). Reactive oxygen species (ROS) play a central role in regulation of Aco functions. Catalytic Aco activity is regulated by reversible oxidation of [4Fe-4S]²⁺ cluster and cysteine residues, so redox-dependent posttranslational modifications (PTMs) have gained increasing consideration as regards possible regulatory effects. These include modifications of cysteine residues by oxidation, nitrosylation and thiolation, as well as Tyr nitration and oxidation of Lys residues to carbonyls. Redox-independent PTMs such as phosphorylation and transamination also have been described. In the presence of a sustained ROS flux, redox-dependent PTMs may lead to enzyme damage and cell stress by impaired energy and iron metabolism. Aconitase has been identified as a protein that undergoes oxidative modification and inactivation in aging and certain oxidative stress-related disorders. Here we describe possible mechanisms of involvement of the two aconitase isoforms, cAco and mAco, in the control of cell metabolism and iron homeostasis, balancing the regulatory, and damaging effects of ROS.

Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.

PubMed

Albright, Benjamin B; Lewis, Valerie A; Ross, Joseph S; Colla, Carrie H

2016-03-01

Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. This is a cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified 2 underlying factors among 8 measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.

42 CFR 425.104 - Legal entity.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Legal entity. 425.104 Section 425.104 Public Health....104 Legal entity. (a) An ACO must be a legal entity, formed under applicable State, Federal, or Tribal... in this part. (b) An ACO formed by two or more otherwise independent ACO participants must be a legal...

42 CFR 425.104 - Legal entity.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Legal entity. 425.104 Section 425.104 Public Health....104 Legal entity. (a) An ACO must be a legal entity, formed under applicable State, Federal, or Tribal... in this part. (b) An ACO formed by two or more otherwise independent ACO participants must be a legal...

42 CFR 425.104 - Legal entity.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Legal entity. 425.104 Section 425.104 Public Health....104 Legal entity. (a) An ACO must be a legal entity, formed under applicable State, Federal, or Tribal... in this part. (b) An ACO formed by two or more otherwise independent ACO participants must be a legal...

Consideration of social values in the establishment of accountable care organizations in the USA.

PubMed

Keren, Ron; Littlejohns, Peter

2012-01-01

The purpose of this paper is to introduce the new US health organizations called accountable care organizations (ACOs) which are expected to improve the quality and reduce the cost of healthcare for Medicare enrolees. It assesses the importance of ACOs, defining and articulating the values that will underpin their strategic and clinical decision making. This paper uses a social values framework developed by Clark and Weale to consider the values relevant to ACOs. It is likely that social values could be made more explicit in a US setting than they have ever been before, via the new ACOs. Social values could start to form part of a local health economy's marketing strategy. ACOs are very new. This paper identifies that they will need to be very explicit about the values relevant to them. The development of ACOs and the articulation of social values therein may even form the basis of a meaningful dialogue on the importance of assessing value for money or cost-effectiveness in the wider US health policy environment.

Roles for specialty societies and vascular surgeons in accountable care organizations.

PubMed

Goodney, Philip P; Fisher, Elliott S; Cambria, Richard P

2012-03-01

With the passage of the Affordable Care Act, accountable care organizations (ACOs) represent a new paradigm in healthcare payment reform. Designed to limit growth in spending while preserving quality, these organizations aim to incant physicians to lower costs by returning a portion of the savings realized by cost-effective, evidence-based care back to the ACO. In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a "seat at the table" will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Beam position monitoring system at CESR

NASA Astrophysics Data System (ADS)

Billing, M. G.; Bergan, W. F.; Forster, M. J.; Meller, R. E.; Rendina, M. C.; Rider, N. T.; Sagan, D. C.; Shanks, J.; Sikora, J. P.; Stedinger, M. G.; Strohman, C. R.; Palmer, M. A.; Holtzapple, R. L.

2017-09-01

The Cornell Electron-positron Storage Ring (CESR) has been converted from a High Energy Physics electron-positron collider to operate as a dedicated synchrotron light source for the Cornell High Energy Synchrotron Source (CHESS) and to conduct accelerator physics research as a test accelerator, capable of studying topics relevant to future damping rings, colliders and light sources. Some of the specific topics that were targeted for the initial phase of operation of the storage ring in this mode, labeled CESRTA (CESR as a Test Accelerator), included 1) tuning techniques to produce low emittance beams, 2) the study of electron cloud development in a storage ring and 3) intra-beam scattering effects. The complete conversion of CESR to CESRTA occurred over a several year period and is described elsewhere. As a part of this conversion the CESR beam position monitoring (CBPM) system was completely upgraded to provide the needed instrumental capabilities for these studies. This paper describes the new CBPM system hardware, its function and representative measurements performed by the upgraded system.

The Sciences ACO Light and Matter Museum

NASA Astrophysics Data System (ADS)

Arnaud, Nicolas; Besson, Martine; Borie, Henri; Brunet, Paul; Chapellier, Maurice; Damany, André; Dartyge, Elisabeth; Delerue, Nicolas; Dhez, Pierre; Ducros, Yves; Gacoin, Marie-Pauline; Haissinski, Jacques; Jean-Marie, Bernard; Jeanjean, Jack; Jolivot, Roland; Jullian, Serge; Khalili, Guyve; Ortega, Jean-Michel; Riskalla, Robert; Roudeau, Patrick; Sommer, Michel; Sotty, Christophe; Szklarz, Georges

2016-04-01

Sciences ACO is a non-profit association based in Orsay (France). It manages a Museum of Light and Matter visited by more than 1,000 people each year. In this unique place, scientists and cultural mediators preserve, exhibit and comment on items of the history of science & technology, to pass on the knowledge of this heritage to the audience. Sciences ACO visitors - among them many high school students and teachers - come to learn about the progress of science and the technology evolution over more than four decades. Sciences ACO is more than just a historical museum: it is a driving force for the development for outreach and pedagogical activities on the Paris-Sud University campus and in the neighboring towns. The history, the present activity and the prospects of the Sciences ACO association are presented in this article.

Metal (Fe, Co, Ni) supported on different aluminas as Fischer-Tropsch catalyst

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dahlan; Marsih, I. Nyoman, E-mail: nyoman@chem.itb.ac.id; Ismunandar

2015-09-30

This research aimed to compare the physico-chemical properties of the same metal M (M = iron, cobalt, nickel) supported on aluminas with different morphology and pore size as Fischer-Tropsch catalyst. The aluminas applied as support were alumina synthesized through hydrothermal process, alumina formed by pretreatment of catapal and commercial alumina which named as Ahy, Aca, and Aco respectively. Ahy has uniform morphology of nanotubes while Aca and Aco showed non-uniform morphology of particle lumps. The particle lumps of Aca were larger than those of Aco. Ahy, Aca, and Aco respectively has average pore diameter of 2.75, 2.86 and 2.9 nm. Metalsmore » were deposited on the supports by incipient-wetness impregnation method. The catalysts were characterized by XRD, H{sub 2}-TPR, and H{sub 2} chemisorption. Catalyst acitivity test for Fischer-Tropsch reaction was carried out in a micro reactor at 200 °C and 1 atm, and molar ratio of H{sub 2}/CO = 2:1. The metal oxide particle size increased in the order M/Aco < M/Aca < M/Ahy. The catalysts reducibility also increased according to the order M/Aco < M/Aca < M/Ahy suggesting that the larger metal oxide particles are more reducible. The number of active site was not proportional to the reducibility because during the reduction, larger metal oxide particles were converted into larger metal particles. On the other hand, the number of active sites was inversely proportional to the particle sizes. The number of active site increased in the order M/Ahy < M/Aco < M/Aca. The catalytic activity also increased in the following order M/Ahy < M/Aco < M/Aca. The activity per active site increased according to the order M/Aca < M/Aco < M/Ahy meaning that for M/Ahy, a little increase in active site will lead to a significance increase in catalytic activity. It showed that Ahy has potential for the better support.« less

Applying Organization Theory to Understanding the Adoption and Implementation of Accountable Care Organizations: Commentary.

PubMed

Shortell, Stephen M

2016-12-01

This commentary highights the key arguments and contributions of institutional thoery, transaction cost economics (TCE) theory, high reliability theory, and organizational learning theory to understanding the development and evolution of Accountable Care Organizations (ACOs). Institutional theory and TCE theory primarily emphasize the external influences shaping ACOs while high reliability theory and organizational learning theory underscore the internal fctors influencing ACO perfromance. A framework based on Implementation Science is proposed to conside the multiple perspectives on ACOs and, in particular, their abiity to innovate to achieve desired cost, quality, and population health goals. © The Author(s) 2016.

Silencing of ACO decreases reproduction and energy metabolism in triazophos-treated female brown plant hoppers, Nilaparvata lugens Stål (Hemiptera: Delphacidae).

PubMed

Liu, Zong-Yu; Jiang, Yi-Ping; Li, Lei; You, Lin-Lin; Wu, You; Xu, Bin; Ge, Lin-Quan; Wu, Jin-Cai

2016-03-01

The brown plant hopper (BPH), Nilaparvata lugens Stål (Hemiptera: Delphacidae), is a major pest affecting rice in Asia, and outbreaks of this pest are closely linked to pesticide-induced stimulation of reproduction. Therefore, the BPH is a classic example of a resurgent pest. However, the effects of different genes on the regulation of pesticide-induced reproductive stimulation in the BPH are unclear. In this study, the regulatory effects of acyl-coenzyme A oxidase (ACO) on the reproduction and biochemistry of the BPH were investigated with gene silencing. The number of eggs laid per female by triazophos (TZP)+dsACO BPH females was significantly lower than those of TZP-treated (without ACO silencing) or TZP+GFP females (negative control), with the number of eggs decreasing by 30.8% (from 529.5 to 366.3) and 32.0% (from 540.5 to 366.3), respectively. The preoviposition period, oviposition period, and longevity of the TZP-treated females were also influenced by dsACO treatment. Additionally, the amounts of crude fat, protein, and some fatty acids (oleic acid, palmitic acid, linoleic acid, stearic acid, and myristoleic acid) in TZP+dsACO females were significantly lower than in TZP-treated females. Thus, ACO is one of the key genes regulating the TZP-induced stimulation of reproduction in BPH females. Copyright © 2015 Elsevier Inc. All rights reserved.

COPD assessment test and severity of airflow limitation in patients with asthma, COPD, and asthma-COPD overlap syndrome.

PubMed

Kurashima, Kazuyoshi; Takaku, Yotaro; Ohta, Chie; Takayanagi, Noboru; Yanagisawa, Tsutomu; Sugita, Yutaka

2016-01-01

The COPD assessment test (CAT) consists of eight nonspecific scores of quality of life. The aim of this study was to compare the health-related quality of life and severity of airflow limitation in patients with asthma, COPD, and asthma-COPD overlap syndrome (ACOS) using the CAT. We examined CAT and lung functions in 138 patients with asthma, 99 patients with COPD, 51 patients with ACOS, and 44 patients with chronic cough as a control. The CAT score was recorded in all subjects, and the asthma control test was also administered to patients with asthma and ACOS. The CAT scores were compared, and the relationships between the scores and lung function parameters were analyzed. The total CAT scores and scores for cough, phlegm, and dyspnea were higher in patients with ACOS than in patients with asthma and COPD. The total CAT scores were correlated with the percent predicted forced expiratory volume in 1 second only in patients with COPD. The total CAT scores and dyspnea scores adjusted by the percent predicted forced expiratory volume in 1 second were higher in patients with ACOS than in patients with COPD and asthma. The CAT scores and asthma control test scores were more closely correlated in patients with ACOS than in patients with asthma. Patients with ACOS have higher disease impacts and dyspnea sensation unproportional to the severity of airflow limitation.

42 CFR 425.20 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Identification Number (TIN), and is formed by one or more ACO participants(s) that is(are) defined at § 425.102(a... or together with one or more other ACO participants comprise(s) an ACO, and that is included on the... surgery by the State in which he performs such function or action. (2) A practitioner who is one of the...

42 CFR 425.20 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Identification Number (TIN), and is formed by one or more ACO participants(s) that is(are) defined at § 425.102(a... or together with one or more other ACO participants comprise(s) an ACO, and that is included on the... surgery by the State in which he performs such function or action. (2) A practitioner who is one of the...

Preliminary study of injection transients in the TPS storage ring

NASA Astrophysics Data System (ADS)

Chen, C. H.; Liu, Y. C.; Y Chen, J.; Chiu, M. S.; Tseng, F. H.; Fann, S.; Liang, C. C.; Huang, C. S.; Y Lee, T.; Y Chen, B.; Tsai, H. J.; Luo, G. H.; Kuo, C. C.

2017-07-01

An optimized injection efficiency is related to a perfect match between the pulsed magnetic fields in the storage ring and transfer line extraction in the TPS. However, misalignment errors, hardware output errors and leakage fields are unavoidable. We study the influence of injection transients on the stored TPS beam and discuss solutions to compensate these. Related simulations and measurements will be presented.

Vacuum system for room temperature X-ray lithography source (XLS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schuchman, J.C.

1988-09-30

A prototype room-temperature X-Ray Lithography Source (XLS)was proposed to be built at Brookhaven National Laboratory as part of a technology-transfer- to-American-industry program. The overall machine comprises a full energy linac, a 170 meter long transport line, and a 39 meter circumference storage ring. The scope of this paper will be limited to describing the storage ring vacuum system. (AIP)

Vacuum system for room temperature X-ray lithography source (XLS)

NASA Astrophysics Data System (ADS)

Schuchman, J. C.

1988-09-01

A prototype room-temperature X-Ray Lithography Source (XLS)was proposed to be built at Brookhaven National Laboratory as part of a technology-transfer- to-American-industry program. The overall machine comprises a full energy linac, a 170 meter long transport line, and a 39 meter circumference storage ring. The scope of this paper will be limited to describing the storage ring vacuum system. (AIP)

Generalized Stability Conditions for an Ultra-Low Energy Electrostatic Charged Particle Storage Ring

NASA Astrophysics Data System (ADS)

Sullivan, Michael

A low energy (~50 eV) electrostatic storage ring has been constructed that can store a recirculating bunch of either electrons or ions. The charged particle bunch 'orbits' within an apparatus consisting of four lenses and two hemispherical deflector analysers, arranged in a 'race-track' configuration of length 64.1 cm. A theoretical study, using transfer matrices from charged particle optics for a 'symmetric' configuration of lens potentials, has been previously completed by Hammond et al. [New J. Phys. 11 (2009) 043033]. That approach was capable of predicting modes of storage which appeared as a resonant-like pattern. An 'asymmetric' configuration, new in this work and extending the previous study to apply to a more general case, has been completed and will be presented alongside experimental results. The level of agreement between the theoretical and experimental results is found to be excellent, and the robustness of the matrix formalism has eliminated the need to rely on computer simulation to achieve storage. This asymmetric arrangement of the lenses allows for greater flexibility in the operation of the ring, creating the potential for a more diverse range of applications and potentially aid in the design of future rings. Several spectra for both electrons and positive ions are presented to provide an indication as to how the charged particle bunch evolves as more orbits are completed. The number of counts inevitably decreases as a function of orbit number due to loss mechanisms. Enhanced measurement techniques, as well as the matrix theory, have made storage of the bunch for over a hundred orbits routine, corresponding to over 65 m travelled, and this is observed directly from the spectra. The application of the storage ring as a multi-pass time-of-flight mass spectrometer has been studied. The isotopes of krypton and xenon have been made to completely separate from one another out of a single pulse of ions. This is observed to occur after ~15 orbits of the ring, roughly 10 m of distance. Initial results have indicated that the mass resolution is approximately 5000. Limitations and potential improvements to the mass resolution are presented.

Measurement of Systematic Error Effects for a Sensitive Storage Ring EDM Polarimeter

NASA Astrophysics Data System (ADS)

Imig, Astrid; Stephenson, Edward

2009-10-01

The Storage Ring EDM Collaboration was using the Cooler Synchrotron (COSY) and the EDDA detector at the Forschungszentrum J"ulich to explore systematic errors in very sensitive storage-ring polarization measurements. Polarized deuterons of 235 MeV were used. The analyzer target was a block of 17 mm thick carbon placed close to the beam so that white noise applied to upstream electrostatic plates increases the vertical phase space of the beam, allowing deuterons to strike the front face of the block. For a detector acceptance that covers laboratory angles larger than 9 ^o, the efficiency for particles to scatter into the polarimeter detectors was about 0.1% (all directions) and the vector analyzing power was about 0.2. Measurements were made of the sensitivity of the polarization measurement to beam position and angle. Both vector and tensor asymmetries were measured using beams with both vector and tensor polarization. Effects were seen that depend upon both the beam geometry and the data rate in the detectors.

Feasibility of a ring FEL at low emittance storage rings

NASA Astrophysics Data System (ADS)

Agapov, I.

2015-09-01

A scheme for generating coherent radiation at latest generation low emittance storage rings such as PETRA III at DESY (Balewski et al., 2004 [1]) is proposed. The scheme is based on focusing and subsequent defocusing of the electron beam in the longitudinal phase space at the undulator location. The expected performance characteristics are estimated for radiation in the wavelength range of 500-1500 eV. It is shown that the average brightness is increased by several orders of magnitude compared to spontaneous undulator radiation, which can open new perspectives for photon-hungry soft X-ray spectroscopy techniques.

PEGASYS: A proposed internal target-spectrometer facility for the PEP storage ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Bibber, K.

A proposal for an internal gas-jet target and forward spectrometer for the PEP storage ring is described. The beam structure, allowable luminosity (L=10/sup 33/ cm/sup /minus/2/s/sup /minus/1/ for H/sub 2/, D/sub 2/ decreasing as Z/sup /minus/1.75/ for nuclear targets) and energy (E/sub e/less than or equal to 15 GeV) make the ring ideal for multiparticle coincidence studies in the scaling regime, and where perturbative QCD may be an apt description of some exclusive and semi-inclusive reactions. 17 refs., 5 figs.

Future Synchrotron Light Sources Based on Ultimate Storage Rings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cai, Yunhai; /SLAC

2012-04-09

The main purpose of this talk is to describe how far one might push the state of the art in storage ring design. The talk will start with an overview of the latest developments and advances in the design of synchrotron light sources based on the concept of an 'ultimate' storage ring. The review will establish how bright a ring based light source might be, where the frontier of technological challenges are, and what the limits of accelerator physics are. Emphasis will be given to possible improvements in accelerator design and developments in technology toward the goal of achieving anmore » ultimate storage ring. An ultimate storage ring (USR), defined as an electron ring-based light source having an emittance in both transverse planes at the diffraction limit for the range of X-ray wavelengths of interest for a scientific community, would provide very high brightness photons having high transverse coherence that would extend the capabilities of X-ray imaging and probe techniques beyond today's performance. It would be a cost-effective, high-coherence 4th generation light source, competitive with one based on energy recovery linac (ERL) technology, serving a large number of users studying material, chemical, and biological sciences. Furthermore, because of the experience accumulated over many decades of ring operation, it would have the great advantage of stability and reliability. In this paper we consider the design of an USR having 10-pm-rad emittance. It is a tremendous challenge to design a storage ring having such an extremely low emittance, a factor of 100 smaller than those in existing light sources, especially such that it has adequate dynamic aperture and beam lifetime. In many ultra-low emittance designs, the injection acceptances are not large enough for accumulation of the electron beam, necessitating on-axis injection where stored electron bunches are completely replaced with newly injected ones. Recently, starting with the MAX-IV 7-bend achromatic cell, we have made significant progress with the design of PEP-X, a USR that would inhabit the decommissioned PEP-II tunnel at SLAC. The enlargement of the dynamic aperture is largely a result of the cancellations of the 4th-order resonances in the 3rd-order achromats and the effective use of lattice optimization programs. In this paper, we will show those cancellations of the 4th-order resonances using an analytical approach based on the exponential Lie operators and the Poisson brackets. Wherever possible, our analytical results will be compared with their numerical counterparts. Using the derived formulae, we will construct 4th-order geometric achromats and use them as modules for the lattice of the PEP-X USR, noting that only geometric terms are canceled to the 4th order.« less

Decision-Making on Medical Innovations in a Changing Healthcare Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

PubMed Central

Trosman, Julia R.; Weldon, Christine B.; Douglas, Michael P.; Deverka, Patricia A.; Watkins, John; Phillips, Kathryn A.

2016-01-01

Background New payment and care organization approaches, such as the Accountable Care Organization (ACO), are reshaping accountability and shifting risk, as well as decision-making, from payers to providers, under the Triple Aim of health reform. The Triple Aim calls for improving experience of care, improving health of populations and reducing healthcare costs. In the era of accelerating scientific advancement of personalized medicine and other innovations, it is critical to understand how the transition to the ACO model impacts decision-making on adoption and utilization of innovative technologies. Methods We interviewed representatives from ten private payers and six provider institutions involved in implementing the ACO model (i.e. ACOs) to understand changes, challenges and facilitators of decision-making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. Results We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs’ decision-making in terms of achieving a balance between the components of the Triple Aim – improving care experience, improving population health and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs’ decisions and ACOs’ insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients’ interest in personalized medicine. Conclusions As new payment models evolve, payers, ACOs and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous and transparent approaches to decision-making on medical innovations. PMID:28212967

How "accountable" are accountable care organizations?

PubMed

Addicott, Rachael; Shortell, Stephen M

2014-01-01

The establishment of accountable care organizations (ACOs) in the Affordable Care Act (ACA) was intended to support both cost savings and high-quality care. However, a key challenge will be to ensure that governance and accountability mechanisms are sufficient to support those twin ambitions. This exploratory study considers how recently developed ACOs have established governance structures and accountability mechanisms, particularly focusing on attempts at collaborative accountability and shared governance arrangements. Four case studies of ACOs across the United States were undertaken, with data collected throughout 2012. These involved 34 semistructured interviews with ACO administrative and clinical leaders, observation of nine meetings, and a review of documentary materials from each ACO. We identified very few examples of physicians being held to account as a collective and therefore only limited evidence of collaborative accountability impacting on behavior change. However, ACO leaders do have many mechanisms available to stimulate change across physicians. The challenge is to determine governance structure(s) and accountability mechanisms that facilitate the most effective combination of approaches, measures, incentives, and sanctions to achieve the goals of more accountable care. Accountability structures and processes will need to be tailored to local membership composition, historical evolution, and current stage of development. There are also some common lessons to be drawn. Shared goals and incentives should be reflected through performance criteria. It is important to align measures and thresholds across payers to ensure ACOs are not unnecessarily burdened or compromised by reporting on different and potentially disjointed measures. Finally, emphasis needs to be placed on the importance of credible, transparent data. This exploratory study provides early evidence regarding how ACOs are establishing their governance and accountability arrangements and provides a foundation for future research and theory-building in this area.

Contributions of relational coordination to care management in accountable care organizations: Views of managerial and clinical leaders.

PubMed

Rundall, Thomas G; Wu, Frances M; Lewis, Valerie A; Schoenherr, Karen E; Shortell, Stephen M

2016-01-01

The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the cost of care. An ACO's success in meeting these objectives depends greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency. The purpose of this paper is twofold: (a) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (b) identify the ways these leaders believe the dimensions influenced care management practices in their organization. We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices. ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions - shared knowledge of team members' tasks, mutual respect, and accuracy of communication - were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning. We propose two hypotheses for future research on relational coordination and care management. If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational coordination's influence on care management in their ACO. We suggest a number of means by which ACO leaders could become more aware of relational coordination and its potential effects.

Radiographic Evidence of Sinonasal Inflammation in Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: An Underrecognized Association.

PubMed

Hamada, Satoshi; Tatsumi, Shuji; Kobayashi, Yoshiki; Matsumoto, Hisako; Yasuba, Hirotaka

Sinonasal inflammation on both clinical examinations and imaging significantly impacts both asthma and chronic obstructive pulmonary disease (COPD). The objective of this study was to examine the association between sinonasal inflammation and asthma-COPD overlap syndrome (ACOS). A total of 112 patients with a ratio of forced expiratory volume in 1 s to forced vital capacity of less than 70% were enrolled. COPD, asthma, and ACOS were clinically diagnosed according to the 2014 Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease guidelines. Sinonasal inflammatory condition was evaluated using sinus computed tomography, and its severity was assessed according to the Lund-Mackay staging (LMS) system. Ethmoid sinus-dominant shadow was defined as the presence of greater LMS scores for the anterior and posterior ethmoid sinuses than for the maxillary sinus. COPD, asthma, and ACOS were diagnosed in 55 (49.1%), 39 (34.8%), and 18 patients (16.1%), respectively. The frequency of radiographic evidence of sinonasal inflammation in patients with COPD, asthma, ACOS was 60.0%, 94.9%, and 72.2%, respectively. Patients with ACOS and COPD had only mild radiographic evidence of sinonasal inflammation (LMS score, 1-7), whereas moderate (LMS score, 8-11) and severe (LMS score, ≥12) radiographic evidence of sinonasal inflammation were detected only in patients with asthma. Furthermore, the frequency of ethmoid sinus-dominant shadow was significantly higher in patients with asthma than in those with COPD and ACOS. Radiographic evidence of sinonasal inflammation was a common comorbidity in ACOS. Future studies are required to examine the role of sinonasal inflammation in ACOS. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The Impact Of Medicare ACOs On Improving Integration And Coordination Of Physical And Behavioral Health Care.

PubMed

Fullerton, Catherine A; Henke, Rachel M; Crable, Erika L; Hohlbauch, Andriana; Cummings, Nicholas

2016-07-01

The accountable care organization (ACO) model holds the promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume. One key to managing the total cost of care is improving care coordination for and treatment of people with behavioral health disorders. We examined qualitative data from ninety organizations participating in Medicare ACO demonstration programs from 2012 through 2015 to determine whether and how they focused on behavioral health care. These ACOs had mixed degrees of engagement in improving behavioral health care for their populations. The biggest challenges included a lack of behavioral health care providers, data availability, and sustainable financing models. Nonetheless, we found substantial interest in integrating behavioral health care into primary care across a majority of the ACOs. Project HOPE—The People-to-People Health Foundation, Inc.

Annealing Ant Colony Optimization with Mutation Operator for Solving TSP.

PubMed

Mohsen, Abdulqader M

2016-01-01

Ant Colony Optimization (ACO) has been successfully applied to solve a wide range of combinatorial optimization problems such as minimum spanning tree, traveling salesman problem, and quadratic assignment problem. Basic ACO has drawbacks of trapping into local minimum and low convergence rate. Simulated annealing (SA) and mutation operator have the jumping ability and global convergence; and local search has the ability to speed up the convergence. Therefore, this paper proposed a hybrid ACO algorithm integrating the advantages of ACO, SA, mutation operator, and local search procedure to solve the traveling salesman problem. The core of algorithm is based on the ACO. SA and mutation operator were used to increase the ants population diversity from time to time and the local search was used to exploit the current search area efficiently. The comparative experiments, using 24 TSP instances from TSPLIB, show that the proposed algorithm outperformed some well-known algorithms in the literature in terms of solution quality.

Breast Imaging: A Paradigm for Accountable Care Organizations.

PubMed

Parikh, Jay R; Yang, Wei T

2016-02-01

Accountable care organizations (ACOs) are being promoted by the Centers of Medicare Services as alternative payment models for radiology reimbursement. Because of its clinical orientation, focus on prevention, standardized reporting, quality orientation through mandatory accreditation, and value demonstration through established outcome metrics, breast imaging offers a unique paradigm for the ACO model in radiology. In radiology, breast imaging represents the paradigm for ACOs.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mcwilliams, A. J.; Daugherty, W. L.; Skidmore, T. E.

The 9975 Type B shipping package is used within the DOE complex for shipping special nuclear materials. This package is re-certified annually in accordance with Safety Analysis Report for Packaging (SARP) requirements. The package is also used at the Savannah River Site as part of the long-term storage configuration of special nuclear materials. As such, the packages do not undergo annual recertification during storage, with uncertainty as to how long some of the package components will meet their functional requirements in the storage environment. The packages are currently approved for up to 15 years storage, and work continues to providemore » a technical basis to extend that period. This report describes efforts by the Savannah River National Laboratory (SRNL) to extend the service life estimate of Viton® GLT and GLT-S fluoroelastomer O-rings used in the 9975 shipping package. O-rings of both GLT and GLT-S compositions are undergoing accelerated aging at elevated temperature, and are periodically tested for compression stress relaxation (CSR) behavior. The CSR behavior of O-rings was evaluated at temperatures from 175 to 400 °F. These collective data were used to develop predictive models for extrapolation of CSR behavior to relevant service temperatures (< 156 °F). The predictive model developed from the CSR data conservatively indicates a service life of approximately 37 years for Viton GLT O-rings at the maximum effective service temperature of 156 °F. The estimated service life for Viton GLT-S O-rings is significantly longer.« less

Ant algorithms for discrete optimization.

PubMed

Dorigo, M; Di Caro, G; Gambardella, L M

1999-01-01

This article presents an overview of recent work on ant algorithms, that is, algorithms for discrete optimization that took inspiration from the observation of ant colonies' foraging behavior, and introduces the ant colony optimization (ACO) metaheuristic. In the first part of the article the basic biological findings on real ants are reviewed and their artificial counterparts as well as the ACO metaheuristic are defined. In the second part of the article a number of applications of ACO algorithms to combinatorial optimization and routing in communications networks are described. We conclude with a discussion of related work and of some of the most important aspects of the ACO metaheuristic.

Aconitase couples metabolic regulation to mitochondrial DNA maintenance.

PubMed

Chen, Xin Jie; Wang, Xiaowen; Kaufman, Brett A; Butow, Ronald A

2005-02-04

Mitochondrial DNA (mtDNA) is essential for cells to maintain respiratory competency and is inherited as a protein-DNA complex called the nucleoid. We have identified 22 mtDNA-associated proteins in yeast, among which is mitochondrial aconitase (Aco1p). We show that this Krebs-cycle enzyme is essential for mtDNA maintenance independent of its catalytic activity. Regulation of ACO1 expression by the HAP and retrograde metabolic signaling pathways directly affects mtDNA maintenance. When constitutively expressed, Aco1p can replace the mtDNA packaging function of the high-mobility-group protein Abf2p. Thus, Aco1p may integrate metabolic signals and mtDNA maintenance.

Accountable Care Organizations: how to dress for success.

PubMed

Hayen, Arthur P; van den Berg, Michael J; Meijboom, Bert R; Westert, Gert P

2013-06-01

Accountable Care Organizations (ACOs) need to reconsider their provider configuration and make it capable of managing clinical and financial risk. To that aim, their management must decide which medical procedures are done by the ACO itself, and which are contracted out to market providers. Making this decision requires a balanced treatment of market and firm organization, recognizing that each has properties that can turn into relative strengths. Such a balanced treatment is lacking in the ACO debate. Using the transaction cost theory, we provide such a balanced treatment of market and firm organization, and discuss implications for the design of ACOs and accountable care initiatives in general.

ACO model should encourage efficient care delivery.

PubMed

Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

2015-09-01

The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance. Copyright © 2015 Elsevier Inc. All rights reserved.

The KACST Heavy-Ion Electrostatic Storage Ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Almuqhim, A. A.; Alshammari, S. M.; El Ghazaly, M. O. A.

2011-10-27

A novel Electrostatic Storage Ring (ESR) for beams at energies up to 30keV/q is now being constructed at the National Centre for Mathematics and Physics (NCMP), King Abdul-Aziz City for Science and Technology (KACST). The ring is designed to be the core of a highly flexible experimental platform that will combine a large package of complementary beam techniques for atomic and molecular physics and related fields. The lattice design had to cover the different experimental techniques that the ring will be equipped with, such as e.g. Electron-Ion, Laser-Ion, Ion-Ion or Ion-Neutral beams, in both crossed and merged-beam configurations. The developmentmore » of such an ESR is realized in a staged approach, in which a simple and early-run adaptation of the ring is built first, and then this basic version is upgraded to a higher symmetry of the ultimate version of the ring. Here, we report a general overview of this technical development with a focus on the layout of the first built stage of the ring.« less

Ringing in the new physics: The politics and technology of electron colliders in the United States, 1956--1972

NASA Astrophysics Data System (ADS)

Paris, Elizabeth

The ``November Revolution'' of 1974 and the experiments that followed consolidated the place of the Standard Model in modern particle physics. Much of the evidence on which these conclusions depended was generated by a new type of tool: colliding beam storage rings, which had been considered physically unfeasible twenty years earlier. In 1956 a young experimentalist named Gerry O'Neill dedicated himself to demonstrating that such an apparatus could do useful physics. The storage ring movement encountered numerous obstacles before generating one of the standard machines for high energy research. In fact, it wasn't until 1970 that the U.S. finally broke ground on its first electron-positron collider. Drawing extensively on archival sources and supplementing them with the personal accounts of many of the individuals who took part, Ringing in the New Physics examines this instance of post-World War II techno-science and the new social, political and scientific tensions that characterize it. The motivations are twofold: first, that the chronicle of storage rings may take its place beside mathematical group theory, computer simulations, magnetic spark chambers, and the like as an important contributor to a view of matter and energy which has been the dominant model for the last twenty-five years. In addition, the account provides a case study for the integration of the personal, professional, institutional, and material worlds when examining an episode in the history or sociology of twentieth century science. The story behind the technological development of storage rings holds fascinating insights into the relationship between theory and experiment, collaboration and competition in the physics community, the way scientists obtain funding and their responsibilities to it, and the very nature of what constitutes ``successful'' science in the post- World War II era.

Experimental Evidence for the Los Alamos Proton Storage Ring Beam Instability

NASA Astrophysics Data System (ADS)

Plum, M.; Fitzgerald, D. H.; Macek, R.; Sander, O.; Thiessen, H. A.; Wang, T. S.; Wilkinson, C.

1997-05-01

Although the exact instability mechanism at the Proton Storage Ring (PSR) has not yet been conclusively identified, the evidence gathered to date is consistent with an e-p instability. We have recently acquired new data which shows that clearing electrodes significantly affect the instability threshold. A set of comprehensive measurements is also planned for the first months of 1997. In this paper we will present our latest data.

Fundamentals of Coherent Synchrotron Radiation in Storage Rings

NASA Astrophysics Data System (ADS)

Sannibale, F.; Byrd, J. M.; Loftsdottir, A.; Martin, M. C.; Venturini, M.

2004-05-01

We present the fundamental concepts for producing stable broadband coherent synchrotron radiation (CSR) in the terahertz frequency region in an electron storage ring. The analysis includes distortion of bunch shape from the synchrotron radiation (SR), enhancing higher frequency coherent emission and limits to stable emission due to a microbunching instability excited by the SR. We use these concepts to optimize the performance of a source for CSR emission.

Something old, something new: Why models need a multi-pool representation of storage reserves

NASA Astrophysics Data System (ADS)

Richardson, Andrew; Carbone, Mariah

2015-04-01

We know surprisingly little about processes regulating the allocation of photosynthetic assimilates to growth, storage, and other metabolic functions. Storage of nonstructural carbon (NSC, principally sugars and starch) is critically important for woody plants, because these reserves enable sessile, long-lived organisms to tolerate biotic and abiotic stress, including pests, disturbance, and drought. But, critical questions about the size and turnover of these reserves remain unanswered. Labeling studies have generally shown rapid use of new (labeled) NSC and inferred fast mixing between old and new NSC, both of which suggest quick turnover of storage reserves. However, recent studies have shown that some of the reserves stored in stem and root tissue are not only a decade old, but also still available to support new tissue growth following catastrophic disturbance. We characterized the distribution of NSC in the stemwood, branches, and roots of two temperate trees, and we used the continuous label offered by the radiocarbon (14C) bomb spike to estimate the mean age of NSC in different tissues of two temperate trees. NSC in branches and outermost stemwood growth rings had the 14C signature of the current growing season. However, NSC in older above- and below-ground tissues was enriched in 14C, indicating that it was produced from older assimilates. Radial patterns of 14C in stemwood NSC showed strong mixing of NSC across the youngest growth rings, with limited "mixing in" of younger NSC to older rings. Sugars in the outermost 5 growth rings, accounting for two-thirds of the stemwood pool, had a mean age < 1 y, whereas sugars in older growth rings had a mean age > 5 y. Thus, there is not a single, well-mixed "storage pool," and indeed "young" and "old" storage compounds appear to be physically isolated from each other. We will discuss the implications of these results for improving model representation of NSC storage and consumption by forest trees. We will suggest that there are conceptual similarities between modeling NSC pools and modeling soil C pools. We will propose future directions for modeling NSCs and also identify key questions that still need to be answered with new experimental work.

Optimization of Medication Use at Accountable Care Organizations.

PubMed

Wilks, Chrisanne; Krisle, Erik; Westrich, Kimberly; Lunner, Kristina; Muhlestein, David; Dubois, Robert

2017-10-01

Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use. To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use. This cross-sectional study consisted of a survey and interviews that gathered information on the perceptions of ACO leadership. The survey contained a medication practices inventory (MPI) composed of 38 capabilities across 6 functional domains related to optimizing medication use. ACOs completed self-assessments that included rating each component of the MPI on a scale of 1 to 10. Fisher's exact tests, 2-proportions tests, t-tests, and logistic regression were used to test for associations between ACO scores on the MPI and performance on financial and quality metrics, and on ACO descriptive characteristics. Of the 847 ACOs that were contacted, 49 provided usable survey data. These ACOs rated their own system's ability to manage the quality and costs of optimizing medication use, providing a 64% and 31% affirmative response, respectively. Three ACOs achieved an overall MPI score of 8 or higher, 45 scored between 4 and 7.9, and 1 scored between 0 and 3.9. Using the 3 score groups, the study did not identify a relationship between MPI scores and achievement on financial or quality benchmarks, ACO provider type, member volume, date of ACO creation, or the presence of a pharmacist in a leadership position. Barriers to optimizing medication use relate to reimbursement for pharmacist integration, lack of health information technology interoperability, lack of data, feasibility issues, and physician buy-in. Compared with 2012 data, data on ACOs that participated in this study show that they continue to build effective strategies to optimize medication use. These ACOs struggle with both notification related to prescription use and measurement of the influence optimized medication use has on costs and quality outcomes. Compared with the earlier study, these data find that more ACOs are involving pharmacists directly in care, expanding the use of generics, electronically transmitting prescriptions, identifying gaps in care and potential adverse events, and educating patients on therapeutic alternatives. ACO-level policies that facilitate practices to optimize medication use are needed. Integrating pharmacists into care, giving both pharmacists and physicians access to clinical data, obtaining physician buy-in, and measuring the impact of practices to optimize medication use may improve these practices. This research was sponsored and funded by the National Pharmaceutical Council (NPC), an industry funded health policy research group that is not involved in lobbying or advocacy. Employees of the sponsor contributed to the research questions, determination of the relevance of the research questions, and the research design. Specifically, there was involvement in the survey and interview instruments. They also contributed to some data interpretation and revision of the manuscript. Leavitt Partners was hired by NPC to conduct research for this study and also serves a number of health care clients, including life sciences companies, provider organizations, accountable care organizations, and payers. Westrich and Dubois are employed by the NPC. Wilks, Krisle, Lunner, and Muhlestein are employed by Leavitt Partners and did not receive separate compensation. Study concept and design were contributed by Krisle, Dubois, and Muhlestein, along with Lunner and Westrich. Krisle and Muhlestein collected the data, and data interpretation was performed by Wilks, Krisle, and Muhlestein, along with Dubois and Westrich. The manuscript was written primarily by Wilks, along with Krisle and Muhlestein, and revised by Wilks, Westrich, Lunner, and Krisle. Preliminary versions of this work were presented at the following: National Council for Prescription Drug Programs Educational Summit, November 1, 2016; Academy Health 2016 Annual Research Meeting, June 27, 2016; Accountable Care Learning Collaborative Webinar, June 16, 2016; the 21st Annual PBMI Drug Benefit Conference, February 29, 2016; National Value-Based Payment and Pay for Performance Summit, February 17, 2016; National Accountable Care Congress, November 17, 2015; and American Journal of Managed Care's ACO Emerging Healthcare Delivery Coalition, Fall 2015 Live Meeting, October 15, 2015.

Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program.

PubMed

Schwartz, Aaron L; Chernew, Michael E; Landon, Bruce E; McWilliams, J Michael

2015-11-01

Wasteful practices are widespread in the US health care system. It is unclear if payment models intended to improve health care efficiency, such as the Medicare accountable care organization (ACO) programs, discourage the provision of low-value services. To assess whether the first year of the Medicare Pioneer ACO program was associated with a reduction in use of low-value services. In a difference-in-differences analysis, we compared use of low-value services between Medicare fee-for-service beneficiaries attributed to health care provider groups that entered the Pioneer program (ACO group) and beneficiaries attributed to other health care providers (control group) before (2009-2011) vs after (2012) Pioneer ACO contracts began. Data analysis was conducted from December 1, 2014, to June 27, 2015. Comparisons were adjusted for beneficiaries' sociodemographic and clinical characteristics as well as for geography. We decomposed estimates according to service characteristics (clinical category, price, and sensitivity to patient preferences) and compared estimates between subgroups of ACOs with higher vs lower baseline use of low-value services. Use of, and spending on, 31 services in instances that provide minimal clinical benefit, measured as annual service counts per 100 beneficiaries and price-standardized annual service spending per 100 beneficiaries. During the precontract period, trends in the use of low-value services were similar for the ACO and control groups. The first year of ACO contracts was associated with a differential reduction (95% CI) of 0.8 low-value services per 100 beneficiaries for the ACO group (-1.2 to -0.4; P < .001), corresponding to a 1.9% differential reduction in service quantity (-2.9% to -0.9%) and a 4.5% differential reduction in spending on low-value services (-7.5% to -1.4%; P = .004). Differential reductions were similar for services less sensitive vs more sensitive to patient preferences and for higher- vs lower-priced services. The ACOs with higher than their markets' mean baseline levels of low-value service use experienced greater service reductions (-1.2 services per 100 beneficiaries; -1.7 to -0.7; P < .001) than did ACOs with use below the mean (-0.2 services per 100 beneficiaries, -0.6 to -0.2; P = .41; P = .003 for test of difference between subgroups). During its first year, the Pioneer ACO program was associated with modest reductions in low-value services, with greater reductions for organizations providing more low-value care. Accountable care organization-like risk contracts may be able to discourage use of low-value services even without specifying services to target.

The Potential-Well Distortion Effect and Coherent Instabilities of Electron Bunches in Storage Rings

NASA Astrophysics Data System (ADS)

Korchuganov, V. N.; Smygacheva, A. S.; Fomin, E. A.

2018-05-01

The effect of electromagnetic interaction between electron bunches and the vacuum chamber of a storage ring on the longitudinal motion of bunches is studied. Specifically, the potential-well distortion effect and the so-called coherent instabilities of coupled bunches are considered. An approximate analytical solution for the frequencies of incoherent oscillations of bunches distributed arbitrarily within the ring is obtained for a distorted potential well. A new approach to determining frequencies of coherent oscillations and an approximate analytical relation for estimating the stability of a system of bunches as a function of their distribution in the accelerator orbit are presented.

Cloud computing task scheduling strategy based on differential evolution and ant colony optimization

NASA Astrophysics Data System (ADS)

Ge, Junwei; Cai, Yu; Fang, Yiqiu

2018-05-01

This paper proposes a task scheduling strategy DEACO based on the combination of Differential Evolution (DE) and Ant Colony Optimization (ACO), aiming at the single problem of optimization objective in cloud computing task scheduling, this paper combines the shortest task completion time, cost and load balancing. DEACO uses the solution of the DE to initialize the initial pheromone of ACO, reduces the time of collecting the pheromone in ACO in the early, and improves the pheromone updating rule through the load factor. The proposed algorithm is simulated on cloudsim, and compared with the min-min and ACO. The experimental results show that DEACO is more superior in terms of time, cost, and load.

Yeast aconitase binds and provides metabolically coupled protection to mitochondrial DNA.

PubMed

Chen, Xin Jie; Wang, Xiaowen; Butow, Ronald A

2007-08-21

Aconitase (Aco1p) is a multifunctional protein: It is an enzyme of the tricarboxylic acid cycle. In animal cells, Aco1p also is a cytosolic protein binding to mRNAs to regulate iron metabolism. In yeast, Aco1p was identified as a component of mtDNA nucleoids. Here we show that yeast Aco1p protects mtDNA from excessive accumulation of point mutations and ssDNA breaks and suppresses reductive recombination of mtDNA. Aconitase binds to both ds- and ssDNA, with a preference for GC-containing sequences. Therefore, mitochondria are opportunistic organelles that seize proteins, such as metabolic enzymes, for construction of the nucleoid, an mtDNA maintenance/segregation apparatus.

The conversion of CESR to operate as the Test Accelerator, CesrTA. Part 1: overview

NASA Astrophysics Data System (ADS)

Billing, M. G.

2015-07-01

Cornell's electron/positron storage ring (CESR) was modified over a series of accelerator shutdowns beginning in May 2008, which substantially improves its capability for research and development for particle accelerators. CESR's energy span from 1.8 to 5.6 GeV with both electrons and positrons makes it ideal for the study of a wide spectrum of accelerator physics issues and instrumentation related to present light sources and future lepton damping rings. Additionally a number of these are also relevant for the beam physics of proton accelerators. This paper outlines the motivation, design and conversion of CESR to a test accelerator, CESRTA, enhanced to study such subjects as low emittance tuning methods, electron cloud (EC) effects, intra-beam scattering, fast ion instabilities as well as general improvements to beam instrumentation. While the initial studies of CESRTA focussed on questions related to the International Linear Collider (ILC) damping ring design, CESRTA is a very flexible storage ring, capable of studying a wide range of accelerator physics and instrumentation questions. This paper contains the outline and the basis for a set of papers documenting the reconfiguration of the storage ring and the associated instrumentation required for the studies described above. Further details may be found in these papers.

Theoretical study of hydrogen storage in a truncated triangular pyramid molecule consisting of pyridine and benzene rings bridged by vinylene groups

NASA Astrophysics Data System (ADS)

Ishikawa, Shigeru; Nemoto, Tetsushi; Yamabe, Tokio

2018-06-01

Hydrogen storage in a truncated triangular pyramid molecule C33H21N3, which consists of three pyridine rings and one benzene ring bridged by six vinylene groups, is studied by quantum chemical methods. The molecule is derived by substituting three benzene rings in a truncated tetrahedron hydrocarbon C36H24 with pyridine rings. The optimized molecular structure under C 3v symmetry shows no imaginary vibrational modes at the B3LYP/cc-pVTZ level of theory. The hydrogen storage process is investigated based on the MP2/cc-pVTZ method. Like the structure before substitution, the C33H21N3 molecule has a cavity that stores a hydrogen molecule with a binding energy of - 140 meV. The Langmuir isotherm shows that this cavity can store hydrogen at higher temperatures and lower pressures than usual physisorption materials. The C33H21N3 molecule has a kinetic advantage over the C36H24 molecule because the former molecule has a lower barrier (+ 560 meV) for the hydrogen molecule entering the cavity compared with the latter molecule (+ 730 meV) owing to the lack of hydrogen atoms narrowing the opening.

Electron-cloud updated simulation results for the PSR, and recent results for the SNS

NASA Astrophysics Data System (ADS)

Pivi, M.; Furman, M. A.

2002-05-01

Recent simulation results for the main features of the electron cloud in the storage ring of the Spallation Neutron Source (SNS) at Oak Ridge, and updated results for the Proton Storage Ring (PSR) at Los Alamos are presented in this paper. A refined model for the secondary emission process including the so called true secondary, rediffused and backscattered electrons has recently been included in the electron-cloud code.

BPM Breakdown Potential in the PEP-II B-factory Storage Ring Collider

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weathersby, Stephen; Novokhatski, Alexander; /SLAC

2010-02-10

High current B-Factory BPM designs incorporate a button type electrode which introduces a small gap between the button and the beam chamber. For achievable currents and bunch lengths, simulations indicate that electric potentials can be induced in this gap which are comparable to the breakdown voltage. This study characterizes beam induced voltages in the existing PEP-II storage ring collider BPM as a function of bunch length and beam current.

Multi-objective dynamic aperture optimization for storage rings

DOE PAGES

Li, Yongjun; Yang, Lingyun

2016-11-30

We report an efficient dynamic aperture (DA) optimization approach using multiobjective genetic algorithm (MOGA), which is driven by nonlinear driving terms computation. It was found that having small low order driving terms is a necessary but insufficient condition of having a decent DA. Then direct DA tracking simulation is implemented among the last generation candidates to select the best solutions. The approach was demonstrated successfully in optimizing NSLS-II storage ring DA.

Towards a 4{sup th} generation storage ring at the Canadian Light Source

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dallin, Les; Wurtz, Ward

2016-07-27

Demands from beamline scientists for more brilliant sources of synchrotron radiation have resulted in the emergence of 4{sup th} generation (diffraction-limited) storage rings. The practical development of the multi-bend achromat (MBA) concept by MAX IV lab has spurred many synchrotron light sources around the world to develop similar machines. For existing facilities two options are available: upgrading existing machines or building a new structure. The Canadian Light Source (CLS) has explored both options. For a new low emittance source in the existing CLS tunnel a decrease in electron energy would be required. A machine similar to the ALS upgrade couldmore » be contemplated. To achieve low emittance at our present energy of 2.9 GeV a new storage ring is desirable. Several options have been investigated. These designs use extremely strong focusing magnets to achieve extremely low emittances in compact lattice achromats.« less

Preparing the MAX IV storage rings for timing-based experiments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stråhlman, C., E-mail: Christian.Strahlman@maxlab.lu.se; Olsson, T., E-mail: Teresia.Olsson@maxlab.lu.se; Leemann, S. C.

2016-07-27

Time-resolved experimental techniques are increasingly abundant at storage ring facilities. Recent developments in accelerator technology and beamline instrumentation allow for simultaneous operation of high-intensity and timing-based experiments. The MAX IV facility is a state-of-the-art synchrotron light source in Lund, Sweden, that will come into operation in 2016. As many storage ring facilities are pursuing upgrade programs employing strong-focusing multibend achromats and passive harmonic cavities (HCs) in high-current operation, it is of broad interest to study the accelerator and instrumentation developments required to enable timing-based experiments at such machines. In particular, the use of hybrid filling modes combined with pulse pickingmore » by resonant excitation or pseudo single bunch has shown promising results. These methods can be combined with novel beamline instrumentation, such as choppers and instrument gating. In this paper we discuss how these techniques can be implemented and employed at MAX IV.« less

Upgrading the Digital Electronics of the PEP-II Bunch Current Monitors at the Stanford Linear Accelerator Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kline, Josh; /SLAC

2006-08-28

The testing of the upgrade prototype for the bunch current monitors (BCMs) in the PEP-II storage rings at the Stanford Linear Accelerator Center (SLAC) is the topic of this paper. Bunch current monitors are used to measure the charge in the electron/positron bunches traveling in particle storage rings. The BCMs in the PEP-II storage rings need to be upgraded because components of the current system have failed and are known to be failure prone with age, and several of the integrated chips are no longer produced making repairs difficult if not impossible. The main upgrade is replacing twelve old (1995)more » field programmable gate arrays (FPGAs) with a single Virtex II FPGA. The prototype was tested using computer synthesis tools, a commercial signal generator, and a fast pulse generator.« less

A compact radiation source for digital subtractive angiography

NASA Astrophysics Data System (ADS)

Wiedemann, H.; Baltay, M.; Carr, R.; Hernandez, M.; Lavender, W.

1994-08-01

Beam requirements for 33 keV radiation used in digital subtraction angiography have been established through extended experimentation first at Stanford and later at the National Synchrotron Light Source in Brookhaven. So far research and development of this medical procedure to image coronary blood vessels have been undertaken on large high energy electron storage rings. With progress in this diagnostic procedure, it is interesting to look for an optimum concept for providing a 33 keV radiation source which would fit into the environment of a hospital. A variety of competing effects and technologies to produce 33 keV radiation are available, but none of these processes provides the combination of sufficient photon flux and monochromaticity except for synchrotron radiation from an electron storage ring. The conceptual design of a compact storage ring optimized to fit into a hospital environment and producing sufficient 33 keV radiation for digital subtraction radiography will be discussed.

X-ray nanoprobes and diffraction-limited storage rings: opportunities and challenges of fluorescence tomography of biological specimens

PubMed Central

de Jonge, Martin D.; Ryan, Christopher G.; Jacobsen, Chris J.

2014-01-01

X-ray nanoprobes require coherent illumination to achieve optic-limited resolution, and so will benefit directly from diffraction-limited storage rings. Here, the example of high-resolution X-ray fluorescence tomography is focused on as one of the most voracious demanders of coherent photons, since the detected signal is only a small fraction of the incident flux. Alternative schemes are considered for beam delivery, sample scanning and detectors. One must consider as well the steps before and after the X-ray experiment: sample preparation and examination conditions, and analysis complexity due to minimum dose requirements and self-absorption. By understanding the requirements and opportunities for nanoscale fluorescence tomography, one gains insight into the R&D challenges in optics and instrumentation needed to fully exploit the source advances that diffraction-limited storage rings offer. PMID:25177992

Collective electron driven linac for high energy physics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seeman, J.T.

1983-08-01

A linac design is presented in which an intense ultrarelativistic electron bunch is used to excite fields in a series of cavities and accelerate charged particles. The intense electron bunch is generated in a simple storage ring to have the required transverse and longitudinal dimensions. The bunch is then transferred to the linac. The linac structure can be inexpensively constructed of spacers and washers. The fields in the cells resulting from the bunch passage are calculated using the program BCI. The results show that certain particles within the driving bunch and also trailing particles of any sign charge can bemore » accelerated. With existing electron storage rings, accelerating gradients greater than 16 MV/m are possible. Examples of two accelerators are given: a 30 GeV electron/positron accelerator useful as an injector for a high energy storage ring and 2) a 110 GeV per beam electron-positron collider.« less

Modeling Systematic Error Effects for a Sensitive Storage Ring EDM Polarimeter

NASA Astrophysics Data System (ADS)

Stephenson, Edward; Imig, Astrid

2009-10-01

The Storage Ring EDM Collaboration has obtained a set of measurements detailing the sensitivity of a storage ring polarimeter for deuterons to small geometrical and rate changes. Various schemes, such as the calculation of the cross ratio [1], can cancel effects due to detector acceptance differences and luminosity differences for states of opposite polarization. Such schemes fail at second-order in the errors, becoming sensitive to geometrical changes, polarization magnitude differences between opposite polarization states, and changes to the detector response with changing data rates. An expansion of the polarimeter response in a Taylor series based on small errors about the polarimeter operating point can parametrize such effects, primarily in terms of the logarithmic derivatives of the cross section and analyzing power. A comparison will be made to measurements obtained with the EDDA detector at COSY-J"ulich. [4pt] [1] G.G. Ohlsen and P.W. Keaton, Jr., NIM 109, 41 (1973).

What is asthma-COPD overlap syndrome? Towards a consensus definition from a round table discussion.

PubMed

Sin, Don D; Miravitlles, Marc; Mannino, David M; Soriano, Joan B; Price, David; Celli, Bartolome R; Leung, Janice M; Nakano, Yasutaka; Park, Hye Yun; Wark, Peter A; Wechsler, Michael E

2016-09-01

Patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) have been largely excluded from pivotal therapeutic trials and, as a result, its treatment remains poorly defined and lacking firm evidence. To date, there is no universally accepted definition of ACOS, which has made it difficult to understand its epidemiology or pathophysiology. Despite many uncertainties, there is emerging agreement that some of the key features of ACOS include persistent airflow limitation in symptomatic individuals 40 years of age and older, a well-documented history of asthma in childhood or early adulthood and a significant exposure history to cigarette or biomass smoke. In this perspective, we propose a case definition of ACOS that incorporates these key features in a parsimonious algorithm that may enable clinicians to better diagnose patients with ACOS and most importantly enable researchers to design therapeutic and clinical studies to elucidate its epidemiology and pathophysiology and to ascertain its optimal management strategies. Copyright ©ERS 2016.

Future considerations for clinical dermatology in the setting of 21st century American policy reform: Accountable Care Organizations.

PubMed

Nguyen, Harrison P; Barbieri, John S; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

2017-01-01

An Accountable Care Organization (ACO) is a network of providers that collaborates to manage care and is financially incentivized to realize cost savings while also optimizing standards of care. Since its introduction as part of the 2010 Patient Protection and Affordable Care Act, ACOs have grown to include 16% of Medicare beneficiaries and currently represent Medicare's largest payment initiative. Although ACOs are still in the pilot phase with multiple structural models being assessed, incentives are being introduced to encourage specialist participation, and dermatologists will have the opportunity to influence both the cost savings and quality standard aspects of these organizations. In this article, part of a health care policy series targeted to dermatologists, we review what an ACO is, its relevance to dermatologists, and essential factors to consider when joining and negotiating with an ACO. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Annealing Ant Colony Optimization with Mutation Operator for Solving TSP

PubMed Central

2016-01-01

Ant Colony Optimization (ACO) has been successfully applied to solve a wide range of combinatorial optimization problems such as minimum spanning tree, traveling salesman problem, and quadratic assignment problem. Basic ACO has drawbacks of trapping into local minimum and low convergence rate. Simulated annealing (SA) and mutation operator have the jumping ability and global convergence; and local search has the ability to speed up the convergence. Therefore, this paper proposed a hybrid ACO algorithm integrating the advantages of ACO, SA, mutation operator, and local search procedure to solve the traveling salesman problem. The core of algorithm is based on the ACO. SA and mutation operator were used to increase the ants population diversity from time to time and the local search was used to exploit the current search area efficiently. The comparative experiments, using 24 TSP instances from TSPLIB, show that the proposed algorithm outperformed some well-known algorithms in the literature in terms of solution quality. PMID:27999590

Accountable care organizations: impact on pharmacy.

PubMed

Amara, Shilpa; Adamson, Robert T; Lew, Indu; Slonim, Anthony

2014-03-01

The Patient Protection and Affordable Care Act (PPACA) has considerably transformed the approaches being used to deliver health care in the United States. It was enacted to expand health insurance access, improve funding for health professions education, and reform patient care delivery. The traditional fee-for-service payment system has been criticized for overspending and providing substandard quality of care. The Accountable Care Organization (ACO) was developed as a payment reform mechanism to slow rising health care costs and improve quality. Under this concept, networks of clinicians and hospitals share responsibility for a population of patients and are held accountable for the financial and clinical outcomes. Due to high rates of medication misuse, nonadherence to therapeutic medication regimens, and preventable adverse drug events, pharmacists are in an ideal position to manage drug therapy and reduce health care expenditures; as such, they may be valuable assets to the ACO team. This article discusses the role of the pharmacist in the era of ACOs specifically and health care reform globally. It outlines pharmacy-related quality of care measures, medication therapy management (MTM) programs (which may provide the foundation for pharmacist involvement in ACOs), and pharmacist functions in patient-centered medical homes (through which ACO services may be organized). The article concludes with a description of successful ACO models that have incorporated pharmacists into their programs.

An Institutional Perspective on Accountable Care Organizations.

PubMed

Goodrick, Elizabeth; Reay, Trish

2016-12-01

We employ aspects of institutional theory to explore how Accountable Care Organizations (ACOs) can effectively manage the multiplicity of ideas and pressures within which they are embedded and consequently better serve patients and their communities. More specifically, we draw on the concept of institutional logics to highlight the importance of understanding the conflicting principles upon which ACOs were founded. Based on previous research conducted both inside and outside health care settings, we argue that ACOs can combine attention to these principles (or institutional logics) in different ways; the options fall on a continuum from (a) segregating the effects of multiple logics from each other by compartmentalizing responses to multiple logics to (b) fully hybridizing the different logics. We suggest that the most productive path for ACOs is to situate their approach between the two extremes of "segregating" and "fully hybridizing." This strategic approach allows ACOs to develop effective responses that combine logics without fully integrating them. We identify three ways that ACOs can embrace institutional complexity short of fully hybridizing disparate logics: (1) reinterpreting practices to make them compatible with other logics; (2) engaging in strategies that take advantage of existing synergy between conflicting logics; (3) creating opportunities for people at frontline to develop innovative ways of working that combine multiple logics. © The Author(s) 2016.

Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO.

PubMed

Hsu, John; Price, Mary; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Weil, Eric; Ferris, Timothy G

2017-05-01

Accountable care organizations (ACOs) appear to lower medical spending, but there is little information on how they do so. We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009-14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects. The care management program (the ACO's primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associated with substantial reductions in rates for hospitalizations and both all and nonemergency ED visits, as well as Medicare spending, when compared to preparticipation levels and to rates and spending for a concurrent sample of beneficiaries who were eligible for but had not yet started the program. Rates of ED visits and hospitalizations were reduced by 6 percent and 8 percent, respectively, and Medicare spending was reduced by 6 percent. Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs. Project HOPE—The People-to-People Health Foundation, Inc.

Contributions of Relational Coordination to Care Management in ACOs: Views of Managerial and Clinical Leaders

PubMed Central

Rundall, Thomas G.; Wu, Frances M.; Lewis, Valerie A.; Schoenherr, Karen E.; Shortell, Stephen M.

2017-01-01

Background The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the total cost of care. An ACO’s success in meeting these objectives will depend greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency. Purpose The purpose of this paper is twofold: (1) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (2) identify the ways these leaders believe the dimensions influenced care management practices in their organization. Methodology/Approach We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices. Findings ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions – shared knowledge of team members’ tasks, mutual respect, and accuracy of communication – were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning. Discussion We propose two hypotheses for future research on relational coordination and care management. Practice Implications If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational coordination’s influence on care management in their ACO. We suggest a number of means by which ACO leaders could become more aware of relational coordination and its potential effects. PMID:25978003

Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients.

PubMed

Odler, Balázs; Ivancsó, István; Somogyi, Vivien; Benke, Kálmán; Tamási, Lilla; Gálffy, Gabriella; Szalay, Balázs; Müller, Veronika

2015-01-01

The association between vitamin D and clinical parameters in obstructive lung diseases (OLDs), including COPD and bronchial asthma, was previously investigated. As asthma-COPD overlap syndrome (ACOS) is a new clinical entity, the prevalence of vitamin D levels in ACOS is unknown. Our aim was to assess the levels of circulating vitamin D (25-hydroxyvitamin D [25(OH)D]) in different OLDs, including ACOS patients, and its correlation with clinical parameters. A total of 106 men and women (control, n=21; asthma, n=44; COPD, n=21; and ACOS, n=20) were involved in the study. All patients underwent detailed clinical examinations; disease control and severity was assessed by disease-specific questionnaires (COPD assessment test, asthma control test, and modified Medical Research Council); furthermore, 25(OH)D levels were measured in all patients. The 25(OH)D level was significantly lower in ACOS and COPD groups compared to asthma group (16.86±1.79 ng/mL and 14.27±1.88 ng/mL vs 25.66±1.91 ng/mL). A positive correlation was found between 25(OH)D level and forced expiratory volume in 1 second (r=0.4433; P<0.0001), forced vital capacity (FVC) (r=0.3741; P=0.0004), forced expiratory flow between 25% and 75% of FVC (r=0.4179; P<0.0001), and peak expiratory flow (r=0.4846; P<0.0001) in OLD patient groups. Asthma control test total scores and the 25(OH)D level showed a positive correlation in the ACOS (r=0.4761; P=0.0339) but not in the asthma group. Higher COPD assessment test total scores correlated with decreased 25(OH)D in ACOS (r=-0.4446; P=0.0495); however, this was not observed in the COPD group. Vitamin D deficiency is present in ACOS patients and circulating 25(OH)D level may affect disease control and severity.

Asthma-COPD overlap syndrome (ACOS) vs 'pure' COPD: a distinct phenotype?

PubMed

Caillaud, D; Chanez, P; Escamilla, R; Burgel, P-R; Court-Fortune, I; Nesme-Meyer, P; Deslee, G; Perez, T; Paillasseur, J-L; Pinet, C; Jebrak, G; Roche, N

2017-01-01

Some studies suggest that asthma-COPD overlap syndrome (ACOS) is associated with worse outcomes than chronic obstructive pulmonary disease (COPD). The goal of this study was to further explore the clinical characteristics and survival of patients with ACOS identified in a real-life cohort of patients with COPD. Data from the French COPD cohort 'INITIATIVES BronchoPneumopathie Chronique Obstructive' (n = 998 patients) were analyzed to assess the frequency of ACOS defined as a physician diagnosis of asthma before the age of 40 years and to analyze its impact. Univariate analyses were performed to assess the relationship between ACOS and sociodemographic characteristics, risk factors (smoking, occupational exposure, atopic diseases), symptoms (chronic bronchitis, dyspnea-modified Medical Research Council scale and baseline dyspnea index), quality of life (QoL), mood disorders, exacerbations, comorbidities, lung function, prescribed treatment, and survival. ACOS was diagnosed in 129 patients (13%). In multivariate analyses, ACOS was associated negatively with cumulative smoking (odds ratio [OR]: 0.992; 95% CI 0.984-1.000 per pack-year) and positively with obesity: OR: 1.97 [1.22-3.16], history of atopic disease (hay fever: OR: 5.50 [3.42-9.00] and atopic dermatitis: OR 3.76 [2.14-6.61]), and drug use (LABA + ICS: 1.86 [1.27-2.74], antileukotrienes 4.83 [1.63-14.34], theophylline: 2.46 [1.23-4.91], and oral corticosteroids: [2.99;.1.26-7.08]). No independent association was found with dyspnea, QoL, exacerbations, and mortality. Compared to 'pure' COPD patients, patients with ACOS exhibit lower cumulative smoking, suffer more from obesity and atopic diseases, and use more asthma treatments. Disease severity (dyspnea, QoL, exacerbations, comorbidities) and prognosis (mortality) are not different from 'pure' COPD patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Symplectic orbit and spin tracking code for all-electric storage rings

NASA Astrophysics Data System (ADS)

Talman, Richard M.; Talman, John D.

2015-07-01

Proposed methods for measuring the electric dipole moment (EDM) of the proton use an intense, polarized proton beam stored in an all-electric storage ring "trap." At the "magic" kinetic energy of 232.792 MeV, proton spins are "frozen," for example always parallel to the instantaneous particle momentum. Energy deviation from the magic value causes in-plane precession of the spin relative to the momentum. Any nonzero EDM value will cause out-of-plane precession—measuring this precession is the basis for the EDM determination. A proposed implementation of this measurement shows that a proton EDM value of 10-29e -cm or greater will produce a statistically significant, measurable precession after multiply repeated runs, assuming small beam depolarization during 1000 s runs, with high enough precision to test models of the early universe developed to account for the present day particle/antiparticle population imbalance. This paper describes an accelerator simulation code, eteapot, a new component of the Unified Accelerator Libraries (ual), to be used for long term tracking of particle orbits and spins in electric bend accelerators, in order to simulate EDM storage ring experiments. Though qualitatively much like magnetic rings, the nonconstant particle velocity in electric rings gives them significantly different properties, especially in weak focusing rings. Like the earlier code teapot (for magnetic ring simulation) this code performs exact tracking in an idealized (approximate) lattice rather than the more conventional approach, which is approximate tracking in a more nearly exact lattice. The Bargmann-Michel-Telegdi (BMT) equation describing the evolution of spin vectors through idealized bend elements is also solved exactly—original to this paper. Furthermore the idealization permits the code to be exactly symplectic (with no artificial "symplectification"). Any residual spurious damping or antidamping is sufficiently small to permit reliable tracking for the long times, such as the 1000 s assumed in estimating the achievable EDM precision. This paper documents in detail the theoretical formulation implemented in eteapot. An accompanying paper describes the practical application of the eteapot code in the Universal Accelerator Libraries (ual) environment to "resurrect," or reverse engineer, the "AGS-analog" all-electric ring built at Brookhaven National Laboratory in 1954. Of the (very few) all-electric rings ever commissioned, the AGS-analog ring is the only relativistic one and is the closest to what is needed for measuring proton (or, even more so, electron) EDM's. The companion paper also describes preliminary lattice studies for the planned proton EDM storage rings as well as testing the code for long time orbit and spin tracking.

Instrumentation for the study of low emittance tuning and beam dynamics at CESR

NASA Astrophysics Data System (ADS)

Billing, M. G.; Dobbins, J. A.; Forster, M. J.; Kreinick, D. L.; Meller, R. E.; Peterson, D. P.; Ramirez, G. A.; Rendina, M. C.; Rider, N. T.; Sagan, D. C.; Shanks, J.; Sikora, J. P.; Stedinger, M. G.; Strohman, C. R.; Williams, H. A.; Palmer, M. A.; Holtzapple, R. L.; Flanagan, J.

2017-11-01

The Cornell Electron-positron Storage Ring (CESR) has been converted from a High Energy Physics electron-positron collider to operate as a dedicated synchrotron light source for the Cornell High Energy Synchrotron Source (CHESS) and to conduct accelerator physics research as a test accelerator, capable of studying topics relevant to future damping rings, colliders and light sources. Some of the specific topics that were targeted for the initial phase of operation of the storage ring in this mode for CESR as a Test Accelerator (CesrTA) included 1) tuning techniques to produce low emittance beams, 2) the study of electron cloud development in a storage ring and 3) intra-beam scattering effects. The complete conversion of CESR to CesrTA occurred over a several year period, described elsewhere [1-3]. In addition to instrumentation for the storage ring, which was created for CesrTA, existing instrumentation was modified to facilitate the entire range of investigations to support these studies. Procedures were developed, often requiring coordinated measurements among different instruments [4]. This paper describes the instruments utilized for the study of beam dynamics during the operation of CesrTA. The treatment of these instruments will remain fairly general in this paper as it focusses on an overview of the instruments themselves. Their interaction and inter-relationships during sequences of observations is found in a companion paper describing the associated measurement techniques. More detailed descriptions and detailed operational performance for some of the instrumentation may be found elsewhere and these will be referenced in the related sections of this paper.

Capturing spiral radial growth of conifers using the superellipse to model tree-ring geometric shape

PubMed Central

Shi, Pei-Jian; Huang, Jian-Guo; Hui, Cang; Grissino-Mayer, Henri D.; Tardif, Jacques C.; Zhai, Li-Hong; Wang, Fu-Sheng; Li, Bai-Lian

2015-01-01

Tree-rings are often assumed to approximate a circular shape when estimating forest productivity and carbon dynamics. However, tree rings are rarely, if ever, circular, thereby possibly resulting in under- or over-estimation in forest productivity and carbon sequestration. Given the crucial role played by tree ring data in assessing forest productivity and carbon storage within a context of global change, it is particularly important that mathematical models adequately render cross-sectional area increment derived from tree rings. We modeled the geometric shape of tree rings using the superellipse equation and checked its validation based on the theoretical simulation and six actual cross sections collected from three conifers. We found that the superellipse better describes the geometric shape of tree rings than the circle commonly used. We showed that a spiral growth trend exists on the radial section over time, which might be closely related to spiral grain along the longitudinal axis. The superellipse generally had higher accuracy than the circle in predicting the basal area increment, resulting in an improved estimate for the basal area. The superellipse may allow better assessing forest productivity and carbon storage in terrestrial forest ecosystems. PMID:26528316

Capturing spiral radial growth of conifers using the superellipse to model tree-ring geometric shape.

PubMed

Shi, Pei-Jian; Huang, Jian-Guo; Hui, Cang; Grissino-Mayer, Henri D; Tardif, Jacques C; Zhai, Li-Hong; Wang, Fu-Sheng; Li, Bai-Lian

2015-01-01

Tree-rings are often assumed to approximate a circular shape when estimating forest productivity and carbon dynamics. However, tree rings are rarely, if ever, circular, thereby possibly resulting in under- or over-estimation in forest productivity and carbon sequestration. Given the crucial role played by tree ring data in assessing forest productivity and carbon storage within a context of global change, it is particularly important that mathematical models adequately render cross-sectional area increment derived from tree rings. We modeled the geometric shape of tree rings using the superellipse equation and checked its validation based on the theoretical simulation and six actual cross sections collected from three conifers. We found that the superellipse better describes the geometric shape of tree rings than the circle commonly used. We showed that a spiral growth trend exists on the radial section over time, which might be closely related to spiral grain along the longitudinal axis. The superellipse generally had higher accuracy than the circle in predicting the basal area increment, resulting in an improved estimate for the basal area. The superellipse may allow better assessing forest productivity and carbon storage in terrestrial forest ecosystems.

Betting on change: Tenet deal with Vanguard shows it's primed to try ACO effort, new payment model.

PubMed

Kutscher, Beth

2013-07-01

Tenet Healthcare Corp.'s acquisition of Vanguard Health Systems is a sign the investor-owned chain is willing to take a chance on alternative payment models such as accountable care organizations. There's no certainty that ACOs will deliver the improvements on quality or cost savings, but Vanguard Vice Chairman Keith Pitts, left, says his system's Pioneer ACO in Detroit has already achieved some cost savings.

Care coordination in accountable care organizations: moving beyond structure and incentives.

PubMed

Press, Matthew J; Michelow, Marilyn D; MacPhail, Lucy H

2012-12-01

Accountable care organizations (ACOs) are considered by many to be a key component of healthcare delivery system improvement. One expectation is that the structural elements of the ACO model, including clinical integration and financial accountability, will lead to better coordination of care for patients. But, while structure and incentives may facilitate the delivery of coordinated care, they will not necessarily ensure that care coordination is done well. For that, physicians and other healthcare providers within ACOs must possess and utilize specific skills, particularly in the areas of collaboration, communication, and teamwork. In this article, we present strategies in 3 domains--training, support tools, and organizational culture--that ACOs can implement to foster the development of these skills and support their use in clinical practice.

Susceptibility to false memories in patients with ACoA aneurysm.

PubMed

Borsutzky, Sabine; Fujiwara, Esther; Brand, Matthias; Markowitsch, Hans J

2010-08-01

We examined ACoA patients regarding their susceptibility to a range of false memory phenomena. We targeted provoked confabulation, false recall and false recognition in the Deese-Roediger-McDermott-paradigm (DRM-paradigm) as well as false recognition in a mirror reading task. ACoA patients produced more provoked confabulations and more false recognition in mirror reading than comparison subjects. Conversely, false recall/false recognition in the DRM-paradigm were similar in patients and controls. Whereas the former two indices of false memories were correlated, no relationship was revealed with the DRM-paradigm. Our results suggest that rupture of ACoA aneurysm leads to an increased susceptibility to a subset of false memories types. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Anaerobic co-digestion of municipal food waste and sewage sludge: A comparative life cycle assessment in the context of a waste service provision.

PubMed

Edwards, Joel; Othman, Maazuza; Crossin, Enda; Burn, Stewart

2017-01-01

This study used life cycle assessment to evaluate the environmental impact of anaerobic co-digestion (AcoD) and compared it against the current waste management system in two case study areas. Results indicated AcoD to have less environmental impact for all categories modelled excluding human toxicity, despite the need to collect and pre-treat food waste separately. Uncertainty modelling confirmed that AcoD has a 100% likelihood of a smaller global warming potential, and for acidification, eutrophication and fossil fuel depletion AcoD carried a greater than 85% confidence of inducing a lesser impact than the current waste service. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Optimatization of transient transformation methods to study gene expression in Musa acuminata (AAA group) cultivar Ambon Lumut

NASA Astrophysics Data System (ADS)

Prayuni, Kinasih; Dwivany, Fenny M.

2015-09-01

Banana is classified as a climateric fruit, whose ripening is regulated by ethylene. Ethylene is synthesized from ACC (1-aminocyclopropane-1-carboxylic acid) by ACC oxidase enzyme which is encoded by ACO gene. Controling an important gene expression in ethylene biosynthesis pathway has became a target to delay the ripening process. Therefore in the previous study we have designed a MaACO-RNAi construct to control MaACO gene expression. In this research, we study the effectiveness of different transient transformation methods to deliver the construct. Direct injection, with or no vaccum infiltration methods were used to deliver MaACO-RNAi construct. All of the methods succesfully deliver the construct into banana fruits based on RT-PCR result.

Resonant structure of low-energy H3+ dissociative recombination

NASA Astrophysics Data System (ADS)

Petrignani, Annemieke; Altevogt, Simon; Berg, Max H.; Bing, Dennis; Grieser, Manfred; Hoffmann, Jens; Jordon-Thaden, Brandon; Krantz, Claude; Mendes, Mario B.; Novotný, Oldřich; Novotny, Steffen; Orlov, Dmitry A.; Repnow, Roland; Sorg, Tobias; Stützel, Julia; Wolf, Andreas; Buhr, Henrik; Kreckel, Holger; Kokoouline, Viatcheslav; Greene, Chris H.

2011-03-01

High-resolution dissociative recombination rate coefficients of rotationally cool and hot H3+ in the vibrational ground state have been measured with a 22-pole trap setup and a Penning ion source, respectively, at the ion storage-ring TSR. The experimental results are compared with theoretical calculations to explore the dependence of the rate coefficient on ion temperature and to study the contributions of different symmetries to probe the rich predicted resonance spectrum. The kinetic energy release was investigated by fragment imaging to derive internal temperatures of the stored parent ions under differing experimental conditions. A systematic experimental assessment of heating effects is performed which, together with a survey of other recent storage-ring data, suggests that the present rotationally cool rate-coefficient measurement was performed at 380-130+50 K and that this is the lowest rotational temperature so far realized in storage-ring rate-coefficient measurements on H3+. This partially supports the theoretical suggestion that temperatures higher than assumed in earlier experiments are the main cause for the large gap between the experimental and the theoretical rate coefficients. For the rotationally hot rate-coefficient measurement a temperature of below 3250 K is derived. From these higher-temperature results it is found that increasing the rotational ion temperature in the calculations cannot fully close the gap between the theoretical and the experimental rate coefficients.

Storage Rings in the Sky: Gamma Ray Bursts and Galactic Gravitational Collapse Stored Energy

NASA Astrophysics Data System (ADS)

Greyber, H. D.

2004-05-01

The recent discovery of almost 100% polarization of the prompt gamma ray emission from GRB021206, (1), confirms my 44 year old ``Strong" Magnetic Field" model (SMF) for galactic dynamics. In SMF, Storage Ring particles were accelerated long ago during the original gravitational collapse of the pregalactic/prequasar plasma cloud that is permeated by an almost uniform primordial magnetic field (2,3) The enormous, intense, slender, relativistic, stable, completely coherent Storage Ring stores a very small fraction of the huge galactic gravitational collapse energy in an almost radiationless state, unless disturbed. The concept of an Astrophysical Storage Ring was introduced by me in l961. At first it was to explain galactic structure, but soon it proved useful to explain active galactic nuclei (AGN) and the dynamics of quasar/AGN jets. AGN and galactic morphology, energetics and dynamics vary as the ratio of magnetic energy to rotational energy in the particular object. Gamma ray bursts (GRB) are due simply to a ``rock". i.e. a white dwarf, ordinary star, neutron sstar, asteroid, planet, etc. falling rapidly through the Storage Ring and being almost instantly vaporized into a hot plasma fireball, causing an electromagnetic shower (2) Then the fireball speeds into the huge organized magnetic field surrounding the current ring, thus generating very highly polarized prompt gamma ray emission (as seen in GRB021206) from the synchrotron radiation process. The timing fits the GRB observations nicely. For instance, a ``rock" racing at 1000 kilometers per second across a 20,000 km. path in the beam would produce a twenty second burst. Other times, a target might track across a short chord for a short burst. Space missions have shown that often typical currents in space plasmas are made up of slender filaments. Thus the puzzling less than one millisecond spikes observed in some GRB are simply describing the structure of that particular ring current at that particular time. 1. W. Coburn and S.E. Boggs, Nature, 423, 415, (2003) 2. H. D. Greyber in a book, After the Dark Ages: When Galaxies Were Young, eds. S.S. Holt and E. P. Smith, AIP Conference Proceedings 470, 388-396. (1998) 3. H. D. Greyber in a Space Telescope Science Institute Report: Poster Papers from their 2001 Spring Symposium, ``The Dark Universe: Matter, Energy and Gravity," ed. Mario Livio, published March 2003, (34-39)

Beamline front end for in-vacuum short period undulator at the photon factory storage ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miyauchi, Hiroshi, E-mail: hiroshi.miyauchi@kek.jp; Department of Accelerator Science, School of High Energy Accelerator Science, SOKENDAI; Tahara, Toshihiro, E-mail: ttahara@post.kek.jp

The straight-section upgrade project of the Photon Factory created four new short straight sections capable of housing in-vacuum short period undulators. The first to fourth short period undulators SGU#17, SGU#03, SGU#01 and SGU#15 were installed at the 2.5-GeV Photon Factory storage ring in 2005, 2006, 2009 and 2013, respectively. The beamline front end for SGU#15 is described in this paper.

A storage ring experiment to detect a proton electric dipole moment

DOE PAGES

Anastassopoulos, V.; Andrianov, S.; Baartman, R.; ...

2016-11-29

We describe a new experiment to detect a permanent electric dipole moment of the proton with a sensitivity of 10 $-$29e cm by using polarized “magic” momentum 0.7 GeV/c protons in an all-electric storage ring. Systematic errors relevant to the experiment are discussed and techniques to address them are presented. The measurement is sensitive to new physics beyond the Standard Model at the scale of 3000 TeV.

A storage ring experiment to detect a proton electric dipole moment.

PubMed

Anastassopoulos, V; Andrianov, S; Baartman, R; Baessler, S; Bai, M; Benante, J; Berz, M; Blaskiewicz, M; Bowcock, T; Brown, K; Casey, B; Conte, M; Crnkovic, J D; D'Imperio, N; Fanourakis, G; Fedotov, A; Fierlinger, P; Fischer, W; Gaisser, M O; Giomataris, Y; Grosse-Perdekamp, M; Guidoboni, G; Hacıömeroğlu, S; Hoffstaetter, G; Huang, H; Incagli, M; Ivanov, A; Kawall, D; Kim, Y I; King, B; Koop, I A; Lazarus, D M; Lebedev, V; Lee, M J; Lee, S; Lee, Y H; Lehrach, A; Lenisa, P; Levi Sandri, P; Luccio, A U; Lyapin, A; MacKay, W; Maier, R; Makino, K; Malitsky, N; Marciano, W J; Meng, W; Meot, F; Metodiev, E M; Miceli, L; Moricciani, D; Morse, W M; Nagaitsev, S; Nayak, S K; Orlov, Y F; Ozben, C S; Park, S T; Pesce, A; Petrakou, E; Pile, P; Podobedov, B; Polychronakos, V; Pretz, J; Ptitsyn, V; Ramberg, E; Raparia, D; Rathmann, F; Rescia, S; Roser, T; Kamal Sayed, H; Semertzidis, Y K; Senichev, Y; Sidorin, A; Silenko, A; Simos, N; Stahl, A; Stephenson, E J; Ströher, H; Syphers, M J; Talman, J; Talman, R M; Tishchenko, V; Touramanis, C; Tsoupas, N; Venanzoni, G; Vetter, K; Vlassis, S; Won, E; Zavattini, G; Zelenski, A; Zioutas, K

2016-11-01

A new experiment is described to detect a permanent electric dipole moment of the proton with a sensitivity of 10 -29 e ⋅ cm by using polarized "magic" momentum 0.7 GeV/c protons in an all-electric storage ring. Systematic errors relevant to the experiment are discussed and techniques to address them are presented. The measurement is sensitive to new physics beyond the standard model at the scale of 3000 TeV.

A storage ring experiment to detect a proton electric dipole moment

NASA Astrophysics Data System (ADS)

Anastassopoulos, V.; Andrianov, S.; Baartman, R.; Baessler, S.; Bai, M.; Benante, J.; Berz, M.; Blaskiewicz, M.; Bowcock, T.; Brown, K.; Casey, B.; Conte, M.; Crnkovic, J. D.; D'Imperio, N.; Fanourakis, G.; Fedotov, A.; Fierlinger, P.; Fischer, W.; Gaisser, M. O.; Giomataris, Y.; Grosse-Perdekamp, M.; Guidoboni, G.; Hacıömeroǧlu, S.; Hoffstaetter, G.; Huang, H.; Incagli, M.; Ivanov, A.; Kawall, D.; Kim, Y. I.; King, B.; Koop, I. A.; Lazarus, D. M.; Lebedev, V.; Lee, M. J.; Lee, S.; Lee, Y. H.; Lehrach, A.; Lenisa, P.; Levi Sandri, P.; Luccio, A. U.; Lyapin, A.; MacKay, W.; Maier, R.; Makino, K.; Malitsky, N.; Marciano, W. J.; Meng, W.; Meot, F.; Metodiev, E. M.; Miceli, L.; Moricciani, D.; Morse, W. M.; Nagaitsev, S.; Nayak, S. K.; Orlov, Y. F.; Ozben, C. S.; Park, S. T.; Pesce, A.; Petrakou, E.; Pile, P.; Podobedov, B.; Polychronakos, V.; Pretz, J.; Ptitsyn, V.; Ramberg, E.; Raparia, D.; Rathmann, F.; Rescia, S.; Roser, T.; Kamal Sayed, H.; Semertzidis, Y. K.; Senichev, Y.; Sidorin, A.; Silenko, A.; Simos, N.; Stahl, A.; Stephenson, E. J.; Ströher, H.; Syphers, M. J.; Talman, J.; Talman, R. M.; Tishchenko, V.; Touramanis, C.; Tsoupas, N.; Venanzoni, G.; Vetter, K.; Vlassis, S.; Won, E.; Zavattini, G.; Zelenski, A.; Zioutas, K.

2016-11-01

A new experiment is described to detect a permanent electric dipole moment of the proton with a sensitivity of 10-29 e ṡ cm by using polarized "magic" momentum 0.7 GeV/c protons in an all-electric storage ring. Systematic errors relevant to the experiment are discussed and techniques to address them are presented. The measurement is sensitive to new physics beyond the standard model at the scale of 3000 TeV.

FLSR - The Frankfurt low energy storage ring

NASA Astrophysics Data System (ADS)

Stiebing, K. E.; Alexandrov, V.; Dörner, R.; Enz, S.; Kazarinov, N. Yu.; Kruppi, T.; Schempp, A.; Schmidt Böcking, H.; Völp, M.; Ziel, P.; Dworak, M.; Dilfer, W.

2010-02-01

An electrostatic storage ring for low-energy ions with a design energy of 50 keV is presently being set up at the Institut für Kernphysik der Johann Wolfgang Goethe-Universität Frankfurt am Main, Germany (IKF). This new device will provide a basis for new experiments on the dynamics of ionic and molecular collisions, as well as for high precision and time resolved laser spectroscopy. In this article, the design parameters of this instrument are reported.

The Status of the Taiwan Photon Source

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuo, C. C.; Wang, J. P.; Chen, J. R.

2010-06-23

NSRRC has been operating a 1.5 GeV synchrotron light source, the Taiwan Light Source (TLS), for over 15 years and has established a large user community. For the future development of synchrotron radiation research in Taiwan, a feasibility study report to construct a 3.0 GeV low-emittance storage ring, the Taiwan Photon Source (TPS), was issued in July 2005. The government approval of the TPS project was obtained in December 2007 and the machine will be built at current site of NSRRC. The project has progressed steadily since and reached several major milestones now: the architect firm has finished the sitemore » plan and civil design, the accelerator design has been fixed, and purchase of long-lead items begins its course. The TPS storage ring has a circumference of 518.4 meters with a concentric booster of 496.8 meters. The storage ring adopted a 24-cell double-bend structure with a 1.6 nm-rad natural emittance. There are six 12-m and eighteen 7-m ID straights. For user research, five new beamlines have been selected for the Phase I operations: the micro protein crystallography, the materials sub-micron diffraction, the inelastic soft x-ray scattering, the coherent x-ray scattering, and the nano probe beamlines. The civil construction is getting ready to start. The commissioning of the TPS storage ring is targeted for 2013.« less

Conditioning of BPM pickup signals for operations of the Duke storage ring with a wide range of single-bunch current

NASA Astrophysics Data System (ADS)

Xu, Wei; Li, Jing-Yi; Huang, Sen-Lin; Z. Wu, W.; Hao, H.; P., Wang; K. Wu, Y.

2014-10-01

The Duke storage ring is a dedicated driver for the storage ring based oscillator free-electron lasers (FELs), and the High Intensity Gamma-ray Source (HIGS). It is operated with a beam current ranging from about 1 mA to 100 mA per bunch for various operations and accelerator physics studies. High performance operations of the FEL and γ-ray source require a stable electron beam orbit, which has been realized by the global orbit feedback system. As a critical part of the orbit feedback system, the electron beam position monitors (BPMs) are required to be able to precisely measure the electron beam orbit in a wide range of the single-bunch current. However, the high peak voltage of the BPM pickups associated with high single-bunch current degrades the performance of the BPM electronics, and can potentially damage the BPM electronics. A signal conditioning method using low pass filters is developed to reduce the peak voltage to protect the BPM electronics, and to make the BPMs capable of working with a wide range of single-bunch current. Simulations and electron beam based tests are performed. The results show that the Duke storage ring BPM system is capable of providing precise orbit measurements to ensure highly stable FEL and HIGS operations.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daugherty, W.; Mcwilliams, A.; Skidmore, E.

The 9975 Type B shipping package is used within the DOE complex for shipping special nuclear materials. This package is re-certified annually in accordance with Safety Analysis Report requirements. The package is also used at the Savannah River Site as part of the long-term storage configuration of special nuclear materials. As such, the packages do not undergo annual recertification during storage, with uncertainty as to how long some of the package components will meet their functional requirements in the storage environment. The packages are currently approved for up to 15 years storage, and work continues to provide a technical basismore » to extend that period. This paper describes efforts by the Savannah River National Laboratory (SRNL) to extend the service life estimate of Viton® GLT and GLT-S fluoroelastomer O-rings used in the 9975 shipping package. O-rings of both compositions are undergoing accelerated aging at elevated temperature, and are periodically tested for compression stress relaxation (CSR) behavior and leak performance. The CSR behavior of O-rings was evaluated at temperatures from 79 °C to 177 °C. These collective data were used to develop predictive models for extrapolation of CSR behavior to relevant service temperatures (< 75 °C). O-rings were also aged in Primary Containment Vessel (PCV) fixtures at temperatures ranging from 79 °C to 232 °C. The fixtures are helium leak tested periodically to determine if they remain leak-tight. The PCV fixture tests demonstrate that the 9975 O-rings will remain leak-tight at temperatures up to 149 °C for 3 years or more, and no leak failures have been observed with up to 8 years aging at 93 °C. Significantly longer periods of leak-tight service are expected at the lower temperatures actually experienced in the storage environment. The predictive model developed from the CSR data conservatively indicates a service life of more than 20 years at the bounding temperature of 75 °C. Although the relationship between CSR behavior and leak-tight performance has not been established for this design, the CSR predictions for this O-ring are conservative relative to leak-tight performance to date.« less

Design of 3 GeV booster ring lattice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Etisken, O., E-mail: ozgur.etisken@cern.ch; Ciftci, A. K., E-mail: abbas.kenan.ciftci@cern.ch

2016-03-25

The aim of this study is to design of a 3 GeV booster ring for the 3 GeV storage ring. Electrons are needed to be accelerated to 3.0 GeV from 0.15 GeV energy. In this frame, we studied on two options for booster ring; a compact booster and the booster that shares the same tunnel with the storage ring. The lattice type has been chosen FODO for both options, lattice parameters are calculated, sextupole magnets are used to decrease dynamic aperture problem and dynamic aperture calculations are also made with considering of the necessary conditions. After designing and calculating ofmore » the parameters, these designs have been compared with each other. In addition to this comparison, these booster design parameters have been compared with some world centers design parameters and the reliability of the booster design is seen. Beam optics, OPA and Elegant simulation programs have been used in the study calculations.« less

Growth, yield and quality attributes of a tropical potato variety (Solanum tuberosum L. cv Kufri chandramukhi) under ambient and elevated carbon dioxide and ozone and their interactions.

PubMed

Kumari, Sumita; Agrawal, Madhoolika

2014-03-01

The present study was designed to study the growth and yield responses of a tropical potato variety (Solanum tuberosum L. cv. Kufri chandramukhi) to different levels of carbon dioxide (382 and 570ppm) and ozone (50 and 70ppb) in combinations using open top chambers (OTCs). Plants were exposed to three ozone levels in combination with ambient CO2 and two ozone levels at elevated CO2. Significant increments in leaf area and total biomass were observed under elevated CO2 in combination with ambient O3 (ECO2+AO3) and elevated O3 (ECO2+EO3), compared to the plants grown under ambient concentrations (ACO2+AO3). Yield measured as fresh weight of potato also increased significantly under ECO2+AO3 and ECO2+EO3. Yield, however, reduced under ambient (ACO2+AO3) and elevated ozone (ACO2+EO3) compared to ACO2 (filtered chamber). Number, fresh and dry weights of tubers of size 35-50mm and>50mm used for direct consumption and industrial purposes, respectively increased maximally under ECO2+AO3. Ambient as well as elevated levels of O3 negatively affected the growth parameters and yield mainly due to reductions in number and weight of tubers of sizes >35mm. The quality of potato tubers was also modified under different treatments. Starch content increased and K, Zn and Fe concentrations decreased under ECO2+AO3 and ECO2+EO3 compared to ACO2+AO3. Starch content reduced under ACO2+AO3 and ACO2+EO3 treatments compared to ACO2. These results clearly suggest that elevated CO2 has provided complete protection to ambient O3 as the potato yield was higher under ECO2+AO3 compared to ACO2. However, ambient CO2 is not enough to protect the plants under ambient O3 levels. Elevated CO2 also provided protection against elevated O3 by improving the yield. Quality of tubers is modified by both CO2 and O3, which have serious implications on human health at present and in future. Copyright © 2013 Elsevier Inc. All rights reserved.

A Direct Experience in a New Accountable Care Organization: Results, Challenges, and the Role of the Neurosurgeon.

PubMed

Kim, Dong H; Lloyd, Christopher; Fernandez, Douglas K; Spielman, Amanda; Bradshaw, David

2017-04-01

The passage of the Affordable Care Act saw the creation of Accountable Care Organizations (ACOs), a new approach to healthcare delivery moving from fee-for-service toward population health. This paper presents a case study of the Memorial Hermann ACO (MHACO), launched in response to the Medicare Shared Savings Program, with goals to align physician and hospital incentives, practice evidence-based medicine, develop care coordination, and increase efficiency. Building blocks included an affiliated primary care network, a clinical integration program (involving shared electronic medical record platforms and quality data reporting), and significant investments in information technology. Presented is the approach taken to form MHACO; the management structure, technology developed, and a 2-year experience. Incorporated in July 2012, the MHACO involved 22 000 Medicare patients. In 2015, Centers for Medicare and Medicaid Services released data showing a composite quality score between 80 and 85 (from a maximum 100) and nearly $53 million in total savings (or 11% of expected expenditure), making MHACO one of the most successful nationally.1 In fewer than 5 years, almost 500 ACOs have developed, and by some estimates, a quarter of Medicare patients are currently enrolled in an ACO. Although ACOs to date have focused on primary care, the future will increasingly involve specialists. At Memorial Hermann, neurosurgeons took an early role in forming collaborative partnerships with the hospital, and started programs that served as precursors to the ACO model. This paper ends with an overview of ACO development, likely changes going forward, and a discussion of the role of specialists in general, and of neurosurgeons in particular. Copyright © 2016 by the Congress of Neurological Surgeons.

The development and psychometric validation of an instrument to evaluate nurses' attitudes towards communication with the patient (ACO).

PubMed

Giménez-Espert, María Del Carmen; Prado-Gascó, Vicente Javier

2018-05-01

Patient communication is a key skill for nurses involved in clinical care. Its measurement is a complex phenomenon that can be addressed through attitude evaluation. To develop and psychometrically test a measure of nurses' attitudes towards communication with patients (ACO), to study the relationship between these dimensions, and to analyse nursing attitudes. To develop and psychometrically test the ACO questionnaire. All hospitals in the province of Valencia were invited by e-mail to distribute the ACO instrument. Ten hospitals took part in the study. The study population was composed of a convenience sample of 400 hospital nurses on general or special services. The inclusion criteria were nurses at the selected centres who had previously provided an informed consent to participate. A literature review and expert consultation (N = 10) was used to develop the content of the questionnaire. The 62-item version of the instrument was applied to a convenience sample of 400 nurses between May 2015 and March 2016. Factor structure was evaluated with exploratory and confirmatory factor analysis (EFA, CFA), and reliability was evaluated with Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE). The final instrument (ACO), composed of 25 items grouped into three attitude dimensions (cognitive, affective and behavioural), had good psychometric properties. In the study sample, nurses had a favourable attitude towards communication. The cognitive and affective dimensions of the ACO should be able to predict the behaviour dimension. The ACO is useful for evaluating current clinical practices, identifying educational needs and assessing the effectiveness of communication training or other interventions intended to improve communication. Copyright © 2018 Elsevier Ltd. All rights reserved.

Sagittal-lung CT measurements in the evaluation of asthma-COPD overlap syndrome: a distinctive phenotype from COPD alone.

PubMed

Qu, Yanjuan; Cao, Yiyuan; Liao, Meiyan; Lu, Zhiyan

2017-07-01

This study aimed at investigating the capability of sagittal-lung computed tomography (CT) measurements in differentiating chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS). Clinical and high-resolution CT of 229 patients including 123 pure COPD patients and 106 ACOS patients were included. Sagittal-lung CT measurements in terms of bilateral lung height (LH), anterior-posterior lung diameter (APLD), diaphragm height (DH), and anterior sterno-diaphragmatic angle (ASDA), as well as inter-pulmonary septum length (IPSL) on axial images were measured both before and after bronchodilator (BD) administration. Comparisons of clinical characteristics and CT measurements between patient groups were performed. All pre-BD quantitative sagittal features measuring diaphragm flattening and hyperinflation were not significantly different between patients with COPD and patients with ACOS (P values all >0.05). Following BD administration, the ACOS patients exhibited lower left LH, bilateral APLD, and bilateral ASDA, but higher right DH, compared to pure COPD patients (P values all <0.05). Right LH, left DH and IPSL were not significantly different between patient groups. Besides, variations of all sagittal-lung CT measurements were significantly larger in patients with ACOS than in patients with pure COPD (P values all <0.001) and showed high performance in differentiating these two kinds of patient, with diagnostic sensitivities ranging from 76.4 to 97.2%, specificities ranging from 86.2 to 100.0%, and accuracies ranging from 80.9 to 90.7%. Sagittal-lung CT measurements allow for differentiating patients with ACOS from those with pure COPD. The ACOS patients had larger post-BD variations of sagittal-lung CT measurements than patients with pure COPD.

Physician practice participation in accountable care organizations: the emergence of the unicorn.

PubMed

Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R

2014-10-01

To provide the first nationally based information on physician practice involvement in ACOs. Primary data from the third National Survey of Physician Organizations (January 2012-May 2013). We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. © Health Research and Educational Trust.

RNA interference of 1-aminocyclopropane-1-carboxylic acid oxidase (ACO1 and ACO2) genes expression prolongs the shelf life of Eksotika (Carica papaya L.) papaya fruit.

PubMed

Sekeli, Rogayah; Abdullah, Janna Ong; Namasivayam, Parameswari; Muda, Pauziah; Abu Bakar, Umi Kalsom; Yeong, Wee Chien; Pillai, Vilasini

2014-06-19

The purpose of this study was to evaluate the effectiveness of using RNA interference in down regulating the expression of 1-aminocyclopropane-1-carboxylic acid oxidase gene in Eksotika papaya. One-month old embryogenic calli were separately transformed with Agrobacterium strain LBA 4404 harbouring the three different RNAi pOpOff2 constructs bearing the 1-aminocyclopropane-1-carboxylic acid oxidase gene. A total of 176 putative transformed lines were produced from 15,000 calli transformed, selected, then regenerated on medium supplemented with kanamycin. Integration and expression of the targeted gene in putatively transformed lines were verified by PCR and real-time RT-PCR. Confined field evaluation of a total of 31 putative transgenic lines planted showed a knockdown expression of the targeted ACO1 and ACO2 genes in 13 lines, which required more than 8 days to achieve the full yellow colour (Index 6). Fruits harvested from lines pRNAiACO2 L2-9 and pRNAiACO1 L2 exhibited about 20 and 14 days extended post-harvest shelf life to reach Index 6, respectively. The total soluble solids contents of the fruits ranged from 11 to 14° Brix, a range similar to fruits from non-transformed, wild type seed-derived plants.

Implementing Accountable Care Organizations: Lessons From a Qualitative Analysis of Four Private Sector Organizations.

PubMed

Walker, Daniel M; Hefner, Jennifer L; Sova, Lindsey N; Hilligoss, Brian; Song, Paula H; McAlearney, Ann Scheck

Accountable care organizations (ACOs) are emerging across the healthcare marketplace and now include Medicare, Medicaid, and private sector payers covering more than 24 million lives. However, little is known about the process of organizational change required to achieve cost savings and quality improvements from the ACO model. This study applies the complex innovation implementation framework to understand the challenges and facilitators associated with the ACO implementation process. We conducted four case studies of private sector ACOs, selected to achieve variation in terms of geography and organizational maturity. Across sites, we used semistructured interviews with 68 key informants to elicit information regarding ACO implementation. Our analysis found challenges and facilitators across all domains in the conceptual framework. Notably, our findings deviated from the framework in two ways. First, findings from the financial resource availability domain revealed both financial and nonfinancial (i.e., labor) resources that contributed to implementation effectiveness. Second, a new domain, patient engagement, emerged as an important factor in implementation effectiveness. We present these deviations in an adapted framework. As the ACO model proliferates, these findings can support implementation efforts, and they highlight the importance of focusing on patients throughout the process. Importantly, this study extends the complex innovation implementation framework to incorporate consumers into the implementation framework, making it more patient centered and aiding future efforts.

Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey

PubMed Central

D’Aunno, Thomas; Friedmann, Peter D.; Chen, Qixuan; Wilson, Donna M.

2016-01-01

To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation’s fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors’ perceptions of market competition, organizational ownership, and geographic location are significantly related to SATinvolvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. PMID:26124307

Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey.

PubMed

D'Aunno, Thomas; Friedmann, Peter D; Chen, Qixuan; Wilson, Donna M

2015-08-01

To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. Copyright © 2015 by Duke University Press.

Intra-Beam Scattering, Impedance, and Instabilities in Ultimate Storage Rings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bane, Karl; /SLAC

We have investigated collective effects in an ultimate storage ring, i.e. one with diffraction limited emittances in both planes, using PEP-X as an example. In an ultimate ring intra-beam scattering (IBS) sets the limit of current that can be stored. In PEP-X, a 4.5 GeV ring running round beams at 200 mA in 3300 bunches, IBS doubles the emittances to 11.5 pm at the design current. The Touschek lifetime is 11 hours. Impedance driven collective effects tend not to be important since the beam current is relatively low. We have investigated collective effects in PEP-X, an ultimate storage ring, i.e.more » one with diffraction limited emittances (at one angstrom wavelength) in both planes. In an ultimate ring intra-beam scattering (IBS) sets the limit of current that can be stored. In PEP-X, IBS doubles the emittances to 11.5 pm at the design current of 200 mA, assuming round beams. The Touschek lifetime is quite large in PEP-X, 11.6 hours, and - near the operating point - increases with decreasing emittance. It is, however, a very sensitive function of momentum acceptance. In an ultimate ring like PEP-X impedance driven collective effects tend not to be important since the beam current is relatively low. Before ultimate PEP-X can be realized, the question of how to run a machine with round beams needs serious study. For example, in this report we assumed that the vertical emittance is coupling dominated. It may turn out that using vertical dispersion is a preferable way to generate round beams. The choice will affect IBS and the Touschek effect.« less

Properties of the electron cloud in a high-energy positron and electron storage ring

DOE PAGES

Harkay, K. C.; Rosenberg, R. A.

2003-03-20

Low-energy, background electrons are ubiquitous in high-energy particle accelerators. Under certain conditions, interactions between this electron cloud and the high-energy beam can give rise to numerous effects that can seriously degrade the accelerator performance. These effects range from vacuum degradation to collective beam instabilities and emittance blowup. Although electron-cloud effects were first observed two decades ago in a few proton storage rings, they have in recent years been widely observed and intensely studied in positron and proton rings. Electron-cloud diagnostics developed at the Advanced Photon Source enabled for the first time detailed, direct characterization of the electron-cloud properties in amore » positron and electron storage ring. From in situ measurements of the electron flux and energy distribution at the vacuum chamber wall, electron-cloud production mechanisms and details of the beam-cloud interaction can be inferred. A significant longitudinal variation of the electron cloud is also observed, due primarily to geometrical details of the vacuum chamber. Furthermore, such experimental data can be used to provide realistic limits on key input parameters in modeling efforts, leading ultimately to greater confidence in predicting electron-cloud effects in future accelerators.« less

How the center for Medicare and Medicaid innovation should test accountable care organizations.

PubMed

Shortell, Stephen M; Casalino, Lawrence P; Fisher, Elliott S

2010-07-01

The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers in ACOs based on their specific circumstances, such as the degree to which they are or are not fully integrated systems. Further, we propose that the CMS assume responsibility for ACO provisions and develop an ordered system for learning how to create and sustain ACOs. Key steps would include setting specific performance goals, developing skills and tools that facilitate change, establishing measurement and accountability mechanisms, and supporting leadership development.

Status of NSLS-II Storage Ring Vacuum Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Doom,L.; Hseuh,H.; Ferreira, M.

2009-05-04

National Synchrotron Light Source II (NSLS-II), being constructed at Brookhaven National Laboratory, is a 3-GeV, high-flux and high- brightness synchrotron radiation facility with a nominal current of 500 mA. The storage ring vacuum system will have extruded aluminium chambers with ante-chamber for photon fans and distributed NEG strip pumping. Discrete photon absorbers will be used to intercept the un-used bending magnet radiation. In-situ bakeout will be implemented to achieve fast conditioning during initial commissioning and after interventions.

Saw-tooth instability in storage rings: simulations and dynamical model

NASA Astrophysics Data System (ADS)

Migliorati, M.; Palumbo, L.; Dattoli, G.; Mezi, L.

1999-11-01

The saw-tooth instability in storage rings is studied by means of a time-domain simulation code which takes into account the self-induced wake fields. The results are compared with those from a dynamical heuristic model exploiting two coupled non-linear differential equations, accounting for the time behavior of the instability growth rate and for the anomalous growth of the energy spread. This model is shown to reproduce the characteristic features of the instability in a fairly satisfactory way.

A storage ring experiment to detect a proton electric dipole moment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anastassopoulos, V.; Andrianov, S.; Baartman, R.

2016-11-01

A new experiment is described to detect a permanent electric dipole moment of the proton with a sensitivity ofmore » $$10^{-29}e\\cdot$$cm by using polarized "magic" momentum $0.7$~GeV/c protons in an all-electric storage ring. Systematic errors relevant to the experiment are discussed and techniques to address them are presented. The measurement is sensitive to new physics beyond the Standard Model at the scale of 3000~TeV.« less

Storage rings for spin-polarized hydrogen

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thompson, D.; Lovelace, R.V.E.; Lee, D.

1989-11-01

A strong-focusing storage ring is proposed for the long-term magnetic confinement of a collisional gas of neutral spin-polarized hydrogen atoms in the Za{l arrow} and Zb{l arrow} hyperfine states. The trap uses the interaction of the magnetic moments of the gas atoms with a static magnetic field. Laser cooling and evaporative cooling can be utilized to enhance the confinement and to offset the influence of viscous heating. An important application of the trap is to the attainment of Bose--Einstein condensation.

Photoswitchable Dihydroazulene Macrocycles for Solar Energy Storage: The Effects of Ring Strain.

PubMed

Vlasceanu, Alexandru; Frandsen, Benjamin N; Skov, Anders B; Hansen, Anne Schou; Rasmussen, Mads Georg; Kjaergaard, Henrik G; Mikkelsen, Kurt V; Nielsen, Mogens Brøndsted

2017-10-06

Efficient energy storage and release are two major challenges of solar energy harvesting technologies. The development of molecular solar thermal systems presents one approach to address these issues by tuning the isomerization reactions of photo/thermoswitches. Here we show that the incorporation of photoswitches into macrocyclic structures is a particularly attractive solution for increasing the storage time. We present the synthesis and properties of a series of macrocycles incorporating two dihydroazulene (DHA) photoswitching subunits, bridged by linkers of varying chain length. Independent of ring size, all macrocycles exhibit stepwise, light-induced, ring-opening reactions (DHA-DHA to DHA-VHF to VHF-VHF; VHF = vinylheptafulvene) with the first DHA undergoing isomerization with a similar efficiency as the uncyclized parent system while the second (DHA-VHF to VHF-VHF) is significantly slower. The energy-releasing, VHF-to-DHA, ring closures also occur in a stepwise manner and are systematically found to proceed slower in the more strained (smaller) cycles, but in all cases with a remarkably slow conversion of the second VHF to DHA. We managed to increase the half-life of the second VHF-to-DHA conversion from 65 to 202 h at room temperature by simply decreasing the ring size. A computational study reveals the smallest macrocycle to have the most energetic VHF-VHF state and hence highest energy density.

Nitrile/Buna N Material Failure Assessment for an O-Ring used on the Gaseous Hydrogen Flow Control Valve (FCV) of the Space Shuttle Main Engine

NASA Technical Reports Server (NTRS)

Wingard, Doug

2006-01-01

After the rollout of Space Shuttle Discovery in April 2005 in preparation for return-to-flight, there was a failure of the Orbiter (OV-103) helium signature leak test in the gaseous hydrogen (GH2) system. Leakage was attributed to the Flow Control Valve (FCV) in Main Engine 3. The FCV determined to be the source of the leak for OV-103 is designated as LV-58. The nitrile/Buna N rubber O-ring seal was removed from LV-58, and failure analysis indicated radial cracks providing leak paths in one quadrant. Cracks were eventually found in 6 of 9 FCV O-rings among the three Shuttle Orbiters, though none were as severe as those for LV-58, OV-103. Testing by EM10 at MSFC on all 9 FCV O- rings included: laser dimensional, Shore A hardness and properties from a dynamic mechanical analyzer (DMA) and an Instron tensile machine. The following test data was obtained on the cracked quadrant of the LV-58, OV-103 O-ring: (1) the estimated compression set was only 9.5%, compared to none for the rest of the O-ring; (2) Shore A hardness for the O.D. was higher by almost 4 durometer points than for the rest of the O-ring; and (3) DMA data showed that the storage/elastic modulus E was almost 25% lower than for the rest of the O-ring. Of the 8 FCV O-rings tested on an Instron, 4 yielded tensile strengths that were below the MIL spec requirement of 1350 psi-a likely influence of rubber cracking. Comparisons were made between values of modulus determined by DNA (elastic) and Instron (Young s). Each nitrile/Buna N O-ring used in the FCV conforms to the MIL-P-25732C specification. A number of such O-rings taken from shelf storage at MSFC and Kennedy Space Center (KSC) were used to generate a reference curve of DMA glass transition temperature (Tg) vs. shelf storage time ranging from 8 to 26 years. A similar reference curve of TGA onset temperature (of rubber weight loss) vs. shelf storage time was also generated. The DMA and TGA data for the used FCV O-rings were compared to the reference curves. Correlations were also made between the DMA modulus (at 22 C) and Shore A hardness for all 9 of the FCV O-rings used among the three Shuttle Orbiters. The radial cracking in the FCV O-rings was determined to be due to ozone attack, as nitrile/Buna N rubber is susceptible to such attack. Nitrile/Buna N material under MIL-P25732C should be used in a hydraulic fluid environment to help protect it from cracking. However, the FCV O-rings were used in an air only environment. The FCV design has as much as a 9-mil gap that allows the O.D. of the O-ring to be directly exposed to ozone, pressurized air and some elevated temperatures, accelerating the weathering process that leads to O-ring cracking. Space Shuttle flights will likely not continue past 2010. Therefore, Shuttle management decided to continue using the nitrile/Buna N material for the FCVs, but have each O-ring replaced after 3 years to minimize any chances for crack initiation.

Flexible matrix composite laminated disk/ring flywheel

NASA Technical Reports Server (NTRS)

Gupta, B. P.; Hannibal, A. J.

1984-01-01

An energy storage flywheel consisting of a quasi-isotropic composite disk overwrapped by a circumferentially wound ring made of carbon fiber and a elastometric matrix is proposed. Through analysis it was demonstrated that with an elastomeric matrix to relieve the radial stresses, a laminated disk/ring flywheel can be designed to store a least 80.3 Wh/kg or about 68% more than previous disk/ring designs. at the same time the simple construction is preserved.

Electric dipole moment planning with a resurrected BNL Alternating Gradient Synchrotron electron analog ring

NASA Astrophysics Data System (ADS)

Talman, Richard M.; Talman, John D.

2015-07-01

There has been much recent interest in directly measuring the electric dipole moments (EDM) of the proton and the electron, because of their possible importance in the present day observed matter/antimatter imbalance in the Universe. Such a measurement will require storing a polarized beam of "frozen spin" particles, 15 MeV electrons or 230 MeV protons, in an all-electric storage ring. Only one such relativistic electric accelerator has ever been built—the 10 MeV "electron analog" ring at Brookhaven National Laboratory in 1954; it can also be referred to as the "AGS analog" ring to make clear it was a prototype for the Alternating Gradient Synchrotron (AGS) proton ring under construction at that time at BNL. (Its purpose was to investigate nonlinear resonances as well as passage through "transition" with the newly invented alternating gradient proton ring design.) By chance this electron ring, long since dismantled and its engineering drawings disappeared, would have been appropriate both for measuring the electron EDM and to serve as an inexpensive prototype for the arguably more promising, but 10 times more expensive, proton EDM measurement. Today it is cheaper yet to "resurrect" the electron analog ring by simulating its performance computationally. This is one purpose for the present paper. Most existing accelerator simulation codes cannot be used for this purpose because they implicitly assume magnetic bending. The new ual/eteapot code, described in detail in an accompanying paper, has been developed for modeling storage ring performance, including spin evolution, in electric rings. Illustrating its use, comparing its predictions with the old observations, and describing new expectations concerning spin evolution and code performance, are other goals of the paper. To set up some of these calculations has required a kind of "archeological physics" to reconstitute the detailed electron analog lattice design from a 1991 retrospective report by Plotkin as well as unpublished notes of Courant describing machine studies performed in 1954-1955. This paper describes the practical application of the eteapot code and provides sample results, with emphasis on emulating lattice optics in the AGS analog ring for comparison with the historical machine studies and to predict the electron spin evolution they would have measured if they had polarized electrons and electron polarimetry. Of greater present day interest is the performance to be expected for a proton storage ring experiment. To exhibit the eteapot code performance and confirm its symplecticity, results are also given for 30 million turn proton spin tracking in an all-electric lattice that would be appropriate for a present day measurement of the proton EDM. The accompanying paper "Symplectic orbit and spin tracking code for all-electric storage rings" documents in detail the theoretical formulation implemented in eteapot, which is a new module in the Unified Accelerator Libraries (ual) environment.

Optical sensing of hydrogen sulphate using rhodamine 6G hydrazide from aqueous medium

NASA Astrophysics Data System (ADS)

Upadhyay, Yachana; Bothra, Shilpa; Kumar, Rajender; Choi, Heung-Jin; Sahoo, Suban K.

2017-06-01

This communication reports the application of rhodamine 6G hydrazide (L) for the selective colorimetric and turn-on fluorescent sensing of hydrogen sulphate ions from aqueous medium. The ring opening of the colourless spirocyclic form of L was selectively triggered in the presence of HSO4- among the other tested anions (F-, Cl-, Br-, I-, AcO-, H2PO4-, NO3-, ClO4-, CN-, HO-, AsO33 - and SO42 -), which gives rise to a pink colour and strong fluorescence in the visible region. Sensor L showed a detection limit down to micromolar range without any interference from the other tested competitive anions. Sensor L was applied for the construction of two inputs (HO- and HSO4-) INHIBIT type molecular logic gate and naked-eye detection of HSO4- using test paper strips.

Phase measurement for driven spin oscillations in a storage ring

NASA Astrophysics Data System (ADS)

Hempelmann, N.; Hejny, V.; Pretz, J.; Soltner, H.; Augustyniak, W.; Bagdasarian, Z.; Bai, M.; Barion, L.; Berz, M.; Chekmenev, S.; Ciullo, G.; Dymov, S.; Eversmann, D.; Gaisser, M.; Gebel, R.; Grigoryev, K.; Grzonka, D.; Guidoboni, G.; Heberling, D.; Hetzel, J.; Hinder, F.; Kacharava, A.; Kamerdzhiev, V.; Keshelashvili, I.; Koop, I.; Kulikov, A.; Lehrach, A.; Lenisa, P.; Lomidze, N.; Lorentz, B.; Maanen, P.; Macharashvili, G.; Magiera, A.; Mchedlishvili, D.; Mey, S.; Müller, F.; Nass, A.; Nikolaev, N. N.; Nioradze, M.; Pesce, A.; Prasuhn, D.; Rathmann, F.; Rosenthal, M.; Saleev, A.; Schmidt, V.; Semertzidis, Y.; Senichev, Y.; Shmakova, V.; Silenko, A.; Slim, J.; Stahl, A.; Stassen, R.; Stephenson, E.; Stockhorst, H.; Ströher, H.; Tabidze, M.; Tagliente, G.; Talman, R.; Thörngren Engblom, P.; Trinkel, F.; Uzikov, Yu.; Valdau, Yu.; Valetov, E.; Vassiliev, A.; Weidemann, C.; Wrońska, A.; Wüstner, P.; Zuprański, P.; Żurek, M.; JEDI Collaboration

2018-04-01

This paper reports the first simultaneous measurement of the horizontal and vertical components of the polarization vector in a storage ring under the influence of a radio frequency (rf) solenoid. The experiments were performed at the Cooler Synchrotron COSY in Jülich using a vector polarized, bunched 0.97 GeV /c deuteron beam. Using the new spin feedback system, we set the initial phase difference between the solenoid field and the precession of the polarization vector to a predefined value. The feedback system was then switched off, allowing the phase difference to change over time, and the solenoid was switched on to rotate the polarization vector. We observed an oscillation of the vertical polarization component and the phase difference. The oscillations can be described using an analytical model. The results of this experiment also apply to other rf devices with horizontal magnetic fields, such as Wien filters. The precise manipulation of particle spins in storage rings is a prerequisite for measuring the electric dipole moment (EDM) of charged particles.

EUTERPE, a small electron storage ring for XRF

NASA Astrophysics Data System (ADS)

Botman, J. I. M.; Mutsaers, P. H. A.; Hagedoorn, H. L.; De Voigt, M. J. A.

1990-04-01

A small-sized electron storage ring is under construction at the Eindhoven University of Technology which will cover the energy range of 15 to 400 MeV. At top energy the characteristic wavelength of the synchrotron radiation spectrum is 8.3 nm for the regular dipole magnets and 1.2 nm corresponding to 1.06 keV for a 10 T wiggler magnet. This will provide useful radiation for X-ray fluorescence (XRF) up to 3.2 keV. Alternatively, photon conversion with a high power CO 2 laser beam of 0.124 eV photons will generate X-rays for XRF with energies ranging from 0.5 to 300 keV, depending on the operating energy of the storage ring. This facility will provide an important extension to the activities of the Eindhoven group on PIXE, RBS and microbeam analysis. A short description of the macnine will be given together with applications and specific examples of the XRF method.

Magnetic Measurements of Storage Ring Magnets for the APS Upgrade Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Doose, C.; Dejus, R.; Jaski, M.

2017-06-01

Extensive prototyping of storage ring magnets is ongoing at the Advanced Photon Source (APS) in support of the APS Multi-Bend Achromat (MBA) upgrade project (APS-U) [1]. As part of the R&D activities four quadrupole magnets with slightly different geometries and pole tip materials, and one sextupole magnet with vanadium permendur (VP) pole tips were designed, built and tested. Magnets were measured individually using a rotating coil and a Hall probe for detailed mapping of the magnetic field. Magnets were then assembled and aligned relative to each other on a steel support plate and concrete plinth using precision machined surfaces tomore » gain experience with the alignment method chosen for the APS-U storage ring magnets. The required alignment of magnets on a common support structure is 30 μm rms. Measurements of magnetic field quality, strength and magnet alignment after subjecting the magnets and assemblies to different tests are presented.« less

Constrained multi-objective optimization of storage ring lattices

NASA Astrophysics Data System (ADS)

Husain, Riyasat; Ghodke, A. D.

2018-03-01

The storage ring lattice optimization is a class of constrained multi-objective optimization problem, where in addition to low beam emittance, a large dynamic aperture for good injection efficiency and improved beam lifetime are also desirable. The convergence and computation times are of great concern for the optimization algorithms, as various objectives are to be optimized and a number of accelerator parameters to be varied over a large span with several constraints. In this paper, a study of storage ring lattice optimization using differential evolution is presented. The optimization results are compared with two most widely used optimization techniques in accelerators-genetic algorithm and particle swarm optimization. It is found that the differential evolution produces a better Pareto optimal front in reasonable computation time between two conflicting objectives-beam emittance and dispersion function in the straight section. The differential evolution was used, extensively, for the optimization of linear and nonlinear lattices of Indus-2 for exploring various operational modes within the magnet power supply capabilities.

ACCELERATORS: Beam based alignment of the SSRF storage ring

NASA Astrophysics Data System (ADS)

Zhang, Man-Zhou; Li, Hao-Hu; Jiang, Bo-Cheng; Liu, Gui-Min; Li, De-Ming

2009-04-01

There are 140 beam position monitors (BPMs) in the Shanghai Synchrotron Radiation Facility (SSRF) storage ring used for measuring the closed orbit. As the BPM pickup electrodes are assembled directly on the vacuum chamber, it is important to calibrate the electrical center offset of the BPM to an adjacent quadrupole magnetic center. A beam based alignment (BBA) method which varies individual quadrupole magnet strength and observes its effects on the orbit is used to measure the BPM offsets in both the horizontal and vertical planes. It is a completely automated technique with various data processing methods. There are several parameters such as the strength change of the correctors and the quadrupoles which should be chosen carefully in real measurement. After several rounds of BBA measurement and closed orbit correction, these offsets are set to an accuracy better than 10 μm. In this paper we present the method of beam based calibration of BPMs, the experimental results of the SSRF storage ring, and the error analysis.

Symplectic orbit and spin tracking code for all-electric storage rings

DOE PAGES

Talman, Richard M.; Talman, John D.

2015-07-22

Proposed methods for measuring the electric dipole moment (EDM) of the proton use an intense, polarized proton beam stored in an all-electric storage ring “trap.” At the “magic” kinetic energy of 232.792 MeV, proton spins are “frozen,” for example always parallel to the instantaneous particle momentum. Energy deviation from the magic value causes in-plane precession of the spin relative to the momentum. Any nonzero EDM value will cause out-of-plane precession—measuring this precession is the basis for the EDM determination. A proposed implementation of this measurement shows that a proton EDM value of 10 –29e–cm or greater will produce a statisticallymore » significant, measurable precession after multiply repeated runs, assuming small beam depolarization during 1000 s runs, with high enough precision to test models of the early universe developed to account for the present day particle/antiparticle population imbalance. This paper describes an accelerator simulation code, eteapot, a new component of the Unified Accelerator Libraries (ual), to be used for long term tracking of particle orbits and spins in electric bend accelerators, in order to simulate EDM storage ring experiments. Though qualitatively much like magnetic rings, the nonconstant particle velocity in electric rings gives them significantly different properties, especially in weak focusing rings. Like the earlier code teapot (for magnetic ring simulation) this code performs exact tracking in an idealized (approximate) lattice rather than the more conventional approach, which is approximate tracking in a more nearly exact lattice. The Bargmann-Michel-Telegdi (BMT) equation describing the evolution of spin vectors through idealized bend elements is also solved exactly—original to this paper. Furthermore the idealization permits the code to be exactly symplectic (with no artificial “symplectification”). Any residual spurious damping or antidamping is sufficiently small to permit reliable tracking for the long times, such as the 1000 s assumed in estimating the achievable EDM precision. This paper documents in detail the theoretical formulation implemented in eteapot. An accompanying paper describes the practical application of the eteapot code in the Universal Accelerator Libraries (ual) environment to “resurrect,” or reverse engineer, the “AGS-analog” all-electric ring built at Brookhaven National Laboratory in 1954. Of the (very few) all-electric rings ever commissioned, the AGS-analog ring is the only relativistic one and is the closest to what is needed for measuring proton (or, even more so, electron) EDM’s. As a result, the companion paper also describes preliminary lattice studies for the planned proton EDM storage rings as well as testing the code for long time orbit and spin tracking.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eriksson, Mikael

Not very long ago, the 3{sup rd} generation storage ring technology was judged as mature. Most of the 3{sup rd} generation storage rings used the Double-Bend Achromat (DBA) or Triple-Bend Achromat (TBA) concepts. It was however a well-known fact that increasing the number of magnet cells in the rings is a powerful way of decreasing the electron beam emittance and thus the source brilliance, but at the penalty of increasing the size and cost of the rings. Preserving the Dynamic Aperture (DA) in the rings became also an issue when increasing the number of magnet cells. The Multi-Bend Achromat (MBA)more » concept, including a miniaturization of the ring elements, has now drastically changed the picture. The MBA rings, now in construction or being planned, offer orders of magnitudes higher brilliance than rings of conventional designs. Several light sources around the world are now implementing or planning to implement this MBA concept. This article touches on the science drivers for higher brilliance. We will then describe the MBA concept with its advantages as well as its challenges. A short survey of the MBA activity around the world will also be presented. The author apologies for focusing on the MAX IV project regarding technical solutions. This is motivated by that MAX IV is the facility he knows best and it might be regarded as a fore-runner for the MBA concept.« less

The Abort Kicker System for the PEP-II Storage Rings at SLAC.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Delamare, Jeffrey E

2003-06-20

The PEP-II project has two storage rings. The HER (High Energy Ring) has up to 1.48 A of election beam at 9 GeV, and the LER (Low Energy Ring) has up to 2.14 A of positron beam at 3.1 GeV. To protect the HER and LER beam lines in the event of a ring component failure, each ring has an abort kicker system which directs the beam into a dump when a failure is detected. Due to the high current of the beams, the beam kick is tapered from 100% to 80% in 7.33 {micro}S (the beam transit time aroundmore » the ring). This taper distributes the energy evenly across the window which separates the ring from the beam dump such that the window is not damaged. The abort kicker trigger is synchronized with the ion clearing gap of the beam allowing for the kicker field to rise from 0-80% while there is no beam in the kicker magnet. Originally the kicker system was designed for a rise time of 370nS [1], but because the ion clearing gap was reduced in half, so was the rise time requirement for the kicker. This report discusses the design of the system interlocks, diagnostics, and modulator with the modifications necessary to accommodate an ion clearing gap of 185nS.« less

Accountable Care Organizations and Population Health Organizations.

PubMed

Casalino, Lawrence P; Erb, Natalie; Joshi, Maulik S; Shortell, Stephen M

2015-08-01

Accountable care organizations (ACOs) and hospitals are investing in improving "population health," by which they nearly always mean the health of the "population" of patients "attributed" by Medicare, Medicaid, or private health insurers to their organizations. But population health can and should also mean "the health of the entire population in a geographic area." We present arguments for and against ACOs and hospitals investing in affecting the socioeconomic determinants of health to improve the health of the population in their geographic area, and we provide examples of ACOs and hospitals that are doing so in a limited way. These examples suggest that ACOs and hospitals can work with other organizations in their community to improve population health. We briefly present recent proposals for such coalitions and for how they could be financed to be sustainable. Copyright © 2015 by Duke University Press.

Physician Practice Participation in Accountable Care Organizations: The Emergence of the Unicorn

PubMed Central

Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R

2014-01-01

Objective To provide the first nationally based information on physician practice involvement in ACOs. Data Sources/Study Setting Primary data from the third National Survey of Physician Organizations (January 2012–May 2013). Study Design We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. Data Collection/Extraction Methods We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. Principal Findings We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Conclusions Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. PMID:24628449

The role of behavioral health services in accountable care organizations.

PubMed

Kathol, Roger G; Patel, Kavita; Sacks, Lee; Sargent, Susan; Melek, Stephen P

2015-02-01

Nationally, care delivery organizations are developing accountable care organizations (ACOs), but few have an appreciation of the importance of behavioral health services or knowledge about how to include them in an ACO since their funding and delivery are currently segregated from other medical services. This commentary reviews data on the impact of patients with concurrent medical and behavioral health conditions. They indicate that three-fourths of patients with behavioral health disorders are seen in the medical setting, but are largely untreated because few medical patients choose to access the behavioral health sector, which is where behavioral health providers are paid to work. Untreated behavioral health conditions in medical patients are associated with persistent medical illness and significantly increased total medical healthcare service use and cost, especially in those with chronic medical conditions. At a national level, those with behavioral health conditions use one-third of total healthcare resources. This will not change unless at-risk ACOs can effectively correct the mismatch between behavioral health patients and behavioral healthcare delivery. The authors suggest that ACO subcontracting for traditional segregated behavioral health services, whether from local provider groups or external vendors, will not achieve ACO-mandated access, treatment, and cost reduction goals. Rather, behavioral health specialists will need to become core ACO member providers. This will allow them to be deployed along with other member providers using value-added delivery approaches in the medical setting to integrate medical and behavioral health service delivery, and to achieve synergistic health and cost improvement.

Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

PubMed

Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

2012-09-01

In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

Interpretations of integration in early accountable care organizations.

PubMed

Kreindler, Sara A; Larson, Bridget K; Wu, Frances M; Carluzzo, Kathleen L; Gbemudu, Josette N; Struthers, Ashley; VAN Citters, Aricca D; Shortell, Stephen M; Nelson, Eugene C; Fisher, Elliott S

2012-09-01

It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together? Using the lens of the social identity approach, this qualitative study examined how four nascent ACOs engaged with the concept of integration. During multiday site visits, we conducted interviews (114 managers and physicians), observations, and document reviews. In no case was the ACO interpreted as a new, overarching entity uniting disparate groups; rather, each site offered a unique interpretation that flowed from its existing strategies for social-identity management: An independent practice association preserved members' cherished value of autonomy by emphasizing coordination, not "integration"; a medical group promoted integration within its employed core, but not with affiliates; a hospital, engaging community physicians who mistrusted integrated systems, reimagined integration as an equal partnership; an integrated delivery system advanced its careful journey towards intergroup consensus by presenting the ACO as a cultural, not structural, change. The ACO appears to be a model flexible enough to work in synchrony with whatever social strategies are most context appropriate, with the potential to promote alignment and functional integration without demanding common identification with a superordinate group. "Soft integration" may be a promising alternative to the vertically integrated model that, though widely assumed to be ideal, has remained unattainable for most organizations. © 2012 Milbank Memorial Fund.

Afferent and efferent projections of the anterior cortical amygdaloid nucleus in the mouse.

PubMed

Cádiz-Moretti, Bernardita; Abellán-Álvaro, María; Pardo-Bellver, Cecília; Martínez-García, Fernando; Lanuza, Enrique

2017-09-01

The anterior cortical amygdaloid nucleus (ACo) is a chemosensory area of the cortical amygdala that receives afferent projections from both the main and accessory olfactory bulbs. The role of this structure is unknown, partially due to a lack of knowledge of its connectivity. In this work, we describe the pattern of afferent and efferent projections of the ACo by using fluorogold and biotinylated dextranamines as retrograde and anterograde tracers, respectively. The results show that the ACo is reciprocally connected with the olfactory system and basal forebrain, as well as with the chemosensory and basomedial amygdala. In addition, it receives dense projections from the midline and posterior intralaminar thalamus, and moderate projections from the posterior bed nucleus of the stria terminalis, mesocortical structures and the hippocampal formation. Remarkably, the ACo projects moderately to the central nuclei of the amygdala and anterior bed nucleus of the stria terminalis, and densely to the lateral hypothalamus. Finally, minor connections are present with some midbrain and brainstem structures. The afferent projections of the ACo indicate that this nucleus might play a role in emotional learning involving chemosensory stimuli, such as olfactory fear conditioning. The efferent projections confirm this view and, given its direct output to the medial part of the central amygdala and the hypothalamic 'aggression area', suggest that the ACo can initiate defensive and aggressive responses elicited by olfactory or, to a lesser extent, vomeronasal stimuli. © 2017 Wiley Periodicals, Inc.

A Stochastic Inversion Method for Potential Field Data: Ant Colony Optimization

NASA Astrophysics Data System (ADS)

Liu, Shuang; Hu, Xiangyun; Liu, Tianyou

2014-07-01

Simulating natural ants' foraging behavior, the ant colony optimization (ACO) algorithm performs excellently in combinational optimization problems, for example the traveling salesman problem and the quadratic assignment problem. However, the ACO is seldom used to inverted for gravitational and magnetic data. On the basis of the continuous and multi-dimensional objective function for potential field data optimization inversion, we present the node partition strategy ACO (NP-ACO) algorithm for inversion of model variables of fixed shape and recovery of physical property distributions of complicated shape models. We divide the continuous variables into discrete nodes and ants directionally tour the nodes by use of transition probabilities. We update the pheromone trails by use of Gaussian mapping between the objective function value and the quantity of pheromone. It can analyze the search results in real time and promote the rate of convergence and precision of inversion. Traditional mapping, including the ant-cycle system, weaken the differences between ant individuals and lead to premature convergence. We tested our method by use of synthetic data and real data from scenarios involving gravity and magnetic anomalies. The inverted model variables and recovered physical property distributions were in good agreement with the true values. The ACO algorithm for binary representation imaging and full imaging can recover sharper physical property distributions than traditional linear inversion methods. The ACO has good optimization capability and some excellent characteristics, for example robustness, parallel implementation, and portability, compared with other stochastic metaheuristics.

Interpretations of Integration in Early Accountable Care Organizations

PubMed Central

Kreindler, Sara A; Larson, Bridget K; Wu, Frances M; Carluzzo, Kathleen L; Gbemudu, Josette N; Struthers, Ashley; Van Citters, Aricca D; Shortell, Stephen M; Nelson, Eugene C; Fisher, Elliott S

2012-01-01

Context It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together? Methods Using the lens of the social identity approach, this qualitative study examined how four nascent ACOs engaged with the concept of integration. During multiday site visits, we conducted interviews (114 managers and physicians), observations, and document reviews. Findings In no case was the ACO interpreted as a new, overarching entity uniting disparate groups; rather, each site offered a unique interpretation that flowed from its existing strategies for social-identity management: An independent practice association preserved members’ cherished value of autonomy by emphasizing coordination, not “integration”; a medical group promoted integration within its employed core, but not with affiliates; a hospital, engaging community physicians who mistrusted integrated systems, reimagined integration as an equal partnership; an integrated delivery system advanced its careful journey towards intergroup consensus by presenting the ACO as a cultural, not structural, change. Conclusions The ACO appears to be a model flexible enough to work in synchrony with whatever social strategies are most context appropriate, with the potential to promote alignment and functional integration without demanding common identification with a superordinate group. “Soft integration” may be a promising alternative to the vertically integrated model that, though widely assumed to be ideal, has remained unattainable for most organizations. PMID:22985278

A Study of Single Pass Ion Effects at the ALS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Byrd, J.M.; Thomson, J.; /LBL, Berkeley

2011-09-13

We report the results of experiments on a 'fast beam-ion instability' at the Advanced Light Source (ALS). This ion instability, which can arise even when the ions are not trapped over multiple beam passages, will likely be important for many future accelerators. In our experiments, we filled the ALS storage ring with helium gas, raising the pressure approximately two orders of magnitude above the nominal pressure. With gaps in the bunch train large enough to avoid conventional (multi-turn) ion trapping, we observed a factor of 2-3 increase in the vertical beam size along with coherent beam oscillations which increased alongmore » the bunch train. Ion trapping has long been recognized as a potential limitation in electron storage rings. The ions, generated by beam-gas collisions, become trapped in the negative potential of the beam and accumulate over multiple beam passages. The trapped ions are then observed to cause a number of deleterious effects such as an increasing beam phase space, a broadening and shifting of the beam transverse oscillation frequencies (tunes), collective beam instabilities, and beam lifetime reductions. All of these effects are of concern for the next generation of accelerators, such as the B-factories or damping rings for future linear colliders, which will store high beam currents with closely spaced bunches and ultra-low beam emittances. One of the standard solutions used to prevent ion trapping is to include a gap in the bunch train which is long compared to the bunch spacing. In this case, the ions are first strongly-focused by the passing electron bunches and then over-focused in the gap. With a sufficiently large gap, the ions can be driven to large amplitudes where they form a diffuse halo and do not affect the beam. In this paper, we describe experiments that study a new regime of transient ion instabilities predicted to arise in future electron storage rings, and linacs with bunch trains. These future rings and linacs, which will be operated with higher beam currents, small transverse beam emittances, and long bunch trains, will use ion clearing gaps to prevent conventional ion trapping. But, while the ion clearing gap may suppress the conventional ion instabilities, it will not suppress a transient beam-ion instability where ions generated and trapped during the passage of a single train lead to a fast instability. While both conventional and transient ion instabilities have the same origin, namely ions produced by the beam, they have different manifestations and, more importantly, the new transient instability can arise even after the conventional ion instability is cured. This new instability is called the 'Fast Beam-Ion Instability' (FBII). In many future rings, the FBII is predicted to have very fast growth rates, much faster than the damping rates of existing and proposed transverse feedback systems, and thus is a potential limitation. To study the FBII, we performed experiments at the ALS, a 1.5 GeV electron storage ring. At the nominal ALS pressure of about 0.24 nTorr, the FBII is not evident. To study the instability, we intentionally added helium gas to the storage-ring vacuum system until the residual gas pressure was increased about 80 nTorr. This brought the predicted growth rate of the instability at least an order of magnitude above the growth rate of conventional multibunch instabilities driven by the RF cavities and above the damping rate of the transverse feedback system (TFB) in the ALS and, thereby, established conditions very similar to those in a future storage ring. We then filled the ring with a relatively short train of bunches, suppressing conventional ion instabilities. In the following, we will first briefly describe This paper describes the experiment and results in more detail.« less

Ant-cuckoo colony optimization for feature selection in digital mammogram.

PubMed

Jona, J B; Nagaveni, N

2014-01-15

Digital mammogram is the only effective screening method to detect the breast cancer. Gray Level Co-occurrence Matrix (GLCM) textural features are extracted from the mammogram. All the features are not essential to detect the mammogram. Therefore identifying the relevant feature is the aim of this work. Feature selection improves the classification rate and accuracy of any classifier. In this study, a new hybrid metaheuristic named Ant-Cuckoo Colony Optimization a hybrid of Ant Colony Optimization (ACO) and Cuckoo Search (CS) is proposed for feature selection in Digital Mammogram. ACO is a good metaheuristic optimization technique but the drawback of this algorithm is that the ant will walk through the path where the pheromone density is high which makes the whole process slow hence CS is employed to carry out the local search of ACO. Support Vector Machine (SVM) classifier with Radial Basis Kernal Function (RBF) is done along with the ACO to classify the normal mammogram from the abnormal mammogram. Experiments are conducted in miniMIAS database. The performance of the new hybrid algorithm is compared with the ACO and PSO algorithm. The results show that the hybrid Ant-Cuckoo Colony Optimization algorithm is more accurate than the other techniques.

A taxonomy of accountable care organizations for policy and practice.

PubMed

Shortell, Stephen M; Wu, Frances M; Lewis, Valerie A; Colla, Carrie H; Fisher, Elliott S

2014-12-01

To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance. Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs. Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data. We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital-physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities. ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations. © Health Research and Educational Trust.

Activation of liver carnitine palmitoyltransferase-1 and mitochondrial acetoacetyl-CoA thiolase is associated with elevated ketone body levels in the elasmobranch Squalus acanthias.

PubMed

Treberg, Jason R; Crockett, Elizabeth L; Driedzic, William R

2006-01-01

Elasmobranch fishes are an ancient group of vertebrates that have unusual lipid metabolism whereby storage lipids are mobilized from the liver for peripheral oxidation largely as ketone bodies rather than as nonesterified fatty acids under normal conditions. This reliance on ketones, even when feeding, implies that elasmobranchs are chronically ketogenic. Compared to specimens sampled within 2 d of capture (recently captured), spiny dogfish Squalus acanthias that were held for 16-33 d without apparent feeding displayed a 4.5-fold increase in plasma concentration of d- beta -hydroxybutyrate (from 0.71 to 3.2 mM) and were considered ketotic. Overt activity of carnitine palmitoyltransferase-1 in liver mitochondria from ketotic dogfish was characterized by an increased apparent maximal activity, a trend of increasing affinity (reduced apparent K(m); P=0.09) for l-carnitine, and desensitization to the inhibitor malonyl-CoA relative to recently captured animals. Acetoacetyl-CoA thiolase (ACoAT) activity in isolated liver mitochondria was also markedly increased in the ketotic dogfish compared to recently captured fish, whereas no difference in 3-hydroxy-3-methylglutaryl-CoA synthase activity was found between these groups, suggesting that ACoAT plays a more important role in the activation of ketogenesis in spiny dogfish than in mammals and birds.

Development of a Bunched Beam Electron Cooler based on ERL and Circulator Ring Technology for the Jefferson Lab Electron-Ion Collider

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benson, Stephen V.; Derbenev, Yaroslav S.; Douglas, David R.

Jefferson Lab is in the process of designing an electron ion collider with unprecedented luminosity at a 45 GeV center-of-mass energy. This luminosity relies on ion cooling in both the booster and the storage ring of the accelerator complex. The cooling in the booster will use a conventional DC cooler similar to the one at COSY. The high-energy storage ring, operating at a momentum of up to 100 GeV/nucleon, requires novel use of bunched-beam cooling. There are two designs for such a cooler. The first uses a conventional Energy Recovery Linac (ERL) with a magnetized beam while the second usesmore » a circulating ring to enhance both peak and average currents experienced by the ion beam. This presentation will describe the design of both the Circulator Cooling Ring (CCR) design and that of the backup option using the stand-alone ERL operated at lower charge but higher repetition rate than the ERL injector required by the CCR-based design.« less

Resonant neutral-particle emission in collisions of electrons with peptide ions in a storage ring.

PubMed

Tanabe, T; Noda, K; Saito, M; Lee, S; Ito, Y; Takagi, H

2003-05-16

Electron-biomolecular ion collisions were studied using an electrostatic storage ring with a merging beam technique for singly protonated peptides (angiotensin I, II, and III). A strong neutral-particle emission at around 6.5 eV was found in addition to neutrals from recombination at low energies. The rates of the high-energy peak greatly decreased with a slight decrease in the number of amino-acid residues from angiotensin I to III. These results suggest that some peptide bonds were selectively cleaved.

Commissioning and Early Operation Experience of the NSLS-II Storage Ring RF System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gao, F.; Rose, J.; Cupolo, J.

2015-05-03

The National Synchrotron Light Source II (NSLS-II) is a 3 GeV electron X-ray user facility commissioned in 2014. The storage ring RF system, essential for replenishing energy loss per turn of the electrons, consists of digital low level RF controllers, 310 kW CW klystron transmitters, CESR-B type superconducting cavities, as well as a supporting cryogenic system. Here we will report on RF commissioning and early operation experience of the system for beam current up to 200mA.

Mass Measurements of Proton-rich Nuclides at the Cooler Storage Ring at IMP

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Y. H.; Xu, H. S.; Wang, M.

2011-11-30

Recent results and progress of mass measurements of proton-rich nuclei using isochronous mass spectrometry (IMS) are reported. The nuclei under investigation were produced via fragmentation of relativistic energy heavy ions of {sup 78}Kr and {sup 58}Ni. After in-flight separation by the fragment separator RIBLL-2, the nuclei were injected and stored in the experimental storage ring CSRe, and their masses were determined from measurements of the revolution times. The impact of these measurements on the stellar nucleosynthesis in the rp-process is discussed.

Conditioning of the vacuum system of the TPS storage ring without baking in situ

NASA Astrophysics Data System (ADS)

Chan, C. K.; Chang, C. C.; Shueh, C.; Yang, I. C.; Wu, L. H.; Chen, B. Y.; Cheng, C. M.; Huang, Y. T.; Chuang, J. Y.; Cheng, Y. T.; Hsiao, Y. M.; Sheng, Albert

2017-04-01

To shorten the machine downtime, a maintenance procedure without baking in situ has been developed and applied to maintain and to upgrade the vacuum system of the TPS storage ring. The data of photon-stimulated desorption (PSD) reveal no obvious discrepancy between baking and not baking the vacuum system in situ. A beam-conditioning dose of extent only 11.8 A h is required to recover quickly the dynamic pressure of an unbaked vacuum system to its pre-intervention value according to the TPS maintenance experience.

Natural variation in expression of genes associated with carotenoid biosynthesis and accumulation in cassava (Manihot esculenta Crantz) storage root.

PubMed

Carvalho, Luiz Jcb; Agustini, Marco Av; Anderson, James V; Vieira, Eduardo A; de Souza, Claudia Rb; Chen, Songbi; Schaal, Barbara A; Silva, Joseane P

2016-06-10

Cassava (Manihot esculenta Crantz) storage root provides a staple food source for millions of people worldwide. Increasing the carotenoid content in storage root of cassava could provide improved nutritional and health benefits. Because carotenoid accumulation has been associated with storage root color, this study characterized carotenoid profiles, and abundance of key transcripts associated with carotenoid biosynthesis, from 23 landraces of cassava storage root ranging in color from white-to-yellow-to-pink. This study provides important information to plant breeding programs aimed at improving cassava storage root nutritional quality. Among the 23 landraces, five carotenoid types were detected in storage root with white color, while carotenoid types ranged from 1 to 21 in storage root with pink and yellow color. The majority of storage root in these landraces ranged in color from pale-to-intense yellow. In this color group, total β-carotene, containing all-E-, 9-Z-, and 13-Z-β-carotene isomers, was the major carotenoid type detected, varying from 26.13 to 76.72 %. Although no α-carotene was observed, variable amounts of a α-ring derived xanthophyll, lutein, was detected; with greater accumulation of α-ring xanthophylls than of β-ring xanthophyll. Lycopene was detected in a landrace (Cas51) with pink color storage root, but it was not detected in storage root with yellow color. Based on microarray and qRT-PCR analyses, abundance of transcripts coding for enzymes involved in carotenoid biosynthesis were consistent with carotenoid composition determined by contrasting HPLC-Diode Array profiles from storage root of landraces IAC12, Cas64, and Cas51. Abundance of transcripts encoding for proteins regulating plastid division were also consistent with the observed differences in total β-carotene accumulation. Among the 23 cassava landraces with varying storage root color and diverse carotenoid types and profiles, landrace Cas51 (pink color storage root) had low LYCb transcript abundance, whereas landrace Cas64 (intense yellow storage root) had decreased HYb transcript abundance. These results may explain the increased amounts of lycopene and total β-carotene observed in landraces Cas51 and Cas64, respectively. Overall, total carotenoid content in cassava storage root of color class representatives were associated with spatial patterns of secondary growth, color, and abundance of transcripts linked to plastid division. Finally, a partial carotenoid biosynthesis pathway is proposed.

Advanced Imaging Utilization and Cost Savings Among Medicare Shared Savings Program Accountable Care Organizations: An Initial Exploratory Analysis.

PubMed

Rosenkrantz, Andrew B; Duszak, Richard

2018-03-01

The purpose of this study was to explore associations between CT and MRI utilization and cost savings achieved by Medicare Shared Savings Program (MSSP)-participating accountable care organizations (ACOs). Summary data were obtained for all MSSP-participating ACOs (n = 214 in 2013; n = 333 in 2014). Multivariable regressions were performed to assess associations of CT and MRI utilization with ACOs' total savings and reaching minimum savings rates to share in Medicare savings. In 2014, 54.4% of ACOs achieved savings, meeting minimum rates to share in savings in 27.6%. Independent positive predictors of total savings included beneficiary risk scores (β = +20,265,720, P = .003) and MRI events (β = +19,964, P = .018) but not CT events (β = +2,084, P = .635). Independent positive predictors of meeting minimum savings rates included beneficiary risk scores (odds ratio = 2108, P = .001) and MRI events (odds ratio = 1.008, P = .002), but not CT events (odds ratio = 1.002, P = .289). Measures not independently associated with savings were total beneficiaries; beneficiaries' gender, age, race or ethnicity; and Medicare enrollment type (P > .05). For ACOs with 2013 and 2014 data, neither increases nor decreases in CT and MRI events between years were associated with 2014 total savings or meeting savings thresholds (P ≥ .466). Higher MRI utilization rates were independently associated with small but significant MSSP ACO savings. The value of MRI might relate to the favorable impact of appropriate advanced imaging utilization on downstream outcomes and other resource utilization. Because MSSP ACOs represent a highly select group of sophisticated organizations subject to rigorous quality and care coordination standards, further research will be necessary to determine if these associations are generalizable to other health care settings. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Childhood Lung Function Predicts Adult Chronic Obstructive Pulmonary Disease and Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome.

PubMed

Bui, Dinh S; Burgess, John A; Lowe, Adrian J; Perret, Jennifer L; Lodge, Caroline J; Bui, Minh; Morrison, Stephen; Thompson, Bruce R; Thomas, Paul S; Giles, Graham G; Garcia-Aymerich, Judith; Jarvis, Debbie; Abramson, Michael J; Walters, E Haydn; Matheson, Melanie C; Dharmage, Shyamali C

2017-07-01

The burden of chronic obstructive pulmonary disease (COPD) is increasing, yet there are limited data on early life risk factors. To investigate the role of childhood lung function in adult COPD phenotypes. Prebronchodilator spirometry was performed for a cohort of 7-year-old Tasmanian children (n = 8,583) in 1968 who were resurveyed at 45 years, and a selected subsample (n = 1,389) underwent prebronchodilator and post-bronchodilator spirometry. For this analysis, COPD was spirometrically defined as a post-bronchodilator FEV 1 /FVC less than the lower limit of normal. Asthma-COPD overlap syndrome (ACOS) was defined as the coexistence of both COPD and current asthma. Associations between childhood lung function and asthma/COPD/ACOS were examined using multinomial regression. At 45 years, 959 participants had neither current asthma nor COPD (unaffected), 269 had current asthma alone, 59 had COPD alone, and 68 had ACOS. The reweighted prevalence of asthma alone was 13.5%, COPD alone 4.1%, and ACOS 2.9%. The lowest quartile of FEV 1 at 7 years was associated with ACOS (odds ratio, 2.93; 95% confidence interval, 1.32-6.52), but not COPD or asthma alone. The lowest quartile of FEV 1 /FVC ratio at 7 years was associated with ACOS (odds ratio, 16.3; 95% confidence interval, 4.7-55.9) and COPD (odds ratio, 5.76; 95% confidence interval, 1.9-17.4), but not asthma alone. Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention. Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function.

Early impact of Medicare accountable care organizations on cancer surgery outcomes.

PubMed

Herrel, Lindsey A; Norton, Edward C; Hawken, Scott R; Ye, Zaojun; Hollenbeck, Brent K; Miller, David C

2016-09-01

Accountable care organizations (ACOs) were established to improve care and outcomes for beneficiaries requiring highly coordinated, complex care. The objective of this study was to evaluate the association between hospital ACO participation and the outcomes of major surgical oncology procedures. This was a retrospective cohort study of Medicare beneficiaries older than 65 years who were undergoing a major surgical resection for colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer from 2011 through 2013. A difference-in-differences analysis was implemented to compare the postimplementation period (January 2013 through December 2013) with the baseline period (January 2011 through December 2012) to assess the impact of hospital ACO participation on 30-day mortality, complications, readmissions, and length of stay (LOS). Among 384,519 patients undergoing major cancer surgery at 106 ACO hospitals and 2561 control hospitals, this study found a 30-day mortality rate of 3.4%, a readmission rate of 12.5%, a complication rate of 43.8%, and a prolonged LOS rate of 10.0% in control hospitals and similar rates in ACO hospitals. Secular trends were noted, with reductions in perioperative adverse events in control hospitals between the baseline and postimplementation periods: mortality (percentage-point reduction, 0.1%; P = .19), readmissions (percentage-point reduction, 0.4%; P = .001), complications (percentage-point reduction, 1.0%; P < .001), and prolonged LOS (percentage-point reduction, 1.1%; P < .001). After accounting for these secular trends, this study identified no significant effect of hospital participation in an ACO on the frequency of perioperative outcomes (difference-in-differences estimator P values, .24-.72). Early hospital participation in the Medicare Shared Savings Program ACO program was not associated with greater reductions in adverse perioperative outcomes for patients undergoing major cancer surgery in comparison with control hospitals. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2739-2746. © 2016 American Cancer Society. © 2016 American Cancer Society.

Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome: Doubled Costs Compared with Patients with Asthma Alone.

PubMed

Gerhardsson de Verdier, Maria; Andersson, Maria; Kern, David M; Zhou, Siting; Tunceli, Ozgur

2015-09-01

Patients with asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) have more rapid disease progression and more exacerbations than do those with either condition alone. Little research has been performed, however, in these patients. The objective was to summarize the health care utilization, costs, and comorbidities of patients with uncontrolled asthma and patients with ACOS. This retrospective analysis used medical and pharmacy claims from large commercial health plans. The study included patients 6 years or older with a diagnosis of asthma and one or more asthma exacerbation (index event). Patients were classified as having asthma alone or ACOS, and the two groups were matched for age, sex, region, index year, index month, and health plan type. Outcomes included rates of comorbid disease, health care utilization, and costs during the 12 months before and after the index exacerbation. Among the matched patients with asthma (6,505 ACOS; 26,060 without COPD), mean annual all-cause health care costs were twice as high as for patients with ACOS ($22,393 vs. $11,716; P < 0.0001). Asthma-related costs, representing 29% of total costs, were nearly twice as high among patients with ACOS ($6,319 vs. 3,356; P < 0.0001). Cost differences were driven by large differences in the proportions of patients with an inpatient hospitalization (34.0% vs. 14.6%; P < 0.0001) or emergency department visit (29.6% vs. 19.9%; P < 0.0001). Nearly all prespecified comorbid conditions were more prevalent in the ACOS group. Patients with asthma and COPD had nearly double the health care costs as did patients with asthma without COPD. The overall disease profile of patients with asthma should be considered when managing patients, rather than treating asthma as a solitary condition. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The conversion of CESR to operate as the Test Accelerator, CesrTA. Part 3: Electron cloud diagnostics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Billing, M. G.; Conway, J. V.; Crittenden, J. A.

Cornell's electron/positron storage ring (CESR) was modified over a series of accelerator shutdowns beginning in May 2008, which substantially improves its capability for research and development for particle accelerators. CESR's energy span from 1.8 to 5.6 GeV with both electrons and positrons makes it ideal for the study of a wide spectrum of accelerator physics issues and instrumentation related to present light sources and future lepton damping rings. Additionally a number of these are also relevant for the beam physics of proton accelerators. This paper is the third in a series of four describing the conversion of CESR to themore » test accelerator, CESRTA. The first two papers discuss the overall plan for the conversion of the storage ring to an instrument capable of studying advanced accelerator physics issues [1] and the details of the vacuum system upgrades [2]. This paper focuses on the necessary development of new instrumentation, situated in four dedicated experimental regions, capable of studying such phenomena as electron clouds (ECs) and methods to mitigate EC effects. The fourth paper in this series describes the vacuum system modifications of the superconducting wigglers to accommodate the diagnostic instrumentation for the study of EC behavior within wigglers. Lastly, while the initial studies of CESRTA focused on questions related to the International Linear Collider damping ring design, CESRTA is a very versatile storage ring, capable of studying a wide range of accelerator physics and instrumentation questions.« less

The conversion of CESR to operate as the Test Accelerator, CesrTA. Part 3: Electron cloud diagnostics

DOE PAGES

Billing, M. G.; Conway, J. V.; Crittenden, J. A.; ...

2016-04-28

Cornell's electron/positron storage ring (CESR) was modified over a series of accelerator shutdowns beginning in May 2008, which substantially improves its capability for research and development for particle accelerators. CESR's energy span from 1.8 to 5.6 GeV with both electrons and positrons makes it ideal for the study of a wide spectrum of accelerator physics issues and instrumentation related to present light sources and future lepton damping rings. Additionally a number of these are also relevant for the beam physics of proton accelerators. This paper is the third in a series of four describing the conversion of CESR to themore » test accelerator, CESRTA. The first two papers discuss the overall plan for the conversion of the storage ring to an instrument capable of studying advanced accelerator physics issues [1] and the details of the vacuum system upgrades [2]. This paper focuses on the necessary development of new instrumentation, situated in four dedicated experimental regions, capable of studying such phenomena as electron clouds (ECs) and methods to mitigate EC effects. The fourth paper in this series describes the vacuum system modifications of the superconducting wigglers to accommodate the diagnostic instrumentation for the study of EC behavior within wigglers. Lastly, while the initial studies of CESRTA focused on questions related to the International Linear Collider damping ring design, CESRTA is a very versatile storage ring, capable of studying a wide range of accelerator physics and instrumentation questions.« less

A 1kW EUV source for lithography based on FEL emission in a compact storage ring

NASA Astrophysics Data System (ADS)

Feser, Michael; Ruth, Ron; Loewen, Rod

2017-10-01

EUV has long been hailed as the next generation lithography technology. Its adoption into high volume manufacturing (HVM), however, has been delayed several technology nodes due to technical issues, many of which can be attributed to the EUV source performance. Today's EUV lithography scanners are powered by laser produce plasma (LPP) sources. They have issues with power scaling beyond 300 W, reliability and contamination. Free Electron Lasers (FELs) have been considered as an alternative EUV source. Advantages of accelerator based sources are the maturity of the accelerator technology, lack of debris/contamination, and ability to provide high power. Industry turned away from this technology because of the requirement to feed up to 10 scanners from one linear FEL to make it economically feasible, the large footprint, and generation of radioactive byproducts. All of these issues are overcome in the presented concept using a compact storage ring with steady-state FEL lasing action. At 1 kW output power, comparable cost and footprint to an LPP source, this source is ideally suited for use on a single scanner and promises reliable, contamination free operation. FEL action in the storage ring is sustained by operating the FEL well below the saturation regime and preserving the equilibrium low emittance and energy distribution of the ring.

Measurement techniques for low emittance tuning and beam dynamics at CESR

NASA Astrophysics Data System (ADS)

Billing, M. G.; Dobbins, J. A.; Forster, M. J.; Kreinick, D. L.; Meller, R. E.; Peterson, D. P.; Ramirez, G. A.; Rendina, M. C.; Rider, N. T.; Sagan, D. C.; Shanks, J.; Sikora, J. P.; Stedinger, M. G.; Strohman, C. R.; Williams, H. A.; Palmer, M. A.; Holtzapple, R. L.; Flanagan, J.

2018-03-01

After operating as a High Energy Physics electron-positron collider, the Cornell Electron-positron Storage Ring (CESR) has been converted to become a dedicated synchrotron light source for the Cornell High Energy Synchrotron Source (CHESS). Over the course of several years CESR was adapted for accelerator physics research as a test accelerator, capable of studying topics relevant to future damping rings, colliders and light sources. Initially some specific topics were targeted for accelerator physic research with the storage ring in this mode, labeled CesrTA. These topics included 1) tuning techniques to produce low emittance beams, 2) the study of electron cloud (EC) development in a storage ring and 3) intra-beam scattering effects. The complete conversion of CESR to CesrTA occurred over a several year period, described elsewhere [1–3]. A number of specific instruments were developed for CesrTA. Much of the pre-existing instrumentation was modified to accommodate the scope of these studies and these are described in a companion paper [4]. To complete this research, a number of procedures were developed or modified, often requiring coordinated measurements among different instruments [5]. This paper provides an overview of types of measurements employed for the study of beam dynamics during the operation of CesrTA.

A strategic tension for hospitals moving upstream: Cede control but maintain accountability.

PubMed

Taylor, Lauren A; Berchuck, Caroline M; Barnett, Katherine Gergen

2018-07-01

Health systems are focusing attention on the role that social determinants of health (SDOH) can and should play in health care delivery. This is especially true among accountable care organizations (ACOs) and Medicaid ACOs in particular. In crafting SDOH strategies, senior leadership teams may face an organizational tension in aiming to cede control over dollars, data and patient experience to community-based organizations (CBOs) while also maintaining financial accountability for health outcomes. We review the history of neighborhood health centers (NHCs) in order to foreshadow the types of critiques ACOs are likely to face in working with CBOs. We conclude by suggesting a several strategies by which ACOs may be lessen accountability concerns, including raising the issue with regulators, using low-risk dollars to fund joint-work, working through an intermediary, providing technical assistance and viewing the relationship as a partnership rather than contract. Copyright © 2018 Elsevier Inc. All rights reserved.

Sustainable competitive advantage for accountable care organizations.

PubMed

Macfarlane, Michael Alex

2014-01-01

In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.

Ethical Practice Under Accountable Care

PubMed Central

Bhandary, Asha; Rizzo, Matthew

2017-01-01

Accountable Care Organizations (ACOs) are a key mechanism of the Patient Protection and Affordable Care Act (PPACA). ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice (no novel conflicts with non-maleficence were identified). Conflicts include a bias against transient populations, a motive to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well. PMID:26002491

Creating Highly Reliable Accountable Care Organizations.

PubMed

Vogus, Timothy J; Singer, Sara J

2016-12-01

Accountable Care Organizations' (ACOs) pursuit of the triple aim of higher quality, lower cost, and improved population health has met with mixed results. To improve the design and implementation of ACOs we look to organizations that manage similarly complex, dynamic, and tightly coupled conditions while sustaining exceptional performance known as high-reliability organizations. We describe the key processes through which organizations achieve reliability, the leadership and organizational practices that enable it, and the role that professionals can play when charged with enacting it. Specifically, we present concrete practices and processes from health care organizations pursuing high-reliability and from early ACOs to illustrate how the triple aim may be met by cultivating mindful organizing, practicing reliability-enhancing leadership, and identifying and supporting reliability professionals. We conclude by proposing a set of research questions to advance the study of ACOs and high-reliability research. © The Author(s) 2016.

Beam measurements using visible synchrotron light at NSLS2 storage ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, Weixing, E-mail: chengwx@bnl.gov; Bacha, Bel; Singh, Om

2016-07-27

Visible Synchrotron Light Monitor (SLM) diagnostic beamline has been designed and constructed at NSLS2 storage ring, to characterize the electron beam profile at various machine conditions. Due to the excellent alignment, SLM beamline was able to see the first visible light when beam was circulating the ring for the first turn. The beamline has been commissioned for the past year. Besides a normal CCD camera to monitor the beam profile, streak camera and gated camera are used to measure the longitudinal and transverse profile to understand the beam dynamics. Measurement results from these cameras will be presented in this paper.more » A time correlated single photon counting system (TCSPC) has also been setup to measure the single bunch purity.« less

Colorimetric anion sensors based on positional effect of nitro group for recognition of biologically relevant anions in organic and aqueous medium, insight real-life application and DFT studies

NASA Astrophysics Data System (ADS)

Singh, Archana; Sahoo, Suban K.; Trivedi, Darshak R.

2018-01-01

A new six colorimetric receptors A1-A6 were designed and synthesized, characterized by typical common spectroscopic techniques like FT-IR, UV-Visible, 1H NMR, 13C NMR and ESI-MS. The receptor A1 and A2 exhibit a significant naked-eye response towards F- and AcO- ions in DMSO. Due to presences of the NO2 group at para and ortho position with extended π-conjugation of naphthyl group carrying sbnd OH as a binding site. Compared to receptor A2, A1 is extremely capable of detecting F- and AcO- ions present in the form of sodium salts in an aqueous medium. This is owed to the occurrence of sbnd NO2 group at para position induced in increasing the acidity of sbnd OH proton. Consequently, it easily gets deprotonated in aqueous media. The detection limit of receptor A1 was turned out to be 0.40 and 0.35 ppm for F- and AcO- ions which is beneath WHO permission level (1.0 ppm). Receptor A1 shows a solitary property of solvatochromism in different aprotic solvents in presence of AcO- ion. Receptor A1 depicts high selectivity towards AcO- ion in DMSO: HEPES buffer (9:1, v/v). Receptor A1 proved itself for real life application by detecting anion in solution and solid state. The binding mechanism of receptor A1 with AcO- and F- ions was monitored from 1HNMR titration and DFT study.

Characterization of electrochemically deposited films from aqueous and ionic liquid cobalt precursors toward hydrogen evolution reactions

NASA Astrophysics Data System (ADS)

Dushatinski, Thomas; Huff, Clay; Abdel-Fattah, Tarek M.

2016-11-01

Electrodepositions of cobalt films were achieved using an aqueous or an ethylene glycol based non-aqueous solution containing choline chloride (vitamin B4) with cobalt chloride hexahydrate precursor toward hydrogen evolution reactions from sodium borohydride (NaBH4) as solid hydrogen feedstock (SHF). The resulting cobalt films had reflectivity at 550 nm of 2.2% for aqueously deposited films (ACoF) and 1.3% for non-aqueously deposited films (NCoF). Surface morphology studied by scanning electron microscopy showed a positive correlation between particle size and thickness. The film thicknesses were tunable between >100 μm and <300 μm for each film. The roughness (Ra) value measurements by Dektak surface profiling showed that the NCoF (Ra = 165 nm) was smoother than the ACoF (Ra = 418 nm). The NCoFs and ACoFs contained only α phase (FCC) crystallites. The NCoFs were crystalline while the ACoFs were largely amorphous from X-ray diffraction analysis. The NCoF had an average Vickers hardness value of 84 MPa as compared to 176 MPa for ACoF. The aqueous precursor has a single absorption maximum at 510 nm and the non-aqueous precursor had three absorption maxima at 630, 670, and 695 nm. The hydrogen evolution reactions over a 1 cm2 catalytic surface with aqueous NaBH4 solutions generated rate constants (K) = equal to 4.9 × 10-3 min-1, 4.6 × 10-3 min-1, and 3.3 × 10-3 min-1 for ACoF, NCoF, and copper substrate respectively.

Second-Line Therapy of Small-Cell Lung Cancer: Topotecan Compared to a Combination Treatment with Adriamycin, Cyclophosphamide And Vincristine (ACO) - a Single Center Experience

PubMed Central

Hagmann, Raphael; Hess, Viviane; Zippelius, Alfred; Rothschild, Sacha I.

2015-01-01

Background: Randomized trials established topotecan and the combination of adriamycin, cyclophosphamide and vincristine (ACO) as second-line therapy options for small-cell lung cancer. We retrospectively evaluated the outcome of SCLC patients undergoing second-line chemotherapy. Patients and Methods: 92 consecutive patients with a diagnosis of SCLC between 2000 and 2010 were analyzed. Results: 86 patients (93.5%) were evaluable for outcome analysis. All patients diagnosed with limited disease (LD) SCLC received platinum-based chemotherapy as first-line treatment. 69 patients (98.6%) diagnosed with extensive disease (ED) SCLC received first-line palliative chemotherapy. In the total cohort, the median overall survival (OS) was 10.3 months (19.2 months and 9.2 months for LD-SCLC and ED-SCLC, respectively). 42 patients received second-line therapy (ACO in 47.6% and topotecan in 31.0% of patients, respectively). Eight patients (19.0%) were re-challenged with platinum/etoposide. Neither the overall response rate (52.9% vs. 22.2%; p=0.128) nor progression-free survival (2.4 vs. 2.4 months; p=0.794) or OS (5.5 vs. 5.0 months; p=0.997) were significantly different between ACO and topotecan. ACO-treated patients showed a trend towards a longer duration of inpatient care. Conclusion: We showed similar outcomes as reported in clinical trials. Second-line combination chemotherapy with ACO did not show superiority to intravenous topotecan, but was associated with a clinically relevant longer hospitalization time. PMID:26516363

The effects of triazophos applied to transgenic Bt rice on the nutritional indexes, Nlvg expression, and population growth of Nilaparvata lugens Stål under elevated CO₂.

PubMed

Ge, Lin-Quan; Sun, Yu-Cheng; Ouyang, Fang; Wu, Jin-Cai; Ge, Feng

2015-02-01

The brown planthopper, Nilaparvata lugens (Stål) (Hemiptera: Delphacidae), is a typical pest in which population resurgence can be induced by insecticides. Warmer global temperatures, associated with anthropogenic climate change, are likely to have marked ecological effects on terrestrial ecosystems. However, the effects of elevated CO2 (eCO2) concentrations on the resurgence of N. lugens that have been treated with pesticides used for transgenic Bt rice cultivation are not fully understood. The present study investigated changes in the protein content, soluble sugar content, free amino acid level, vitellogenin (Nlvg) mRNA expression, and the population growth of N. lugens on transgenic Bt rice (TT51) following triazaophos foliar spray under conditions of eCO2. The results showed that the protein content in the fat bodies and ovaries of N. lugens adult females in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under ambient CO2 (aCO2) and was also higher than that in females feeding on the non-transgenic parent (MH63) under aCO2 at different days after emergence (DAEs). The soluble sugar content and free amino level of adult females in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under aCO2 and was also higher than in MH63 under aCO2 at 1 and 3 DAE. The Nlvg mRNA expression level of N. lugens adult females in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under aCO2 and was also higher than in MH63 under aCO2 at 1 and 3 DAE. The population number of N. lugens in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under aCO2 and was also higher than in MH63 under aCO2. The present findings provide important information for integrated pest management with transgenic varieties and a better understanding of the resurgence mechanism of N. lugens under eCO2. Copyright © 2014 Elsevier Inc. All rights reserved.

Personnel in blue and white FCR bldg 30 during STS-106

NASA Image and Video Library

2000-09-19

JSC2000-E-22832 (13 September 2000) --- Gary Ford intently watches a monitor at the Assembly and Checkout Officer (ACO) console in Houston's Mission Control Center (MCC). The ACO is responsible for station assembly, activation and checkout operations.

Advanced Photon Source accelerator ultrahigh vacuum guide

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, C.; Noonan, J.

1994-03-01

In this document the authors summarize the following: (1) an overview of basic concepts of ultrahigh vacuum needed for the APS project, (2) a description of vacuum design and calculations for major parts of APS, including linac, linac waveguide, low energy undulator test line, positron accumulator ring (PAR), booster synchrotron ring, storage ring, and insertion devices, and (3) cleaning procedures of ultrahigh vacuum (UHV) components presently used at APS.

Carbonylation of Mitochondrial Aconitase with 4-Hydroxy-2-(E)-nonenal: Localization and Relative Reactivity of Addition Sites

PubMed Central

Liu, Qingyuan; Simpson, David C.; Gronert, Scott

2013-01-01

Mass spectrometry was used to investigate the effects of exposing mitochondrial aconitase (ACO2) to the membrane lipid peroxidation product, 4-hydroxy-2-(E)-nonenal (HNE). ACO2 was selected for this study because (1) it is known to be inactivated by HNE, (2) elevated concentrations of HNE-adducted ACO2 have been associated with disease states, (3) extensive structural information is available, and (4) the iron-sulfur cluster in ACO2 offers a critical target for HNE adduction. The aim of this study was to relate the inactivation of ACO2 by HNE to structural features. Initially, western blotting and an enzyme activity assay were used to assess aggregate effects and then gel electrophoresis, in-gel digestion, and tandem mass spectrometry were used to identify HNE addition sites. HNE addition reaction rates were determined for the most significant sites using the iTRAQ approach. The most reactive sites were Cys358, Cys421, and Cys424, the three iron-sulfur cluster-coordinating cysteines, Cys99, the closest non-ligated cysteine to the cluster, and Cys565, which is located in the cleft leading to the active site. Interestingly, both enzyme activity assay and iTRAQ relative abundance plots appeared to be trending toward horizontal asymptotes, rather than completion. PMID:23518448

A Taxonomy of Accountable Care Organizations for Policy and Practice

PubMed Central

Shortell, Stephen M; Wu, Frances M; Lewis, Valerie A; Colla, Carrie H; Fisher, Elliott S

2014-01-01

Objective To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance. Data Sources/Study Setting Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs. Study Design Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data. Principal Findings We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital–physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities. Conclusions ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations. PMID:25251146

Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality.

PubMed

Huber, Thomas P; Shortell, Stephen M; Rodriguez, Hector P

2017-08-01

Examine the extent to which physician organization participation in an accountable care organization (ACO) and electronic health record (EHR) functionality are associated with greater adoption of care transition management (CTM) processes. A total of 1,398 physician organizations from the third National Study of Physician Organization survey (NSPO3), a nationally representative sample of medical practices in the United States (January 2012-May 2013). We used data from the third National Study of Physician Organization survey (NSPO3) to assess medical practice characteristics, including CTM processes, ACO participation, EHR functionality, practice type, organization size, ownership, public reporting, and pay-for-performance participation. Multivariate linear regression models estimated the extent to which ACO participation and EHR functionality were associated with greater CTM capabilities, controlling for practice size, ownership, public reporting, and pay-for-performance participation. Approximately half (52.4 percent) of medical practices had a formal program for managing care transitions in place. In adjusted analyses, ACO participation (p < .001) and EHR functionality (p < .001) were independently associated with greater use of CTM processes among medical practices. The growth of ACOs and similar provider risk-bearing arrangements across the country may improve the management of care transitions by physician organizations. © Health Research and Educational Trust.

Emittance and lifetime measurement with damping wigglers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, G. M.; Shaftan, T., E-mail: shaftan@bnl.gov; Cheng, W. X.

National Synchrotron Light Source II (NSLS-II) is a new third-generation storage ring light source at Brookhaven National Laboratory. The storage ring design calls for small horizontal emittance (<1 nm-rad) and diffraction-limited vertical emittance at 12 keV (8 pm-rad). Achieving low value of the beam size will enable novel user experiments with nm-range spatial and meV-energy resolution. The high-brightness NSLS-II lattice has been realized by implementing 30-cell double bend achromatic cells producing the horizontal emittance of 2 nm rad and then halving it further by using several Damping Wigglers (DWs). This paper is focused on characterization of the DW effects inmore » the storage ring performance, namely, on reduction of the beam emittance, and corresponding changes in the energy spread and beam lifetime. The relevant beam parameters have been measured by the X-ray pinhole camera, beam position monitors, beam filling pattern monitor, and current transformers. In this paper, we compare the measured results of the beam performance with analytic estimates for the complement of the 3 DWs installed at the NSLS-II.« less

Higher-Order Systematic Effects in the Muon Beam-Spin Dynamics for Muon g-2

NASA Astrophysics Data System (ADS)

Crnkovic, Jason; Brown, Hugh; Krouppa, Brandon; Metodiev, Eric; Morse, William; Semertzidis, Yannis; Tishchenko, Vladimir

2016-03-01

The BNL Muon g-2 Experiment (E821) produced a precision measurement of the muon anomalous magnetic moment, where as the Fermilab Muon g-2 Experiment (E989) is an upgraded version of E821 that has a goal of producing a measurement with approximately 4 times more precision. Improving the precision requires a more detailed understanding of the experimental systematic effects, and so three higher-order systematic effects in the muon beam-spin dynamics have recently been found and estimated for E821. The beamline systematic effect originates from muon production in beamline spectrometers, as well as from muons traversing beamline bending magnets. The kicker systematic effect comes from a combination of the variation in time spent inside the muon storage ring across a muon bunch and the temporal structure of the storage ring kicker waveform. Finally, the detector systematic effect arises from a combination of the energy dependent muon equilibrium orbit in the storage ring, muon decay electron drift time, and decay electron detector acceptance effects. Brookhaven Natl Lab.

New dendritic gelator bearing carbazole in each branching unit: selected response to fluoride ion in gel phase.

PubMed

Xu, Defang; Liu, Xingliang; Lu, Ran; Xue, Pengchong; Zhang, Xiaofei; Zhou, Huipeng; Jia, Junhui

2011-03-07

A new dendritic gelator with carbazole as the building block (HBCD) was synthesized. It was found that H-bonding between the amide groups and π-π interaction between the aromatic rings played predominant roles in the gel formation. Meanwhile, significant aggregation-induced emission enhancement was observed in the gel state due to the formation of J-aggregates and the restricted molecular motion. Notably, the gel state of HBCD can be destroyed upon addition of F(-), accompanied by fluorescence enhancement on account of the formation of N-HF(-), which could further lead to the increased coplanarity of HBCD. The sensory capability of HBCD exhibited a high selectivity towards F(-) instead of the Cl(-), Br(-), I(-) and AcO(-) anions, which could be explained by the fact that the steric hindrance of the dendrimer would go against the interactions between the larger anions and HBCD.

The magnetic toroidal sector: a broad-band electron-positron pair spectrometer

NASA Astrophysics Data System (ADS)

Hagmann, Siegbert; Hillenbrand, Pierre-Michel; Litvinov, Yuri; Spillmann, Uwe

2016-05-01

At the future relativistic storage-ring HESR at FAIR the study of electron-positron pairs from non-nuclear, atomic processes will be one of the goals of the experimental program with kinematically complete experiments focusing on momentum spectroscopy of coincident emission of electrons and positrons from free-free pairs and corresponding recoil ions. The underlying production mechanisms belong to central topics of QED in strong fields. We present first results on the electron-optical properties of a magnetic toroidal sector configuration enabling coincident detection of free-free electron-positron pairs; this spectrometer is suitable for implementation into a storage ring with a supersonic jet target and covering a wide range of lepton emission into the forward hemisphere. The simulation calculations are performed using the OPERA code.

3 GeV Booster Synchrotron Conceptual Design Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wiedemann, Helmut

2009-06-02

Synchrotron light cna be produced from a relativistic particle beam circulating in a storage ring at extremely high intensity and brilliance over a large spectral region reaching from the far infrared regime to hard x-rays. The particles, either electrons or positrons, radiate as they are deflected in the fields of the storage ring bending magnets or of magnets specially optimized for the production of synchrotron light. The synchrotron light being very intense and well collimated in the forward direction has become a major tool in a large variety of research fields in physics, chemistry, material science, biology, and medicine.

Safe operating conditions for NSLS-II Storage Ring Frontends commissioning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seletskiy, S.; Amundsen, C.; Ha, K.

2015-04-02

The NSLS-II Storage Ring Frontends are designed to safely accept the synchrotron radiation fan produced by respective insertion device when the electron beam orbit through the ID is locked inside the predefined Active Interlock Envelope. The Active Interlock is getting enabled at a particular beam current known as AI safe current limit. Below such current the beam orbit can be anywhere within the limits of the SR beam acceptance. During the FE commissioning the beam orbit is getting intentionally disturbed in the particular ID. In this paper we explore safe operating conditions for the Frontends commissioning.

DESY II, a new injector for the DESY storage rings PETRA and DORIS II

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hemmie, G.

1983-08-01

There is a proposal to build a new 9 GeV electron synchrotron as a dedicated injector for the storage rings DORIS and PETRA. This machine will be housed in the old DESY-tunnel side-by-side with the original DESY-synchrotron. It is characterized by a separated function lattice, a 12.5 Hz repetition frequency, an all-metal vacuum chamber and a high shunt impedance rf-system. After commissioning of this new machine in 1984, the old DESY-synchrotron could be converted into a dedicated proton-accelerator as part of the injection chain for HERA.

Explicit symplectic orbit and spin tracking method for electric storage ring

DOE PAGES

Hwang, Kilean; Lee, S. Y.

2016-08-18

We develop a symplectic charged particle tracking method for phase space coordinates and polarization in all electric storage rings. Near the magic energy, the spin precession tune is proportional to the fractional momentum deviation δ m from the magic energy, and the amplitude of the radial and longitudinal spin precession is proportional to η/δ m, where η is the electric dipole moment for an initially vertically polarized beam. As a result, the method can be used to extract the electron electric dipole moment of a charged particle by employing narrow band frequency analysis of polarization around the magic energy.

Experience with Round Beam Operation at The Advanced Photon Source

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xiao, A.; Emery, L.; Sajaev, V.

2015-01-01

Very short Touschek lifetime becomes a common issue for next-generation ultra-low emittance storage ring light sources. In order to reach a longer beamlifetime, such amachine often requires operating with a vertical-to-horizontal emittance ratio close to an unity, i.e. a “round beam”. In tests at the APS storage ring, we determined how a round beam can be reached experimentally. Some general issues, such as beam injection, optics measurement and corrections, and orbit correction have been tested also. To demonstrate that a round beam was achieved, the beam size ratio is calibrated using beam lifetime measurement.

Three-dimensional ordering of cold ion beams in a storage ring: A molecular-dynamics simulation study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yuri, Yosuke, E-mail: yuri.yosuke@jaea.go.jp

Three-dimensional (3D) ordering of a charged-particle beams circulating in a storage ring is systematically studied with a molecular-dynamics simulation code. An ion beam can exhibit a 3D ordered configuration at ultralow temperature as a result of powerful 3D laser cooling. Various unique characteristics of the ordered beams, different from those of crystalline beams, are revealed in detail, such as the single-particle motion in the transverse and longitudinal directions, and the dependence of the tune depression and the Coulomb coupling constant on the operating points.

Attractors in Sequence Space: Agent-Based Exploration of MHC I Binding Peptides.

PubMed

Jäger, Natalie; Wisniewska, Joanna M; Hiss, Jan A; Freier, Anja; Losch, Florian O; Walden, Peter; Wrede, Paul; Schneider, Gisbert

2010-01-12

Ant Colony Optimization (ACO) is a meta-heuristic that utilizes a computational analogue of ant trail pheromones to solve combinatorial optimization problems. The size of the ant colony and the representation of the ants' pheromone trails is unique referring to the given optimization problem. In the present study, we employed ACO to generate novel peptides that stabilize MHC I protein on the plasma membrane of a murine lymphoma cell line. A jury of feedforward neural network classifiers served as fitness function for peptide design by ACO. Bioactive murine MHC I H-2K(b) stabilizing as well as nonstabilizing octapeptides were designed, synthesized and tested. These peptides reveal residue motifs that are relevant for MHC I receptor binding. We demonstrate how the performance of the implemented ACO algorithm depends on the colony size and the size of the search space. The actual peptide design process by ACO constitutes a search path in sequence space that can be visualized as trajectories on a self-organizing map (SOM). By projecting the sequence space on a SOM we visualize the convergence of the different solutions that emerge during the optimization process in sequence space. The SOM representation reveals attractors in sequence space for MHC I binding peptides. The combination of ACO and SOM enables systematic peptide optimization. This technique allows for the rational design of various types of bioactive peptides with minimal experimental effort. Here, we demonstrate its successful application to the design of MHC-I binding and nonbinding peptides which exhibit substantial bioactivity in a cell-based assay. Copyright © 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Citrus CitNAC62 cooperates with CitWRKY1 to participate in citric acid degradation via up-regulation of CitAco3.

PubMed

Li, Shao-Jia; Yin, Xue-Ren; Wang, Wen-Li; Liu, Xiao-Fen; Zhang, Bo; Chen, Kun-Song

2017-06-15

Citric acid is the predominant organic acid of citrus fruit. Degradation of citric acid occurs during fruit development, influencing fruit acidity. Associations of CitAco3 transcripts and citric acid degradation have been reported for citrus fruit. Here, transient overexpression of CitAco3 significantly reduced the citric acid content of citrus leaves and fruits. Using dual luciferase assays, it was shown that CitNAC62 and CitWRKY1 could transactivate the promoter of CitAco3. Subcellular localization results showed that CitWRKY1 was located in the nucleus and CitNAC62 was not. Yeast two-hybrid analysis and bimolecular fluorescence complementation (BiFC) assays indicated that the two differently located transcription factors could interact with each other. Furthermore, BiFC showed that the protein-protein interaction occurred only in the nucleus, indicating the potential mobility of CitNAC62 in plant cells. A synergistic effect on citrate content was observed between CitNAC62 and CitWRKY1. Transient overexpression of CitNAC62 or CitWRKY1 led to significantly lower citrate content in citrus fruit. The combined expression of CitNAC62 and CitWRKY1 resulted in lower citrate content compared with the expression of CitNAC62 or CitWRKY1 alone. The transcript abundance of CitAco3 was consistent with the citrate content. Thus, we propose that a complex of CitWRKY1 and CitNAC62 contributes to citric acid degradation in citrus fruit, potentially via modulation of CitAco3. © The Author 2017. Published by Oxford University Press on behalf of the Society for Experimental Biology.

Colorimetric anion sensors based on positional effect of nitro group for recognition of biologically relevant anions in organic and aqueous medium, insight real-life application and DFT studies.

PubMed

Singh, Archana; Sahoo, Suban K; Trivedi, Darshak R

2018-01-05

A new six colorimetric receptors A1-A6 were designed and synthesized, characterized by typical common spectroscopic techniques like FT-IR, UV-Visible, 1 H NMR, 13 C NMR and ESI-MS. The receptor A1 and A2 exhibit a significant naked-eye response towards F - and AcO - ions in DMSO. Due to presences of the NO 2 group at para and ortho position with extended π-conjugation of naphthyl group carrying OH as a binding site. Compared to receptor A2, A1 is extremely capable of detecting F - and AcO - ions present in the form of sodium salts in an aqueous medium. This is owed to the occurrence of NO 2 group at para position induced in increasing the acidity of OH proton. Consequently, it easily gets deprotonated in aqueous media. The detection limit of receptor A1 was turned out to be 0.40 and 0.35ppm for F - and AcO - ions which is beneath WHO permission level (1.0ppm). Receptor A1 shows a solitary property of solvatochromism in different aprotic solvents in presence of AcO - ion. Receptor A1 depicts high selectivity towards AcO - ion in DMSO: HEPES buffer (9:1, v/v). Receptor A1 proved itself for real life application by detecting anion in solution and solid state. The binding mechanism of receptor A1 with AcO - and F - ions was monitored from 1 HNMR titration and DFT study. Copyright © 2017 Elsevier B.V. All rights reserved.

Pharmacologic activation of peroxisome proliferator-activating receptor-α accelerates hepatic fatty acid oxidation in neonatal pigs

PubMed Central

Shim, Kwanseob; Jacobi, Sheila; Odle, Jack; Lin, Xi

2018-01-01

Up-regulation of peroxisome proliferator-activating receptor-α (PPARα) and increasing fatty acid oxidation are important for reducing pre-weaning mortality of pigs. We examined the time-dependent regulatory effects of PPARα activation via oral postnatal clofibrate administration (75 mg/(kg-BW·d) for up to 7 days) on mitochondrial and peroxisomal fatty acid oxidation in pigs, a species with limited hepatic fatty acid oxidative capacity due to low ketogenesis. Hepatic oxidation was increased by 44-147% (depending on fatty acid chain-length) and was attained after only 4 days of clofibrate treatment. Acyl-CoA oxidase (ACO) and carnitine palmitoyltransferase I (CPTI) activities accelerated in parallel. The increase in CPTI activity was accompanied by a rapid reduction in the sensitivity of CPTI to malonyl-CoA inhibition. The mRNA abundance of CPTI and ACO, as well as peroxisomal keto-acyl-CoA thiolase (KetoACoA) and mitochondrial malonyl-CoA decarboxylase (MCD), also were augmented greatly. However, the increase in ACO activity and MCD expression were different from CPTI, and significant interactions were observed between postnatal age and clofibrate administration. Furthermore, the expression of acetyl-CoA carboxylase β (ACCβ) decreased with postnatal age and clofibrate had no effect on its expression. Collectively these results demonstrate that the expression of PPARα target genes and the increase in fatty acid oxidation induced by clofibrate are time- and age-dependent in the liver of neonatal pigs. Although the induction patterns of CPTI, MCD, ACO, KetoACoA, and ACCβ are different during the early postnatal period, 4 days of exposure to clofibrate were sufficient to robustly accelerate fatty acid oxidation.

Theory of the polarization of highly charged ions in storage rings: Production, preservation, observation and application to the search for a violation of the fundamental symmetries

NASA Astrophysics Data System (ADS)

Bondarevskaya, A.; Prozorov, A.; Labzowsky, L.; Plunien, G.; Liesen, D.; Bosch, F.

2011-10-01

Theoretical concepts for the production, preservation and control of polarized highly charged ion beams in storage rings are investigated. It is argued that hydrogen-like ions can be polarized efficiently by optical pumping of the Zeeman sublevels of ground state hyperfine levels and that the maximum achievable nuclear polarization exceeds 90%. In order to study the preservation of the polarization during the ion motion through the magnetic system of the ring, the concept of the instantaneous quantization axis is introduced. It is suggested that the employment of “Siberian snakes” may help to preserve the ion beam polarization in the ring. The control of the beam polarization can be achieved by different methods: by measuring the Stokes parameters for the emitted photons or by observing the angular dependence of the transition rates for polarized ions. The important motivation for the production of polarized ion beams is the possibility to observe parity nonconservation effects in the hyperfine-quenched transitions in helium-like highly charged ions, where these effects can reach an unprecedented high value for atomic physics. The possible observation of parity nonconservation effects connected with the nuclear anapole moment is also discussed. A method for the observation of the electric dipole moment of an electron in a storage ring with a polarized highly charged ion beam is proposed. This method allows, in principle, to improve the existing boundaries for the electric dipole moment of an electron. However, the requirements of the corresponding experiment are very stringent.

Coupling tree rings and eddy covariance to estimate long-term above and belowground carbon storage at the stand level

NASA Astrophysics Data System (ADS)

Dye, A.; Alexander, M. R.; Bishop, D.; Pederson, N.; Hessl, A. E.

2016-12-01

Storage of carbon in terrestrial plants and soils directly reduces atmospheric carbon concentration, and it is thereby imperative to improve our understanding of where carbon is being stored and released in an ecosystem and how storages and releases are changing over time. At data-rich sites, coupling alternative measurements of carbon flux can improve this understanding. Here, we present a methodology to inversely model stand-level net storage and release of above- and belowground carbon over a period of 1-2 decades using co-located tree-ring plots and eddy covariance towers at three eastern U.S. forests. We reconstructed annual aboveground wood production (aNPP) from tree rings collected near eddy covariance towers. We compared our aNPP reconstructions with annual tower NEE to address whether interannual variations are correlated. Despite modest correlation, we observed magnitude differences between both records that vary annually. We interpret these differences as indicative of changes in belowground carbon storage, i.e. an aNPP:NEE ratio > 1 indicates a net release of belowground carbon and a ratio < 1 a net storage of belowground carbon. For this interpretation, we assume the following: a) carbon not directed to above or belowground pools is insignificant, b) carbon not stored above ground is stored below ground, and c) mature trees do not add to a storage pool at a higher level every year. While the offset between biometric aNPP and tower NEE could partially be attributed to the diversion of assimilated carbon to nonstructural carbohydrates instead of growth, we argue that this becomes a less important factor over longer time scales in a mature tree. Our approach does not quantify belowground NPP or allocation, but we present a method for estimating belowground carbon storage and release at the stand level, an otherwise difficult task at this scale due to heterogeneity across the stand.

Maury Goodman

Science.gov Websites

the 29th International Cosmic Ray Conference, Pune India, August 10, 2005 Reactor Searches for Theta Rings, Bombay India, August 2, 2005 NOvA Presentation at the Workshop on Physics of Atmospheric Neutrinos and Neutrinos from Muon Storage Rings, Bombay India, August 2, 2005 The Double Chooz Double Fast

76 FR 82205 - Airworthiness Directives; Cessna Aircraft Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... (ACO), 1801 Airport Road, Room 100, Mid- Continent Airport, Wichita, Kansas 67209; phone: (316) 946-4154; fax: (316) 946-4107; email: [email protected] . SUPPLEMENTARY INFORMATION: Comments Invited... (ACO), 1801 Airport Road, Room 100, Mid-Continent Airport, Wichita, Kansas 67209; phone: (316) 946-4154...

Accountable Care Organizations and Antitrust Enforcement: Promoting Competition and Innovation.

PubMed

Feinstein, Deborah L; Kuhlmann, Patrick; Mucchetti, Peter J

2015-08-01

The antitrust laws stand to protect consumers of health care services from conduct that would raise prices, lower quality, and decrease innovation by lessening competition. Importantly, though, vigorous antitrust enforcement does not impede accountable care organizations (ACOs) and similar collaborations that advance these same goals of better and more efficient care; in fact, by fostering competitive markets, the antitrust laws encourage such initiatives. This article summarizes the legal framework that the federal antitrust agencies - the Federal Trade Commission and the Antitrust Division of the US Department of Justice - use to analyze ACOs and other collaborations among health care providers. It outlines the guidance provided by the federal antitrust agencies concerning when ACOs and other provider collaborations likely would harm competition and consumers. In addition, it reviews common antitrust issues that can arise with ACOs and provides examples of enforcement actions that have prevented health care providers from taking or continuing anticompetitive actions. Copyright © 2015 by Duke University Press.

Low-peak-to-average power ratio and low-complexity asymmetrically clipped optical orthogonal frequency-division multiplexing uplink transmission scheme for long-reach passive optical network.

PubMed

Zhou, Ji; Qiao, Yaojun

2015-09-01

In this Letter, we propose a discrete Hartley transform (DHT)-spread asymmetrically clipped optical orthogonal frequency-division multiplexing (DHT-S-ACO-OFDM) uplink transmission scheme in which the multiplexing/demultiplexing process also uses the DHT algorithm. By designing a simple encoding structure, the computational complexity of the transmitter can be reduced from O(Nlog(2)(N)) to O(N). At the probability of 10(-3), the peak-to-average power ratio (PAPR) of 2-ary pulse amplitude modulation (2-PAM)-modulated DHT-S-ACO-OFDM is approximately 9.7 dB lower than that of 2-PAM-modulated conventional ACO-OFDM. To verify the feasibility of the proposed scheme, a 4-Gbit/s DHT-S-ACO-OFDM uplink transmission scheme with a 1∶64 way split has been experimentally implemented using 100-km standard single-mode fiber (SSMF) for a long-reach passive optical network (LR-PON).

New Hampshire Nurse Practitioners Take the Lead in Forming an Accountable Care Organization.

PubMed

Wright, Wendy L

In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program. Hospitalization rates for NP-managed patients are among the lowest in the state. Cost of care for NP-managed patients is $66.85 less per member per month than the participating physician-managed patients. Data from this ACO provide evidence that NPs provide cost-effective, quality health care and are integral to the formation and sustainability of any ACO.

ASSOCIATION BETWEEN PAYMENT REFORM AND PROVIDER CONSOLIDATION

PubMed Central

Neprash, Hannah T.; Chernew, Michael E.; McWilliams, J. Michael

2017-01-01

Provider consolidation has been associated with higher health care prices and spending. Prevailing wisdom assumes that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing from a number of data sources from 2008 onward, we examined the relationship between Medicare’s Accountable Care Organization (ACO) programs and provider consolidation. According to multiple measures, consolidation was underway in 2008–2010, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and specialty-oriented physician group size increased after the ACA, we found minimal evidence associating consolidation with ACO penetration at a market level or with ACO participation by physicians within markets. We conclude that payment reform has been associated with little acceleration in consolidation apart from trends already underway, but with some evidence of potential defensive consolidation in response to new payment models. PMID:28167725

Characterisation of ethylene pathway components in non-climacteric capsicum.

PubMed

Aizat, Wan M; Able, Jason A; Stangoulis, James C R; Able, Amanda J

2013-11-28

Climacteric fruit exhibit high ethylene and respiration levels during ripening but these levels are limited in non-climacteric fruit. Even though capsicum is in the same family as the well-characterised climacteric tomato (Solanaceae), it is non-climacteric and does not ripen normally in response to ethylene or if harvested when mature green. However, ripening progresses normally in capsicum fruit when they are harvested during or after what is called the 'Breaker stage'. Whether ethylene, and components of the ethylene pathway such as 1-aminocyclopropane 1-carboxylate (ACC) oxidase (ACO), ACC synthase (ACS) and the ethylene receptor (ETR), contribute to non-climacteric ripening in capsicum has not been studied in detail. To elucidate the behaviour of ethylene pathway components in capsicum during ripening, further analysis is therefore needed. The effects of ethylene or inhibitors of ethylene perception, such as 1-methylcyclopropene, on capsicum fruit ripening and the ethylene pathway components may also shed some light on the role of ethylene in non-climacteric ripening. The expression of several isoforms of ACO, ACS and ETR were limited during capsicum ripening except one ACO isoform (CaACO4). ACS activity and ACC content were also low in capsicum despite the increase in ACO activity during the onset of ripening. Ethylene did not stimulate capsicum ripening but 1-methylcyclopropene treatment delayed the ripening of Breaker-harvested fruit. Some of the ACO, ACS and ETR isoforms were also differentially expressed upon treatment with ethylene or 1-methylcyclopropene. ACS activity may be the rate limiting step in the ethylene pathway of capsicum which restricts ACC content. The differential expression of several ethylene pathway components during ripening and upon ethylene or 1-methylclopropene treatment suggests that the ethylene pathway may be regulated differently in non-climacteric capsicum compared to the climacteric tomato. Ethylene independent pathways may also exist in non-climacteric ripening as evidenced by the up-regulation of CaACO4 during ripening onset despite being negatively regulated by ethylene exposure. However, some level of ethylene perception may still be needed to induce ripening especially during the Breaker stage. A model of capsicum ripening is also presented to illustrate the probable role of ethylene in this non-climacteric fruit.

Sc-Decorated Porous Graphene for High-Capacity Hydrogen Storage: First-Principles Calculations.

PubMed

Chen, Yuhong; Wang, Jing; Yuan, Lihua; Zhang, Meiling; Zhang, Cairong

2017-08-02

The generalized gradient approximation (GGA) function based on density functional theory is adopted to investigate the optimized geometrical structure, electron structure and hydrogen storage performance of Sc modified porous graphene (PG). It is found that the carbon ring center is the most stable adsorbed position for a single Sc atom on PG, and the maximum number of adsorbed H₂ molecules is four with the average adsorption energy of -0.429 eV/H₂. By adding a second Sc atom on the other side of the system, the hydrogen storage capacity of the system can be improved effectively. Two Sc atoms located on opposite sides of the PG carbon ring center hole is the most suitable hydrogen storage structure, and the hydrogen storage capacity reach a maximum 9.09 wt % at the average adsorption energy of -0.296 eV/H₂. The adsorption of H₂ molecules in the PG system is mainly attributed to orbital hybridization among H, Sc, and C atoms, and Coulomb attraction between negatively charged H₂ molecules and positively charged Sc atoms.

Sc-Decorated Porous Graphene for High-Capacity Hydrogen Storage: First-Principles Calculations

PubMed Central

Chen, Yuhong; Wang, Jing; Yuan, Lihua; Zhang, Meiling

2017-01-01

The generalized gradient approximation (GGA) function based on density functional theory is adopted to investigate the optimized geometrical structure, electron structure and hydrogen storage performance of Sc modified porous graphene (PG). It is found that the carbon ring center is the most stable adsorbed position for a single Sc atom on PG, and the maximum number of adsorbed H2 molecules is four with the average adsorption energy of −0.429 eV/H2. By adding a second Sc atom on the other side of the system, the hydrogen storage capacity of the system can be improved effectively. Two Sc atoms located on opposite sides of the PG carbon ring center hole is the most suitable hydrogen storage structure, and the hydrogen storage capacity reach a maximum 9.09 wt % at the average adsorption energy of −0.296 eV/H2. The adsorption of H2 molecules in the PG system is mainly attributed to orbital hybridization among H, Sc, and C atoms, and Coulomb attraction between negatively charged H2 molecules and positively charged Sc atoms. PMID:28767084

Stem water storage in five coexisting temperate broad-leaved tree species: significance, temporal dynamics and dependence on tree functional traits.

PubMed

Köcher, Paul; Horna, Viviana; Leuschner, Christoph

2013-08-01

The functional role of internal water storage is increasingly well understood in tropical trees and conifers, while temperate broad-leaved trees have only rarely been studied. We examined the magnitude and dynamics of the use of stem water reserves for transpiration in five coexisting temperate broad-leaved trees with largely different morphology and physiology (genera Fagus, Fraxinus, Tilia, Carpinus and Acer). We expected that differences in water storage patterns would mostly reflect species differences in wood anatomy (ring vs. diffuse-porous) and wood density. Sap flux density was recorded synchronously at five positions along the root-to-branch flow path of mature trees (roots, three stem positions and branches) with high temporal resolution (2 min) and related to stem radius changes recorded with electronic point dendrometers. The daily amount of stored stem water withdrawn for transpiration was estimated by comparing the integrated flow at stem base and stem top. The temporal coincidence of flows at different positions and apparent time lags were examined by cross-correlation analysis. Our results confirm that internal water stores play an important role in the four diffuse-porous species with estimated 5-12 kg day(-1) being withdrawn on average in 25-28 m tall trees representing 10-22% of daily transpiration; in contrast, only 0.5-2.0 kg day(-1) was withdrawn in ring-porous Fraxinus. Wood density had a large influence on storage; sapwood area (diffuse- vs. ring-porous) may be another influential factor but its effect was not significant. Across the five species, the length of the time lag in flow at stem top and stem base was positively related to the size of stem storage. The stem stores were mostly exhausted when the soil matrix potential dropped below -0.1 MPa and daily mean vapor pressure deficit exceeded 3-5 hPa. We conclude that stem storage is an important factor improving the water balance of diffuse-porous temperate broad-leaved trees in moist periods, while it may be of low relevance in dry periods and in ring-porous species.

Effects of neutral and anionic substituents on the carbonyl stretching bands of substituted methylbenzoates

NASA Astrophysics Data System (ADS)

Vassileva, P. J.; Binev, I. G.; Juchnovski, I. N.

Effects of neutral and anionic substitutents on frequencies (ν CO) and integrated intensities ( ACO) of the carbonyl stretching bands of substituted methylbenzoates (solvent dimethyl sulphoxide) have been studied in relation to Hammett's equation: satisfactory correlations have been found between ν CO and σ + constants, as well as by using the dual-parameter equations to Yukawa, Tsuno and Taft; ACO have been found to increase in cases of strong electron-releasing substituents. It has been found that constants of anionic substituents, determined on the basis of nitrile i.r. frequencies and intensities, reflect satisfactorily the effects of these substituents on ν CO and ACO of methylbenzoates.

PCMHs, ACOs, and medication management: lessons learned from early research partnerships.

PubMed

Schnur, Evan S; Adams, Alex J; Klepser, Donald G; Doucette, William R; Scott, David M

2014-02-01

The Patient Protection and Affordable Care Act has greatly accelerated the formation of team-based models of care delivery, primarily accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).  Many have written about the need to incorporate medication management services into these systems in order to improve care and reduce total health care costs. Two primary ways of doing so have emerged: (1) an embedded model, whereby pharmacists are employed directly by a physician practice, or (2) a "virtual care team" model, whereby a PCMH or ACO develops an arrangement with external pharmacists in community settings to provide coordinated services.

Acetate selective fluorescent turn-on sensors derived using vitamin B6 cofactor pyridoxal-5-phosphate

NASA Astrophysics Data System (ADS)

Sharma, Darshna; Kuba, Aman; Thomas, Rini; Ashok Kumar, S. K.; Kuwar, Anil; Choi, Heung-Jin; Sahoo, Suban K.

2016-03-01

Two new Schiff base receptors have been synthesized by condensation of pyridoxal-5-phosphate with 2-aminophenol (L1) or aniline (L2). In DMSO, the receptors showed both chromogenic and 'turn-on' fluorescence responses selectively in the presence of AcO- and F-. However, in mixed DMSO-H2O medium, the receptors showed AcO- selective 'turn-on' fluorescence without any interference from other tested anions including F-. The detection limit for AcO- was found to be 7.37 μM and 22.9 μM using the receptors L1 and L2, respectively.

76 FR 67991 - Medicare Program; Final Waivers in Connection With the Shared Savings Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-02

... governance, management, and leadership of the ACO, as well as program integrity, transparency, compliance... ACOs to promote accountability for individual Medicare beneficiaries and population health management...-kickback statute safe harbors include, among others, those for employment, personal services and management...

Field Modeling, Symplectic Tracking, and Spin Decoherence for EDM and Muon $$g\\textrm{-}2$$ Lattices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Valetov, Eremey Vladimirovich

2017-01-01

While the first particle accelerators were electrostatic machines, and several electrostatic storage rings were subsequently commissioned and operated, electrostatic storage rings pose a number of challenges. Unlike motion in the magnetic field, where particle energy remains constant, particle energy generally changes in electrostatic elements. Conservation of energy in an electrostatic element is, in practice, only approximate, and it requires careful and accurate design, manufacturing, installation, and operational use. Electrostatic deflectors require relatively high electrostatic fields, tend to introduce nonlinear aberrations of all orders, and are more challenging to manufacture than homogeneous magnetic dipoles. Accordingly, magnetic storage rings are overwhelmingly prevalent.more » The search for electric dipole moments (EDMs) of fundamental particles is of key importance in the study of C and CP violations and their sources. C and CP violations are part of the Sakharov conditions that explain the matter–antimatter asymmetry in the universe. Determining the source of CP violations would provide valuable empirical insight for beyond-Standard-Model physics. EDMs of fundamental particles have not to this date been experimentally observed. The search for fundamental particle EDMs has narrowed the target search region; however, an EDM signal is yet to be discovered. In 2008, Brookhaven National Laboratory (BNL) had proposed the frozen spin (FS) concept for the search of a deuteron EDM. The FS concept envisions launching deuterons through a storage ring with combined electrostatic and magnetic fields. The electrostatic and magnetic fields are in a proportion that would, without an EDM, freeze the deuteron’s spin along its momentum as the deuteron moves around the lattice. The radial electrostatic field would result in a torque on the spin vector, proportional to a deuteron EDM, rotating the spin vector out of the midplane.« less

Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

PubMed

Conway, Sarah J; Himmelrich, Sarah; Feeser, Scott A; Flynn, John A; Kravet, Steven J; Bailey, Jennifer; Hebert, Lindsay C; Donovan, Susan H; Kachur, Sarah G; Brown, Patricia M C; Baumgartner, William A; Berkowitz, Scott A

2018-02-02

Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.

Surgery scheduling optimization considering real life constraints and comprehensive operation cost of operating room.

PubMed

Xiang, Wei; Li, Chong

2015-01-01

Operating Room (OR) is the core sector in hospital expenditure, the operation management of which involves a complete three-stage surgery flow, multiple resources, prioritization of the various surgeries, and several real-life OR constraints. As such reasonable surgery scheduling is crucial to OR management. To optimize OR management and reduce operation cost, a short-term surgery scheduling problem is proposed and defined based on the survey of the OR operation in a typical hospital in China. The comprehensive operation cost is clearly defined considering both under-utilization and overutilization. A nested Ant Colony Optimization (nested-ACO) incorporated with several real-life OR constraints is proposed to solve such a combinatorial optimization problem. The 10-day manual surgery schedules from a hospital in China are compared with the optimized schedules solved by the nested-ACO. Comparison results show the advantage using the nested-ACO in several measurements: OR-related time, nurse-related time, variation in resources' working time, and the end time. The nested-ACO considering real-life operation constraints such as the difference between first and following case, surgeries priority, and fixed nurses in pre/post-operative stage is proposed to solve the surgery scheduling optimization problem. The results clearly show the benefit of using the nested-ACO in enhancing the OR management efficiency and minimizing the comprehensive overall operation cost.

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.316 - Monitoring of ACOs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality measurement data reported by the ACO as well as aggregate annual and quarterly reports. (ii... described in paragraph (a)(2) of this section (as appropriate) to identify trends and patterns suggesting... quality performance standards or fails to report on one or more quality measures, in addition to actions...

42 CFR 425.316 - Monitoring of ACOs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality measurement data reported by the ACO as well as aggregate annual and quarterly reports. (ii... described in paragraph (a)(2) of this section (as appropriate) to identify trends and patterns suggesting... quality performance standards or fails to report on one or more quality measures, in addition to actions...

42 CFR 425.316 - Monitoring of ACOs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... quality measurement data reported by the ACO as well as aggregate annual and quarterly reports. (ii... described in paragraph (a)(2) of this section (as appropriate) to identify trends and patterns suggesting... quality performance standards or fails to report on one or more quality measures, in addition to actions...

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii) Preventative health. (iv) At... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... defined by CMS based on national Medicare fee-for-service rates, national MA quality measure rates, or a...

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2014 CFR

2014-10-01

... four domains: (i) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... a point scale for the measures. (2)(i) CMS will define the quality benchmarks using fee-for-service...

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii) Preventative health. (iv) At... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... defined by CMS based on national Medicare fee-for-service rates, national MA quality measure rates, or a...

42 CFR § 512.230 - Beneficiary inclusion criteria.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Scope of Episodes... in the Next Generation ACO model; (2) An ACO in a track of the Comprehensive ESRD Care Model... a member of a physician group practice that initiates BPCI Model 2 episodes at the EPM participant...

75 FR 57039 - Medicare Program; Workshop Regarding Accountable Care Organizations, and Implications Regarding...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

... panel discussions and a listening session on certain legal issues related to Accountable Care Organizations (ACOs). Physicians, physician associations, hospitals, health systems, consumers, and all others...-mail to [email protected] or sent via regular mail to: Attn: ACO Legal Issues, Mail Stop C5-15...

Storing keV negative ions for an hour: the lifetime of the metastable ^(2)P((1/2)^(o)) level in ^(32)S^(-).

PubMed

Bäckström, E; Hanstorp, D; Hole, O M; Kaminska, M; Nascimento, R F; Blom, M; Björkhage, M; Källberg, A; Löfgren, P; Reinhed, P; Rosén, S; Simonsson, A; Thomas, R D; Mannervik, S; Schmidt, H T; Cederquist, H

2015-04-10

We use a novel electrostatic ion storage ring to measure the radiative lifetime of the upper level in the 3p^{5} ^{2}P_{1/2}^{o}→3p^{5} ^{2}P_{3/2}^{o} spontaneous radiative decay in ^{32}S^{-} to be 503±54  sec. This is by orders of magnitude the longest lifetime ever measured in a negatively charged ion. Cryogenic cooling of the storage ring gives a residual-gas pressure of a few times 10^{-14} mbar at 13 K and storage of 10 keV sulfur anions for more than an hour. Our experimental results differ by 1.3σ from the only available theoretical prediction [P. Andersson et al., Phys. Rev. A 73, 032705 (2006)].

CsI-Silicon Particle detector for Heavy ions Orbiting in Storage rings (CsISiPHOS)

NASA Astrophysics Data System (ADS)

Najafi, M. A.; Dillmann, I.; Bosch, F.; Faestermann, T.; Gao, B.; Gernhäuser, R.; Kozhuharov, C.; Litvinov, S. A.; Litvinov, Yu. A.; Maier, L.; Nolden, F.; Popp, U.; Sanjari, M. S.; Spillmann, U.; Steck, M.; Stöhlker, T.; Weick, H.

2016-11-01

A heavy-ion detector was developed for decay studies in the Experimental Storage Ring (ESR) at the GSI Helmholtz Centre for Heavy Ion Research in Darmstadt, Germany. This detector serves as a prototype for the in-pocket particle detectors for future experiments with the Collector Ring (CR) at FAIR (Facility for Antiproton and Ion Research). The detector includes a stack of six silicon pad sensors, a double-sided silicon strip detector (DSSD), and a CsI(Tl) scintillation detector. It was used successfully in a recent experiment for the detection of the β+-decay of highly charged 142Pm60+ ions. Based on the ΔE / E technique for particle identification and an energy resolution of 0.9% for ΔE and 0.5% for E (Full Width at Half Maximum (FWHM)), the detector is well-suited to distinguish neighbouring isobars in the region of interest.

Saturation of the laser-induced narrowband coherent synchrotron radiation process: Experimental observation at a storage ring

NASA Astrophysics Data System (ADS)

Hosaka, M.; Yamamoto, N.; Takashima, Y.; Szwaj, C.; Le Parquier, M.; Evain, C.; Bielawski, S.; Adachi, M.; Zen, H.; Tanikawa, T.; Kimura, S.; Katoh, M.; Shimada, M.; Takahashi, T.

2013-02-01

We study the efficiency limitation affecting laser-induced coherent synchrotron radiation (CSR) at high laser power. Experiments are made on the UVSOR-II storage ring in conditions of narrowband terahertz CSR emission. While, at moderate power, CSR power increases quadratically with laser power, a noticeable decrease in efficiency and eventually a decrease in CSR power is observed experimentally at high power. Details of the underlying process are analyzed numerically. As the saturation effect depends almost instantaneously on the laser intensity, the saturation occurs locally in longitudinal space. This has important consequences on the modulation pattern induced on the electron bunch.

Progress on the Design of the Storage Ring Vacuum System for the Advanced Photon Source Upgrade Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stillwell, B.; Billett, B.; Brajuskovic, B.

2017-06-20

Recent work on the design of the storage ring vacuum system for the Advanced Photon Source Upgrade project (APS-U) includes: revising the vacuum system design to accommodate a new lattice with reverse bend magnets, modifying the designs of vacuum chambers in the FODO sections for more intense incident synchrotron radiation power, modifying the design of rf-shielding bellows liners for better performance and reliability, modifying photon absorber designs to make better use of available space, and integrated planning of components needed in the injection, extraction and rf cavity straight sections. An overview of progress in these areas is presented.

Development and operating experience of a short-period superconducting undulator at the Advanced Photon Source

DOE PAGES

Ivanyushenkov, Y.; Harkay, K.; Abliz, M.; ...

2015-04-01

In this study, a decade-long effort at the Advanced Photon Source (APS) of Argonne National Laboratory (ANL) on development of superconducting undulators culminated in December 2012 with the installation of the first superconducting undulator “SCU0” into Sector 6 of the APS storage ring. The device was commissioned in January 2013 and has been in user operation since. This paper presents the magnetic and cryogenic design of the SCU0 together with the results of stand-alone cold tests. The initial commissioning and characterization of SCU0 as well as its operating experience in the APS storage ring are described.

Measurement of Tensor Analyzing Powers for Elastic Electron Scattering from a Polarized 2H Target Internal to a Storage Ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

M. Ferro-Luzzi; M. Bouwhuis; E. Passchier

1996-09-23

We report an absolute measurement of the tensor analyzing powers T20 and T22 in elastic electron-deuteron scattering at a momentum transfer of 1.6 fm{sup -1}. The novel approach of this measurement is the use of a tensor polarized 2H target internal to an electron storage ring, with in situ measurement of the polarization of the target gas. Scattered electrons and recoil deuterons were detected in coincidence with two large acceptance nonmagnetic detectors. The techniques demonstrated have broad applicability to further measurements of spin-dependent electron scattering.

Broadband impedance calculations and single bunch instabilities estimations of of the HLS-II storage ring

NASA Astrophysics Data System (ADS)

Zhang, Qing-Kun; Wang, Lin; Li, Wei-Min; Gao, Wei-Wei

2015-12-01

The upgrade project of the Hefei Light Source storage ring is under way. In this paper, the broadband impedances of resistive wall and coated ceramic vacuum chamber are calculated using the analytic formula, and the wake fields and impedances of other designed vacuum chambers are simulated by CST code, and then a broadband impedance model is obtained. Using the theoretical formula, longitudinal and transverse single bunch instabilities are discussed. With the carefully-designed vacuum chamber, we find that the thresholds of the beam instabilities are higher than the beam current goal. Supported by Natural Science Foundation of China (11175182, 11175180)

Transparent lattice characterization with gated turn-by-turn data of diagnostic bunch train

NASA Astrophysics Data System (ADS)

Li, Yongjun; Cheng, Weixing; Ha, Kiman; Rainer, Robert

2017-11-01

Methods of characterization of a storage ring's lattice have traditionally been intrusive to routine operations. More importantly, the lattice seen by particles can drift with the beam current due to collective effects. To circumvent this, we have developed a novel approach for dynamically characterizing a storage ring's lattice that is transparent to operations. Our approach adopts a dedicated filling pattern which has a short, separate diagnostic bunch train (DBT). Through the use of a bunch-by-bunch feedback system, the DBT can be selectively excited on demand. Gated functionality of a beam position monitor system is capable of collecting turn-by-turn data of the DBT, from which the lattice can then be characterized after excitation. As the DBT comprises only about one percent of the total operational bunches, the effects of its excitation are negligible to users. This approach allows us to localize the distributed quadrupolar wakefields generated in the storage ring vacuum chamber during beam accumulation. While effectively transparent to operations, our approach enables us to dynamically control the beta beat and phase beat, and unobtrusively optimize performance of the National Synchrotron Light Source-II accelerator during routine operations.

Upgrade of BPM Electronics for the SPring-8 Storage Ring

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sasaki, Shigeki; Fujita, Takahiro; Shoji, Masazumi

2006-11-20

SPring-8, a 3rd generation synchrotron light source, has operated since 1997. Improvement of BPM performance is required as a part of upgrading activities of the storage ring as a light source. We have developed new electronics circuits for signal processing of the storage ring BPM, with target performance of sub-{mu}m range resolution with sufficiently fast measurement speed and good long-term stability. A set of the new circuits consists of multiplexers, an RF amplifier, a mixer, an IF amplifier, and a local oscillator for analog signal processing. The IF amplifier outputs are sampled with 16-bit 2-MSPS ADC on ADC boards andmore » the data are sent to a DSP board. The sampled data are processed and converted to position information in the DSP. A multiplexing method was employed to have a better stability of the performance by cancellation of variation common to each channel. Evaluation of the performance by using a prototype shows that position resolution well into the sub-{mu}m range has been achieved with a bandwidth of 1 kHz, and long-term stability of within 1 {mu}m has also been achieved.« less

Transparent lattice characterization with gated turn-by-turn data of diagnostic bunch train

DOE PAGES

Li, Yongjun; Cheng, Weixing; Ha, Kiman; ...

2017-11-21

Methods of characterization of a storage ring's lattice have traditionally been intrusive to routine operations. More importantly, the lattice seen by particles can drift with the beam current due to collective effects. To circumvent this, we have developed a novel approach for dynamically characterizing a storage ring's lattice that is transparent to operations. Our approach adopts a dedicated filling pattern which has a short, separate Diagnostic Bunch-Train (DBT). Through the use of a bunch-by-bunch feedback system, the DBT can be selectively excited on-demand. Gated functionality of a beam position monitor system is capable of collecting turn-by-turn data of the DBT,more » from which the lattice can then be characterized after excitation. As the DBT comprises only about one percent of the total operational bunches, the effects of its excitation are negligible to users. Therefore, this approach allows us to localize the distributed quadrupolar wake fields generated in the storage ring vacuum chamber during beam accumulation. While effectively transparent to operations, our approach enables us to dynamically control the beta-beat and phase-beat, and unobtrusively optimize performance of National Synchrotron Light Source-II accelerator during routine operations.« less

Synchrotron oscillation effects on an rf-solenoid spin resonance

NASA Astrophysics Data System (ADS)

Benati, P.; Chiladze, D.; Dietrich, J.; Gaisser, M.; Gebel, R.; Guidoboni, G.; Hejny, V.; Kacharava, A.; Kamerdzhiev, V.; Kulessa, P.; Lehrach, A.; Lenisa, P.; Lorentz, B.; Maier, R.; Mchedlishvili, D.; Morse, W. M.; Öllers, D.; Pesce, A.; Polyanskiy, A.; Prasuhn, D.; Rathmann, F.; Semertzidis, Y. K.; Stephenson, E. J.; Stockhorst, H.; Ströher, H.; Talman, R.; Valdau, Yu.; Weidemann, Ch.; Wüstner, P.

2012-12-01

New measurements are reported for the time dependence of the vertical polarization of a 0.97GeV/c deuteron beam circulating in a storage ring and perturbed by an rf solenoid. The storage ring is the cooler synchrotron (COSY) located at the Forschungszentrum Jülich. The beam polarization was measured continuously using a 1.5 cm thick carbon target located at the edge of the circulating deuteron beam and the scintillators of the EDDA detector. An rf solenoid mounted on the ring was used to generate fields at and near the frequency of the 1-Gγ spin resonance. Measurements were made of the vertical beam polarization as a function of time with the operation of the rf solenoid in either fixed or continuously variable frequency mode. Using rf-solenoid strengths as large as 2.66×10-5revolutions/turn, slow oscillations (˜1Hz) were observed in the vertical beam polarization. When the circulating beam was continuously electron cooled, these oscillations completely reversed the polarization and showed no sign of diminishing in amplitude. But for the uncooled beam, the oscillation amplitude was damped to nearly zero within a few seconds. A simple spin-tracking model without the details of the COSY ring lattice was successful in reproducing these oscillations and demonstrating the sensitivity of the damping to the magnitude of the synchrotron motion of the beam particles. The model demonstrates that the characteristic features of measurements made in the presence of large synchrotron oscillations are distinct from the features of such measurements when made off resonance. These data were collected in preparation for a study of the spin coherence time, a beam property that needs to become long to enable a search for an electric dipole moment using a storage ring.

Accountable care organizations: financial advantages of larger hospital organizations.

PubMed

Camargo, Rodrigo; Camargo, Thaisa; Deslich, Stacie; Paul, David P; Coustasse, Alberto

2014-01-01

Accountable care organizations (ACOs) are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of this study suggest that ACOs based in a larger hospital organization are more likely to meet Centers for Medicare and Medicaid Services criteria for formation because of financial and structural assets of those entities.

New Methods for the Detection and Interception of Frequency-Hopped Waveforms

DTIC Science & Technology

1990-11-01

that £[p2 Q2 /O] = uF + 2 + o(cos 0 + 6 sin9)2 + 4n(acos0+/3sin)(7ycos0+6sinO)+o r(acos0+sinO)2 I + ( acosO +/3sinO) 2(Tcos9+ 6sin O)2 (3.134) i which...Jcins I lopk ins lI mvtrsi! t3 A pplied Physics Laborator Before1 NII After Figure 4.4: Deconvolut ion Applivod to Oi-fFci i r 100 The Johns 11opkins...Arlington, VA 20360 Library 2 Naval Postgraduate School Monterey, CA 92940 Library 2 Naval Research Laborator . Washington, DC 20375 Library 2 J. W

Tips for medical practice success in the upcoming accountable care era.

PubMed

Bobbitt, Julian D

2012-01-01

Due to the unsustainable cost of healthcare, the movement to accountable care will be inevitable. This author predicts that recent Medicare Accountable Care Organization (ACO) regulations will energize ACO development. There are specific practical strategies every medical practice leader should know in order to navigate this new healthcare environment successfully. There is a window of opportunity, which will not stay open long, to control a medical practice's destiny in molding a fair, sustainable, and successful ACO. Not being prepared and defaulting to the status quo through passivity is also a choice that promises more work for less compensation for medical practices. The choice is clear, and the blueprint for success is available.

In-space inertial energy storage design

NASA Technical Reports Server (NTRS)

Studer, P. A.; Evans, H. E.

1981-01-01

Flywheel energy storage is a means of significantly improving the performance of space power systems. Two study contracts have been completed to investigate the merits of a magnetically suspended, ironless armature, ring rotor 'Mechanical Capacitor' design. The design of a suitable energy storage system is evaluated, taking into account baseline requirements, the motor generator, details regarding the suspension design, power conditioning, the rotor, and an example design. It appears on the basis of this evaluation that the inertial (flywheel) energy storage design is feasible.

Distributed trace using central performance counter memory

DOEpatents

Satterfield, David L; Sexton, James C

2013-10-22

A plurality of processing cores, are central storage unit having at least memory connected in a daisy chain manner, forming a daisy chain ring layout on an integrated chip. At least one of the plurality of processing cores places trace data on the daisy chain connection for transmitting the trace data to the central storage unit, and the central storage unit detects the trace data and stores the trace data in the memory co-located in with the central storage unit.

Distributed trace using central performance counter memory

DOEpatents

Satterfield, David L.; Sexton, James C.

2013-01-22

A plurality of processing cores, are central storage unit having at least memory connected in a daisy chain manner, forming a daisy chain ring layout on an integrated chip. At least one of the plurality of processing cores places trace data on the daisy chain connection for transmitting the trace data to the central storage unit, and the central storage unit detects the trace data and stores the trace data in the memory co-located in with the central storage unit.

The March to Accountable Care Organizations--How Will Rural Fare?

ERIC Educational Resources Information Center

MacKinney, A. Clinton; Mueller, Keith J.; McBride, Timothy D.

2011-01-01

Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA)…

Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models.

PubMed

Neprash, Hannah T; Chernew, Michael E; McWilliams, J Michael

2017-02-01

Provider consolidation has been associated with higher health care prices and spending. The prevailing wisdom is that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing on data from a number of sources from 2008 onward, we examined the relationship between Medicare's accountable care organization (ACO) programs and provider consolidation. We found that consolidation was under way in the period 2008-10, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and the size of specialty-oriented physician groups increased after the ACA was passed, we found minimal evidence that consolidation was associated with ACO penetration at the market level or with physicians' participation in ACOs within markets. We conclude that payment reform has been associated with little acceleration in consolidation in addition to trends already under way, but there is evidence of potential defensive consolidation in response to new payment models. Project HOPE—The People-to-People Health Foundation, Inc.

Research on global path planning based on ant colony optimization for AUV

NASA Astrophysics Data System (ADS)

Wang, Hong-Jian; Xiong, Wei

2009-03-01

Path planning is an important issue for autonomous underwater vehicles (AUVs) traversing an unknown environment such as a sea floor, a jungle, or the outer celestial planets. For this paper, global path planning using large-scale chart data was studied, and the principles of ant colony optimization (ACO) were applied. This paper introduced the idea of a visibility graph based on the grid workspace model. It also brought a series of pheromone updating rules for the ACO planning algorithm. The operational steps of the ACO algorithm are proposed as a model for a global path planning method for AUV. To mimic the process of smoothing a planned path, a cutting operator and an insertion-point operator were designed. Simulation results demonstrated that the ACO algorithm is suitable for global path planning. The system has many advantages, including that the operating path of the AUV can be quickly optimized, and it is shorter, safer, and smoother. The prototype system successfully demonstrated the feasibility of the concept, proving it can be applied to surveys of unstructured unmanned environments.

Regulatory neutrality is essential to establishing a level playing field for accountable care organizations.

PubMed

Bacher, Gary E; Chernew, Michael E; Kessler, Daniel P; Weiner, Stephen M

2013-08-01

Accountable care organizations (ACOs) are among the most widely discussed models for encouraging movement away from fee-for-service payment arrangements. Although ACOs have the potential to slow health spending growth and improve quality of care, regulating them poses special challenges. Regulations, particularly those that affect both ACOs and Medicare Advantage plans, could inadvertently favor or disfavor certain kinds of providers or payers. Such favoritism could drive efficient organizations from the market and thus increase costs or reduce quality of and access to care. To avoid this type of outcome, we propose a general principle: Regulation of ACOs should strive to preserve a level playing field among different kinds of organizations seeking the same cost, quality, and access objectives. This is known as regulatory neutrality. We describe the implications of regulatory neutrality in four key areas: antitrust, financial solvency regulation, Medicare governance requirements, and Medicare payment models. We also discuss issues relating to short-term versus long-term perspectives--to promote the goal of regulatory neutrality and allow the most efficient organizations to prevail in the marketplace.

15. DETAILED VIEW OF ENRICHED URANIUM STORAGE TANK. THE ADDITION ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

15. DETAILED VIEW OF ENRICHED URANIUM STORAGE TANK. THE ADDITION OF THE GLASS RINGS SHOWN AT THE TOP OF THE TANK HELPS PREVENT THE URANIUM FROM REACHING CRITICALITY LIMITS. (4/12/62) - Rocky Flats Plant, General Manufacturing, Support, Records-Central Computing, Southern portion of Plant, Golden, Jefferson County, CO

A permanent-magnet rotor for a high-temperature superconducting bearing

NASA Astrophysics Data System (ADS)

Mulcahy, T. M.; Hull, J. R.; Uherka, K. L.; Abboud, R. G.; Wise, J. H.; Carnegie, D. W.

1995-06-01

Design, fabrication, and performance, of a 1/3-m dia., 10-kg flywheel rotor with only one bearing is discussed. To achieve low-loss energy storage, the rotor's segmented-ring permanent-magnet (PM) is optimized for levitation and circumferential homogeneity. The magnet's carbon composite bands enable practical energy storage.

Assessment of gene order computing methods for Alzheimer's disease

PubMed Central

2013-01-01

Background Computational genomics of Alzheimer disease (AD), the most common form of senile dementia, is a nascent field in AD research. The field includes AD gene clustering by computing gene order which generates higher quality gene clustering patterns than most other clustering methods. However, there are few available gene order computing methods such as Genetic Algorithm (GA) and Ant Colony Optimization (ACO). Further, their performance in gene order computation using AD microarray data is not known. We thus set forth to evaluate the performances of current gene order computing methods with different distance formulas, and to identify additional features associated with gene order computation. Methods Using different distance formulas- Pearson distance and Euclidean distance, the squared Euclidean distance, and other conditions, gene orders were calculated by ACO and GA (including standard GA and improved GA) methods, respectively. The qualities of the gene orders were compared, and new features from the calculated gene orders were identified. Results Compared to the GA methods tested in this study, ACO fits the AD microarray data the best when calculating gene order. In addition, the following features were revealed: different distance formulas generated a different quality of gene order, and the commonly used Pearson distance was not the best distance formula when used with both GA and ACO methods for AD microarray data. Conclusion Compared with Pearson distance and Euclidean distance, the squared Euclidean distance generated the best quality gene order computed by GA and ACO methods. PMID:23369541

Impact of anatomical variations of the circle of Willis on the incidence of aneurysms and their recurrence rate following endovascular treatment.

PubMed

Songsaeng, D; Geibprasert, S; Willinsky, R; Tymianski, M; TerBrugge, K G; Krings, T

2010-11-01

To analyse the impact of anatomical variations of the parent arteries on the incidence and recurrence rate following coil embolization of aneurysms of the anterior (AcoA), posterior communicating artery (PcoA) and basilar artery (BA) tip. Two hundred and two (96 AcoA, 67 PcoA, and 29 BA) aneurysms in 200 patients were treated with coil embolization between January 2000 and April 2008. Parent artery variations at each location were classified as: AcoA: A1 aplasia versus hypoplasia versus symmetrical size; PcoA: foetal origin versus medium versus small size, BA: cranial versus caudal versus asymmetrical fusion. The incidence of aneurysms and difference between recurrence rates for each group were recorded on follow-up. AcoA, PcoA, and BA aneurysms were more often associated with embryonically earlier vessel wall dispositions (A1 aplasia, foetal PcoA, asymmetrical fusion). Two of these variations were also associated with aneurysm recurrence following coil embolization: asymmetrical A1 segment (p=0.01), and asymmetrical BA tip (p=0.02). AcoA, PcoA, and BA tip aneurysms tend to occur more often in anatomically variant parent artery dispositions, some of which are related to aneurysm recurrence following coil embolization. This may relate to a more fragile vessel disposition as it is not fully matured or to altered haemodynamics secondary to the anatomical variations. Copyright © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

CedA is a novel Escherichia coli protein that activates the cell division inhibited by chromosomal DNA over-replication.

PubMed

Katayama, T; Takata, M; Sekimizu, K

1997-11-01

We isolated and characterized a new gene related to the control of cell division regulation in Escherichia coli. At 30 degrees C, the dnaAcos mutant causes over-replication of the chromosome, and colony formation is inhibited. We found that, at this temperature, the dnaAcos cells form filaments; therefore, septum formation is inhibited. This inhibition was independent of SfiA, an inhibitor of the septum-forming protein, FtsZ. To identify factors involved in this pathway of inhibition, we isolated seven multicopy suppressors for the cold-sensitive phenotype of the dnaAcos mutant. One of these proved to be a previously unknown gene, which we named cedA. This gene encoded a 12 kDa protein and resided at 38.9min on the E. coli genome map. A multicopy supply of the cedA gene to the dnaAcos cells did not repress over-replication of the chromosome but did stimulate cell division of the host, the result being growth of cells with an abnormally elevated chromosomal copy number. Therefore, the expression level of the cedA gene seems to be important for inhibiting cell division of the dnaAcos mutant at 30 degrees C. We propose that over-replication of the chromosome activates a pathway for inhibiting cell division and that the cedA gene modulates this division control. In the dnaA+ background, cedA also seems to affect cell division.

Labile dissolved organic carbon supply limits hyporheic denitrification

NASA Astrophysics Data System (ADS)

Zarnetske, Jay P.; Haggerty, Roy; Wondzell, Steven M.; Baker, Michelle A.

2011-12-01

We used an in situ steady state 15N-labeled nitrate (15NO3-) and acetate (AcO-) well-to-wells injection experiment to determine how the availability of labile dissolved organic carbon (DOC) as AcO-influences microbial denitrification in the hyporheic zone of an upland (third-order) agricultural stream. The experimental wells receiving conservative (Cl- and Br) and reactive (15NO3-) solute tracers had hyporheic median residence times of 7.0 to 13.1 h, nominal flowpath lengths of 0.7 to 3.7 m, and hypoxic conditions (<1.5 mg O2 L-1). All receiving wells demonstrated 15N2 production during ambient conditions, indicating that the hyporheic zone was an environment with active denitrification. The subsequent addition of AcO- stimulated more denitrification as evidenced by significant δ15N2 increases by factors of 2.7 to 26.1 in receiving wells and significant decreases of NO3- and DO in the two wells most hydrologically connected to the injection. The rate of nitrate removal in the hyporheic zone increased from 218 kg ha-1 yr-1 to 521 kg ha-1 yr-1 under elevated AcO- conditions. In all receiving wells, increases of bromide and 15N2 occurred without concurrent increases in AcO-, indicating that 100% of AcO- was retained or lost in the hyporheic zone. These results support the hypothesis that denitrification in anaerobic portions of the hyporheic zone is limited by labile DOC supply.

Energy storage apparatus

NASA Technical Reports Server (NTRS)

Studer, P. A.; Evans, H. E. (Inventor)

1978-01-01

A high efficiency, flywheel type energy storage device which comprises an electronically commutated d.c. motor/generator unit having a massive flywheel rotor magnetically suspended around a ring shaped stator is presented. During periods of low energy demand, the storage devices were operated as a motor, and the flywheel motor was brought up to operating speed. Energy was drawn from the device functioning as a generator as the flywheel rotor rotated during high energy demand periods.

Overview of a flywheel stack energy storage system

NASA Technical Reports Server (NTRS)

Kirk, James A.; Anand, Davinder K.

1988-01-01

The concept of storing electrical energy in rotating flywheels provides an attractive substitute to batteries. To realize these advantages the critical technologies of rotor design, composite materials, magnetic suspension, and high efficiency motor/generators are reviewed in this paper. The magnetically suspended flywheel energy storage system, currently under development at the University of Maryland, consisting of a family of interference assembled rings, is presented as an integrated solution for energy storage.

Characterisation of ethylene pathway components in non-climacteric capsicum

PubMed Central

2013-01-01

Background Climacteric fruit exhibit high ethylene and respiration levels during ripening but these levels are limited in non-climacteric fruit. Even though capsicum is in the same family as the well-characterised climacteric tomato (Solanaceae), it is non-climacteric and does not ripen normally in response to ethylene or if harvested when mature green. However, ripening progresses normally in capsicum fruit when they are harvested during or after what is called the ‘Breaker stage’. Whether ethylene, and components of the ethylene pathway such as 1-aminocyclopropane 1-carboxylate (ACC) oxidase (ACO), ACC synthase (ACS) and the ethylene receptor (ETR), contribute to non-climacteric ripening in capsicum has not been studied in detail. To elucidate the behaviour of ethylene pathway components in capsicum during ripening, further analysis is therefore needed. The effects of ethylene or inhibitors of ethylene perception, such as 1-methylcyclopropene, on capsicum fruit ripening and the ethylene pathway components may also shed some light on the role of ethylene in non-climacteric ripening. Results The expression of several isoforms of ACO, ACS and ETR were limited during capsicum ripening except one ACO isoform (CaACO4). ACS activity and ACC content were also low in capsicum despite the increase in ACO activity during the onset of ripening. Ethylene did not stimulate capsicum ripening but 1-methylcyclopropene treatment delayed the ripening of Breaker-harvested fruit. Some of the ACO, ACS and ETR isoforms were also differentially expressed upon treatment with ethylene or 1-methylcyclopropene. Conclusions ACS activity may be the rate limiting step in the ethylene pathway of capsicum which restricts ACC content. The differential expression of several ethylene pathway components during ripening and upon ethylene or 1-methylclopropene treatment suggests that the ethylene pathway may be regulated differently in non-climacteric capsicum compared to the climacteric tomato. Ethylene independent pathways may also exist in non-climacteric ripening as evidenced by the up-regulation of CaACO4 during ripening onset despite being negatively regulated by ethylene exposure. However, some level of ethylene perception may still be needed to induce ripening especially during the Breaker stage. A model of capsicum ripening is also presented to illustrate the probable role of ethylene in this non-climacteric fruit. PMID:24286334

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries.

PubMed

Colla, Carrie H; Lewis, Valerie A; Kao, Lee-Sien; O'Malley, A James; Chang, Chiang-Hua; Fisher, Elliott S

2016-08-01

Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. Total spending decreased by $34 (95% CI, -$52 to -$15) per beneficiary-quarter after ACO contract implementation across the overall Medicare population (n = 15 592 600) and decreased $114 in clinically vulnerable patients (n = 8 673 823) (95% CI, -$178 to -$50). In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively (95% CIs: -2.1 to -0.4 and -4.8 to -1.3), and hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively (95% CIs: -5.2 to -0.7 and -7.1 to -1.2). Changes in total spending associated with ACOs did not vary by clinical condition of beneficiaries. Medicare ACO programs are associated with modest reductions in spending and use of hospitals and emergency departments. Savings were realized through reductions in use of institutional settings in clinically vulnerable patients.

Space-charge-sustained microbunch structure in the Los Alamos Proton Storage Ring

NASA Astrophysics Data System (ADS)

Cousineau, S.; Danilov, V.; Holmes, J.; Macek, R.

2004-09-01

We present experimental data from the Los Alamos Proton Storage Ring (PSR) showing long-lived linac microbunch structure during beam storage with no rf bunching. Analysis of the experimental data and particle-in-cell simulations of the experiments indicate that space charge, coupled with energy spread effects, is responsible for the sustained microbunch structure. The simulated longitudinal phase space of the beam reveals a well-defined separatrix in the phase space between linac microbunches, with particles executing unbounded motion outside of the separatrix. We show that the longitudinal phase space of the beam was near steady state during the PSR experiments, such that the separatrix persisted for long periods of time. Our simulations indicate that the steady state is very sensitive to the experimental conditions. Finally, we solve the steady-state problem in an analytic, self-consistent fashion for a set of periodic longitudinal space-charge potentials.

Computational Analysis on Performance of Thermal Energy Storage (TES) Diffuser

NASA Astrophysics Data System (ADS)

Adib, M. A. H. M.; Adnan, F.; Ismail, A. R.; Kardigama, K.; Salaam, H. A.; Ahmad, Z.; Johari, N. H.; Anuar, Z.; Azmi, N. S. N.

2012-09-01

Application of thermal energy storage (TES) system reduces cost and energy consumption. The performance of the overall operation is affected by diffuser design. In this study, computational analysis is used to determine the thermocline thickness. Three dimensional simulations with different tank height-to-diameter ratio (HD), diffuser opening and the effect of difference number of diffuser holes are investigated. Medium HD tanks simulations with double ring octagonal diffuser show good thermocline behavior and clear distinction between warm and cold water. The result show, the best performance of thermocline thickness during 50% time charging occur in medium tank with height-to-diameter ratio of 4.0 and double ring octagonal diffuser with 48 holes (9mm opening ~ 60%) acceptable compared to diffuser with 6mm ~ 40% and 12mm ~ 80% opening. The conclusion is computational analysis method are very useful in the study on performance of thermal energy storage (TES).

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Measures to assess the quality of care furnished by an ACO. 425.500 Section 425.500 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... success in promoting the aims of better care for individuals, better health for populations, and lower...

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Measures to assess the quality of care furnished by an ACO. 425.500 Section 425.500 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... success in promoting the aims of better care for individuals, better health for populations, and lower...

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Measures to assess the quality of care furnished by an ACO. 425.500 Section 425.500 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... success in promoting the aims of better care for individuals, better health for populations, and lower...

Improved Modeling of Intelligent Tutoring Systems Using Ant Colony Optimization

ERIC Educational Resources Information Center

Rastegarmoghadam, Mahin; Ziarati, Koorush

2017-01-01

Swarm intelligence approaches, such as ant colony optimization (ACO), are used in adaptive e-learning systems and provide an effective method for finding optimal learning paths based on self-organization. The aim of this paper is to develop an improved modeling of adaptive tutoring systems using ACO. In this model, the learning object is…

The Need for Dynamic Airspace Management in Coalition Operations (The International C2 Journal, Volume 5, Number 3, 2011)

DTIC Science & Technology

2011-01-01

Automated Deep Operations Coordination System (JADOCS), Theater Battle Management Core System ( TBMCS ), and Air Defense System Integrator (ADSI). NATO’s...be submitted to TBMCS at the AOC for inclusion in the daily ACO or change ACO. Missions requiring rapid response, such as MEDEVACs, fire missions

48 CFR 42.602 - Assignment and location.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Assignment and location. (a) A CACO may be assigned only when (1) the contractor has at least two locations with resident ACO's or (2) the need for a CACO is approved by the agency head or designee (for this... devoted to a single contractor). One of the resident ACO's may be designated to perform the CACO functions...

48 CFR 42.602 - Assignment and location.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Assignment and location. (a) A CACO may be assigned only when (1) the contractor has at least two locations with resident ACO's or (2) the need for a CACO is approved by the agency head or designee (for this... devoted to a single contractor). One of the resident ACO's may be designated to perform the CACO functions...

An academic health center sees both challenges and enabling forces as it creates an accountable care organization.

PubMed

Tallia, Alfred F; Howard, Jenna

2012-11-01

Health care reform presents academic health centers with an opportunity to test new systems of care, such as accountable care organizations (ACOs), that are intended to improve patients' health and well-being, mitigate the anticipated shortage in primary care providers, and bend the cost curve. In its ongoing efforts to develop an ACO, the Robert Wood Johnson Medical School, an academic health center, has found helpful a rapidly evolving competitive environment and insurers willing to experiment with new models of care. But the center has also encountered six types of barriers: conceptual, financial, cultural, regulatory, organizational, and historical. How this academic health center has faced these barriers offers valuable lessons to other health systems engaged in creating ACOs.

Astrochemistry in TSR and CSR Ion Storage Rings

NASA Astrophysics Data System (ADS)

Novotny, Oldrich

2017-04-01

Dissociative recombination (DR) of molecular ions plays a key role in controlling the charge density and composition of the cold interstellar medium (ISM). Experimental data on DR are required in order to understand the chemical network in the ISM and related processes such as star formation from molecular clouds. Needed data include not only total reaction cross sections, but also the chemical composition and excitation states of the neutral products. Utilizing the TSR storage ring in Heidelberg, Germany, we have carried out DR measurements for astrophysically important molecular ions. We use a merged electron-ion beams technique combined with event-by-event fragment counting and fragment imaging. The count rate of detected neutral DR products yields the absolute DR rate coefficient. Imaging the distribution of fragment distances provides information on the kinetic energy released including the states of both the initial molecule and the final products. Additional kinetic energy sensitivity of the employed detector allows for identification of fragmentation channels by fragment-mass combination within each dissociation event. Such combined information is essential for studies on DR of polyatomic ions with multi-channel breakup. The recently commissioned Cryogenic Storage Ring (CSR) in Heidelberg, Germany, extends the experimental capabilities of TSR by operation at cryogenic temperatures down to 6 K. At these conditions residual gas densities down to 100 cm-3 can be reached resulting in beam storage times of several hours. Long storage in the cold environment allows the ions to relax down to their rotational ground state, thus mimicking well the conditions in the cold ISM. A variety of astrophysically relevant reactions will be investigated at these conditions, such as DR, electron impact excitation, ion-neutral collisions, etc. We report our TSR results on DR of HCl+ and D2Cl+. We also present first results from the CSR commissioning experiments.

Electric fields, electron production, and electron motion at the stripper foil in the Los Alamos Proton Storage Ring

NASA Astrophysics Data System (ADS)

Plum, M.

The beam instability at the Los Alamos Proton Storage Ring (PSR) most likely involves coupled oscillations between electrons and protons. For this instability to occur, there must be a strong source of electrons. Investigation of the various sources of electrons in the PSR had begun. Copious electron production is expected in the injection section because this section contains the stripper foil. This foil is mounted near the center of the beam pipe, and both circulating and injected protons pass through it, thus allowing ample opportunity for electron production. This paper discusses various mechanisms for electron production, beam-induced electric fields, and electron motion in the vicinity of the foil.

Lifetimes of relativistic heavy-ion beams in the High Energy Storage Ring of FAIR

NASA Astrophysics Data System (ADS)

Shevelko, V. P.; Litvinov, Yu. A.; Stöhlker, Th.; Tolstikhina, I. Yu.

2018-04-01

The High Energy Storage Ring, HESR, will be constructed at the Facility for Antiproton and Ion Research, FAIR, Darmstadt. For the first time, it will be possible to perform experiments with cooled high-intensity stable and radioactive heavy ions at highly relativistic energies. To design experiments at the HESR, realistic estimations of beam lifetimes are indispensable. Here we report calculated cross sections and lifetimes for typical U88+ , U90+ , U92+ , Sn49+ and Sn50+ ions in the energy range E = 400 MeV/u-5 GeV/u, relevant for the HESR. Interactions with the residual gas and with internal gas-jet targets are also considered.

Benchmarking of Touschek Beam Lifetime Calculations for the Advanced Photon Source

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xiao, A.; Yang, B.

2017-06-25

Particle loss from Touschek scattering is one of the most significant issues faced by present and future synchrotron light source storage rings. For example, the predicted, Touschek-dominated beam lifetime for the Advanced Photon Source (APS) Upgrade lattice in 48-bunch, 200-mA timing mode is only ~ 2 h. In order to understand the reliability of the predicted lifetime, a series of measurements with various beam parameters was performed on the present APS storage ring. This paper first describes the entire process of beam lifetime measurement, then compares measured lifetime with the calculated one by applying the measured beam parameters. The resultsmore » show very good agreement.« less

Emittance measurements in low energy ion storage rings

NASA Astrophysics Data System (ADS)

Hunt, J. R.; Carli, C.; Resta-López, J.; Welsch, C. P.

2018-07-01

The development of the next generation of ultra-low energy antiproton and ion facilities requires precise information about the beam emittance to guarantee optimum performance. In the Extra-Low ENergy Antiproton storage ring (ELENA) the transverse emittances will be measured by scraping. However, this diagnostic measurement faces several challenges: non-zero dispersion, non-Gaussian beam distributions due to effects of the electron cooler and various systematic errors such as closed orbit offsets and inaccurate rms momentum spread estimation. In addition, diffusion processes, such as intra-beam scattering might lead to emittance overestimates. Here, we present algorithms to efficiently address the emittance reconstruction in presence of the above effects, and present simulation results for the case of ELENA.

Development and operating experience of a 1.1-m-long superconducting undulator at the Advanced Photon Source

NASA Astrophysics Data System (ADS)

Ivanyushenkov, Y.; Harkay, K.; Borland, M.; Dejus, R.; Dooling, J.; Doose, C.; Emery, L.; Fuerst, J.; Gagliano, J.; Hasse, Q.; Kasa, M.; Kenesei, P.; Sajaev, V.; Schroeder, K.; Sereno, N.; Shastri, S.; Shiroyanagi, Y.; Skiadopoulos, D.; Smith, M.; Sun, X.; Trakhtenberg, E.; Xiao, A.; Zholents, A.; Gluskin, E.

2017-10-01

Development of superconducting undulators continues at the Advanced Photon Source (APS). Two years after successful installation and commissioning of the first relatively short superconducting undulator "SCU0" in Sector 6 of the APS storage ring, the second 1.1-m-long superconducting undulator "SCU1" was installed in Sector 1 of the APS. The device has been in user operation since its commissioning in May 2015. This paper describes the magnetic and cryogenic design of the SCU1 together with the results of stand-alone cold tests. The SCU1's magnetic and cryogenic performance as well as its operating experience in the APS storage ring are also presented.

The Effect of Gas Ion Bombardment on the Secondary Electron Yield of TiN, TiCN and TiZrV Coatings For Suppressing Collective Electron Effects in Storage Rings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Le Pimpec, F.; /PSI, Villigen; Kirby, R.E.

In many accelerator storage rings running positively charged beams, ionization of residual gas and secondary electron emission (SEE) in the beam pipe will give rise to an electron cloud which can cause beam blow-up or loss of the circulating beam. A preventative measure that suppresses electron cloud formation is to ensure that the vacuum wall has a low secondary emission yield (SEY). The SEY of thin films of TiN, sputter deposited Non-Evaporable Getters and a novel TiCN alloy were measured under a variety of conditions, including the effect of re-contamination from residual gas.

Search for the 1P 1 charmonium state in overlinepp annihilations at the CERN intersecting storage rings

NASA Astrophysics Data System (ADS)

Baglin, C.; Baird, S.; Bassompierre, G.; Borreani, G.; Brient, J.-C.; Broll, C.; Brom, J.-M.; Bugge, L.; Buran, T.; Burq, J.-P.; Bussière, A.; Buzzo, A.; Cester, R.; Chemarin, M.; Chevallier, M.; Escoubes, B.; Fay, J.; Ferroni, S.; Gracco, V.; Guillaud, J.-P.; Khan-Aronsen, E.; Kirsebom, K.; Kylling, A.; Ille, B.; Lambert, M.; Leistam, L.; Lundby, A.; Macri, M.; Marchetto, F.; Menichetti, E.; Mörch, Ch.; Mouellic, B.; Olsen, D.; Pastrone, N.; Petrillo, L.; Pia, M. G.; Poole, J.; Poulet, M.; Rinaudo, G.; Santroni, A.; Severi, M.; Skjevling, G.; Stapnes, S.; Stugu, B.; R704 Collaboration

1986-04-01

This experiment has been performed at the CERN Intersecting Storage Rings to study the direct formation of charmonium states in antiproton-proton annihilations. The experimental program has partly been devoted to an inclusive scan for overlinepp → J/ψ + X in the range 3520-3530 MeV/ c2. A cluster of five events has been observed in a narrow energy band, centred on the centre of gravity of the 3P J states where the 1P 1 is expected to be. When interpreted as a new resonace, these data yield a mass m = 3525.4±0.8 MeV/ c2.

Modification of a liquid hydrogen tank for integrated refrigeration and storage

NASA Astrophysics Data System (ADS)

Swanger, A. M.; Jumper, K. M.; Fesmire, J. E.; Notardonato, W. U.

2015-12-01

The modification and outfitting of a 125,000-liter liquid hydrogen tank was performed to provide integrated refrigeration and storage capability. These functions include zero boil-off, liquefaction, and densification and therefore require provisions for sub-atmospheric tank pressures within the vacuum-jacketed, multilayer insulated tank. The primary structural modification was to add stiffening rings inside the inner vessel. The internal stiffening rings were designed, built, and installed per the ASME Boiler and Pressure Vessel Code, Section VIII, to prevent collapse in the case of vacuum jacket failure in combination with sub-atmospheric pressure within the tank. For the integrated refrigeration loop, a modular, skeleton-type heat exchanger, with refrigerant temperature instrumentation, was constructed using the stiffening rings as supports. To support the system thermal performance testing, three custom temperature rakes were designed and installed along the 21-meter length of the tank, once again using rings as supports. The temperature rakes included a total of 20 silicon diode temperature sensors mounted both vertically and radially to map the bulk liquid temperature within the tank. The tank modifications were successful and the system is now operational for the research and development of integrated refrigeration technology.

Comparative transcriptome analysis reveals distinct ethylene-independent regulation of ripening in response to low temperature in kiwifruit.

PubMed

Asiche, William O; Mitalo, Oscar W; Kasahara, Yuka; Tosa, Yasuaki; Mworia, Eric G; Owino, Willis O; Ushijima, Koichiro; Nakano, Ryohei; Yano, Kentaro; Kubo, Yasutaka

2018-03-21

Kiwifruit are classified as climacteric since exogenous ethylene (or its analogue propylene) induces rapid ripening accompanied by ethylene production under positive feedback regulation. However, most of the ripening-associated changes (Phase 1 ripening) in kiwifruit during storage and on-vine occur largely in the absence of any detectable ethylene. This ripening behavior is often attributed to basal levels of system I ethylene, although it is suggested to be modulated by low temperature. To elucidate the mechanisms regulating Phase 1 ripening in kiwifruit, a comparative transcriptome analysis using fruit continuously exposed to propylene (at 20 °C), and during storage at 5 °C and 20 °C was conducted. Propylene exposure induced kiwifruit softening, reduction of titratable acidity (TA), increase in soluble solids content (SSC) and ethylene production within 5 days. During storage, softening and reduction of TA occurred faster in fruit at 5 °C compared to 20 °C although no endogenous ethylene production was detected. Transcriptome analysis revealed 3761 ripening-related differentially expressed genes (DEGs), of which 2742 were up-regulated by propylene while 1058 were up-regulated by low temperature. Propylene exclusively up-regulated 2112 DEGs including those associated with ethylene biosynthesis and ripening such as AcACS1, AcACO2, AcPL1, AcXET1, Acβ-GAL, AcAAT, AcERF6 and AcNAC7. Similarly, low temperature exclusively up-regulated 467 DEGS including AcACO3, AcPL2, AcPMEi, AcADH, Acβ-AMY2, AcGA2ox2, AcNAC5 and AcbZIP2 among others. A considerable number of DEGs such as AcPG, AcEXP1, AcXET2, Acβ-AMY1, AcGA2ox1, AcNAC6, AcMADS1 and AcbZIP1 were up-regulated by either propylene or low temperature. Frequent 1-MCP treatments failed to inhibit the accelerated ripening and up-regulation of associated DEGs by low temperature indicating that the changes were independent of ethylene. On-vine kiwifruit ripening proceeded in the absence of any detectable endogenous ethylene production, and coincided with increased expression of low temperature-responsive DEGs as well as the decrease in environmental temperature. These results indicate that kiwifruit possess both ethylene-dependent and low temperature-modulated ripening mechanisms that are distinct and independent of each other. The current work provides a foundation for elaborating the control of these two ripening mechanisms in kiwifruit.

Gender and asthma-chronic obstructive pulmonary disease overlap syndrome.

PubMed

Wheaton, Anne G; Pleasants, Roy A; Croft, Janet B; Ohar, Jill A; Heidari, Khosrow; Mannino, David M; Liu, Yong; Strange, Charlie

2016-09-01

To assess relationships between obstructive lung diseases, respiratory symptoms, and comorbidities by gender. Data from 12 594 adult respondents to the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were used. Five categories of chronic obstructive airway disease (OAD) were defined: former asthma only, current asthma only, chronic obstructive pulmonary disease (COPD) only, asthma-COPD overlap syndrome (ACOS), and none. Associations of these categories with respiratory symptoms (frequent productive cough, shortness of breath, and impaired physical activities due to breathing problems), overall health, and comorbidities were assessed using multivariable logistic regression for men and women. Overall, 16.2% of men and 18.7% of women reported a physician diagnosis of COPD and/or asthma. Former asthma only was higher among men than women (4.9% vs. 3.2%, t-test p = 0.008). Current asthma only was more prevalent among women than men (7.2% vs. 4.7%, p < 0.001), as was ACOS (4.0% vs. 2.2%, p < 0.001). Having COPD only did not differ between women (4.3%) and men (4.4%). Adults with ACOS were most likely to report the 3 respiratory symptoms. COPD only and ACOS were associated with higher likelihoods of poor health and most comorbidities for men and women. Current asthma only was also associated with these outcomes among women, but not among men. In this large population-based sample, women were more likely than men to report ACOS and current asthma, but not COPD alone. Gender differences were evident between the OAD groups in sociodemographic characteristics, respiratory symptoms, and comorbidities, as well as overall health.

Chronic Obstructive Pulmonary Disease and Heart Failure Self-Management Kits for Outpatient Transitions of Care.

PubMed

Boylan, Paul; Joseph, Tina; Hale, Genevieve; Moreau, Cynthia; Seamon, Matthew; Jones, Renee

2018-03-01

To develop heart failure (HF) and chronic obstructive pulmonary disease (COPD) self-management kits in an accountable care organization (ACO) to facilitate patients' self-care and prevent hospital readmissions. Pharmacists practice in an outpatient-based ACO. They participate in interprofessional office visits with providers and independently manage maintenance pharmacotherapies. Pharmacists collaborate with an interprofessional team within the ACO including physicians, nurses, case managers, and paramedics. Two commonly encountered diseases are chronic COPD and HF. Reducing preventable readmissions for these conditions are important quality benchmarks and cost-saving strategies. Pharmacists were responsible for developing HF and COPD self-management kits containing patient education materials and prescriptions to facilitate self-care. Prior to kit development, pharmacists performed a literature review to determine the presence of previously published findings on these topics. The interprofessional team continually evaluates the successes and limitations of this initiative. Pharmacists developed training and instructions for ACO allied health professionals in an effort to incorporate the self-management kits in clinical practice. The initial literature search revealed no studies describing the intervention of interest. Innovative programs designed to help reduce preventable readmissions are lacking in primary care. Implementation of the self-management kits was accepted by interprofessional ACO leadership and is currently being integrated into allied health workflow. Patients at risk for having an exacerbation of COPD or HF should receive self-management strategies. Prompt therapy prior to exacerbations reduces hospital admissions and readmissions, speeds recovery, and slows disease progression. Pharmacist-facilitated implementation of self-management kits may be developed by interprofessional health care teams.

Meta-heuristic ant colony optimization technique to forecast the amount of summer monsoon rainfall: skill comparison with Markov chain model

NASA Astrophysics Data System (ADS)

Chaudhuri, Sutapa; Goswami, Sayantika; Das, Debanjana; Middey, Anirban

2014-05-01

Forecasting summer monsoon rainfall with precision becomes crucial for the farmers to plan for harvesting in a country like India where the national economy is mostly based on regional agriculture. The forecast of monsoon rainfall based on artificial neural network is a well-researched problem. In the present study, the meta-heuristic ant colony optimization (ACO) technique is implemented to forecast the amount of summer monsoon rainfall for the next day over Kolkata (22.6°N, 88.4°E), India. The ACO technique belongs to swarm intelligence and simulates the decision-making processes of ant colony similar to other adaptive learning techniques. ACO technique takes inspiration from the foraging behaviour of some ant species. The ants deposit pheromone on the ground in order to mark a favourable path that should be followed by other members of the colony. A range of rainfall amount replicating the pheromone concentration is evaluated during the summer monsoon season. The maximum amount of rainfall during summer monsoon season (June—September) is observed to be within the range of 7.5-35 mm during the period from 1998 to 2007, which is in the range 4 category set by the India Meteorological Department (IMD). The result reveals that the accuracy in forecasting the amount of rainfall for the next day during the summer monsoon season using ACO technique is 95 % where as the forecast accuracy is 83 % with Markov chain model (MCM). The forecast through ACO and MCM are compared with other existing models and validated with IMD observations from 2008 to 2012.

Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes.

PubMed

Kaewpoowat, Quanhathai; Salazar, Lucrecia; Aguilera, Elizabeth; Wootton, Susan H; Hasbun, Rodrigo

2016-06-01

To describe the clinical manifestations, cerebrospinal fluid (CSF) characteristics, imaging studies and prognostic factors of adverse clinical outcomes (ACO) among adults with herpes simplex virus (HSV) or varicella zoster virus (VZV) CNS infections. Retrospective review of adult patients with positive HSV or VZV polymerase chain reaction on CSF from an observational study of meningitis or encephalitis in Houston, TX (2004-2014), and New Orleans, LA (1999-2008). Ninety-eight adults patients were identified; 25 had encephalitis [20 (20.4 %) HSV, 5 (5.1 %) VZV], and 73 had meningitis [60 (61.1 %) HSV and 13 (13.3 %) VZV]. HSV and VZV had similar presentations except for nausea (P < 0.01) and rash (P < 0.001). The CSF profile did not differ between HSV and VZV infection. Abnormal neuroimaging findings were found in 11.6 % (10/86) brain CTs and 21.3 % (16/75) brain MRIs. The EEG was abnormal in 57.9 % (11/19). Sixteen patients (16.3 %) had an ACO (10 HSV encephalitis, 3 VZV encephalitis and 3 VZV meningitis). Intravenous acyclovir administered within 48 h was protective against an ACO [OR 0.19 (0.04-0.80), P = 0.02). However, on logistic regression only Charlson comorbidity score >1 and an encephalitis presentation were independently associated with an ACO. The treatment for HSV meningitis was variable, and all patients had a good clinical outcome. Alpha herpes CNS infections due to HSV and VZV infections have similar clinical and laboratory manifestations. ACO was observed more frequently in those patients with comorbidities and an encephalitis presentation.

Athena Community Office

NASA Astrophysics Data System (ADS)

Martínez-Núnez, S.; Barcons, X.; Barret, D.; Bozzo, E.; Carrera, F. J.; Ceballos, M. T.; Gómez, S.; Monterde, M. P.; Rau, A.

2017-03-01

The Athena Community Office (ACO) has been established by ESA's Athena Science Study Team (ASST) in order to obtain support in performing its tasks assigned by ESA, and most specially in the ASST role as "focal point for the interests of the broad scientific community". The ACO is led by the Instituto de Física de Cantabria (CSIC-UC), and its activities are funded by CSIC and UC. Further ACO contributors are the University of Geneva, MPE and IRAP. In this poster, we present ACO to the Spanish Astronomical Community, informing about its main responsibilities, which are: assist the ASST in organising and collecting support from the Athena Working Groups and Topical Panels; organise and maintain the documentation generated by the Athena Working Groups and Topical Panels; manage the Working Group and Topical Panel membership lists; assist the ASST in promoting Athena science capabilities in the research world, through conferences and workshops; keep a record of all papers and presentations related to Athena; support the production of ASST documents; produce and distribute regularly an Athena Newsletter, informing the community about all mission and science developments; create and maintain the Athena Community web portal; maintain an active communication activity; promote, organise and support Athena science-related public outreach, in coordination with ESA and other agencies involved when appropriate; and, design, produce materials and provide pointers to available materials produced by other parties. In summary, ACO is meant to become a focal point to facilitate the scientific exchange between the Athena activities and the scientific community at large, and to disseminate the Athena science objectives to the general public.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burkel, L.; Dejus, R.; Maines, J.

This report is a description of the current status of the magnetic measurement facility and is a basic instructional manual for the operation of the facility and its components. Please refer to the appendices for more detailed information about specific components and procedures. The purpose of the magnetic measurement facility is to take accurate measurements of the magnetic field in the gay of the IDs in order to determine the effect of the ID on the stored particle beam and the emitted radiation. The facility will also play an important role when evaluating new ideas, novel devices, and inhouse prototypesmore » as part of the ongoing research and development program at the APS. The measurements will be performed with both moving search coils and moving Hall probes. The IDs will be evaluated by computer modeling of the emitted radiation for any given (measured) magnetic field map. The quality of the magnetic field will be described in terms of integrated multipoles for the effect on Storage Ring performance and in terms of the derived trajectories for the emitted radiation. Before being installed on the Storage Ring, every device will be measured and characterized to assure that it is compatible with Storage Ring requirements and radiation specifications. The accuracy that the APS needs to achieve for magnetic measurements will be based on these specifications.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huamg, C. W., E-mail: huang.zw@nsrrc.org.tw; Hwang, C. S., E-mail: cshwang@nsrrc.org.tw; Department of Electrophysics, National Chiao Tung University, Hsinchu 300, Taiwan

The Taiwan Photon Source (TPS) has been successfully commissioned. However, the minimum emittance in the TPS lattice is 1.6 nm rad. In the existing TPS storage ring lattice, it is imperative to reduce the emittance to below 1 nm rad. Therefore, a feasibility study for reducing the effective emittance of the TPS storage ring by using a Robinson wiggler was launched; the reduction is necessary to enhance the photon brilliance. In this study, a permanent-magnet multiperiod Robinson wiggler (MRW) was developed for use instead of the single-period Robinson wiggler. In general, the quadruple field of a combined function magnet inmore » the storage ring is approximately few tesla per meter. According to beam dynamic analysis, we found that it is necessary to adopt a high gradient (40 T/m) combined-function MRW magnet to reduce the emittance effectively. Therefore, a high gradient field strength is required in the combined function MRW magnet. In this study, the quadrupole field strength of the MRW magnet was allowed to be approximately 40 T/m at a magnet gap of 20 mm. The period length of the MRW magnet was 300 mm and the period number was 16. The of MRWs is discussed in regard to the possibility of increasing the photon brilliance from IU22.« less

Electron cooling of a bunched ion beam in a storage ring

NASA Astrophysics Data System (ADS)

Zhao, He; Mao, Lijun; Yang, Jiancheng; Xia, Jiawen; Yang, Xiaodong; Li, Jie; Tang, Meitang; Shen, Guodong; Ma, Xiaoming; Wu, Bo; Wang, Geng; Ruan, Shuang; Wang, Kedong; Dong, Ziqiang

2018-02-01

A combination of electron cooling and rf system is an effective method to compress the beam bunch length in storage rings. A simulation code based on multiparticle tracking was developed to calculate the bunched ion beam cooling process, in which the electron cooling, intrabeam scattering (IBS), ion beam space-charge field, transverse and synchrotron motion are considered. Meanwhile, bunched ion beam cooling experiments have been carried out in the main cooling storage ring (CSRm) of the Heavy Ion Research Facility in Lanzhou, to investigate the minimum bunch length obtained by the cooling method, and study the dependence of the minimum bunch length on beam and machine parameters. The experiments show comparable results to those from simulation. Based on these simulations and experiments, we established an analytical model to describe the limitation of the bunch length of the cooled ion beam. It is observed that the IBS effect is dominant for low intensity beams, and the space-charge effect is much more important for high intensity beams. Moreover, the particles will not be bunched for much higher intensity beam. The experimental results in CSRm show a good agreement with the analytical model in the IBS dominated regime. The simulation work offers us comparable results to those from the analytical model both in IBS dominated and space-charge dominated regimes.

An ant colony optimization based algorithm for identifying gene regulatory elements.

PubMed

Liu, Wei; Chen, Hanwu; Chen, Ling

2013-08-01

It is one of the most important tasks in bioinformatics to identify the regulatory elements in gene sequences. Most of the existing algorithms for identifying regulatory elements are inclined to converge into a local optimum, and have high time complexity. Ant Colony Optimization (ACO) is a meta-heuristic method based on swarm intelligence and is derived from a model inspired by the collective foraging behavior of real ants. Taking advantage of the ACO in traits such as self-organization and robustness, this paper designs and implements an ACO based algorithm named ACRI (ant-colony-regulatory-identification) for identifying all possible binding sites of transcription factor from the upstream of co-expressed genes. To accelerate the ants' searching process, a strategy of local optimization is presented to adjust the ants' start positions on the searched sequences. By exploiting the powerful optimization ability of ACO, the algorithm ACRI can not only improve precision of the results, but also achieve a very high speed. Experimental results on real world datasets show that ACRI can outperform other traditional algorithms in the respects of speed and quality of solutions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Eight reasons payer interoperability and data sharing are essential in ACOs. Interoperability standards could be a prerequisite to measuring care.

PubMed

Mookencherry, Shefali

2012-01-01

It makes strategic and business sense for payers and providers to collaborate on how to take substantial cost out of the healthcare delivery system. Acting independently, neither medical groups, hospitals nor health plans have the optimal mix of resources and incentives to significantly reduce costs. Payers have core assets such as marketing, claims data, claims processing, reimbursement systems and capital. It would be cost prohibitive for all but the largest providers to develop these capabilities in order to compete directly with insurers. Likewise, medical groups and hospitals are positioned to foster financial interdependence among providers and coordinate the continuum of patient illnesses and care settings. Payers and providers should commit to reasonable clinical and cost goals, and share resources to minimize expenses and financial risks. It is in the interest of payers to work closely with providers on risk-management strategies because insurers need synergy with ACOs to remain cost competitive. It is in the interest of ACOs to work collaboratively with payers early on to develop reasonable and effective performance benchmarks. Hence, it is essential to have payer interoperability and data sharing integrated in an ACO model.

Improving the Interpretability of Classification Rules Discovered by an Ant Colony Algorithm: Extended Results.

PubMed

Otero, Fernando E B; Freitas, Alex A

2016-01-01

Most ant colony optimization (ACO) algorithms for inducing classification rules use a ACO-based procedure to create a rule in a one-at-a-time fashion. An improved search strategy has been proposed in the cAnt-Miner[Formula: see text] algorithm, where an ACO-based procedure is used to create a complete list of rules (ordered rules), i.e., the ACO search is guided by the quality of a list of rules instead of an individual rule. In this paper we propose an extension of the cAnt-Miner[Formula: see text] algorithm to discover a set of rules (unordered rules). The main motivations for this work are to improve the interpretation of individual rules by discovering a set of rules and to evaluate the impact on the predictive accuracy of the algorithm. We also propose a new measure to evaluate the interpretability of the discovered rules to mitigate the fact that the commonly used model size measure ignores how the rules are used to make a class prediction. Comparisons with state-of-the-art rule induction algorithms, support vector machines, and the cAnt-Miner[Formula: see text] producing ordered rules are also presented.

Accountable Care Organizations: roles and opportunities for hospitals.

PubMed

Schoenbaum, Stephen C

2011-08-01

Federal health reform has established Medicare Accountable Care Organizations (ACOs) as a new program, and some states and private payers have been independently developing ACO pilot projects. The objective is to hold provider groups accountable for the quality and cost of care to a population. The financial models for providers generally build off of shared savings between the payers and providers or some type of global payment that includes the possibility of partial or full capitation. For ACOs to achieve the same outcomes with lower costs or, better yet, improved outcomes with the same or lower costs, the delivery system will need to become more oriented toward primary care and care coordination than is currently the case. Providers of clinical services, in order to be more effective, efficient, and coordinated, will need to be supported by a variety of shared services, such as off-hours care, easy access to specialties, and information exchanges. These services can be organized by an ACO as a medical neighborhood or community. Hospitals, because they have a management structure, history of developing programs and services, and accessibility 24/7/365, are logical leaders of this enhancement of health care delivery for populations and other providers.

Fermilab Tevatron and Pbar source status report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Edwards, H.

1986-08-01

The antiproton production cycle is enumerated, and the commissioning of the antiproton source is described, giving milestones and major obstacles. The Tevatron collider operation is described, including procedure to load the Tevatron with three bunches of protons and three bunches of antiprotons. Commissioning of the Main Ring and Tevatron for collider operation is described. Development and accelerator studies in four areas were necessary: main ring RF manipulations; controls and applications software support; Tevatron storage and low-beta squeeze sequence; and study of various beam transfers, storage steps, and sequences. Final tests are described. A long range upgrade program is presently undermore » evaluation to accomplish these goals: luminosity increase to 5 x 10/sup 31/ cm/sup -2/sec/sup -1/, production rates up to 4 x 10/sup 11/ antiprotons/hr, and intensity increase for fixed target operation. Beam quality is to be improved by the injector and main ring upgrades, and the luminosity goal is addressed by the Collider upgrade. (LEW)« less

Kicker field simulation and measurement for the muon g-2 experiment at FNAL

NASA Astrophysics Data System (ADS)

Chang, Seung Pyo; Kim, Young Im; Choi, Jihoon; Semertzidis, Yannis; muon g-2 experiment Collaboration

2017-01-01

In the Muon g-2 experiment, muon beam is injected to the storage ring in a slightly tilted orbit whose center is 77 mm away from the center of the ring. The kicker is needed to send the muon beam to the central orbit. The magnetic kicker is designed for the experiment and about 0.1 Tm field integral is needed. The peak current pulse is 4200 A to make this field integral. This strong kicker pulse could make unwanted eddy current occur. This eddy current could spoil the main magnetic field of the storage ring. This could be a critical threat to the precision of experiment. The kicker field simulation has done using OPERA to estimate the effects. Also the kicker field should be measured based on Faraday effect. The measurement has tested in the lab before install the experiment area. In this presentation, the simulation and measurement results will be discussed. This work was supported by IBS-R017-D1-2016-a00.

Nuclear-matter radius studies from 58Ni(α ,α ) experiments at the GSI Experimental Storage Ring with the EXL facility

NASA Astrophysics Data System (ADS)

Zamora, J. C.; Aumann, T.; Bagchi, S.; Bönig, S.; Csatlós, M.; Dillmann, I.; Dimopoulou, C.; Egelhof, P.; Eremin, V.; Furuno, T.; Geissel, H.; Gernhäuser, R.; Harakeh, M. N.; Hartig, A.-L.; Ilieva, S.; Kalantar-Nayestanaki, N.; Kiselev, O.; Kollmus, H.; Kozhuharov, C.; Krasznahorkay, A.; Kröll, Th.; Kuilman, M.; Litvinov, S.; Litvinov, Yu. A.; Mahjour-Shafiei, M.; Mutterer, M.; Nagae, D.; Najafi, M. A.; Nociforo, C.; Nolden, F.; Popp, U.; Rigollet, C.; Roy, S.; Scheidenberger, C.; von Schmid, M.; Steck, M.; Streicher, B.; Stuhl, L.; Thürauf, M.; Uesaka, T.; Weick, H.; Winfield, J. S.; Winters, D.; Woods, P. J.; Yamaguchi, T.; Yue, K.; Zenihiro, J.

2017-09-01

A novel method for measuring nuclear reactions in inverse kinematics with stored ion beams was successfully used to extract the nuclear-matter radius of 58Ni. The experiment was performed at the experimental heavy-ion storage ring at the GSI facility using a stored 58Ni beam at energies of 100 and 150 MeV/u and an internal helium gas-jet target. Elastically scattered α -recoils at low momentum transfers were measured with an in-ring detector system compatible with ultrahigh vacuum. Experimental angular distributions were fitted using density-dependent optical model potentials within the eikonal approximation. This permitted the extraction of the point-matter root-mean-square radius of 58Ni with an average value of 3.70(7) fm. Results from this work are in good agreement with several experiments performed in the past in normal kinematics. This pioneering experiment demonstrates a major breakthrough towards future investigations with far-from-stability stored beams using the present technique.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Talman, Richard M.; Talman, John D.

Proposed methods for measuring the electric dipole moment (EDM) of the proton use an intense, polarized proton beam stored in an all-electric storage ring “trap.” At the “magic” kinetic energy of 232.792 MeV, proton spins are “frozen,” for example always parallel to the instantaneous particle momentum. Energy deviation from the magic value causes in-plane precession of the spin relative to the momentum. Any nonzero EDM value will cause out-of-plane precession—measuring this precession is the basis for the EDM determination. A proposed implementation of this measurement shows that a proton EDM value of 10 –29e–cm or greater will produce a statisticallymore » significant, measurable precession after multiply repeated runs, assuming small beam depolarization during 1000 s runs, with high enough precision to test models of the early universe developed to account for the present day particle/antiparticle population imbalance. This paper describes an accelerator simulation code, eteapot, a new component of the Unified Accelerator Libraries (ual), to be used for long term tracking of particle orbits and spins in electric bend accelerators, in order to simulate EDM storage ring experiments. Though qualitatively much like magnetic rings, the nonconstant particle velocity in electric rings gives them significantly different properties, especially in weak focusing rings. Like the earlier code teapot (for magnetic ring simulation) this code performs exact tracking in an idealized (approximate) lattice rather than the more conventional approach, which is approximate tracking in a more nearly exact lattice. The Bargmann-Michel-Telegdi (BMT) equation describing the evolution of spin vectors through idealized bend elements is also solved exactly—original to this paper. Furthermore the idealization permits the code to be exactly symplectic (with no artificial “symplectification”). Any residual spurious damping or antidamping is sufficiently small to permit reliable tracking for the long times, such as the 1000 s assumed in estimating the achievable EDM precision. This paper documents in detail the theoretical formulation implemented in eteapot. An accompanying paper describes the practical application of the eteapot code in the Universal Accelerator Libraries (ual) environment to “resurrect,” or reverse engineer, the “AGS-analog” all-electric ring built at Brookhaven National Laboratory in 1954. Of the (very few) all-electric rings ever commissioned, the AGS-analog ring is the only relativistic one and is the closest to what is needed for measuring proton (or, even more so, electron) EDM’s. As a result, the companion paper also describes preliminary lattice studies for the planned proton EDM storage rings as well as testing the code for long time orbit and spin tracking.« less

An undulator based soft x-ray source for microscopy on the Duke electron storage ring

NASA Astrophysics Data System (ADS)

Johnson, Lewis Elgin

1998-09-01

This dissertation describes the design, development, and installation of an undulator-based soft x-ray source on the Duke Free Electron Laser laboratory electron storage ring. Insertion device and soft x-ray beamline physics and technology are all discussed in detail. The Duke/NIST undulator is a 3.64-m long hybrid design constructed by the Brobeck Division of Maxwell Laboratories. Originally built for an FEL project at the National Institute of Standards and Technology, the undulator was acquired by Duke in 1992 for use as a soft x-ray source for the FEL laboratory. Initial Hall probe measurements on the magnetic field distribution of the undulator revealed field errors of more than 0.80%. Initial phase errors for the device were more than 11 degrees. Through a series of in situ and off-line measurements and modifications we have re-tuned the magnet field structure of the device to produce strong spectral characteristics through the 5th harmonic. A low operating K has served to reduce the effects of magnetic field errors on the harmonic spectral content. Although rms field errors remained at 0.75%, we succeeded in reducing phase errors to less than 5 degrees. Using trajectory simulations from magnetic field data, we have computed the spectral output given the interaction of the Duke storage ring electron beam and the NIST undulator. Driven by a series of concerns and constraints over maximum utility, personnel safety and funding, we have also constructed a unique front end beamline for the undulator. The front end has been designed for maximum throughput of the 1st harmonic around 40A in its standard mode of operation. The front end has an alternative mode of operation which transmits the 3rd and 5th harmonics. This compact system also allows for the extraction of some of the bend magnet produced synchrotron and transition radiation from the storage ring. As with any well designed front end system, it also provides excellent protection to personnel and to the storage ring. A diagnostic beamline consisting of a transmission grating spectrometer and scanning wire beam profile monitor was constructed to measure the spatial and spectral characteristics of the undulator radiation. Test of the system with a circulating electron beam has confirmed the magnetic and focusing properties of the undulator, and verified that it can be used without perturbing the orbit of the beam.

A short-term operating room surgery scheduling problem integrating multiple nurses roster constraints.

PubMed

Xiang, Wei; Yin, Jiao; Lim, Gino

2015-02-01

Operating room (OR) surgery scheduling determines the individual surgery's operation start time and assigns the required resources to each surgery over a schedule period, considering several constraints related to a complete surgery flow and the multiple resources involved. This task plays a decisive role in providing timely treatments for the patients while balancing hospital resource utilization. The originality of the present study is to integrate the surgery scheduling problem with real-life nurse roster constraints such as their role, specialty, qualification and availability. This article proposes a mathematical model and an ant colony optimization (ACO) approach to efficiently solve such surgery scheduling problems. A modified ACO algorithm with a two-level ant graph model is developed to solve such combinatorial optimization problems because of its computational complexity. The outer ant graph represents surgeries, while the inner graph is a dynamic resource graph. Three types of pheromones, i.e. sequence-related, surgery-related, and resource-related pheromone, fitting for a two-level model are defined. The iteration-best and feasible update strategy and local pheromone update rules are adopted to emphasize the information related to the good solution in makespan, and the balanced utilization of resources as well. The performance of the proposed ACO algorithm is then evaluated using the test cases from (1) the published literature data with complete nurse roster constraints, and 2) the real data collected from a hospital in China. The scheduling results using the proposed ACO approach are compared with the test case from both the literature and the real life hospital scheduling. Comparison results with the literature shows that the proposed ACO approach has (1) an 1.5-h reduction in end time; (2) a reduction in variation of resources' working time, i.e. 25% for ORs, 50% for nurses in shift 1 and 86% for nurses in shift 2; (3) an 0.25h reduction in individual maximum overtime (OT); and (4) an 42% reduction in the total OT of nurses. Comparison results with the real 10-workday hospital scheduling further show the advantage of the ACO in several measurements. Instead of assigning all surgeries by a surgeon to only one OR and the same nurses by traditional manual approach in hospital, ACO realizes a more balanced surgery arrangement by assigning the surgeries to different ORs and nurses. It eventually leads to shortening the end time within the confidential interval of [7.4%, 24.6%] with 95% confidence level. The ACO approach proposed in this paper efficiently solves the surgery scheduling problem with daily nurse roster while providing a shortened end time and relatively balanced resource allocations. It also supports the advantage of integrating the surgery scheduling with the nurse scheduling and the efficiency of systematic optimization considering a complete three-stage surgery flow and resources involved. Copyright © 2014 Elsevier B.V. All rights reserved.

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

PubMed Central

Colla, Carrie H.; Lewis, Valerie A.; Kao, Lee-Sien; O’Malley, A. James; Chang, Chiang-Hua; Fisher, Elliott S.

2016-01-01

IMPORTANCE Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. OBJECTIVE To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. EXPOSURES Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. MAIN OUTCOMES AND MEASURES Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. RESULTS Total spending decreased by $34 (95% CI, −$52 to −$15) per beneficiary-quarter after ACO contract implementation across the overall Medicare population (n = 15 592 600) and decreased $114 in clinically vulnerable patients (n = 8 673 823) (95% CI, −$178 to −$50). In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively (95% CIs: −2.1 to −0.4 and −4.8 to −1.3), and hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively (95% CIs: −5.2 to −0.7 and −7.1 to −1.2). Changes in total spending associated with ACOs did not vary by clinical condition of beneficiaries. CONCLUSIONS AND RELEVANCE Medicare ACO programs are associated with modest reductions in spending and use of hospitals and emergency departments. Savings were realized through reductions in use of institutional settings in clinically vulnerable patients. PMID:27322485

Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

PubMed

McLellan, Robert K; Sherman, Bruce; Loeppke, Ronald R; McKenzie, Judith; Mueller, Kathryn L; Yarborough, Charles M; Grundy, Paul; Allen, Harris; Larson, Paul W

2012-04-01

In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering momentum and evolving among physicians. But, the potential exists for implementation of both of these concepts across a much broader community of patients. By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine (OEM) physicians, the power of these concepts would be significantly enhanced. Occupational and environmental medicine provides a well-established infrastructure and parallel strategies that could serve as a force multiplier in achieving the fundamental goals of the PCMH model and ACOs. In this paradigm, the workplace-where millions of Americans spend a major portion of their daily lives-becomes an essential element, next to communities and homes, in an integrated system of health anchored by the PCMH and ACO concepts. To be successful, OEM physicians will need to think and work innovatively about how they can provide today's employer health services-ranging from primary care and preventive care to workers' compensation and disability management-within tomorrow's PCMH and ACO models.

Integration Strategies of Pharmacists in Primary Care-Based Accountable Care Organizations: A Report from the Accountable Care Organization Research Network, Services, and Education.

PubMed

Joseph, Tina; Hale, Genevieve M; Eltaki, Sara M; Prados, Yesenia; Jones, Renee; Seamon, Matthew J; Moreau, Cynthia; Gernant, Stephanie A

2017-05-01

The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal. As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care. Pharmacist-provided care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional care settings, their role has often been overlooked in the primary care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice faculty dedicated to using innovative approaches to patient care, while providing unique learning experiences for pharmacy students by partnering with ACOs in the South Florida region. Five opportunities are presented for pharmacists to improve medication use specifically in primary care-based ACOs: medication therapy management, annual wellness visits, chronic disease state management, chronic care management, and transitions of care. Several challenges and barriers that prevent the full integration of pharmacists into primary care-based ACOs include lack of awareness of pharmacist roles in primary care; complex laws and regulations surrounding clinical protocols, such as collaborative practice agreements; provider status that allows compensation for pharmacist services; and limited access to medical records. By understanding and maximizing the role of pharmacists, several opportunities exist to better manage the medication-use process in value-based care settings. As more organizations realize benefits and overcome barriers to the integration of pharmacists into patient care, programs involve pharmacists will become an increasingly common approach to improve outcomes and reduce the total cost of care and will improve the financial viability of primary care-based ACOs. No outside funding supported this research. The authors report no conflicts of interest related to this manuscript. Study concept and design were contributed by Joseph, Hale, and Eltaki, with assistance from the other authors. Prados and Jones took the lead in data collection and data interpretation and analysis, with assistance from the other authors. The manuscript was written primarily by Joseph and Hale, along with the other authors, and revised primarily by Seamon and Gernant, along with the other authors.

Physical properties of asteroids in comet-like orbits in the infrared asteroidal survey catalogs

NASA Astrophysics Data System (ADS)

Kim, Y.; Ishiguro, M.; Usui, F.

2014-07-01

Dormant comet and Infrared Asteroidal Survey Catalogs. Comet nucleus is a solid body consisting of dark refractory material and ice. Cometary volatiles sublimate from subsurface layer by solar heating, leaving behind large dust grains on the surface. Eventually, the appearance could turn into asteroidal rather than cometary. It is, therefore, expected that there would be ''dormant comets'' in the list of known asteroids. Over past decade, several ground-based studies have been performed to dig out such dormant comets. One common approach is applying a combination of optical and dynamical properties learned from active comet nucleus to the list of known asteroids. Typical comet nucleus has (i) Tisserand parameter with respect to Jupiter, T_{J}<3, (ii) low geometric albedo, p_{v}<0.1 and (iii) reddish or neutral spectra, similar to P, D, C-type asteroids. Following past ground-based surveys, infrared space missions gave us an opportunity to work on further study of dormant comets. To the present, three infrared asteroidal catalogs taken with IRAS[1], AKARI[2] and WISE[3] are available, providing information of sizes and albedos which are useful to study the physical properties of dormant comets as well as asteroids. Usui et al. (2014) merged three infrared asteroidal catalogs with valid sizes and albedos into single catalog, what they called I-A-W[4]. We applied a huge dataset of asteroids in I-A-W to investigate the physical properties of asteroids in comet-like orbits (ACOs, whose orbits satisfy Q>4.5 au and T_{J}<3). Here we present a study of ACOs in infrared asteroidal catalogs taken with AKARI, IRAS and WISE. In this presentation, we aim to introduce albedo and size properties of ACOs in infrared asteroidal survey catalogs, in combination with orbital and spectral properties from literature. Results and Implications. We summarize our finding and implication as followings: - are 123 ACOs (Q>4.5 au and T_J<3) in I-A-W catalog after rejection of objects with large orbital uncertainties. - Majority (˜80 %) of ACOs have low albedo (p_{v}<0.1), showing similar albedo distribution to active comet nuclei. - Low-albedo ACOs have the cumulative size distribution shallower than that of active comet nuclei. - High-albedo (p_{v}≥0.1) ACOs consist of small (D<3 km) bodies are concentrated in near-Earth space. - We suggest that such high-albedo, small near-Earth asteroids are susceptible to Yarkovsky effect and injected into comet-like orbits.

The temporal distribution and carbon storage of large oak wood in streams and floodplain deposits

Treesearch

Richard P. Guyette; Daniel C. Dey; Michael C. Stambaugh

2008-01-01

We used tree-ring dating and 14C dating to document the temporal distribution and carbon storage of oak (Quercus spp.) wood in trees recruited and buried by streams and floodplains in northern Missouri, USA. Frequency distributions indicated that oak wood has been accumulating in Midwest streams continually since at least the...

A FODO racetrack ring for nuSTORM: design and optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, A.; Bross, A.; Neuffer, D.

2017-07-01

The goal of nuSTORM is to provide well-defined neutrino beams for precise measurements of neutrino cross-sections and oscillations. The nuSTORM decay ring is a compact racetrack storage ring with a circumference of ~ 480 m that incorporates large aperture (60 cm diameter) magnets. There are many challenges in the design. In order to incorporate the Orbit Combination section (OCS), used for injecting the pion beam into the ring, a dispersion suppressor is needed adjacent to the OCS . Concurrently, in order to maximize the number of useful muon decays, strong bending dipoles are needed in the arcs to minimize the arcmore » length. These dipoles create strong chromatic effects, which need to be corrected by nonlinear sextupole elements in the ring. In this paper, a FODO racetrack ring design and its optimization using sextupolar fields via both a Genetic Algorithm (GA) and a Simulated Annealing (SA) algorithm will be discussed.« less

Sensory acceptability of squid rings gamma irradiated for shelf-life extension

NASA Astrophysics Data System (ADS)

Tomac, Alejandra; Cova, María C.; Narvaiz, Patricia; Yeannes, María I.

2017-01-01

The feasibility of extending the shelf-life of a squid product by gamma irradiation was analyzed. Illex argentinus rings were irradiated at 4 and 8 kGy; and stored at 4±1 °C during 77 days. No mesophilic bacteria, enterobacteriaceae and coliforms were detected in irradiated rings during storage. Psychrotrophic bacteria were significantly reduced by irradiation; their counts were fitted to a growth model which was further used for shelf-life estimations: 3 and 27 days for 0 and 4 kGy, respectively. Initially, non-irradiated as well as irradiated rings had very good sensory scores. The overall acceptability of 4 and 8 kGy rings did not decrease during 27 and 64 days, respectively, while control samples spoiled after 3 days. A radiation dose range for squid rings preservation was defined, which attained the technological shelf-life extension objective, without impairing sensory quality.

Correction to AD/RHIC-47, Beam Transfer From AGS to RHIC

DOE Office of Scientific and Technical Information (OSTI.GOV)

Claus, J.; Foelsche, H.

1988-12-12

RHIC an acronym for Relativistic Heavy Ion Collider, is a facility for colliding heavy ions with each other, proposed for construction at Brookhaven National Laboratory. This facility and the motivation for building it, have been described. It consists of two intersecting storage rings and the purpose of this note is to describe how these two rings are to be filled with beam.

Simulation of emittance dilution in electron storage ring from Compton backscattering

NASA Astrophysics Data System (ADS)

Blumberg, L. N.; Blum, E.

A Monte-Carlo simulation of Compton backscattered kappa(sub L) = 3.2-micron photons from an IR-FEL on 75-MeV electrons in a storage ring yields an RMS electron energy spread of delta(sub E) = 11.9-keV for a sample of 10(exp 7) single scattering events. Electrons are sampled from a beam of natural energy spread sigma(sub E) = 5.6-keV and damped transverse angle spreads sigma(sub x)(prime) = .041-mrad and sigma(sub y)(prime) = .052-mrad (100%) coupling, scaled from the 200-MeV BNL XLS compact storage ring. The Compton-scattered x-rays are generated from an integral of the CM Klein-Nishina cross-section transformed to the lab. A tracking calculation has also been performed in 6-dimensional phase space. Initial electron coordinates are selected randomly from a Gaussian distribution of RMS spreads sigma(sub xo) = .102-mm, sigma(sub x(prime)o) = .041-mrad, sigma(sub yo) = .018-mm, sigma(sub y(prime)o) = .052-mrad, sigma(sub (phi)o) = 22-mrad and sigma(sub Eo) = 6-keV. A sample of 10000 electrons were each following for 40000 turns around the ring through an RF cavity of f(sub RF) = 211.54-MHz and peak voltage V(sub m)=300-keV. Preliminary results indicate that the resulting energy distribution is quite broad with an RMS width of delta(sub E) = 124-keV. The transverse widths are only slightly increased from their original values, i.e. delta(sub x) = .106-mm and delta(sub x)(prime) = .043 mrad. The scaled energy spread of delta(sub E) approximately = 360-keV for approximately 350,000 turns desired in a 10-msec x-ray angiography exposure is well within the RF bucket used here; even V(sub m) less than 50-kV is adequate. Further, the electron energy spread adds a negligible RMS x-ray energy spread of delta(sub Ex) = .32-keV. The electron energy damping time of tau(sub E) = 379-msec at 75-MeV in an XLS-type ring allows for damping this induced spread and top-off of the ring between heart cycles.

Item Selection for the Development of Short Forms of Scales Using an Ant Colony Optimization Algorithm

ERIC Educational Resources Information Center

Leite, Walter L.; Huang, I-Chan; Marcoulides, George A.

2008-01-01

This article presents the use of an ant colony optimization (ACO) algorithm for the development of short forms of scales. An example 22-item short form is developed for the Diabetes-39 scale, a quality-of-life scale for diabetes patients, using a sample of 265 diabetes patients. A simulation study comparing the performance of the ACO algorithm and…

Holistic Contract Administration in Army Forces Abroad

DTIC Science & Technology

2016-10-01

Defense (DoD) civil- ian personnel—i.e., 1910 Quality Assurance Specialist, 1102 Contract Specialist, and 1103 Industrial Property Management Specialist... 1103 -series civilian property ad- ministrators throughout ACC, the battalion experienced diffi- culties hiring for these positions during its deployment...tasks. Counting on 1103 support, ACOs received minimal property training prior to deploy- ment. This proved to be a major setback as ACOs struggled

Asthma Is a Risk Factor for Respiratory Exacerbations Without Increased Rate of Lung Function Decline: Five-Year Follow-up in Adult Smokers From the COPDGene Study.

PubMed

Hayden, Lystra P; Hardin, Megan E; Qiu, Weiliang; Lynch, David A; Strand, Matthew J; van Beek, Edwin J; Crapo, James D; Silverman, Edwin K; Hersh, Craig P

2018-02-01

Previous investigations in adult smokers from the COPDGene Study have shown that early-life respiratory disease is associated with reduced lung function, COPD, and airway thickening. Using 5-year follow-up data, we assessed disease progression in subjects who had experienced early-life respiratory disease. We hypothesized that there are alternative pathways to reaching reduced FEV 1 and that subjects who had childhood pneumonia, childhood asthma, or asthma-COPD overlap (ACO) would have less lung function decline than subjects without these conditions. Subjects returning for 5-year follow-up were assessed. Childhood pneumonia was defined by self-reported pneumonia at < 16 years. Childhood asthma was defined as self-reported asthma diagnosed by a health professional at < 16 years. ACO was defined as subjects with COPD who self-reported asthma diagnosed by a health-professional at ≤ 40 years. Smokers with and those without these early-life respiratory diseases were compared on measures of disease progression. Follow-up data from 4,915 subjects were examined, including 407 subjects who had childhood pneumonia, 323 subjects who had childhood asthma, and 242 subjects with ACO. History of childhood asthma or ACO was associated with an increased exacerbation frequency (childhood asthma, P < .001; ACO, P = .006) and odds of severe exacerbations (childhood asthma, OR, 1.41; ACO, OR, 1.42). History of childhood pneumonia was associated with increased exacerbations in subjects with COPD (absolute difference [β], 0.17; P = .04). None of these early-life respiratory diseases were associated with an increased rate of lung function decline or progression on CT scans. Subjects who had early-life asthma are at increased risk of developing COPD and of having more active disease with more frequent and severe respiratory exacerbations without an increased rate of lung function decline over a 5-year period. ClinicalTrials.gov; No. NCT00608764; https://clinicaltrials.gov. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Impact of chronic cough on quality of life.

PubMed

French, C L; Irwin, R S; Curley, F J; Krikorian, C J

Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. To determine whether chronic cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of chronic cough with specific therapy improved these adverse effects. The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a chronic, persistently troublesome cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for cough, ACOS and SIP instruments were readministered. The ages, sex, duration, and spectra and frequencies of the causes of cough were similar to multiple other studies. At baseline, patients reported a mean +/- SD of 8.6 +/- 4.8 types of adverse occurrences related to cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (P<.02). After cough disappeared with treatment, ACOS complaints decreased to a mean +/- SD of 1.9 +/- 3.2 (P<.0001) as did total (mean +/- SD, 4.8 +/- 4.5 to 1.8 +/- 2.2) (P= .004), psychosocial (mean +/- SD, 4.2 +/- 6.8 to 0.8 +/- 2.3) (P = .004), and physical (mean +/- SD, 2.2 +/- 2.9 to 0.9 +/- 1.8) (P = .05) SIP scores. Multiple linear regression analysis showed that 54% of variability of the psychosocial SIP score was explained by 4 ACOS items while none of the physical score was explained. Chronic cough was associated with deterioration in patients' quality of life. The health-related dysfunction was most likely psychosocial. The ACOS and SIP appear to be valid tools in assessing the impact of chronic cough.

Differences in the effects of Asian dust on pulmonary function between adult patients with asthma and those with asthma–chronic obstructive pulmonary disease overlap syndrome

PubMed Central

Watanabe, Masanari; Noma, Hisashi; Kurai, Jun; Sano, Hiroyuki; Ueda, Yasuto; Mikami, Masaaki; Yamamoto, Hiroyuki; Tokuyasu, Hirokazu; Kato, Kazuhiro; Konishi, Tatsuya; Tatsukawa, Toshiyuki; Shimizu, Eiji; Kitano, Hiroya

2016-01-01

Background Asian dust (AD) exposure exacerbates pulmonary dysfunction in patients with asthma. Asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS), characterized by coexisting symptoms of asthma and chronic obstructive pulmonary disease, is considered a separate disease entity. Previously, we investigated the effects of AD on pulmonary function in adult patients with asthma. Here, we present the findings of our further research on the differences in the effects of AD exposure on pulmonary function between patients with asthma alone and those with ACOS. Methods Between March and May 2012, we conducted a panel study wherein we monitored daily peak expiratory flow (PEF) values in 231 adult patients with asthma. These patients were divided into 190 patients with asthma alone and 41 patients with ACOS in this study. Daily AD particle levels were measured using light detection and ranging systems. Two heavy AD days (April 23 and 24) were determined according to the Japan Meteorological Agency definition. A linear mixed model was used to estimate the association between PEF and AD exposure. Results Increments in the interquartile range of AD particles (0.018 km−1) led to PEF changes of −0.50 L/min (95% confidence interval, −0.98 to −0.02) in patients with asthma alone and −0.11 L/min (−0.11 to 0.85) in patients with ACOS. The PEF changes after exposure to heavy AD were −2.21 L/min (−4.28 to −0.15) in patients with asthma alone and −2.76 L/min (−6.86 to 1.35) in patients with ACOS. In patients with asthma alone, the highest decrease in PEF values was observed on the heavy AD day, with a subsequent gradual increase over time. Conclusion Our results suggest that the effects of AD exposure on pulmonary function differ between patients with asthma alone and ACOS, with the former exhibiting a greater likelihood of decreased pulmonary function after AD exposure. PMID:26869784

Patterns of Storage, Synthesis and Changing Light Levels Revealed by Carbon Isotope Microsampling within Eocene Metasequoia Tree Rings

NASA Astrophysics Data System (ADS)

Jahren, H.; Sternberg, L.

2005-12-01

Fossil tree rings from Axel Heiberg Island were microanalyzed for δ13C value in order to assess patterns of tree growth and carbon storage within the Middle Eocene (~45 Ma) Arctic paleoenvironment. Wood from four Metasequoia-type individuals was subsampled for analysis: each individual fossil consisted of between 4 and 10 large (~1 cm thick) consecutive tree rings. One of the fossils displayed an obvious concentric pattern, allowing for the determination of the direction of growth with isotopic pattern. Each ring was divided into ~1 mm thick subsamples, resulting in 5-10 δ13C value determinations per period of ring growth (i.e., growing season). All rings revealed a distinct pattern that was characteristic across growing seasons and across individual fossils. Early in the season, δ13C was at its highest value but descended systematically and sharply to its lowest value at the end of the growing season. Total decrease ranged between 3 and 5 ‰ over the course of each growing season. Identical patterns were observed in the δ13C value of alpha-cellulose isolated from each subsample, indicating that the trends observed did not represent changing levels of secondary metabolites, but rather a seasonal adjustment in the bulk source of carbon used during biosynthesis. Our results are consistent with the following annual pattern of wood synthesis 1.) complete dependence on the mobilization of stored carbon compounds early in the growing season; 2.) systematically increasing use of actively-acquired photosynthate during the growing season; 3.) complete reliance on active photosynthate by the end of the growing season. An additional and significant source of 13C discrimination is declining light levels late in the growing season, and likely contributes to the extreme pattern of δ13C decrease seen across each ring. Our results mimic those seen from modern broadleaf deciduous trees (Helle & Schlesser 2004), but differ from those seen in modern conifers (Barbour et al 2002), underlining the important influence of dormancy, storage and changing light levels on carbon cycling within the Paleogene polar forests. Helle & Schleser 2004: Plant, Cell and Environment 27:367-380. Barbour, Walcroft & Farquhar 2002: Plant, Cell and Environment 25: 1483-1499.

The design improvement of horizontal stripline kicker in TPS storage ring

NASA Astrophysics Data System (ADS)

Chou, P. J.; Chan, C. K.; Chang, C. C.; Hsu, K. T.; Hu, K. H.; Kuan, C. K.; Sheng, I. C.

2017-07-01

We plan to replace the existing horizontal stripline kicker of the transverse feedback system with an improved design. Large reflected power was observed at the downstream port of stripline kicker driven by the feedback amplifier. A rapid surge of vacuum pressure was observed when we tested the high current operation in TPS storage ring in April 2016. A burned feedthrough of the horizontal stripline kicker was discovered during a maintenance shutdown. The improved design is targeted to reduce the reflection of driving power from feedback system and to reduce beam induced RF heating. This major modification of the design is described. The results of RF simulation performed with the electromagnetic code GdfidL are reported as well.

Impact parameter sensitive study of inner-shell atomic processes in the experimental storage ring

NASA Astrophysics Data System (ADS)

Gumberidze, A.; Kozhuharov, C.; Zhang, R. T.; Trotsenko, S.; Kozhedub, Y. S.; DuBois, R. D.; Beyer, H. F.; Blumenhagen, K.-H.; Brandau, C.; Bräuning-Demian, A.; Chen, W.; Forstner, O.; Gao, B.; Gassner, T.; Grisenti, R. E.; Hagmann, S.; Hillenbrand, P.-M.; Indelicato, P.; Kumar, A.; Lestinsky, M.; Litvinov, Yu. A.; Petridis, N.; Schury, D.; Spillmann, U.; Trageser, C.; Trassinelli, M.; Tu, X.; Stöhlker, Th.

2017-10-01

In this work, we present a pilot experiment in the experimental storage ring (ESR) at GSI devoted to impact parameter sensitive studies of inner shell atomic processes for low-energy (heavy-) ion-atom collisions. The experiment was performed with bare and He-like xenon ions (Xe54+, Xe52+) colliding with neutral xenon gas atoms, resulting in a symmetric collision system. This choice of the projectile charge states was made in order to compare the effect of a filled K-shell with the empty one. The projectile and target X-rays have been measured at different observation angles for all impact parameters as well as for the impact parameter range of ∼35-70 fm.

Ultrashort high-brightness pulses from storage rings

NASA Astrophysics Data System (ADS)

Khan, Shaukat

2017-09-01

The brightness of short-wavelength radiation from accelerator-based sources can be increased by coherent emission in which the radiation intensity scales with the number of contributing electrons squared. This requires a microbunched longitudinal electron distribution, which is the case in free-electron lasers. The brightness of light sources based on electron storage rings was steadily improved, but could profit further from coherent emission. The modulation of the electron energy by a continuous-wave laser field may provide steady-state microbunching in the infrared regime. For shorter wavelengths, the energy modulation can be converted into a temporary density modulation by a dispersive chicane. One particular goal is coherent emission from a very short "slice" within an electron bunch in order to produce ultrashort radiation pulses with high brightness.