Sample records for plan cms complexes

  1. 42 CFR 457.150 - CMS review of State plan material.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... State plan material. (a) Basis for action. CMS reviews each State plan and plan amendment to determine... on complete plan. CMS approves or disapproves the State plan or plan amendment only in its entirety... disapprove the State plan or plan amendment, or to determine that previously approved material no longer...

  2. 42 CFR 417.801 - Agreements between CMS and health care prepayment plans.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Agreements between CMS and health care prepayment... CMS and health care prepayment plans. (a) General requirement. (1) In order to participate and receive... written agreement with CMS. (2) An existing group practice prepayment plan (GPPP) that continues as an...

  3. 42 CFR 423.509 - Termination of contract by CMS.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...: (1) Termination of contract by CMS. (i) CMS notifies the Part D plan sponsor in writing at least 45... experiences financial difficulties so severe that its ability to make necessary health services available is...) CMS notifies the Part D plan sponsor in writing that its contract will be terminated on a date...

  4. 45 CFR 150.301 - General rule regarding the imposition of civil money penalties.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS... to CMS's enforcement authority under § 150.101(b)(2), or any non-Federal governmental plan (or employer that sponsors a non-Federal governmental plan) that is subject to CMS's enforcement authority...

  5. Intelligent systems and advanced user interfaces for design, operation, and maintenance of command management systems

    NASA Technical Reports Server (NTRS)

    Potter, William J.; Mitchell, Christine M.

    1993-01-01

    Historically, command management systems (CMS) have been large and expensive spacecraft-specific software systems that were costly to build, operate, and maintain. Current and emerging hardware, software, and user interface technologies may offer an opportunity to facilitate the initial formulation and design of a spacecraft-specific CMS as well as to develop a more generic CMS system. New technologies, in addition to a core CMS common to a range of spacecraft, may facilitate the training and enhance the efficiency of CMS operations. Current mission operations center (MOC) hardware and software include Unix workstations, the C/C++ programming languages, and an X window interface. This configuration provides the power and flexibility to support sophisticated and intelligent user interfaces that exploit state-of-the-art technologies in human-machine interaction, artificial intelligence, and software engineering. One of the goals of this research is to explore the extent to which technologies developed in the research laboratory can be productively applied in a complex system such as spacecraft command management. Initial examination of some of these issues in CMS design and operation suggests that application of technologies such as intelligent planning, case-based reasoning, human-machine systems design and analysis tools (e.g., operator and designer models), and human-computer interaction tools (e.g., graphics, visualization, and animation) may provide significant savings in the design, operation, and maintenance of the CMS for a specific spacecraft as well as continuity for CMS design and development across spacecraft. The first six months of this research saw a broad investigation by Georgia Tech researchers into the function, design, and operation of current and planned command management systems at Goddard Space Flight Center. As the first step, the researchers attempted to understand the current and anticipated horizons of command management systems at Goddard. Preliminary results are given on CMS commonalities and causes of low re-use, and methods are proposed to facilitate increased re-use.

  6. 42 CFR 457.150 - CMS review of State plan material.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies § 457.150 CMS review of... 42 Public Health 4 2010-10-01 2010-10-01 false CMS review of State plan material. 457.150 Section...

  7. 42 CFR 447.256 - Procedures for CMS action on assurances and State plan amendments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Procedures for CMS action on assurances and State... for Inpatient Hospital and Long-Term Care Facility Services Payment Rates § 447.256 Procedures for CMS action on assurances and State plan amendments. (a) Criteria for approval. (1) CMS approval action on...

  8. Using the GlideinWMS System as a Common Resource Provisioning Layer in CMS

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

    Balcas, J.; Belforte, S.; Bockelman, B.

    2015-12-23

    CMS will require access to more than 125k processor cores for the beginning of Run 2 in 2015 to carry out its ambitious physics program with more and higher complexity events. During Run1 these resources were predominantly provided by a mix of grid sites and local batch resources. During the long shut down cloud infrastructures, diverse opportunistic resources and HPC supercomputing centers were made available to CMS, which further complicated the operations of the submission infrastructure. In this presentation we will discuss the CMS effort to adopt and deploy the glideinWMS system as a common resource provisioning layer to grid,more » cloud, local batch, and opportunistic resources and sites. We will address the challenges associated with integrating the various types of resources, the efficiency gains and simplifications associated with using a common resource provisioning layer, and discuss the solutions found. We will finish with an outlook of future plans for how CMS is moving forward on resource provisioning for more heterogenous architectures and services.« less

  9. CMS-G from Beta vulgaris ssp. maritima is maintained in natural populations despite containing an atypical cytochrome c oxidase.

    PubMed

    Meyer, Etienne H; Lehmann, Caroline; Boivin, Stéphane; Brings, Lea; De Cauwer, Isabelle; Bock, Ralph; Kühn, Kristina; Touzet, Pascal

    2018-02-23

    While mitochondrial mutants of the respiratory machinery are rare and often lethal, cytoplasmic male sterility (CMS), a mitochondrially inherited trait that results in pollen abortion, is frequently encountered in wild populations. It generates a breeding system called gynodioecy. In Beta vulgaris ssp. maritima , a gynodioecious species, we found CMS-G to be widespread across the distribution range of the species. Despite the sequencing of the mitochondrial genome of CMS-G, the mitochondrial sterilizing factor causing CMS-G is still unknown. By characterizing biochemically CMS-G, we found that the expression of several mitochondrial proteins is altered in CMS-G plants. In particular, Cox1, a core subunit of the cytochrome c oxidase (complex IV), is larger but can still assemble into complex IV. However, the CMS-G-specific complex IV was only detected as a stabilized dimer. We did not observe any alteration of the affinity of complex IV for cytochrome c ; however, in CMS-G, complex IV capacity is reduced. Our results show that CMS-G is maintained in many natural populations despite being associated with an atypical complex IV. We suggest that the modified complex IV could incur the associated cost predicted by theoretical models to maintain gynodioecy in wild populations. © 2018 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

  10. 42 CFR 447.256 - Procedures for CMS action on assurances and State plan amendments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... plan amendments. 447.256 Section 447.256 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... action on assurances and State plan amendments. (a) Criteria for approval. (1) CMS approval action on State plans and State plan amendments, is taken in accordance with subpart B of part 430 of this chapter...

  11. 42 CFR 447.256 - Procedures for CMS action on assurances and State plan amendments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... plan amendments. 447.256 Section 447.256 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... action on assurances and State plan amendments. (a) Criteria for approval. (1) CMS approval action on State plans and State plan amendments, is taken in accordance with subpart B of part 430 of this chapter...

  12. 42 CFR 417.402 - Effective date of initial regulations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.402 Effective date of... implementing regulations. (b) No new cost plan contracts are accepted by CMS. CMS will, however, accept and...

  13. Evolution of CMS workload management towards multicore job support

    NASA Astrophysics Data System (ADS)

    Pérez-Calero Yzquierdo, A.; Hernández, J. M.; Khan, F. A.; Letts, J.; Majewski, K.; Rodrigues, A. M.; McCrea, A.; Vaandering, E.

    2015-12-01

    The successful exploitation of multicore processor architectures is a key element of the LHC distributed computing system in the coming era of the LHC Run 2. High-pileup complex-collision events represent a challenge for the traditional sequential programming in terms of memory and processing time budget. The CMS data production and processing framework is introducing the parallel execution of the reconstruction and simulation algorithms to overcome these limitations. CMS plans to execute multicore jobs while still supporting singlecore processing for other tasks difficult to parallelize, such as user analysis. The CMS strategy for job management thus aims at integrating single and multicore job scheduling across the Grid. This is accomplished by employing multicore pilots with internal dynamic partitioning of the allocated resources, capable of running payloads of various core counts simultaneously. An extensive test programme has been conducted to enable multicore scheduling with the various local batch systems available at CMS sites, with the focus on the Tier-0 and Tier-1s, responsible during 2015 of the prompt data reconstruction. Scale tests have been run to analyse the performance of this scheduling strategy and ensure an efficient use of the distributed resources. This paper presents the evolution of the CMS job management and resource provisioning systems in order to support this hybrid scheduling model, as well as its deployment and performance tests, which will enable CMS to transition to a multicore production model for the second LHC run.

  14. Evolution of CMS Workload Management Towards Multicore Job Support

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

    Perez-Calero Yzquierdo, A.; Hernández, J. M.; Khan, F. A.

    The successful exploitation of multicore processor architectures is a key element of the LHC distributed computing system in the coming era of the LHC Run 2. High-pileup complex-collision events represent a challenge for the traditional sequential programming in terms of memory and processing time budget. The CMS data production and processing framework is introducing the parallel execution of the reconstruction and simulation algorithms to overcome these limitations. CMS plans to execute multicore jobs while still supporting singlecore processing for other tasks difficult to parallelize, such as user analysis. The CMS strategy for job management thus aims at integrating single andmore » multicore job scheduling across the Grid. This is accomplished by employing multicore pilots with internal dynamic partitioning of the allocated resources, capable of running payloads of various core counts simultaneously. An extensive test programme has been conducted to enable multicore scheduling with the various local batch systems available at CMS sites, with the focus on the Tier-0 and Tier-1s, responsible during 2015 of the prompt data reconstruction. Scale tests have been run to analyse the performance of this scheduling strategy and ensure an efficient use of the distributed resources. This paper presents the evolution of the CMS job management and resource provisioning systems in order to support this hybrid scheduling model, as well as its deployment and performance tests, which will enable CMS to transition to a multicore production model for the second LHC run.« less

  15. 45 CFR 150.317 - Factors CMS uses to determine the amount of penalty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Factors CMS uses to determine the amount of... RELATING TO HEALTH CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement With Respect to Issuers and Non-Federal Governmental Plans-Civil Money Penalties § 150.317 Factors CMS...

  16. Comparison of the accuracy of maxillary position between conventional model surgery and virtual surgical planning.

    PubMed

    Ritto, F G; Schmitt, A R M; Pimentel, T; Canellas, J V; Medeiros, P J

    2018-02-01

    The aim of this study was to determine whether virtual surgical planning (VSP) is an accurate method for positioning the maxilla when compared to conventional articulator model surgery (CMS), through the superimposition of computed tomography (CT) images. This retrospective study included the records of 30 adult patients submitted to bimaxillary orthognathic surgery. Two groups were created according to the treatment planning performed: CMS and VSP. The treatment planning protocol was the same for all patients. Pre- and postoperative CT images were superimposed and the linear distances between upper jaw reference points were measured. Measurements were then compared to the treatment planning, and the difference in accuracy between CMS and VSP was determined using the t-test for independent samples. The success criterion adopted was a mean linear difference of <2mm. The mean linear difference between planned and obtained movements for CMS was 1.27±1.05mm, and for VSP was 1.20±1.08mm. With CMS, 80% of overlapping reference points had a difference of <2mm, while for VSP this value was 83.6%. There was no statistically significant difference between the two techniques regarding accuracy (P>0.05). Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. 45 CFR 150.343 - Notice of proposed penalty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement With Respect to Issuers and Non-Federal Governmental Plans-Civil Money Penalties § 150.343 Notice of proposed penalty. If CMS... penalty. The notice includes the following: (a) A description of the HIPAA requirements that CMS has...

  18. 42 CFR 423.509 - Termination of contract by CMS.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Part D plan in writing 90 days before the intended date of the termination. (ii) The Part D plan... sponsor; (B) The Part D plan sponsor experiences financial difficulties so severe that its ability to make...)(4) of this section. (ii) CMS notifies the MA organization in writing that its contract will be...

  19. 42 CFR 423.509 - Termination of contract by CMS.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... plan in writing 90 days before the intended date of the termination. (ii) The Part D plan sponsor... sponsor; (B) The Part D plan sponsor experiences financial difficulties so severe that its ability to make...)(4) of this section. (ii) CMS notifies the MA organization in writing that its contract will be...

  20. 42 CFR 457.160 - Notice and timing of CMS action on State plan material.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Introduction; State Plans for Child Health Insurance Programs and Outreach Strategies... 42 Public Health 4 2010-10-01 2010-10-01 false Notice and timing of CMS action on State plan...

  1. 42 CFR 423.509 - Termination of contract by CMS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...: (1) Termination of contract by CMS. (i) CMS notifies the Part D plan in writing 90 days before the... difficulties so severe that its ability to make necessary health services available is impaired to the point of... writing that its contract will be terminated on a date specified by CMS. If a termination in is effective...

  2. 42 CFR 423.509 - Termination of contract by CMS.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...: (1) Termination of contract by CMS. (i) CMS notifies the Part D plan in writing 90 days before the... difficulties so severe that its ability to make necessary health services available is impaired to the point of... writing that its contract will be terminated on a date specified by CMS. If a termination in is effective...

  3. 42 CFR 423.758 - Collection of civil money penalties imposed by CMS.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Collection of civil money penalties imposed by CMS... BENEFIT Intermediate Sanctions § 423.758 Collection of civil money penalties imposed by CMS. (a) When a Part D plan sponsor does not request a hearing CMS initiates collection of the civil money penalty...

  4. 42 CFR 423.758 - Collection of civil money penalties imposed by CMS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Collection of civil money penalties imposed by CMS... Intermediate Sanctions § 423.758 Collection of civil money penalties imposed by CMS. (a) When a Part D plan sponsor does not request a hearing CMS initiates collection of the civil money penalty following the...

  5. 40 CFR Table 8 to Subpart Jjjjjj... - Applicability of General Provisions to Subpart JJJJJJ

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... malfunctions ASAP No. § 63.6(e)(3) SSM Plan No. § 63.6(f)(1) SSM exemption No. § 63.6(h)(1) SSM exemption No... operation No. § 63.8(c)(1)(iii) Requirement to develop SSM Plan for CMS No. § 63.8(d)(3) Written procedures for CMS Yes, except for the last sentence, which refers to an SSM plan. SSM plans are not required...

  6. 40 CFR Table 8 to Subpart Jjjjjj... - Applicability of General Provisions to Subpart JJJJJJ

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... malfunctions ASAP No. § 63.6(e)(3) SSM Plan No. § 63.6(f)(1) SSM exemption No. § 63.6(h)(1) SSM exemption No... operation No. § 63.8(c)(1)(iii) Requirement to develop SSM Plan for CMS No. § 63.8(d)(3) Written procedures for CMS Yes, except for the last sentence, which refers to an SSM plan. SSM plans are not required...

  7. 40 CFR Table 8 to Subpart Jjjjjj... - Applicability of General Provisions to Subpart JJJJJJ

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... malfunctions ASAP No. § 63.6(e)(3) SSM Plan No. § 63.6(f)(1) SSM exemption No. § 63.6(h)(1) SSM exemption No... operation No. § 63.8(c)(1)(iii) Requirement to develop SSM Plan for CMS No. § 63.8(d)(3) Written procedures for CMS Yes, except for the last sentence, which refers to an SSM plan. SSM plans are not required...

  8. 40 CFR Table 8 to Subpart Jjjjjj... - Applicability of General Provisions to Subpart JJJJJJ

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... malfunctions ASAP No. § 63.6(e)(3) SSM Plan No. § 63.6(f)(1) SSM exemption No. § 63.6(h)(1) SSM exemption No... operation No. § 63.8(c)(1)(iii) Requirement to develop SSM Plan for CMS No. § 63.8(d)(3) Written procedures for CMS Yes, except for the last sentence, which refers to an SSM plan. SSM plans are not required...

  9. 76 FR 18555 - Statement of Organization, Functions, and Delegations of Authority

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ... leadership over the strategic planning process and the development of CMS strategic goals, metrics, and plans. Direct the development of financial and health care trend analysis and management insight report to inform senior CMS leadership strategic decision making. Set priorities for CSP direction, budget...

  10. 42 CFR 417.404 - General requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.404 General requirements. (a) In order to contract with CMS under the Medicare program, an entity must— (1) Be determined by CMS to be an HMO or CMP...

  11. 45 CFR 150.101 - Basis and scope.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS... that apply to group health plans that are non-Federal governmental plans are enforced by CMS using the procedures described in § 150.301 et seq. (2) Enforcement with respect to health insurance issuers. The...

  12. 45 CFR 150.101 - Basis and scope.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS... that apply to group health plans that are non-Federal governmental plans are enforced by CMS using the procedures described in § 150.301 et seq. (2) Enforcement with respect to health insurance issuers. The...

  13. Intelligent Systems and Advanced User Interfaces for Design, Operation, and Maintenance of Command Management Systems

    NASA Technical Reports Server (NTRS)

    Mitchell, Christine M.

    1998-01-01

    Historically Command Management Systems (CMS) have been large, expensive, spacecraft-specific software systems that were costly to build, operate, and maintain. Current and emerging hardware, software, and user interface technologies may offer an opportunity to facilitate the initial formulation and design of a spacecraft-specific CMS as well as a to develop a more generic or a set of core components for CMS systems. Current MOC (mission operations center) hardware and software include Unix workstations, the C/C++ and Java programming languages, and X and Java window interfaces representations. This configuration provides the power and flexibility to support sophisticated systems and intelligent user interfaces that exploit state-of-the-art technologies in human-machine systems engineering, decision making, artificial intelligence, and software engineering. One of the goals of this research is to explore the extent to which technologies developed in the research laboratory can be productively applied in a complex system such as spacecraft command management. Initial examination of some of the issues in CMS design and operation suggests that application of technologies such as intelligent planning, case-based reasoning, design and analysis tools from a human-machine systems engineering point of view (e.g., operator and designer models) and human-computer interaction tools, (e.g., graphics, visualization, and animation), may provide significant savings in the design, operation, and maintenance of a spacecraft-specific CMS as well as continuity for CMS design and development across spacecraft with varying needs. The savings in this case is in software reuse at all stages of the software engineering process.

  14. 42 CFR 422.2266 - Deemed approval.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... approval. If CMS has not disapproved the distribution of marketing materials or forms submitted by an MA organization with respect to an MA plan in an area, CMS is deemed not to have disapproved the distribution in all other areas covered by the MA plan and organization except with regard to any portion of the...

  15. 76 FR 76595 - Medical Loss Ratio Rebate Requirements for Non-Federal Governmental Plans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-07

    ..., Department of Health and Human Services, Attention: CMS-9998-IFC2, P.O. Box 8010, Baltimore, MD 21244-8010... for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9998-IFC2... premium paid by subscribers of non-Federal governmental plans for the benefit of subscribers, ensuring...

  16. 42 CFR 417.464 - End of CMS's liability for payment: Disenrollment of beneficiaries and termination or default of...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of beneficiaries and termination or default of contract. 417.464 Section 417.464 Public Health... PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Enrollment, Entitlement, and Disenrollment under Medicare Contract § 417.464 End of CMS's liability for...

  17. 40 CFR Table 9 to Subpart Vvvvvv... - Applicability of General Provisions to Subpart VVVVVV

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 63.6(e)(1)(i) and (ii), (e)(3), and (f)(1) SSM Requirements No See § 63.11495(d) for general duty... Emissions and CMS Operation No 63.8(c)(1)(iii) Requirement to Develop SSM Plan for CMS No 63.8(c)(4) Yes... sentence, which refers to an SSM plan. SSM plans are not required. 63.8(g)(1)-(g)(4) Yes Data reduction...

  18. 40 CFR Table 9 to Subpart Vvvvvv... - Applicability of General Provisions to Subpart VVVVVV

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 63.6(e)(1)(i) and (ii), (e)(3), and (f)(1) SSM Requirements No See § 63.11495(d) for general duty... Emissions and CMS Operation No 63.8(c)(1)(iii) Requirement to Develop SSM Plan for CMS No 63.8(c)(4) Yes... sentence, which refers to an SSM plan. SSM plans are not required. 63.8(g)(1)-(g)(4) Yes Data reduction...

  19. CMS proposes prioritizing patient preferences, linking patients to follow-up care in discharge planning process.

    PubMed

    2016-03-01

    Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule.

  20. Status and commissioning of the CMS experiment

    NASA Astrophysics Data System (ADS)

    Wulz, C.-E.

    2008-05-01

    The construction status of the CMS experiment at the Large Hadron Collider and strategies for commissioning the subdetectors, the magnet, the trigger and the data acquisition are described. The first operations of CMS as a unified system, using either cosmic rays or test data, and the planned activities until the startup of the LHC are presented.

  1. 45 CFR 150.317 - Factors CMS uses to determine the amount of penalty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... level of financial and other impacts on affected individuals. (3) Other factors as justice may require. ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Factors CMS uses to determine the amount of... With Respect to Issuers and Non-Federal Governmental Plans-Civil Money Penalties § 150.317 Factors CMS...

  2. 75 FR 80058 - Notice of Hearing: Reconsideration of Disapproval of California State Plan Amendments (SPAs) 08...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-21

    ...; and 08-019 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice of hearing. SUMMARY: This notice announces an administrative hearing to be held on February 10, 2011, at the CMS San Francisco Regional Office, 90 7th Street, 5-300 (5W), San Francisco, California 94103 to reconsider CMS...

  3. A Planning and Assessment Model for Developing Effective CMS Support

    ERIC Educational Resources Information Center

    Johnson, Douglas F.

    2004-01-01

    At the University of Florida, in Spring 2003, more than 32,000 individuals enrolled in courses using the centrally-supported Course Management System (CMS). Because less than 1 full time equivalent (FTE) was allocated to support the CMS, this created problems for both users and support providers. In the face of rapid growth, support resources for…

  4. 42 CFR 423.2010 - When CMS, the IRE, or Part D plan sponsors may participate in an ALJ hearing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Part D plan sponsor to participate must be made within 5 calendar days of receipt of the notice of hearing. (2) Within 5 calendar days of receipt of a request to participate in a non-expedited hearing, the... the timeframe designated by the ALJ. (g) The ALJ cannot draw any adverse inferences if CMS, the IRE...

  5. 42 CFR 423.2010 - When CMS, the IRE, or Part D plan sponsors may participate in an ALJ hearing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Part D plan sponsor to participate must be made within 5 calendar days of receipt of the notice of hearing. (2) Within 5 calendar days of receipt of a request to participate in a non-expedited hearing, the... the timeframe designated by the ALJ. (g) The ALJ cannot draw any adverse inferences if CMS, the IRE...

  6. Using the CMS threaded framework in a production environment

    DOE PAGES

    Jones, C. D.; Contreras, L.; Gartung, P.; ...

    2015-12-23

    During 2014, the CMS Offline and Computing Organization completed the necessary changes to use the CMS threaded framework in the full production environment. We will briefly discuss the design of the CMS Threaded Framework, in particular how the design affects scaling performance. We will then cover the effort involved in getting both the CMSSW application software and the workflow management system ready for using multiple threads for production. Finally, we will present metrics on the performance of the application and workflow system as well as the difficulties which were uncovered. As a result, we will end with CMS' plans formore » using the threaded framework to do production for LHC Run 2.« less

  7. Soluble curcumin amalgamated chitosan microspheres augmented drug delivery and cytotoxicity in colon cancer cells: In vitro and in vivo study.

    PubMed

    Jyoti, Kiran; Bhatia, Richa Kaur; Martis, Elvis A F; Coutinho, Evans C; Jain, Upendra Kumar; Chandra, Ramesh; Madan, Jitender

    2016-12-01

    In present investigation, initially curcumin was complexed with 2-HP-β-CD (curcumin-2-HP-β-CD-complex) in 1:1 ratio and later amalgamated with chitosan microspheres (curcumin-2-HP-β-CD-CMs) for selective delivery in colon only through oral route of administration. Various analytical, spectral and in-silico docking techniques revealed that the curcumin was deeply inserted in the 2-HP-β-CD cavity with apparent stability constant of 3.35×10 -3 M. Furthermore, the mean particle size of 6.8±2.6μm and +39.2±4.1mV surface charge of curcumin-2-HP-β-CD-complex-CMs in addition to encapsulation efficiency of about 79.8±6.3% exhibited that the tailored microspheres were optimum for colon delivery of curcumin. This was also demonstrated in dissolution testing and standard cell proliferation assay in which curcumin-2-HP-β-CD-complex-CMs exhibited maximum release in simulated colonic fluid (SCF, pH ∼7.0-8.0, almond emulsion-β-glucosidase) with improved therapeutic index in HT-29 cells. Consistently, curcumin-2-HP-β-CD-complex-CMs successively enhanced the colonic bio-distribution of curcumin by ∼8.36 folds as compared to curcumin suspension in preclinical pharmacokinetic studies. In conclusion, curcumin-2-HP-β-CD-complex-CMs warrant further in vivo tumor regression study to establish its therapeutic efficacy in experimental colon cancer. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. 42 CFR 422.254 - Submission of bids.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... part or may choose not to renew the contract. (4) Substantial differences between bids. An MA organization's bid submissions must reflect differences in benefit packages or plan costs that CMS determines to represent substantial differences relative to a sponsor's other bid submissions. (5) CMS may...

  9. 42 CFR 422.254 - Submission of bids.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... this part or may choose not to renew the contract. (4) Substantial differences between bids. An MA organization's bid submissions must reflect differences in benefit packages or plan costs that CMS determines to represent substantial differences relative to a sponsor's other bid submissions. (5) CMS may...

  10. 42 CFR 422.254 - Submission of bids.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... this part or may choose not to renew the contract. (4) Substantial differences between bids. An MA organization's bid submissions must reflect differences in benefit packages or plan costs that CMS determines to represent substantial differences relative to a sponsor's other bid submissions. (5) CMS may...

  11. 42 CFR 422.451 - Moratorium on new local preferred provider organization plans.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... for MA Regional Plans § 422.451 Moratorium on new local preferred provider organization plans. CMS... service area unless the MA organization seeking to offer the plan was offering a local preferred provider...

  12. 42 CFR 422.451 - Moratorium on new local preferred provider organization plans.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for MA Regional Plans § 422.451 Moratorium on new local preferred provider organization plans. CMS... service area unless the MA organization seeking to offer the plan was offering a local preferred provider...

  13. 42 CFR 457.630 - Grants procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Payments to States § 457.630 Grants procedures. (a) General provisions. Once CMS has approved a State child health plan, CMS makes quarterly grant awards to the State to cover the Federal share of expenditures for child...

  14. CMS Analysis School Model

    NASA Astrophysics Data System (ADS)

    Malik, S.; Shipsey, I.; Cavanaugh, R.; Bloom, K.; Chan, Kai-Feng; D'Hondt, J.; Klima, B.; Narain, M.; Palla, F.; Rolandi, G.; Schörner-Sadenius, T.

    2014-06-01

    To impart hands-on training in physics analysis, CMS experiment initiated the concept of CMS Data Analysis School (CMSDAS). It was born over three years ago at the LPC (LHC Physics Centre), Fermilab and is based on earlier workshops held at the LPC and CLEO Experiment. As CMS transitioned from construction to the data taking mode, the nature of earlier training also evolved to include more of analysis tools, software tutorials and physics analysis. This effort epitomized as CMSDAS has proven to be a key for the new and young physicists to jump start and contribute to the physics goals of CMS by looking for new physics with the collision data. With over 400 physicists trained in six CMSDAS around the globe, CMS is trying to engage the collaboration in its discovery potential and maximize physics output. As a bigger goal, CMS is striving to nurture and increase engagement of the myriad talents, in the development of physics, service, upgrade, education of those new to CMS and the career development of younger members. An extension of the concept to the dedicated software and hardware schools is also planned, keeping in mind the ensuing upgrade phase.

  15. Rhode Island congestion management plan : executive summary

    DOT National Transportation Integrated Search

    1997-09-01

    This document provides an overview of the Rhode Island Congestion Management System (CMS) program consisting of the following: Congestion Management System Plan; Incident Management Plan; and Intelligent Transportation System (ITS) Early Deployment P...

  16. 77 FR 37683 - Statement of Organization, Functions, and Delegations of Authority

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-22

    ... update of strategic plans and performance goals. Oversees the CMS Challenge Competition, working with... strategic plans with Department of Health and Human Services' 5-year strategic plan and performance goals...

  17. 42 CFR 457.200 - Program reviews.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... administration of the CHIP plan. In order to determine whether the State is complying with the Federal requirements and the provisions of its plan, CMS reviews State and local administration of the CHIP plan...

  18. 42 CFR 457.200 - Program reviews.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... administration of the CHIP plan. In order to determine whether the State is complying with the Federal requirements and the provisions of its plan, CMS reviews State and local administration of the CHIP plan...

  19. 42 CFR 457.200 - Program reviews.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... administration of the CHIP plan. In order to determine whether the State is complying with the Federal requirements and the provisions of its plan, CMS reviews State and local administration of the CHIP plan...

  20. 42 CFR 457.200 - Program reviews.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... administration of the CHIP plan. In order to determine whether the State is complying with the Federal requirements and the provisions of its plan, CMS reviews State and local administration of the CHIP plan...

  1. 42 CFR 457.200 - Program reviews.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... administration of the CHIP plan. In order to determine whether the State is complying with the Federal requirements and the provisions of its plan, CMS reviews State and local administration of the CHIP plan...

  2. 78 FR 30218 - Pre-Existing Condition Insurance Plan Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-22

    ..., Department of Health and Human Services, Attention: CMS-9995-IFC3, P.O. Box 8010, Baltimore, MD 21244-8010... for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9995-IFC3... Secretary shall make such adjustments as are necessary to eliminate such deficit.'' We have codified this...

  3. 42 CFR 423.514 - Validation of Part D reporting requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... that CMS requires, statistics indicating the following— (1) The cost of its operations. (2) The...) Other matters that CMS may require. (b) Significant business transactions. Each Part D plan sponsor must... authorizes an extension of time), the following: (1) A description of significant business transactions, as...

  4. Neuropsychological function in children with primary complex motor stereotypies.

    PubMed

    Mahone, E Mark; Ryan, Matthew; Ferenc, Lisa; Morris-Berry, Christina; Singer, Harvey S

    2014-10-01

    Complex motor stereotypies (CMS) are patterned, repetitive, rhythmic, and involuntary movements that persist over time. They are divided into two subgroups dependent on the presence of other developmental problems: 'primary' (development is otherwise typical) or 'secondary' (associated with autism, intellectual disability, or sensory deficits). There are no currently published studies that examine neuropsychological function in children with primary CMS. This case-control study examines whether children with primary CMS manifest neurobehavioral deficits. Fifty-seven children with primary CMS (32 males, 25 females; mean age 6y 8mo, SD 2y 4mo, range 4-12y) with negative screens for autism and 57 comparison participants (32 males, 25 females; mean age 6y 6mo, SD 2y 1mo) completed neuropsychological assessments of IQ, reading ability, attention, language, and motor and executive functions. Parents completed ratings of their child's repetitive movement severity. The CMS group performed significantly less well than comparison participants on motor skills and IQ tests (both p<0.01), although IQ was consistently in the average range. One-third of the CMS group showed signs of developmental motor coordination difficulties. Parent report of stereotypy severity was significantly associated with parent report of inattention and executive dysfunction. Children with primary CMS were found to have largely intact neuropsychological profiles. Stereotypy severity appears to be associated with executive dysfunction. Although motor difficulties were observed in children with CMS, these were not correlated with parent report of symptom severity. © 2014 Mac Keith Press.

  5. A search for a heavy Majorana neutrino and a radiation damage simulation for the HF detector

    NASA Astrophysics Data System (ADS)

    Wetzel, James William

    A search for heavy Majorana neutrinos is performed using an event signature defined by two same-sign muons accompanied by two jets. This search is an extension of previous searches, (L3, DELPHI, CMS, ATLAS), using 19.7 fb -1 of data from the 2012 Large Hadron Collider experimental run collected by the Compact Muon Solenoid experiment. A mass window of 40-500 GeV/ c2 is explored. No excess events above Standard Model backgrounds is observed, and limits are set on the mixing element squared, |VmuN|2, as a function of Majorana neutFnrino mass. The Hadronic Forward (HF) Detector's performance will degrade as a function of the number of particles delivered to the detector over time, a quantity referred to as integrated luminosity and measured in inverse femtobarns (fb-1). In order to better plan detector upgrades, the CMS Forward Calorimetry Task Force (FCAL) group and the CMS Hadronic Calorimeter (HCAL) group have requested that radiation damage be simulated and the subsequent performance of the HF subdetector be studied. The simulation was implemented into both the CMS FastSim and CMS FullSim simulation packages. Standard calorimetry performance metrics were computed and are reported. The HF detector can expect to perform well through the planned delivery of 3000 fb-1.

  6. Medicare capitation model, functional status, and multiple comorbidities: model accuracy

    PubMed Central

    Noyes, Katia; Liu, Hangsheng; Temkin-Greener, Helena

    2012-01-01

    Objective This study examined financial implications of CMS-Hierarchical Condition Categories (HCC) risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. Study Design The study used 1992-2000 data from the Medicare Current Beneficiary Survey and corresponding Medicare claims. The pairs of comorbidities were formed based on the prior evidence about possible synergy between these conditions and activities of daily living (ADL) deficiencies and included heart disease and cancer, lung disease and cancer, stroke and hypertension, stroke and arthritis, congestive heart failure (CHF) and osteoporosis, diabetes and coronary artery disease, CHF and dementia. Methods For each beneficiary, we calculated the actual Medicare cost ratio as the ratio of the individual’s annualized costs to the mean annual Medicare cost of all people in the study. The actual Medicare cost ratios, by ADLs, were compared to the HCC ratios under the CMS-HCC payment model. Using multivariate regression models, we tested whether having the identified pairs of comorbidities affects the accuracy of CMS-HCC model predictions. Results The CMS-HCC model underpredicted Medicare capitation payments for patients with hypertension, lung disease, congestive heart failure and dementia. The difference between the actual costs and predicted payments was partially explained by beneficiary functional status and less than optimal adjustment for these chronic conditions. Conclusions Information about beneficiary functional status should be incorporated in reimbursement models since underpaying providers for caring for population with multiple comorbidities may provide severe disincentives for managed care plans to enroll such individuals and to appropriately manage their complex and costly conditions. PMID:18837646

  7. 76 FR 29249 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-20

    ... collection; Title of Information Collection: State Plan Template to Implement Section 6062 of the Deficit Reduction Act; Form No.: CMS-10232 (OMB : 0938-1045); Use: The Deficit Reduction Act (DRA) provides States..., 2011. OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk Officer, Fax Number: (202...

  8. CMS Analysis School Model

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

    Malik, S.; Shipsey, I.; Cavanaugh, R.

    To impart hands-on training in physics analysis, CMS experiment initiated the concept of CMS Data Analysis School (CMSDAS). It was born over three years ago at the LPC (LHC Physics Centre), Fermilab and is based on earlier workshops held at the LPC and CLEO Experiment. As CMS transitioned from construction to the data taking mode, the nature of earlier training also evolved to include more of analysis tools, software tutorials and physics analysis. This effort epitomized as CMSDAS has proven to be a key for the new and young physicists to jump start and contribute to the physics goals ofmore » CMS by looking for new physics with the collision data. With over 400 physicists trained in six CMSDAS around the globe, CMS is trying to engage the collaboration in its discovery potential and maximize physics output. As a bigger goal, CMS is striving to nurture and increase engagement of the myriad talents, in the development of physics, service, upgrade, education of those new to CMS and the career development of younger members. An extension of the concept to the dedicated software and hardware schools is also planned, keeping in mind the ensuing upgrade phase.« less

  9. 42 CFR 423.272 - Review and negotiation of bid and approval of plans submitted by potential Part D sponsors.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...-PD plans with the following exceptions: (1) Exemption from negotiations. These plans are exempt from... prescription drug coverage and actuarial determinations. (1) Application of revenue requirements standard. CMS... in benefits offered under the plan. (c) Limited risk plans. (1) Application of limited risk plans...

  10. 42 CFR 423.272 - Review and negotiation of bid and approval of plans submitted by potential Part D sponsors.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-PD plans with the following exceptions: (1) Exemption from negotiations. These plans are exempt from... prescription drug coverage and actuarial determinations. (1) Application of revenue requirements standard. CMS... in benefits offered under the plan. (c) Limited risk plans. (1) Application of limited risk plans...

  11. The Medicare Health Outcomes Survey program: overview, context, and near-term prospects.

    PubMed

    Jones, Nathaniel; Jones, Stephanie L; Miller, Nancy A

    2004-07-12

    In 1996, the Centers for Medicare & Medicaid Services (CMS) initiated the Medicare Health Outcomes Survey (HOS). It is the first national survey to measure the quality of life and functional health status of Medicare beneficiaries enrolled in managed care. The program seeks to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability and improving health outcomes based on competition. The context that led to the development of the HOS was formed by the convergence of the following factors: 1) a recognized need to monitor the performance of managed care plans, 2) technical expertise and advancement in the areas of quality measurement and health outcomes assessment, 3) the existence of a tested functional health status assessment tool (SF-36)1, which was valid for an elderly population, 4) CMS leadership, and 5) political interest in quality improvement. Since 1998, there have been six baseline surveys and four follow up surveys. CMS, working with its partners, performs the following tasks as part of the HOS program: 1) Supports the technical/scientific development of the HOS measure, 2) Certifies survey vendors, 3) Collects Health Plan Employer Data and Information Set(HEDIS)2 HOS data, 4) Cleans, scores, and disseminates annual rounds of HOS data, public use files and reports to CMS, Quality Improvement Organizations (QIOs), Medicare+Choice Organizations (M+COs), and other stakeholders, 5) Trains M+COs and QIOs in the use of functional status measures and best practices for improving care, 6) Provides technical assistance to CMS, QIOs, M+COs and other data users, and 7) Conducts analyses using HOS data to support CMS and HHS priorities.CMS has recently sponsored an evaluation of the HOS program, which will provide the information necessary to enhance the future administration of the program. Information collected to date reveals that the HOS program is a valuable tool that provides a rich set of data that is useful for quality monitoring and improvement efforts. To enhance the future of the HOS program, many stakeholders recommend the implementation of incentives to encourage the use of the data, while others identify the need to monitor the health status of plan disenrollees.Overall, the HOS program represents an important vehicle for collecting outcomes data from Medicare beneficiaries. The new Medicare Prescription Drug, Improvement, and Modernization Act (2003) mandates the collection and use of data for outcomes measurement. Consequently, it is important to improve HOS to most effectively meet the mandate.

  12. Medicare+Choice: what lies ahead?

    PubMed

    Layne, R Jeffrey

    2002-03-01

    Health plans have continued to exit the Medicare+Choice program in recent years, despite efforts of Congress and the Centers for Medicare and Medicaid Services (CMS) to reform the program. Congress and CMS therefore stand poised to make additional, substantial reforms to the program. CMS has proposed to consolidate its oversight of the program, extend the due date for Medicare+Choice plans to file their adjusted community rate proposals, revise risk-adjustment processes, streamline the marketing review process, enhance quality-improvement requirements, institute results based performance assessment audits, coordinate policy changes to coincide with contracting cycles, expand its fall advertising campaign for the program, provide better employer-based Medicare options for beneficiaries, and take steps to minimize beneficiary costs. Congressional leaders have proposed various legislative remedies to improve the program, including creation of an entirely new pricing structure for the program based on a competitive bidding process.

  13. 42 CFR 423.32 - Enrollment process.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... individual successfully enrolls in another PDP or MA-PD plan; (ii) The individual voluntarily disenrolls from... under this part as of December 31, 2005, remain enrolled in that plan as of January 1, 2006, and receive... a plan poses potential harm to plan members, CMS may implement passive enrollment procedures. (1...

  14. 42 CFR 423.32 - Enrollment process.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... individual successfully enrolls in another PDP or MA-PD plan; (ii) The individual voluntarily disenrolls from... under this part as of December 31, 2005, remain enrolled in that plan as of January 1, 2006, and receive... a plan poses potential harm to plan members, CMS may implement passive enrollment procedures. (1...

  15. Probing New Physics with Jets at the LHC

    ScienceCinema

    Harris, Robert

    2017-12-09

    The Large Hadron Collider at CERN has the potential to make a major discovery as early as 2008 from simple measurements of events with two high energy jets. This talk will present the jet trigger and analysis plans of the CMS collaboration, which were produced at the LHC Physics Center at Fermilab. Plans to search the two jet channel for generic signals of new particles and forces will be discussed. I will present the anticipated sensitivity of the CMS experiment to a variety of models of new physics, including quark compositeness, technicolor, superstrings, extra dimensions and grand unification.

  16. The elution of colistimethate sodium from polymethylmethacrylate and calcium phosphate cement beads.

    PubMed

    Waterman, Paige; Barber, Melissa; Weintrob, Amy C; VanBrakle, Regina; Howard, Robin; Kozar, Michael P; Andersen, Romney; Wortmann, Glenn

    2012-06-01

    Gram-negative bacilli resistance to all antibiotics, except for colistimethate sodium (CMS), is an emerging healthcare concern. Incorporating CMS into orthopedic cement to treat bone and soft-tissue infections due to these bacteria is attractive, but the data regarding the elution of CMS from cement are conflicting. The in vitro analysis of the elution of CMS from polymethylmethacrylate (PMMA) and calcium phosphate (CP) cement beads is reported. PMMA and CP beads containing CMS were incubated in phosphate-buffered saline and the eluate sampled at sequential time points. The inhibition of the growth of a strain of Acinetobacter baumannii complex by the eluate was measured by disk diffusion and microbroth dilution assays, and the presence of CMS in the eluate was measured by mass spectroscopy. Bacterial growth was inhibited by the eluate from both PMMA and CP beads. Mass spectroscopy demonstrated greater elution of CMS from CP beads than PMMA beads. The dose of CMS in PMMA beads was limited by failure of bead integrity. CMS elutes from both CP and PMMA beads in amounts sufficient to inhibit bacterial growth in vitro. The clinical implications of these findings require further study.

  17. Congestion Management System Process Report

    DOT National Transportation Integrated Search

    1996-03-01

    In January 1995, the Indianapolis Metropolitan Planning Organization with the help of an interagency Study Review Committee began the process of developing a Congestion Management System (CMS) Plan resulting in this report. This report documents the ...

  18. Individualized Quality Control Plan (IQCP): Is It Value-Added for Clinical Microbiology?

    PubMed Central

    Miller, Melissa B.; Hindler, Janet

    2015-01-01

    The Center for Medicaid and Medicare Services (CMS) recently published their Individualized Quality Control Plan (IQCP [https://www.cms.gov/regulations-and-guidance/legislation/CLIA/Individualized_Quality_Control_Plan_IQCP.html]), which will be the only option for quality control (QC) starting in January 2016 if laboratories choose not to perform Clinical Laboratory Improvement Act (CLIA) [U.S. Statutes at Large 81(1967):533] default QC. Laboratories will no longer be able to use “equivalent QC” (EQC) or the Clinical and Laboratory Standards Institute (CLSI) standards alone for quality control of their microbiology systems. The implementation of IQCP in clinical microbiology laboratories will most certainly be an added burden, the benefits of which are currently unknown. PMID:26447112

  19. Efficacy of parent-delivered behavioral therapy for primary complex motor stereotypies.

    PubMed

    Specht, Matthew W; Mahone, E Mark; Kline, Tina; Waranch, Richard; Brabson, Laurel; Thompson, Carol B; Singer, Harvey S

    2017-02-01

    Primary complex motor stereotypies (CMS) are persistent, patterned, repetitive, rhythmic movements in young people with typical development. This study evaluated the efficacy of an instructional DVD as a home-based, parent-administered, behavioral therapy for primary CMS. Eighty-one children with primary CMS were enrolled. Primary outcome measures included the Stereotypy Severity Scale (SSS) - Motor and Impairment scores, and Stereotypy Linear Analog Scale (SLAS). Mean CMS onset was 13.4 months (SD 13.1). Eligibility required observed CMS. Psychiatric disorders were not exclusionary and a stable medication regimen was required. Intellectual disability, neurological disorder, autism spectrum disorder, and tics were exclusionary. Initial assessments were completed via REDCap before receipt of the DVD. Fifty-four of the 81 children (34 male, 20 female; mean age 8y 2mo, SD 1.42, range 7-14y) completed assessments at 1, 2, or 3 months after receiving the DVD. Reductions (baseline to last assessment) in SSS Motor, SSS Impairment, and SLAS scores (all p<0.001) represented change ratios of -15%, -24%, and a -20% respectively. Greatest relative treatment benefit was observed by younger children (ages 7-8y), and by 1 month after receipt of DVD, while a parent global assessment scale showed progressive improvement throughout the study. An instructional DVD for parent-delivered behavioral therapy was a safe, effective intervention for primary CMS. © 2016 Mac Keith Press.

  20. Efficacy of parent-delivered behavioral therapy for primary complex motor stereotypies

    PubMed Central

    Specht, Matthew W; Mahone, E Mark; Kline, Tina; Waranch, Richard; Brabson, Laurel; Thompson, Carol B; Singer, Harvey S

    2016-01-01

    Aim ‘Primary’ complex motor stereotypies (CMS) are persistent, patterned, repetitive, rhythmic movements in young people with typical development. This study evaluated the efficacy of an instructional DVD as a home-based, parent-administered, behavioral therapy for primary CMS. Method Eighty-one children with primary CMS were enrolled. Primary outcome measures included the Stereotypy Severity Scale (SSS) – Motor and Impairment scores, and Stereotypy Linear Analog Scale (SLAS). Mean CMS onset was 13.4 months (SD 13.1). Eligibility required observed CMS. Psychiatric disorders were not exclusionary and a stable medication regimen was required. Intellectual disability, neurological disorder, autism spectrum disorder, and tics were exclusionary. Initial assessments were completed via REDCap before receipt of the DVD. Fifty-four of the 81 children (34 male, 20 female; mean age 8y 2mo, SD 1.42, range 7–14y) completed assessments at 1, 2, or 3 months after receiving the DVD. Results Reductions (baseline to last assessment) in SSS Motor, SSS Impairment, and SLAS scores (all p<0.001) represented change ratios of –15%, –24%, and a –20%, respectively. Greatest relative treatment benefit was observed by younger children (ages 7–8y), and by one month after receipt of DVD, while a parent global assessment scale showed progressive improvement throughout the study. Interpretation An instructional DVD for parent-delivered behavioral therapy was a safe, effective intervention for primary CMS. PMID:27259464

  1. 42 CFR 457.65 - Effective date and duration of State plans and plan amendments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... funding. A State plan amendment that changes the source of the State share of funding can take effect no.... Except as otherwise limited by this section— (1) A State plan or plan amendment takes effect on the day... amendment. (3) A State plan amendment that takes effect prior to submission of the amendment to CMS may...

  2. 42 CFR 457.65 - Effective date and duration of State plans and plan amendments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... funding. A State plan amendment that changes the source of the State share of funding can take effect no.... Except as otherwise limited by this section— (1) A State plan or plan amendment takes effect on the day... amendment. (3) A State plan amendment that takes effect prior to submission of the amendment to CMS may...

  3. 77 FR 292 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-04

    ... Pricing Tool. Ultimately, CMS decides whether to approve the plan pricing (i.e., payment and premium...: Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP); Use: Under... to submit an actuarial pricing ``bid'' for each plan offered to Medicare beneficiaries for approval...

  4. 76 FR 1435 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... approve the plan pricing (i.e., payment and premium) proposed by each organization. Form Number: CMS...: CY 2012 Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP... required to submit an actuarial pricing ``bid'' for each plan offered to Medicare beneficiaries for...

  5. Diagnosis-related Groups and Hospital Inpatient Federal Reimbursement.

    PubMed

    Rimler, Simcha B; Gale, Brian D; Reede, Deborah L

    2015-10-01

    To understand the complex system of reimbursement for health care services, it is helpful to have a working knowledge of the historic context of diagnosis-related groups (DRGs), as well as their utility and increasing relevance. Congress implemented the DRG system in 1983 in response to rapidly increasing health care costs. The DRG system was designed to control hospital reimbursements by replacing retrospective payments with prospective payments for hospital charges. This article explains how these payments are calculated. Every inpatient admission is classified into one of several hundred DRGs that are based on the diagnosis, complications, and comorbidities. The Centers for Medicare & Medicaid Services (CMS) assigns each DRG a weight that the CMS uses in conjunction with hospital-specific data to determine reimbursement. A population's DRGs represent the resources needed to treat the medical disorders of that population. Hospital administrators use this information to budget and plan for the future. The Affordable Care Act and other recent legislation affect medical reimbursement by altering the DRG system. Radiologic procedures in particular are affected. This legislation will give DRGs an even larger role in determining reimbursements in the coming years. © RSNA, 2015.

  6. Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk.

    PubMed

    Bowling, C Barrett; Zhang, Rebecca; Franch, Harold; Huang, Yijian; Mirk, Anna; McClellan, William M; Johnson, Theodore M; Kutner, Nancy G

    2015-03-21

    The usage of nursing home (NH) services is a marker of frailty among older adults. Although the Centers for Medicare & Medicaid Services (CMS) revised the Medical Evidence Report Form CMS-2728 in 2005 to include data collection on NH institutionalization, the validity of this item has not been reported. There were 27,913 patients ≥ 75 years of age with incident end-stage renal disease (ESRD) in 2006, which constituted our analysis cohort. We determined the accuracy of the CMS-2728 using a matched cohort that included the CMS Minimum Data Set (MDS) 2.0, often employed as a "gold standard" metric for identifying patients receiving NH care. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the CMS-2728 NH item. Next, we compared characteristics and mortality risk by CMS-2728 and MDS NH status agreement. The sensitivity, specificity, PPV and NPV of the CMS-2728 for NH status were 33%, 97%, 80% and 79%, respectively. Compared to those without the MDS or CMS-2728 NH indicator (No MDS/No 2728), multivariable adjusted hazard ratios (95% confidence interval) for mortality associated with NH status were 1.55 (1.46 - 1.64) for MDS/2728, 1.48 (1.42 - 1.54) for MDS/No 2728, and 1.38 (1.25 - 1.52) for No MDS/2728. NH utilization was more strongly associated with mortality than other CMS-2728 items in the model. The CMS-2728 underestimated NH utilization among older adults with incident ESRD. The potential for misclassification may have important ramifications for assessing prognosis, developing advanced care plans and providing coordinated care.

  7. 42 CFR 422.2266 - Deemed approval.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... submitted by an MA organization with respect to an MA plan in an area, CMS is deemed not to have disapproved the distribution in all other areas covered by the MA plan and organization except with regard to any...

  8. A Population WB-PBPK Model of Colistin and its Prodrug CMS in Pigs: Focus on the Renal Distribution and Excretion.

    PubMed

    Viel, Alexis; Henri, Jérôme; Bouchène, Salim; Laroche, Julian; Rolland, Jean-Guy; Manceau, Jacqueline; Laurentie, Michel; Couet, William; Grégoire, Nicolas

    2018-03-12

    The objective was the development of a whole-body physiologically-based pharmacokinetic (WB-PBPK) model for colistin, and its prodrug colistimethate sodium (CMS), in pigs to explore their tissue distribution, especially in kidneys. Plasma and tissue concentrations of CMS and colistin were measured after systemic administrations of different dosing regimens of CMS in pigs. The WB-PBPK model was developed based on these data according to a non-linear mixed effect approach and using NONMEM software. A detailed sub-model was implemented for kidneys to handle the complex disposition of CMS and colistin within this organ. The WB-PBPK model well captured the kinetic profiles of CMS and colistin in plasma. In kidneys, an accumulation and slow elimination of colistin were observed and well described by the model. Kidneys seemed to have a major role in the elimination processes, through tubular secretion of CMS and intracellular degradation of colistin. Lastly, to illustrate the usefulness of the PBPK model, an estimation of the withdrawal periods after veterinary use of CMS in pigs was made. The WB-PBPK model gives an insight into the renal distribution and elimination of CMS and colistin in pigs; it may be further developed to explore the colistin induced-nephrotoxicity in humans.

  9. Plan-provider integration, premiums, and quality in the Medicare Advantage market.

    PubMed

    Frakt, Austin B; Pizer, Steven D; Feldman, Roger

    2013-12-01

    To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration. With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents. We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). © Health Research and Educational Trust.

  10. Recent Highlights of Metabolomics in Chinese Medicine Syndrome Research

    PubMed Central

    Zhang, Ai-hua; Sun, Hui; Qiu, Shi; Wang, Xi-jun

    2013-01-01

    Chinese medicine syndrome (CMS, “ZHENG” in Chinese) is an understanding of the regularity of disease occurrence and development as well as a certain stage of a comprehensive response of patients with body condition. However, because of the complexity of CMS and the limitation of present investigation method, the research for deciphering the scientific basis and systematic features of CMS is difficult to go further. Metabolomics enables mapping of early biochemical changes in disease and hence provides an opportunity to develop predictive biomarkers. Moreover, its method and design resemble those of traditional Chinese medicine (TCM) which focuses on human disease via the integrity of close relationship between body and syndromes. In the systemic context, metabolomics has a convergence with TCM syndrome; therefore it could provide useful tools for exploring essence of CMS disease, facilitating personalized TCM, and will help to in-depth understand CMS. The integration of the metabolomics and CMS aspects will give promise to bridge the gap between Chinese and Western medicine and help catch the traditional features of CMS. In this paper, particular attention will be paid to the past successes in applications of robust metabolomic approaches to contribute to low-molecular-weight metabolites (biomarkers) discovery in CMS research and development. PMID:24302964

  11. Individualized Quality Control Plan (IQCP): Is It Value-Added for Clinical Microbiology?

    PubMed

    Sharp, Susan E; Miller, Melissa B; Hindler, Janet

    2015-12-01

    The Center for Medicaid and Medicare Services (CMS) recently published their Individualized Quality Control Plan (IQCP [https://www.cms.gov/regulations-and-guidance/legislation/CLIA/Individualized_Quality_Control_Plan_IQCP.html]), which will be the only option for quality control (QC) starting in January 2016 if laboratories choose not to perform Clinical Laboratory Improvement Act (CLIA) [U.S. Statutes at Large 81(1967):533] default QC. Laboratories will no longer be able to use "equivalent QC" (EQC) or the Clinical and Laboratory Standards Institute (CLSI) standards alone for quality control of their microbiology systems. The implementation of IQCP in clinical microbiology laboratories will most certainly be an added burden, the benefits of which are currently unknown. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  12. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and PACE...

  13. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and PACE...

  14. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and PACE...

  15. Enantioselectively controlled release of chiral drug (metoprolol) using chiral mesoporous silica materials

    NASA Astrophysics Data System (ADS)

    Guo, Zhen; Du, Yu; Liu, Xianbin; Ng, Siu-Choon; Chen, Yuan; Yang, Yanhui

    2010-04-01

    Chiral porous materials have attracted burgeoning attention on account of their potential applications in many areas, such as enantioseparation, chiral catalysis, chemical sensors and drug delivery. In this report, chiral mesoporous silica (CMS) materials with various pore sizes and structures were prepared using conventional achiral templates (other than chiral surfactant) and a chiral cobalt complex as co-template. The synthesized CMS materials were characterized by x-ray diffraction, nitrogen physisorption, scanning electron microscope and transmission electron microscope. These CMS materials, as carriers, were demonstrated to be able to control the enantioselective release of a representative chiral drug (metoprolol). The release kinetics, as modeled by the power law equation, suggested that the release profiles of metoprolol were remarkably dependent on the pore diameter and pore structure of CMS materials. More importantly, R- and S-enantiomers of metoprolol exhibited different release kinetics on CMS compared to the corresponding achiral mesoporous silica (ACMS), attributable to the existence of local chirality on the pore wall surface of CMS materials. The chirality of CMS materials on a molecular level was further substantiated by vibrational circular dichroism measurements.

  16. Trends in Medicare Part D Medication Therapy Management Eligibility Criteria

    PubMed Central

    Wang, Junling; Shih, Ya-Chen Tina; Qin, Yolanda; Young, Theo; Thomas, Zachary; Spivey, Christina A.; Solomon, David K.; Chisholm-Burns, Marie

    2015-01-01

    Background To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized. Objectives To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs. Methods This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008–2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans. Results For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7% of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20% of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80% restricting enrollment to patients with 3 or more chronic diseases. Conclusion The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans. PMID:26380030

  17. Relationships between Medicare Advantage contract characteristics and quality-of-care ratings: an observational analysis of Medicare Advantage star ratings.

    PubMed

    Xu, Peng; Burgess, James F; Cabral, Howard; Soria-Saucedo, Rene; Kazis, Lewis E

    2015-03-03

    The Centers for Medicare & Medicaid Services (CMS) publishes star ratings on Medicare Advantage (MA) contracts to measure plan quality of care with implications for reimbursement and bonuses. To investigate whether MA contract characteristics are associated with quality of care through the Medicare plan star ratings. Retrospective study of MA star ratings in 2010. Unadjusted and adjusted multivariable linear regression models assessed the relationship between 5-star rating summary scores and plan characteristics. CMS MA contracts nationally. 409 (71%) of a total of 575 MA contracts, covering 10.56 million Medicare beneficiaries (90% of the MA population) in the United States in 2010. The MA quality ratings summary score (stars range from 1 to 5) is a quality measure based on 36 indicators related to processes of care, health outcomes, access to care, and beneficiary satisfaction. Nonprofit, larger, and older MA contracts were more likely to receive higher star ratings. Star ratings ranged from 2 to 5. Nonprofit contracts received an average 0.55 (95% CI, 0.42 to 0.67) higher star ratings than for-profit contracts (P  < 0.001) after controls were set for contract characteristics. The study focused on persons aged 65 years or older covered by MA. In 2010, nonprofit MA contracts received significantly higher star ratings than for-profit contracts. When comparing health plans in the future, the CMS should give increasing attention to for-profit plans with lower quality ratings and consider developing programs to assist newer and smaller plans in improving their care for Medicare beneficiaries. None.

  18. Precise mapping of the magnetic field in the CMS barrel yoke using cosmic rays

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

    Chatrchyan, S.; et al.,

    2010-03-01

    The CMS detector is designed around a large 4 T superconducting solenoid, enclosed in a 12000-tonne steel return yoke. A detailed map of the magnetic field is required for the accurate simulation and reconstruction of physics events in the CMS detector, not only in the inner tracking region inside the solenoid but also in the large and complex structure of the steel yoke, which is instrumented with muon chambers. Using a large sample of cosmic muon events collected by CMS in 2008, the field in the steel of the barrel yoke has been determined with a precision of 3 tomore » 8% depending on the location.« less

  19. 42 CFR 417.165 - Reapplication for qualification.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Continued Regulation of Federally Qualified Health Maintenance Organizations... CMS for purposes of section 1310 of the PHS Act may, after completing the corrective action required...

  20. Measures of emergency preparedness contributing to nursing home resilience.

    PubMed

    Lane, Sandi J; McGrady, Elizabeth

    2017-12-13

    Resilience approaches have been successfully applied in crisis management, disaster response, and high reliability organizations and have the potential to enhance existing systems of nursing home disaster preparedness. This study's purpose was to determine how the Center for Medicare and Medicaid Services (CMS) "Emergency Preparedness Checklist Recommended Tool for Effective Health Care Facility Planning" contributes to organizational resilience by identifying the benchmark resilience items addressed by the CMS Emergency Preparedness Checklist and items not addressed by the CMS Emergency Preparedness Checklist, and to recommend tools and processes to improve resilience for nursing homes. The CMS Emergency Preparedness Checklist items were compared to the Resilience Benchmark Tool items; similar items were considered matches. Resilience Benchmark Tool items with no CMS Emergency Preparedness Checklist item matches were considered breaches in nursing home resilience. The findings suggest that the CMS Emergency Preparedness Checklist can be used to measure some aspects of resilience, however, there were many resilience factors not addressed. For nursing homes to prepare and respond to crisis situations, organizations need to embrace a culture that promotes individual resilience-related competencies that when aggregated enable the organization to improve its resiliency. Social workers have the skills and experience to facilitate this change.

  1. [Research survey on the information gathering methods, attitudes, and requests from care managers about the pharmaceutical service by pharmacists in home care].

    PubMed

    Nanaumi, Yoko; Onda, Mitsuko; Sakurai, Hidehiko; Tanaka, Rie; Tsubota, Kenichi; Matoba, Shunya; Mukai, Yusuke; Arakawa, Yukio; Hayase, Yukitoshi

    2011-01-01

    Care Managers (CMs) were surveyed to clarify the issues involving the promotion of cooperation between care managers and pharmacists in long-term-care and explore solutions. The length of work experience, occupational background, experience of pharmaceutical service; pharmacist visit patients' home for providing medicine and pharmaceutical care into a care plan, degree of understanding on pharmaceutical service, and awareness of work involved in pharmaceutical service were studied to see whether there made differences in the requests from CMs for information on pharmacists and for information gathering methods. The χ(2) test was used to this end. The opinions and requests described by the CMs were validated through text mining. More CMs tended to obtain information and knowledge through training sessions and professional magazines than those who did so through cooperation with pharmacists on a practical level. However, the survey strongly indicated that CMs with high level of understanding and awareness of pharmaceutical service wished to obtain information on pharmacists through cooperation with them on a practical level, and CMs with low level of understanding and awareness of pharmaceutical service wished to obtain such information through training sessions and professional magazines. Results of text mining showed that CMs wished pharmacists to strengthen the cooperation with physicians and provide information on pharmaceutical service. These findings have led to the conclusion that the issues surrounding the promotion of cooperation between CMs and pharmacists centered around "work cooperation on a practical level" and "provision of information to CMs about the roles of pharmacies and pharmacists and their work."

  2. 40 CFR Table 10 to Subpart Dddd of... - Applicability of General Provisions to Subpart DDDD

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... plan approval procedures; performance audit requirements; internal and external QA procedures for... control plan on record for 5 years. Keep old versions for 5 years after revisions Yes. § 63.8(e) CMS...

  3. 42 CFR 431.992 - Corrective action plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.992 Corrective action plan. (a) The State agency must develop a separate corrective action plan for Medicaid and CHIP, which is not required to be approved by... which the State's Medicaid or CHIP error rates are posted on the CMS contractor's Web site. (d) The...

  4. 42 CFR 431.992 - Corrective action plan.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.992 Corrective action plan. (a) The State agency must develop a separate corrective action plan for Medicaid and CHIP, which is not required to be approved by... which the State's Medicaid or CHIP error rates are posted on the CMS contractor's Web site. (d) The...

  5. 42 CFR 431.992 - Corrective action plan.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.992 Corrective action plan. (a) The State agency must develop a separate corrective action plan for Medicaid and CHIP, which is not required to be approved by... which the State's Medicaid or CHIP error rates are posted on the CMS contractor's Web site. (d) The...

  6. Dataset definition for CMS operations and physics analyses

    NASA Astrophysics Data System (ADS)

    Franzoni, Giovanni; Compact Muon Solenoid Collaboration

    2016-04-01

    Data recorded at the CMS experiment are funnelled into streams, integrated in the HLT menu, and further organised in a hierarchical structure of primary datasets and secondary datasets/dedicated skims. Datasets are defined according to the final-state particles reconstructed by the high level trigger, the data format and the use case (physics analysis, alignment and calibration, performance studies). During the first LHC run, new workflows have been added to this canonical scheme, to exploit at best the flexibility of the CMS trigger and data acquisition systems. The concepts of data parking and data scouting have been introduced to extend the physics reach of CMS, offering the opportunity of defining physics triggers with extremely loose selections (e.g. dijet resonance trigger collecting data at a 1 kHz). In this presentation, we review the evolution of the dataset definition during the LHC run I, and we discuss the plans for the run II.

  7. 42 CFR 417.400 - Basis and scope.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.400 Basis and scope. (a) Statutory basis. The... CMPs that contract with CMS to furnish covered services to Medicare beneficiaries. (b) Scope. (1) This...

  8. Operative management of brainstem cavernous malformations.

    PubMed

    Asaad, Wael F; Walcott, Brian P; Nahed, Brian V; Ogilvy, Christopher S

    2010-09-01

    Brainstem cavernous malformations (CMs) are complex lesions associated with hemorrhage and neurological deficit. In this review, the authors describe the anatomical nuances relating to the operative techniques for these challenging lesions. The resection of brainstem CMs in properly selected patients has been demonstrated to reduce the risk of rehemorrhage and can be achieved relatively safely in experienced hands.

  9. Are computational models of any use to psychiatry?

    PubMed

    Huys, Quentin J M; Moutoussis, Michael; Williams, Jonathan

    2011-08-01

    Mathematically rigorous descriptions of key hypotheses and theories are becoming more common in neuroscience and are beginning to be applied to psychiatry. In this article two fictional characters, Dr. Strong and Mr. Micawber, debate the use of such computational models (CMs) in psychiatry. We present four fundamental challenges to the use of CMs in psychiatry: (a) the applicability of mathematical approaches to core concepts in psychiatry such as subjective experiences, conflict and suffering; (b) whether psychiatry is mature enough to allow informative modelling; (c) whether theoretical techniques are powerful enough to approach psychiatric problems; and (d) the issue of communicating clinical concepts to theoreticians and vice versa. We argue that CMs have yet to influence psychiatric practice, but that they help psychiatric research in two fundamental ways: (a) to build better theories integrating psychiatry with neuroscience; and (b) to enforce explicit, global and efficient testing of hypotheses through more powerful analytical methods. CMs allow the complexity of a hypothesis to be rigorously weighed against the complexity of the data. The paper concludes with a discussion of the path ahead. It points to stumbling blocks, like the poor communication between theoretical and medical communities. But it also identifies areas in which the contributions of CMs will likely be pivotal, like an understanding of social influences in psychiatry, and of the co-morbidity structure of psychiatric diseases. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. SU-E-T-610: Comparison of Treatment Times Between the MLCi and Agility Multileaf Collimators

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

    Ramsey, C; Bowling, J

    2014-06-01

    Purpose: The Agility is a new 160-leaf MLC developed by Elekta for use in their Infinity and Versa HD linacs. As compared to the MLCi, the Agility increased the maximum leaf speed from 2 cm/s to 3.5 cm/s, and the maximum primary collimator speed from 1.5 cm/s to 9.0 cm/s. The purpose of this study was to determine if the Agility MLC resulted in improved plan quality and/or shorter treatment times. Methods: An Elekta Infinity that was originally equipped with a 80 leaf MLCi was upgraded to an 160 leaf Agility. Treatment plan quality was evaluated using the Pinnacle planningmore » system with SmartArc. Optimization was performed once for the MLCi and once for the Agility beam models using the same optimization parameters and the same number of iterations. Patient treatment times were measured for all IMRT, VMAT, and SBRT patients treated on the Infinity with the MLCi and Agility MLCs. Treatment times were extracted from the EMR and measured from when the patient first walked into the treatment room until exiting the treatment room. Results: 11,380 delivery times were measured for patients treated with the MLCi, and 1,827 measurements have been made for the Agility MLC. The average treatment times were 19.1 minutes for the MLCi and 20.8 minutes for the Agility. Using a t-test analysis, there was no difference between the two groups (t = 0.22). The dose differences between patients planned with the MLCi and the Agility MLC were minimal. For example, the dose difference for the PTV, GTV, and cord for a head and neck patient planned using Pinnacle were effectively equivalent. However, the dose to the parotid glands was slightly worse with the Agility MLC. Conclusion: There was no statistical difference in treatment time, or any significant dosimetric difference between the Agility MLC and the MLCi.« less

  11. 42 CFR 411.120 - Appeals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Under Group Health Plans: General Provisions § 411.120 Appeals. (a) Parties to the determination. The... employers or employee organizations that contributed to the plan during the calendar year for which CMS... in facsimile or other electronic medium) and in the manner stipulated in the notice of nonconformance...

  12. 42 CFR 422.2268 - Standards for MA organization marketing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... marketing representatives, or CMS. (j) Use providers or provider groups to distribute printed information comparing the benefits of different health plans unless the providers, provider groups, or pharmacies accept and display materials from all health plans with which the providers, provider groups, or pharmacies...

  13. 42 CFR 417.406 - Application and determination.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.406 Application and determination. (a... forth in § 417.407. (2) If an entity no longer meets those requirements, CMS terminates the contract of...

  14. 42 CFR 417.401 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.401 Definitions. As used in this subpart and subparts K...) means an actuarial estimate made by CMS in advance of an HMO's or CMP's contract period that represents...

  15. Trends in Medicare Service Volume for Cataract Surgery and the Impact of the Medicare Physician Fee Schedule.

    PubMed

    Gong, Dan; Jun, Lin; Tsai, James C

    2017-08-01

    To calculate the associations between Medicare payment and service volume for complex and noncomplex cataract surgeries. The 2005-2009 CMS Part B National Summary Data Files, CMS Part B Carrier Summary Data Files, and the Medicare Physician Fee Schedule. Conducting a retrospective, longitudinal analysis using a fixed-effects model of Medicare Part B carriers representing all 50 states and the District of Columbia from 2005 to 2009, we calculated the Medicare payment-service volume elasticities for noncomplex (CPT 66984) and complex (CPT 66982) cataract surgeries. Service volume data were extracted from the CMS Part B National Summary and Carrier Summary Data Files. Payment data were extracted from the Medicare Physician Fee Schedule. From 2005 to 2009, the proportion of total cataract services billed as complex increased from 3.2 to 6.7 percent. Every 1 percent decrease in Medicare payment was associated with a nonsignificant change in noncomplex cataract service volume (elasticity = 0.15, 95 percent CI [-0.09, 0.38]) but a statistically significant increase in complex cataract service volume (elasticity = -1.12, 95 percent CI [-1.60, -0.63]). Reduced Medicare payment was associated with a significant increase in complex cataract service volume but not in noncomplex cataract service volume, resulting in a shift toward performing a greater proportion of complex cataract surgeries from 2005 to 2009. © Health Research and Educational Trust.

  16. Origin of the CMS gene locus in rapeseed cybrid mitochondria: active and inactive recombination produces the complex CMS gene region in the mitochondrial genomes of Brassicaceae.

    PubMed

    Oshima, Masao; Kikuchi, Rie; Imamura, Jun; Handa, Hirokazu

    2010-01-01

    CMS (cytoplasmic male sterile) rapeseed is produced by asymmetrical somatic cell fusion between the Brassica napus cv. Westar and the Raphanus sativus Kosena CMS line (Kosena radish). The CMS rapeseed contains a CMS gene, orf125, which is derived from Kosena radish. Our sequence analyses revealed that the orf125 region in CMS rapeseed originated from recombination between the orf125/orfB region and the nad1C/ccmFN1 region by way of a 63 bp repeat. A precise sequence comparison among the related sequences in CMS rapeseed, Kosena radish and normal rapeseed showed that the orf125 region in CMS rapeseed consisted of the Kosena orf125/orfB region and the rapeseed nad1C/ccmFN1 region, even though Kosena radish had both the orf125/orfB region and the nad1C/ccmFN1 region in its mitochondrial genome. We also identified three tandem repeat sequences in the regions surrounding orf125, including a 63 bp repeat, which were involved in several recombination events. Interestingly, differences in the recombination activity for each repeat sequence were observed, even though these sequences were located adjacent to each other in the mitochondrial genome. We report results indicating that recombination events within the mitochondrial genomes are regulated at the level of specific repeat sequences depending on the cellular environment.

  17. The CMS Tier0 goes cloud and grid for LHC Run 2

    DOE PAGES

    Hufnagel, Dirk

    2015-12-23

    In 2015, CMS will embark on a new era of collecting LHC collisions at unprecedented rates and complexity. This will put a tremendous stress on our computing systems. Prompt Processing of the raw data by the Tier-0 infrastructure will no longer be constrained to CERN alone due to the significantly increased resource requirements. In LHC Run 2, we will need to operate it as a distributed system utilizing both the CERN Cloud-based Agile Infrastructure and a significant fraction of the CMS Tier-1 Grid resources. In another big change for LHC Run 2, we will process all data using the multi-threadedmore » framework to deal with the increased event complexity and to ensure efficient use of the resources. Furthermore, this contribution will cover the evolution of the Tier-0 infrastructure and present scale testing results and experiences from the first data taking in 2015.« less

  18. The CMS TierO goes Cloud and Grid for LHC Run 2

    NASA Astrophysics Data System (ADS)

    Hufnagel, Dirk

    2015-12-01

    In 2015, CMS will embark on a new era of collecting LHC collisions at unprecedented rates and complexity. This will put a tremendous stress on our computing systems. Prompt Processing of the raw data by the Tier-0 infrastructure will no longer be constrained to CERN alone due to the significantly increased resource requirements. In LHC Run 2, we will need to operate it as a distributed system utilizing both the CERN Cloud-based Agile Infrastructure and a significant fraction of the CMS Tier-1 Grid resources. In another big change for LHC Run 2, we will process all data using the multi-threaded framework to deal with the increased event complexity and to ensure efficient use of the resources. This contribution will cover the evolution of the Tier-0 infrastructure and present scale testing results and experiences from the first data taking in 2015.

  19. Status and Plan for The Upgrade of The CMS Pixel Detector

    NASA Astrophysics Data System (ADS)

    Lu, Rong-Shyang; CMS Collaboration

    2016-04-01

    The silicon pixel detector is the innermost component of the CMS tracking system and plays a crucial role in the all-silicon CMS tracker. While the current pixel tracker is designed for and performing well at an instantaneous luminosity of up to 1 ×1034cm-2s-1, it can no longer be operated efficiently at significantly higher values. Based on the strong performance of the LHC accelerator, it is anticipated that peak luminosities of two times the design luminosity are likely to be reached before 2018 and perhaps significantly exceeded in the running period until 2022, referred to as LHC Run 3. Therefore, an upgraded pixel detector, referred to as the phase 1 upgrade, is planned for the year-end technical stop in 2016. With a new pixel readout chip (ROC), an additional fourth layer, two additional endcap disks, and a significantly reduced material budget the upgraded pixel detector will be able to sustain the efficiency of the pixel tracker at the increased requirements imposed by high luminosities and pile-up. The main new features of the upgraded pixel detector will be an ultra-light mechanical design, a digital readout chip with higher rate capability and a new cooling system. These and other design improvements, along with results of Monte Carlo simulation studies for the expected performance of the new pixel detector, will be discussed and compared to those of the current CMS detector.

  20. 42 CFR 433.138 - Identifying liable third parties.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... processing and information retrieval system. Basic requirement—Development of an action plan. (1) If a State has a mechanized claims processing and information retrieval system approved by CMS under subpart C of... plan must be integrated with the mechanized claims processing and information retrieval system. (2) The...

  1. 42 CFR 433.138 - Identifying liable third parties.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... processing and information retrieval system. Basic requirement—Development of an action plan. (1) If a State has a mechanized claims processing and information retrieval system approved by CMS under subpart C of... plan must be integrated with the mechanized claims processing and information retrieval system. (2) The...

  2. 42 CFR 433.138 - Identifying liable third parties.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... processing and information retrieval system. Basic requirement—Development of an action plan. (1) If a State has a mechanized claims processing and information retrieval system approved by CMS under subpart C of... plan must be integrated with the mechanized claims processing and information retrieval system. (2) The...

  3. 42 CFR 430.12 - Submittal of State plans and plan amendments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... periodic reports on the Medicaid program, excluding periodic statistical, budget and fiscal reports. (iii... the Medicaid program. For changes related to advance directive requirements, amendments must be... concerning advance directives. (2) Prompt submittal of amendments is necessary— (i) So that CMS can determine...

  4. 45 CFR 150.103 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS...-Federal governmental health plan uses as a basis for a decision whether to enroll an individual under the... insurance policy issued to a group health plan or an association or trust that summarizes the benefits and...

  5. 45 CFR 150.103 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS...-Federal governmental health plan uses as a basis for a decision whether to enroll an individual under the... insurance policy issued to a group health plan or an association or trust that summarizes the benefits and...

  6. Cavernous malformations isolated from cranial nerves: Unexpected diagnosis?

    PubMed

    Rotondo, Michele; Natale, Massimo; D'Avanzo, Raffaele; Pascale, Michela; Scuotto, Assunta

    2014-11-01

    Cranial nerves (CN) cavernous malformations (CMs) are lesions that are isolated from the CNs. The authors present three cases of CN CMs, for which MR was demonstrated to be critical for management, and surgical resection produced good outcomes for the patients. Surgical removal is the recommended course of action to restore or preserve neurological function and to eliminate the risk of future haemorrhage. However, the anatomical location and the complexity of nearby neural structures can make these lesions difficult to access and remove. In this study, the authors review the literature of reported cases of CN CMs to analyse the clinical and radiographic presentations, surgical approaches and neurological outcomes. A MEDLINE/Pub Med search was performed and revealed 86 cases of CN CMs. The authors report three additional cases in this study for a total of 89 cases. CMs affecting the optic nerve (CN II), oculomotor nerve (CN III), facial/vestibule-cochlear nerves (CN VII, CN VIII) have been described. The records of three patients were reviewed with respect to the lesion locations, symptoms, surgical approaches and therapeutic considerations. Clinical and radiological follow-up results are reported. Three patients (2 females, 1 male; age range 21-37 year) presented with three CN lesions. One lesion involved CN III, one lesion involved CN VII-CN VIII, and one involved CN II. The patient with the CN III lesion had a one-month history of mild right ptosis and diplopia. The patient with the CN VII-CN VIII lesion exhibited acute hearing loss and on the left and left facial paresis. The patient with the opticchiasmatic lesion presented with acute visual deterioration on the right and a left temporal field deficit in the left eye. Pterional and orbitozygomatic craniotomies were performed for the CN III lesion and the CN II lesion, and retrosigmoid craniotomy was performed for the cerebello-pontine angle lesion. All patients experienced symptom improvement after surgery. On MR follow-up, recurrence was excluded in all patients. CN CMs present with specific symptoms and require complex surgical techniques for resection. These lesions are frequently symptomatic, because of the complexity of the origin tissue. Symptomatic CN CMs should be resected microsurgically and completely when possible to prevent further losses of nerve function, improve function, avoid recurrence, and to eliminate the risk of future haemorrhages. The authors discuss the therapeutic options and the radiological features of these infrequent localisation of CMs. Specifically, the authors focus on the role of magnetic resonance imaging in the identification of these rare lesions. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Increasing Testing Efficiency through the Development of an IT-Based Adaptive Testing Tool for Competency Measurement

    ERIC Educational Resources Information Center

    Kleinhans, Janne; Schumann, Matthias

    2015-01-01

    Purpose: This paper investigates the potential of computerized adaptive testing for CMs to reduce test time. In the context of education and training, competency measurement (CM) is a central challenge in competency management. For complex CMs, a compromise must be addressed between the time available and the quality of the measurements.…

  8. Modelling and simulating a crisis management system: an organisational perspective

    NASA Astrophysics Data System (ADS)

    Chaawa, Mohamed; Thabet, Inès; Hanachi, Chihab; Ben Said, Lamjed

    2017-04-01

    Crises are complex situations due to the dynamism of the environment, its unpredictability and the complexity of the interactions among several different and autonomous involved organisations. In such a context, establishing an organisational view as well as structuring organisations' communications and their functioning is a crucial requirement. In this article, we propose a multi-agent organisational model (OM) to abstract, simulate and analyse a crisis management system (CMS). The objective is to evaluate the CMS from an organisational view, to assess its strength as well as its weakness and to provide deciders with some recommendations for a more flexible and reactive CMS. The proposed OM is illustrated through a real case study: a snowstorm in a Tunisian region. More precisely, we made the following contribution: firstly, we provide an environmental model that identifies the concepts involved in the crisis. Then, we define a role model that copes with the involved actors. In addition, we specify the organisational structure and the interaction model that rule communications and structure actors' functioning. Those models, built following the GAIA methodology, abstract the CMS from an organisational perspective. Finally, we implemented a customisable multi-agent simulator based on the Janus platform to analyse, through several performed simulations, the organisational model.

  9. Cellular Manufacturing System with Dynamic Lot Size Material Handling

    NASA Astrophysics Data System (ADS)

    Khannan, M. S. A.; Maruf, A.; Wangsaputra, R.; Sutrisno, S.; Wibawa, T.

    2016-02-01

    Material Handling take as important role in Cellular Manufacturing System (CMS) design. In several study at CMS design material handling was assumed per pieces or with constant lot size. In real industrial practice, lot size may change during rolling period to cope with demand changes. This study develops CMS Model with Dynamic Lot Size Material Handling. Integer Linear Programming is used to solve the problem. Objective function of this model is minimizing total expected cost consisting machinery depreciation cost, operating costs, inter-cell material handling cost, intra-cell material handling cost, machine relocation costs, setup costs, and production planning cost. This model determines optimum cell formation and optimum lot size. Numerical examples are elaborated in the paper to ilustrate the characterictic of the model.

  10. 42 CFR 422.114 - Access to services under an MA private fee-for-service plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Access to services under an MA private fee-for... Beneficiary Protections § 422.114 Access to services under an MA private fee-for-service plan. (a) Sufficient access. (1) An MA organization that offers an MA private fee-for-service plan must demonstrate to CMS...

  11. 42 CFR 422.114 - Access to services under an MA private fee-for-service plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Access to services under an MA private fee-for... Beneficiary Protections § 422.114 Access to services under an MA private fee-for-service plan. (a) Sufficient access. (1) An MA organization that offers an MA private fee-for-service plan must demonstrate to CMS...

  12. Factors affecting pharmacists’ recommendation of complementary medicines – a qualitative pilot study of Australian pharmacists

    PubMed Central

    2012-01-01

    Background Complementary medicines (CMs) are widely used by the Australian public, and pharmacies are major suppliers of these medicines. The integration of CMs into pharmacy practice is well documented, but the behaviours of pharmacists in recommending CMs to customers are less well studied. This study reports on factors that influence whether or not pharmacists in Australia recommend CMs to their customers. Methods Data were collected from semi-structured interviews with twelve practicing pharmacists based in Brisbane, Australia. The qualitative data were analysed by thematic analysis. Results The primary driver of the recommendation of CMs was a desire to provide a health benefit to the customer. Other important drivers were an awareness of evidence of efficacy, customer feedback and pharmacy protocols to recommend a CM alongside a particular pharmaceutical medication. The primary barrier to the recommendation of CMs was safety concerns around patients on multiple medications or with complex health issues. Also, a lack of knowledge of CMs, a perceived lack of evidence or a lack of time to counsel patients were identified as barriers. There was a desire to see a greater integration of CM into formal pharmacy education. Additionally, the provision of good quality educational materials was seen as important to allow pharmacists to assess levels of evidence for CMs and educate them on their safe and appropriate use. Conclusions Pharmacists who frequently recommend CMs identify many potential benefits for patients and see it as an important part of providing a ‘healthcare solution’. To encourage the informed use of CMs in pharmacy there is a need for the development of accessible, quality resources on CMs. In addition, incorporation of CM education into pharmacy curricula would better prepare graduate pharmacists for community practice. Ultimately, such moves would contribute to the safe and effective use of CMs to the benefit of consumers. PMID:23051066

  13. Pharmacokinetics of Chinese medicines: strategies and perspectives.

    PubMed

    Yan, Ru; Yang, Ying; Chen, Yijia

    2018-01-01

    The modernization and internationalization of Chinese medicines (CMs) are hampered by increasing concerns on the safety and the efficacy. Pharmacokinetic (PK) study is indispensable to establish concentration-activity/toxicity relationship and facilitate target identification and new drug discovery from CMs. To cope with tremendous challenges rooted from chemical complexity of CMs, the classic PK strategies have evolved rapidly from PK study focusing on marker/main drug components to PK-PD correlation study adopting metabolomics approaches to characterize associations between disposition of global drug-related components and host metabolic network shifts. However, the majority of PK studies of CMs have adopted the approaches tailored for western medicines and focused on the systemic exposures of drug-related components, most of which were found to be too low to account for the holistic benefits of CMs. With an area under concentration-time curve- or activity-weighted approach, integral PK attempts to understand the PK-PD relevance with the integrated PK profile of multiple co-existing structural analogs (prototyes/metabolites). Cellular PK-PD complements traditional PK-PD when drug targets localize inside the cells, instead of at the surface of cell membrane or extracellular space. Considering the validated clinical benefits of CMs, reverse pharmacology-based reverse PK strategy was proposed to facilitate target identification and new drug discovery. Recently, gut microbiota have demonstrated multifaceted roles in drug efficacy/toxicity. In traditional oral intake, the presystemic interactions of CMs with gut microbiota seem inevitable, which can contribute to the holistic benefits of CMs through biotransforming CMs components, acting as the peripheral target, and regulating host drug disposition. Hence, we propose a global PK-PD approach which includes the presystemic interaction of CMs with gut microbiota and combines omics with physiologically based pharmacokinetic modeling to offer a comprehensive understanding of the PK-PD relationship of CMs. Moreover, validated clinical benefits of CMs and poor translational potential of animal PK data urge more research efforts in human PK study.

  14. CMS results in the Combined Computing Readiness Challenge CCRC'08

    NASA Astrophysics Data System (ADS)

    Bonacorsi, D.; Bauerdick, L.; CMS Collaboration

    2009-12-01

    During February and May 2008, CMS participated to the Combined Computing Readiness Challenge (CCRC'08) together with all other LHC experiments. The purpose of this worldwide exercise was to check the readiness of the Computing infrastructure for LHC data taking. Another set of major CMS tests called Computing, Software and Analysis challenge (CSA'08) - as well as CMS cosmic runs - were also running at the same time: CCRC augmented the load on computing with additional tests to validate and stress-test all CMS computing workflows at full data taking scale, also extending this to the global WLCG community. CMS exercised most aspects of the CMS computing model, with very comprehensive tests. During May 2008, CMS moved more than 3.6 Petabytes among more than 300 links in the complex Grid topology. CMS demonstrated that is able to safely move data out of CERN to the Tier-1 sites, sustaining more than 600 MB/s as a daily average for more than seven days in a row, with enough headroom and with hourly peaks of up to 1.7 GB/s. CMS ran hundreds of simultaneous jobs at each Tier-1 site, re-reconstructing and skimming hundreds of millions of events. After re-reconstruction the fresh AOD (Analysis Object Data) has to be synchronized between Tier-1 centers: CMS demonstrated that the required inter-Tier-1 transfers are achievable within a few days. CMS also showed that skimmed analysis data sets can be transferred to Tier-2 sites for analysis at sufficient rate, regionally as well as inter-regionally, achieving all goals in about 90% of >200 links. Simultaneously, CMS also ran a large Tier-2 analysis exercise, where realistic analysis jobs were submitted to a large set of Tier-2 sites by a large number of people to produce a chaotic workload across the systems, and with more than 400 analysis users in May. Taken all together, CMS routinely achieved submissions of 100k jobs/day, with peaks up to 200k jobs/day. The achieved results in CCRC'08 - focussing on the distributed workflows - are presented and discussed.

  15. Repeated asenapine treatment does not participate in the mild stress induced FosB/ΔFosB expression in the rat hypothalamic paraventricular nucleus neurons.

    PubMed

    Kiss, Alexander; Majercikova, Zuzana

    2017-02-01

    Effect of repeated asenapine (ASE) treatment on FosB/ΔFosB expression was studied in the hypothalamic paraventricular nucleus (PVN) of male rats exposed to chronic mild stress (CMS) for 21days. Our intention was to find out whether repeated ASE treatment for 14days may: 1) induce FosB/ΔFosB expression in the PVN; 2) activate selected PVN neuronal phenotypes, synthesizing oxytocin (OXY), vasopressin (AVP), corticoliberin (CRH) or tyrosine hydroxylase (TH); and 3) interfere with the impact of CMS. Control, ASE, CMS, and CMS+ASE treated groups were used. CMS included restraint, social isolation, crowding, swimming, and cold. From the 7th day of CMS, rats received ASE (0.3mg/kg) or saline (300μl/rat) subcutaneously, twice a day for 14days. They were sacrificed on the day 22nd (16-18h after last treatments). FosB/ΔFosB was visualized with avidin biotin peroxidase complex and OXY, AVP, CRH or TH antibodies by fluorescent dyes. Saline and ASE did not promote FosB/ΔFosB expression in the PVN. CMS and CMS+ASE elicited FosB/ΔFosB-expression in the PVN, whereas, ASE did not augment or attenuate FosB/ΔFosB induction elicited by CMS. FosB/ΔFosB-CRH occurred after CMS and CMS+ASE treatments in the PVN middle sector, while FosB/ΔFosB-AVP and FosB/ΔFosB-OXY after CMS and CMS+ASE treatments in the PVN posterior sector. FosB/ΔFosB-TH colocalization was rare. Larger FosB/ΔFosB profiles, running above the PVN, did not show any colocalizations. The study provides an anatomical/functional knowledge about an unaccented nature of prolonged ASE treatment at the level of PVN and excludes its positive or negative interplay with CMS effect. Data indicate that long-lasting ASE treatment might not act as a stressor acting at the PVN level. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. CMS Innovation Center Health Care Innovation Awards

    PubMed Central

    Berry, Sandra H.; Concannon, Thomas W.; Morganti, Kristy Gonzalez; Auerbach, David I.; Beckett, Megan K.; Chen, Peggy G.; Farley, Donna O.; Han, Bing; Harris, Katherine M.; Jones, Spencer S.; Liu, Hangsheng; Lovejoy, Susan L.; Marsh, Terry; Martsolf, Grant R.; Nelson, Christopher; Okeke, Edward N.; Pearson, Marjorie L.; Pillemer, Francesca; Sorbero, Melony E.; Towe, Vivian; Weinick, Robin M.

    2013-01-01

    Abstract The Center for Medicare and Medicaid Innovation within the Centers for Medicare & Medicaid Services (CMS) has funded 108 Health Care Innovation Awards, funded through the Affordable Care Act, for applicants who proposed compelling new models of service delivery or payment improvements that promise to deliver better health, better health care, and lower costs through improved quality of care for Medicare, Medicaid, and Children's Health Insurance Program enrollees. CMS is also interested in learning how new models would affect subpopulations of beneficiaries (e.g., those eligible for Medicare and Medicaid and complex patients) who have unique characteristics or health care needs that could be related to poor outcomes. In addition, the initiative seeks to identify new models of workforce development and deployment, as well as models that can be rapidly deployed and have the promise of sustainability. This article describes a strategy for evaluating the results. The goal for the evaluation design process is to create standardized approaches for answering key questions that can be customized to similar groups of awardees and that allow for rapid and comparable assessment across awardees. The evaluation plan envisions that data collection and analysis will be carried out on three levels: at the level of the individual awardee, at the level of the awardee grouping, and as a summary evaluation that includes all awardees. Key dimensions for the evaluation framework include implementation effectiveness, program effectiveness, workforce issues, impact on priority populations, and context. The ultimate goal is to identify strategies that can be employed widely to lower cost while improving care. PMID:28083297

  17. 78 FR 49518 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-14

    ... Comparative Database.'' In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3521, AHRQ invites the... Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey Comparative Database Request for... Medicare & Medicaid Services (CMS) to provide comparative data to support public reporting of health plan...

  18. 42 CFR 422.102 - Supplemental benefits.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Supplemental benefits. (a) Mandatory supplemental benefits. (1) Subject to CMS approval, an MA organization may require Medicare enrollees of an MA plan (other than an MSA plan) to accept or pay for services in addition to Medicare-covered services described in § 422.101. (2) If the MA organization imposes mandatory...

  19. 42 CFR 423.2268 - Standards for Part D marketing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... misrepresents the PDP Sponsor, its marketing representatives, or CMS. (j) Use providers, provider groups, or... different Part D plans unless providers, provider groups or pharmacies accept and display materials from all Part D plan sponsors with which the providers, provider groups or pharmacies contract. The use of...

  20. 42 CFR 417.420 - Basic rules on enrollment and entitlement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Enrollment, Entitlement, and Disenrollment under Medicare Contract § 417.420... HMO or CMP that has in effect a contract with CMS under subpart L of this part. (b) Entitlement. If a...

  1. Commissioning of the first chambers of the CMS GE1/1 muon station

    NASA Astrophysics Data System (ADS)

    Ressegotti, Martina; CMS Muon Group

    2017-12-01

    The upgrades of the LHC planned in the next years will increase the instantaneous luminosity up to 5 × 1034 cm -2 s -1 after Long Shutdown 3, a value about five times higher than the nominal one for which the CMS experiment was designed. The resulting larger rate of interactions will produce a higher pileup environment that will challenge the trigger system of the CMS experiment in its original configuration, in particular in the endcap region. As part of the upgrade program of the CMS muon endcaps, additional muon detectors based on Gas Electron Multiplier (GEM) technology will be installed, in order to be able to sustain a physics program during high-luminosity operation without performance losses. The installation of the GE1/1 station is scheduled for Long Shutdown 2 in 2019-2020 already a demonstrator composed of five superchambers has been installed during the Extended Year-End Technical Stop at the beginning of 2017. Its goal is to test the system’s operational conditions and also to demonstrate the integration of the GE1/1 chambers into the CMS online system. The status of the installation and commissioning of the GE1/1 demonstrator is presented.

  2. Medicare Part D: successes and continuing challenges. Impact of Medicare Part D on Massachusetts health programs and beneficiaries.

    PubMed

    Thomas, Cindy Parks; Sussman, Jeffrey

    2007-05-30

    On January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Drug Benefit, or "Medicare Part D." The program offers prescription drug coverage for the one million Medicare beneficiaries in Massachusetts. Part D affects Massachusetts state health programs and beneficiaries in a number of ways. The program: (1) provides prescription drug insurance, including catastrophic coverage, through a choice of private prescription drug plans (PDPs) or integrated Medicare Advantage (MA-PD) health plans; (2) shifts prescription drug coverage for dual-eligible Medicare / Medicaid beneficiaries from Medicaid to Medicare Part D drug plans; (3) requires a maintenance-of-effort, or "clawback" payments from states to CMS designed to capture a portion of states' Medicaid savings to help finance the benefit; (4) offers additional help for premiums and cost sharing to low income beneficiaries through the Low Income Subsidy (LIS); and (5) provides a subsidy to employer groups that maintain their own prescription drug coverage for retired beneficiaries. This paper summarizes the activities involved in implementing Medicare Part D, the impact it has had on Massachusetts health programs, and the experiences of beneficiaries and others conducting outreach and enrollment. The data are drawn from interviews with officials and documents provided by state health programs, CMS and the Social Security Administration, and representatives of provider and advocacy groups involved in the enrollment and ongoing support of Medicare beneficiaries.

  3. Using Amazon's Elastic Compute Cloud to dynamically scale CMS computational resources

    NASA Astrophysics Data System (ADS)

    Evans, D.; Fisk, I.; Holzman, B.; Melo, A.; Metson, S.; Pordes, R.; Sheldon, P.; Tiradani, A.

    2011-12-01

    Large international scientific collaborations such as the Compact Muon Solenoid (CMS) experiment at the Large Hadron Collider have traditionally addressed their data reduction and analysis needs by building and maintaining dedicated computational infrastructure. Emerging cloud computing services such as Amazon's Elastic Compute Cloud (EC2) offer short-term CPU and storage resources with costs based on usage. These services allow experiments to purchase computing resources as needed, without significant prior planning and without long term investments in facilities and their management. We have demonstrated that services such as EC2 can successfully be integrated into the production-computing model of CMS, and find that they work very well as worker nodes. The cost-structure and transient nature of EC2 services makes them inappropriate for some CMS production services and functions. We also found that the resources are not truely "on-demand" as limits and caps on usage are imposed. Our trial workflows allow us to make a cost comparison between EC2 resources and dedicated CMS resources at a University, and conclude that it is most cost effective to purchase dedicated resources for the "base-line" needs of experiments such as CMS. However, if the ability to use cloud computing resources is built into an experiment's software framework before demand requires their use, cloud computing resources make sense for bursting during times when spikes in usage are required.

  4. 40 CFR 63.1210 - What are the notification requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... change in information already provided under § 63.9. 63.1206(b)(5)(i) Notification of changes in design...), 63.9(e) 63.9(g)(1) and (3) Notification of performance test and continuous monitoring system evaluation, including the performance test plan and CMS performance evaluation plan.1 63.1210(b) Notification...

  5. 40 CFR 63.1210 - What are the notification requirements?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... change in information already provided under § 63.9. 63.1206(b)(5)(i) Notification of changes in design...), 63.9(e) 63.9(g)(1) and (3) Notification of performance test and continuous monitoring system evaluation, including the performance test plan and CMS performance evaluation plan.1 63.1210(b) Notification...

  6. PyCMSXiO: an external interface to script treatment plans for the Elekta® CMS XiO treatment planning system

    NASA Astrophysics Data System (ADS)

    Xing, Aitang; Arumugam, Sankar; Holloway, Lois; Goozee, Gary

    2014-03-01

    Scripting in radiotherapy treatment planning systems not only simplifies routine planning tasks but can also be used for clinical research. Treatment planning scripting can only be utilized in a system that has a built-in scripting interface. Among the commercially available treatment planning systems, Pinnacle (Philips) and Raystation (Raysearch Lab.) have inherent scripting functionality. CMS XiO (Elekta) is a widely used treatment planning system in radiotherapy centres around the world, but it does not have an interface that allows the user to script radiotherapy plans. In this study an external scripting interface, PyCMSXiO, was developed for XiO using the Python programming language. The interface was implemented as a python package/library using a modern object-oriented programming methodology. The package was organized as a hierarchy of different classes (objects). Each class (object) corresponds to a plan object such as the beam of a clinical radiotherapy plan. The interface of classes was implemented as object functions. Scripting in XiO using PyCMSXiO is comparable with Pinnacle scripting. This scripting package has been used in several research projects including commissioning of a beam model, independent three-dimensional dose verification for IMRT plans and a setup-uncertainty study. Ease of use and high-level functions provided in the package achieve a useful research tool. It was released as an open-source tool that may benefit the medical physics community.

  7. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury.

    PubMed

    Nash, Mark S; Cowan, Rachel E; Kressler, Jochen

    2012-09-01

    Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuition-centered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives.

  8. Pompe Disease Results in a Golgi-based Glycosylation Deficit in Human Induced Pluripotent Stem Cell-derived Cardiomyocytes*

    PubMed Central

    Raval, Kunil K.; Tao, Ran; White, Brent E.; De Lange, Willem J.; Koonce, Chad H.; Yu, Junying; Kishnani, Priya S.; Thomson, James A.; Mosher, Deane F.; Ralphe, John C.; Kamp, Timothy J.

    2015-01-01

    Infantile-onset Pompe disease is an autosomal recessive disorder caused by the complete loss of lysosomal glycogen-hydrolyzing enzyme acid α-glucosidase (GAA) activity, which results in lysosomal glycogen accumulation and prominent cardiac and skeletal muscle pathology. The mechanism by which loss of GAA activity causes cardiomyopathy is poorly understood. We reprogrammed fibroblasts from patients with infantile-onset Pompe disease to generate induced pluripotent stem (iPS) cells that were differentiated to cardiomyocytes (iPSC-CM). Pompe iPSC-CMs had undetectable GAA activity and pathognomonic glycogen-filled lysosomes. Nonetheless, Pompe and control iPSC-CMs exhibited comparable contractile properties in engineered cardiac tissue. Impaired autophagy has been implicated in Pompe skeletal muscle; however, control and Pompe iPSC-CMs had comparable clearance rates of LC3-II-detected autophagosomes. Unexpectedly, the lysosome-associated membrane proteins, LAMP1 and LAMP2, from Pompe iPSC-CMs demonstrated higher electrophoretic mobility compared with control iPSC-CMs. Brefeldin A induced disruption of the Golgi in control iPSC-CMs reproduced the higher mobility forms of the LAMPs, suggesting that Pompe iPSC-CMs produce LAMPs lacking appropriate glycosylation. Isoelectric focusing studies revealed that LAMP2 has a more alkaline pI in Pompe compared with control iPSC-CMs due largely to hyposialylation. MALDI-TOF-MS analysis of N-linked glycans demonstrated reduced diversity of multiantennary structures and the major presence of a trimannose complex glycan precursor in Pompe iPSC-CMs. These data suggest that Pompe cardiomyopathy has a glycan processing abnormality and thus shares features with hypertrophic cardiomyopathies observed in the congenital disorders of glycosylation. PMID:25488666

  9. Neurodegenerative evidences during early onset of depression in CMS rats as detected by proton magnetic resonance spectroscopy at 7 T.

    PubMed

    Hemanth Kumar, B S; Mishra, Sushanta Kumar; Rana, Poonam; Singh, Sadhana; Khushu, Subash

    2012-06-15

    Depression is a complex psychiatric disorder characterized by anhedonia and feeling of sadness and chronic mild stress (CMS) seems to be a valuable animal model of depression. CMS animal model was induced and validated using behavioral studies. In the present study we investigated the neuro-metabolite changes occurring in prefrontal cortex and hippocampus during the onset of depression, in CMS rat model using in vivo proton magnetic resonance spectroscopy ((1)H MRS) at field strength of 7 T. Results showed that CMS caused depression-like behavior in rats, as indicated by the decrease in sucrose consumption and locomotor activity. (1)H MRS was performed in both control and CMS rats (n=10, in each group) and the quantitative assessment of the neurometabolites was done using LC model. Relative concentrations of all the metabolites along with the macromolecules were calculated for analysis. The results revealed a significant decrease of glutamate (Glu), glutamine (Gln), NAA+NAAG, Glx and GABA levels in both hippocampus and prefrontal cortex of CMS animals and an elevated level of myo-ionisitol (mI) and taurine (Tau) was observed only in hippocampus. These metabolite fluctuations revealed by proton MRS indicate that there might be change in the neuronal integrity of the glial cells and neurons within prefrontal cortex and hippocampus in CMS model of depression. The present study also suggests that there may be a degenerative process concerning the brain morphology in the CMS rats. The overall finding using (1)H MRS suggests that, there might be a major role of the glia and neuron in the onset of depression. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. The CMS DBS query language

    NASA Astrophysics Data System (ADS)

    Kuznetsov, Valentin; Riley, Daniel; Afaq, Anzar; Sekhri, Vijay; Guo, Yuyi; Lueking, Lee

    2010-04-01

    The CMS experiment has implemented a flexible and powerful system enabling users to find data within the CMS physics data catalog. The Dataset Bookkeeping Service (DBS) comprises a database and the services used to store and access metadata related to CMS physics data. To this, we have added a generalized query system in addition to the existing web and programmatic interfaces to the DBS. This query system is based on a query language that hides the complexity of the underlying database structure by discovering the join conditions between database tables. This provides a way of querying the system that is simple and straightforward for CMS data managers and physicists to use without requiring knowledge of the database tables or keys. The DBS Query Language uses the ANTLR tool to build the input query parser and tokenizer, followed by a query builder that uses a graph representation of the DBS schema to construct the SQL query sent to underlying database. We will describe the design of the query system, provide details of the language components and overview of how this component fits into the overall data discovery system architecture.

  11. Educating the Public about Meteorites and Impacts through Virtual Field Trips and Classroom Experience Boxes

    NASA Astrophysics Data System (ADS)

    Ashcraft, Teresa; Hines, R.; Minitti, M.; Taylor, W.; Morris, M. A.; Wadhwa, M.

    2014-01-01

    With specimens representing over 2,000 individual meteorites, the Center for Meteorite Studies (CMS) at Arizona State University (ASU) is home to the world's largest university-based meteorite collection. As part of our mission to provide educational opportunities that expand awareness and understanding of the science of meteoritics, CMS continues to develop new ways to engage the public in meteorite and space science, including the opening of a new Meteorite Gallery, and expansion of online resources through upgrades to the CMS website, meteorites.asu.edu. In 2008, CMS was the recipient of a philanthropic grant to improve online education tools and develop loanable modules for educators. These modules focus on the origin of meteorites, and contain actual meteorite specimens, media resources, a user guide, and lesson plans, as well as a series of engaging activities that utilize hands-on materials geared to help students develop logical thinking, analytical skills, and proficiency in STEM disciplines. In 2010, in partnership with the ASU NASA Astrobiology Institute team, CMS obtained a NASA EPOESS grant to develop Virtual Field Trips (VFTs) complemented by loanable “Experience Boxes” containing lesson plans, media, and hands-on objects related to the VFT sites. One VFT-Box pair focuses on the record of the oldest multicellular organisms on Earth. The second VFT-Box pair focuses on the Upheaval Dome (UD) structure, a meteorite impact crater in Utah’s Canyonlands National Park. UD is widely accepted as the deeply eroded remnant of a ~5 kilometer impact crater (e.g. Kriens et al., 1999). The alternate hypothesis that the Dome was formed by the upwelling of salt from a deposit underlying the region (e.g. Jackson et al., 1998) makes UD an ideal site to learn not only about specific scientific principles present in the Next Generation Science Standards, but also the process of scientific inquiry. The VFTs are located on an interactive website dedicated to VFTs, vft.asu.edu. Starting in 2014, the accompanying Boxes will be housed with CMS and other educational partners for educators to borrow free of charge.

  12. A broader understanding of care managers' attitudes of advance care planning: a concurrent nested design.

    PubMed

    Aultman, Julie; Baughman, Kristin R; Ludwick, Ruth

    2018-05-18

    To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a mixed methods approach. A concurrent nested design was used to acquire a deeper understanding of ACP, and to identify nuances between quantitative and qualitative data. Past quantitative studies on providers have identified barriers related to time, culture, knowledge, responsibility, and availability of legal documents. These barriers, and accompanying attitudes and feelings, have been taken at face value without rich qualitative data to identify under what conditions and to what extent a barrier impacts care. A two-part multisite, mixed methods study was conducted using surveys and focus groups. Surveys were completed by 458 CMs at 10 Area Agencies on Aging and 62 participated in one of 8 focus groups. Data were analyzed using a concurrent nested design with individual data analysis and a merged data approach. There were three main distinctions between the quantitative and qualitative data. First, while CMs reported on the survey that ACP was not too time consuming, focus group data revealed that time was an issue especially related to competing priorities. Second on the survey 60% of the CMS reported they had enough knowledge, but qualitative data revealed about more nuances. Last, the reported comfort levels in the quantitative data were less overt in the qualitative date where additional feelings and attitudes were revealed, e.g., frustration with families, preferences for more physician involvement. CMs reported their attitudes about ACP, clarified through a rigorous mixed methods analysis. Care managers can successfully lead ACP discussions, but require further education, resources, and team-based guidance. ACP is essential for reducing emotional, social, and financial burdens associated with health care decision-making, and CMs can positively impact ACP discussions when appropriately supported by the clinical community. The many nuances in the ACP process that we found illustrate the need for ongoing discussions, education and research on this important topic. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Medicare program; revisions to the Medicare Advantage and Part D prescription drug contract determinations, appeals, and intermediate sanctions processes. Final rule with comment period.

    PubMed

    2007-12-05

    This rule with comment period finalizes the Medicare program provisions relating to contract determinations involving Medicare Advantage (MA) organizations and Medicare Part D prescription drug plan sponsors, including eliminating the reconsideration process for review of contract determinations, revising the provisions related to appeals of contract determinations, and clarifying the process for MA organizations and Part D plan sponsors to complete corrective action plans. In this final rule with comment period, we also clarify the intermediate sanction and civil money penalty (CMP) provisions that apply to MA organizations and Medicare Part D prescription drug plan sponsors, modify elements of their compliance plans, retain voluntary self-reporting for Part D sponsors and implement a voluntary self-reporting recommendation for MA organizations, and revise provisions to ensure HHS has access to the books and records of MA organizations and Part D plan sponsors' first tier, downstream, and related entities. Although we have decided not to finalize the mandatory self-reporting provisions that we proposed, CMS remains committed to adopting a mandatory self-reporting requirement. To that end, we are requesting comments that will assist CMS in crafting a future proposed regulation for a mandatory self-reporting requirement.

  14. GSC configuration management plan

    NASA Technical Reports Server (NTRS)

    Withers, B. Edward

    1990-01-01

    The tools and methods used for the configuration management of the artifacts (including software and documentation) associated with the Guidance and Control Software (GCS) project are described. The GCS project is part of a software error studies research program. Three implementations of GCS are being produced in order to study the fundamental characteristics of the software failure process. The Code Management System (CMS) is used to track and retrieve versions of the documentation and software. Application of the CMS for this project is described and the numbering scheme is delineated for the versions of the project artifacts.

  15. GABA and Glutamate in Children with Primary Complex Motor Stereotypies: A 1H MRS Study at 7T

    PubMed Central

    Harris, A. D.; Singer, H. S.; Horska, A.; Kline, T.; Ryan, M.; Edden, R. A. E.; Mahone, E. Mark

    2015-01-01

    Background and Purpose Complex motor stereotypies (CMS) are rhythmic, repetitive, fixed, purposeful but purposeless movements that stop with distraction. They can occur in otherwise normal healthy children (primary stereotypies), as well in those with autism spectrum disorders (secondary stereotypies). The underlying neurobiological basis for these movements is unknown, but thought to involve cortical-striatal-thalamo-cortical pathways. In order to further clarify potential neurochemical alterations, GABA, glutamate (Glu), glutamine (Gln), N-acetyl aspartate (NAA) and choline (Cho) levels were measured in four frontostriatal regions, using 1H MRS at 7T. Materials and Methods A total of 18 children with primary CMS and 24 typically developing controls, ages 5-10 years completed MRS at 7T. Single voxel STEAM acquisitions from the anterior cingulate cortex (ACC), premotor cortex (PMC), dorsolateral prefrontal cortex (DLPFC) and striatum were obtained and metabolites were quantified with respect to creatine using LCModel. Results The 7T scan was well tolerated by all participants. Compared to controls, children with CMS had lower levels of GABA ACC (GABA/Cr, p=0.049; GABA/Glu: p=0.051) and striatum (GABA/Cr: p= 0.028; GABA/Glu: p=0.0037), but not the DLPFC or PMC. Glu, Gln, NAA, and Cho levels did not differ between groups in any of the aforementioned regions. Within the CMS group, reduced GABA/Cr in the ACC was significantly associated with greater severity of motor stereotypies (r=-0.59, p= 0.021). Conclusions These results suggest possible GABAergic dysfunction within corticostriatal pathways in children with primary CMS. PMID:26542237

  16. Stability of Colistin and Colistin Methanesulfonate in Aqueous Media and Plasma as Determined by High-Performance Liquid Chromatography

    PubMed Central

    Li, Jian; Milne, Robert W.; Nation, Roger L.; Turnidge, John D.; Coulthard, Kingsley

    2003-01-01

    The stabilities of colistin and colistin methanesulfonate (CMS) in different aqueous media were studied by specific high-performance liquid chromatography (HPLC) methods. Colistin was stable in water at 4 and 37°C for up to 60 days and 120 h, respectively. However, degradation was observed when colistin was stored in isotonic phosphate buffer (0.067 M, pH 7.4) and human plasma at 37°C. The stability of CMS from three different sources in water was explored by strong-anion-exchange (SAX) HPLC for CMS and by measuring the concentrations of colistin formed from the hydrolysis of CMS. The peaks of CMS in SAX HPLC disappeared almost completely after 12 h at 37°C, but appeared to remain intact for up to 2 days at 4°C. Over the same period, there was no formation of colistin at 4°C. In water, phosphate buffer, and plasma, there was rapid formation of colistin within 24 to 48 h at 37°C from the three sources of CMS. The hydrolysis products were assumed to be a complex mixture of many different sulfomethyl derivatives, including colistin. The stability of a fourth source of CMS in Mueller-Hinton broth examined during 30 min at 37°C revealed no formation of colistin. Along with previous microbiological studies, this suggested that different sulfomethyl CMSs possess intrinsic antibacterial activity. These results will be helpful for understanding the pharmacokinetics and pharmacodynamics of colistin and CMS in humans and animals. PMID:12654671

  17. 77 FR 75633 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-21

    ... state agencies to (among other things): (1) Submit and amend Medicaid state plans, CHIP state plans, and..., demonstration, and benchmark and grant programs. It will be used by CMS to (among other things): (1) Provide for.... The webinar can be accessed on the Internet at: http://www.medicaid.gov/State-Resource-Center/Medicaid...

  18. Increase in Testing Efficiency through the Development of an IT-Based Adaptive Testing Tool for Competency Measurement Applied to a Health Worker Training Test Case

    ERIC Educational Resources Information Center

    Kleinhans, Janne; Schumann, Matthias

    2015-01-01

    In the context of education and training, competency measurement (CM) is a central challenge in competency management. For complex CMs, a compromise must be addressed between the time available and the number of dimensions to be measured or the quality of the measurements. Increasing the efficiency of existing tests for CMs therefore poses a key…

  19. 42 CFR 421.3 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... “intermediary” also means a Blue Cross plan that has entered into a subcontract approved by CMS with the Blue Cross and Blue Shield Association to perform intermediary functions. [71 FR 68228, Nov. 24, 2006] ...

  20. 42 CFR 421.3 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... “intermediary” also means a Blue Cross plan that has entered into a subcontract approved by CMS with the Blue Cross and Blue Shield Association to perform intermediary functions. [71 FR 68228, Nov. 24, 2006] ...

  1. 42 CFR 421.3 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... “intermediary” also means a Blue Cross plan that has entered into a subcontract approved by CMS with the Blue Cross and Blue Shield Association to perform intermediary functions. [71 FR 68228, Nov. 24, 2006] ...

  2. 42 CFR 423.4 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... with section 1860D-11(c) of the Act and with CMS actuarial guidelines. Brand name drug means a drug for... Part D plan sponsor's management functions under contract or delegation; (2) Furnishes services to...

  3. 42 CFR 417.598 - Annual enrollment reconciliation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.598 Annual enrollment reconciliation. CMS... conducts this reconciliation as necessary to ensure that the payments made do not exceed or fall short of...

  4. 77 FR 23264 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-18

    ... the existing home health prospective payment system. The study team's analytic plan focuses on... populations that cannot be learned through analyses of administrative data. Form Number: CMS-10429 (OCN: 0938...

  5. Dendritic Core-Multishell Nanocarriers in Murine Models of Healthy and Atopic Skin.

    PubMed

    Radbruch, Moritz; Pischon, Hannah; Ostrowski, Anja; Volz, Pierre; Brodwolf, Robert; Neumann, Falko; Unbehauen, Michael; Kleuser, Burkhard; Haag, Rainer; Ma, Nan; Alexiev, Ulrike; Mundhenk, Lars; Gruber, Achim D

    2017-12-01

    Dendritic hPG-amid-C18-mPEG core-multishell nanocarriers (CMS) represent a novel class of unimolecular micelles that hold great potential as drug transporters, e.g., to facilitate topical therapy in skin diseases. Atopic dermatitis is among the most common inflammatory skin disorders with complex barrier alterations which may affect the efficacy of topical treatment.Here, we tested the penetration behavior and identified target structures of unloaded CMS after topical administration in healthy mice and in mice with oxazolone-induced atopic dermatitis. We further examined whole body distribution and possible systemic side effects after simulating high dosage dermal penetration by subcutaneous injection.Following topical administration, CMS accumulated in the stratum corneum without penetration into deeper viable epidermal layers. The same was observed in atopic dermatitis mice, indicating that barrier alterations in atopic dermatitis had no influence on the penetration of CMS. Following subcutaneous injection, CMS were deposited in the regional lymph nodes as well as in liver, spleen, lung, and kidney. However, in vitro toxicity tests, clinical data, and morphometry-assisted histopathological analyses yielded no evidence of any toxic or otherwise adverse local or systemic effects of CMS, nor did they affect the severity or course of atopic dermatitis.Taken together, CMS accumulate in the stratum corneum in both healthy and inflammatory skin and appear to be highly biocompatible in the mouse even under conditions of atopic dermatitis and thus could potentially serve to create a depot for anti-inflammatory drugs in the skin.

  6. Global transcriptomic analysis of induced cardiomyocytes predicts novel regulators for direct cardiac reprogramming.

    PubMed

    Talkhabi, Mahmood; Razavi, Seyed Morteza; Salari, Ali

    2017-06-01

    Heart diseases are the most significant cause of morbidity and mortality in the world. De novo generated cardiomyocytes (CMs) are a great cellular source for cell-based therapy and other potential applications. Direct cardiac reprogramming is the newest method to produce CMs, known as induced cardiomyocytes (iCMs). During a direct cardiac reprogramming, also known as transdifferentiation, non-cardiac differentiated adult cells are reprogrammed to cardiac identity by forced expression of cardiac-specific transcription factors (TFs) or microRNAs. To this end, many different combinations of TFs (±microRNAs) have been reported for direct reprogramming of mouse or human fibroblasts to iCMs, although their efficiencies remain very low. It seems that the investigated TFs and microRNAs are not sufficient for efficient direct cardiac reprogramming and other cardiac specific factors may be required for increasing iCM production efficiency, as well as the quality of iCMs. Here, we analyzed gene expression data of cardiac fibroblast (CFs), iCMs and adult cardiomyocytes (aCMs). The up-regulated and down-regulated genes in CMs (aCMs and iCMs) were determined as CM and CF specific genes, respectively. Among CM specific genes, we found 153 transcriptional activators including some cardiac and non-cardiac TFs that potentially activate the expression of CM specific genes. We also identified that 85 protein kinases such as protein kinase D1 (PKD1), protein kinase A (PRKA), calcium/calmodulin-dependent protein kinase (CAMK), protein kinase C (PRKC), and insulin like growth factor 1 receptor (IGF1R) that are strongly involved in establishing CM identity. CM gene regulatory network constructed using protein kinases, transcriptional activators and intermediate proteins predicted some new transcriptional activators such as myocyte enhancer factor 2A (MEF2A) and peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PPARGC1A), which may be required for qualitatively and quantitatively efficient direct cardiac reprogramming. Taken together, this study provides new insights into the complexity of cell fate conversion and better understanding of the roles of transcriptional activators, signaling pathways and protein kinases in increasing the efficiency of direct cardiac reprogramming and maturity of iCMs.

  7. 42 CFR 423.504 - General provisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., beginning on the date the entity notified CMS of the intention to non-renew the most recent previous... inspect any books, contracts, and records of the Part D plan sponsor that pertain to— (A) The ability of...

  8. Diode Laser Stapedotomy vs Conventional Stapedotomy in Otosclerosis: A Double-Blinded Randomized Clinical Trial.

    PubMed

    Parida, Pradipta Kumar; Kalaiarasi, Raja; Gopalakrishnan, Surianarayana

    2016-06-01

    To assess and compare the efficacy of diode laser stapedotomy (DLS) and conventional manual stapedotomy (CMS) in the treatment of otosclerosis. Randomized clinical trial. Tertiary health center. We randomly assigned 60 patients with otosclerosis planned for primary stapedotomy to receive either DLS or CMS. Primary outcome measure was hearing gain measured by pure-tone audiometry (PTA) performed preoperatively and postoperatively. Hearing gain was compared within and between the groups. Secondary outcome measures were the incidence of intraoperative (bleeding and fractured footplate) and postoperative (vomiting, vertigo, sensorineural hearing loss, tinnitus, facial nerve paralysis, and hospital stay) morbidities. Sixty primary stapedotomies (30 in the CMS group and 30 in the DLS group) done for 60 patients (male, n = 42; female, n = 18) were included in the analysis. Preoperative mean air-bone (AB) gap in the DLS and CMS groups was 38.51 ± 8.643 dB and 36.42 ± 8.678 dB, respectively. Mean AB gap at 6 month was 10.86 ± 5.383 dB and 11.05 ± 5.236 dB in the CMS and DLS groups, respectively. Air conduction was improved by 24.98 ± 5.348 dB in the DLS group and 24.08 ± 5.911 dB in the CMS group at 6 months. No statistically significant differences were found in hearing gain between the 2 groups at 6 months (P > .05). A decreased rate and severity of intraoperative bleeding, postoperative vertigo, and vomiting were observed with the diode laser (0%, 6.6%, and 10%) compared with the conventional technique (16.7%, 16.7%, and 16.7%), but these differences were not statistically significant (P > .05). Hearing outcomes and complications of DLS were similar to CMS. These study findings confirm the efficacy of the diode laser in stapedotomy, but DLS offers no advantages over CMS for otosclerosis surgery. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  9. Dual-RiverSonde measurements of two-dimensional river flow patterns

    USGS Publications Warehouse

    Teague, C.C.; Barrick, D.E.; Lilleboe, P.M.; Cheng, R.T.; Stumpner, P.; Burau, J.R.

    2008-01-01

    Two-dimensional river flow patterns have been measured using a pair of RiverSondes in two experiments in the Sacramento-San Joaquin River Delta system of central California during April and October 2007. An experiment was conducted at Walnut Grove, California in order to explore the use of dual RiverSondes to measure flow patterns at a location which is important in the study of juvenile fish migration. The data available during the first experiment were limited by low wind, so a second experiment was conducted at Threemile Slough where wind conditions and surface turbulence historically have resulted in abundant data. Both experiments included ADCP near-surface velocity measurements from either manned or unmanned boats. Both experiments showed good comparisons between the RiverSonde and ADCP measurements. The flow conditions at both locations are dominated by tidal effects, with partial flow reversal at Walnut Grove and complete flow reversal at Threemile Slough. Both systems showed complex flow patterns during the flow reversals. Quantitative comparisons between the RiverSondes and an ADCP on a manned boat at Walnut Grove showed mean differences of 4.5 cm/s in the u (eastward) and 7.6 cm/s in the v (northward) components, and RMS differences of 14.7 cm/s in the u component and 21.0 cm/s in the v component. Quantitative comparisons between the RiverSondes and ADCPs on autonomous survey vessels at Threemile Slough showed mean differences of 0.007 cm/s in the u component and 0.5 cm/s in the v component, and RMS differences of 7.9 cm/s in the u component and 13.5 cm/s in the v component after obvious outliers were removed. ?? 2008 IEEE.

  10. Efficient monitoring of CRAB jobs at CMS

    NASA Astrophysics Data System (ADS)

    Silva, J. M. D.; Balcas, J.; Belforte, S.; Ciangottini, D.; Mascheroni, M.; Rupeika, E. A.; Ivanov, T. T.; Hernandez, J. M.; Vaandering, E.

    2017-10-01

    CRAB is a tool used for distributed analysis of CMS data. Users can submit sets of jobs with similar requirements (tasks) with a single request. CRAB uses a client-server architecture, where a lightweight client, a server, and ancillary services work together and are maintained by CMS operators at CERN. As with most complex software, good monitoring tools are crucial for efficient use and longterm maintainability. This work gives an overview of the monitoring tools developed to ensure the CRAB server and infrastructure are functional, help operators debug user problems, and minimize overhead and operating cost. This work also illustrates the design choices and gives a report on our experience with the tools we developed and the external ones we used.

  11. Efficient Monitoring of CRAB Jobs at CMS

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

    Silva, J. M.D.; Balcas, J.; Belforte, S.

    CRAB is a tool used for distributed analysis of CMS data. Users can submit sets of jobs with similar requirements (tasks) with a single request. CRAB uses a client-server architecture, where a lightweight client, a server, and ancillary services work together and are maintained by CMS operators at CERN. As with most complex software, good monitoring tools are crucial for efficient use and longterm maintainability. This work gives an overview of the monitoring tools developed to ensure the CRAB server and infrastructure are functional, help operators debug user problems, and minimize overhead and operating cost. This work also illustrates themore » design choices and gives a report on our experience with the tools we developed and the external ones we used.« less

  12. 42 CFR 423.272 - Review and negotiation of bid and approval of plans submitted by potential Part D sponsors.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... submitted by potential Part D sponsors. 423.272 Section 423.272 Public Health CENTERS FOR MEDICARE... and negotiation of bid and approval of plans submitted by potential Part D sponsors. (a) Review and...) Substantial differences between bids—(i) General. CMS approves a bid only if it finds that the benefit package...

  13. 42 CFR 423.272 - Review and negotiation of bid and approval of plans submitted by potential Part D sponsors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... submitted by potential Part D sponsors. 423.272 Section 423.272 Public Health CENTERS FOR MEDICARE... and negotiation of bid and approval of plans submitted by potential Part D sponsors. (a) Review and...) Substantial differences between bids—(i) General. CMS approves a bid only if it finds that the benefit package...

  14. 42 CFR 423.272 - Review and negotiation of bid and approval of plans submitted by potential Part D sponsors.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... submitted by potential Part D sponsors. 423.272 Section 423.272 Public Health CENTERS FOR MEDICARE... Approval § 423.272 Review and negotiation of bid and approval of plans submitted by potential Part D... from the formulary. (3) Substantial differences between bids—(i) General. CMS approves a bid only if it...

  15. 76 FR 43237 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-20

    ... General OMB Office of Management and Budget PHS Act Public Health Service Act QHP Qualified Health Plan...) performs some of the issuer's management functions under contract or delegation. Thus, CMS would permit a... billing, and case management from a health insurance issuer that existed on July 16, 2009, as long as the...

  16. 42 CFR 457.203 - Administrative and judicial review of action on State plan material.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... determines that his or her original decision was incorrect, CMS will pay the State a lump sum equal to any... with the Administrator's action on State plan material under § 457.150 may, within 60 days after... of hearing. Within 30 days after receipt of the request, the Administrator notifies the State of the...

  17. The CMS Level-1 Calorimeter Trigger for LHC Run II

    NASA Astrophysics Data System (ADS)

    Sinthuprasith, Tutanon

    2017-01-01

    The phase-1 upgrades of the CMS Level-1 calorimeter trigger have been completed. The Level-1 trigger has been fully commissioned and it will be used by CMS to collect data starting from the 2016 data run. The new trigger has been designed to improve the performance at high luminosity and large number of simultaneous inelastic collisions per crossing (pile-up). For this purpose it uses a novel design, the Time Multiplexed Design, which enables the data from an event to be processed by a single trigger processor at full granularity over several bunch crossings. The TMT design is a modular design based on the uTCA standard. The architecture is flexible and the number of trigger processors can be expanded according to the physics needs of CMS. Intelligent, more complex, and innovative algorithms are now the core of the first decision layer of CMS: the upgraded trigger system implements pattern recognition and MVA (Boosted Decision Tree) regression techniques in the trigger processors for pT assignment, pile up subtraction, and isolation requirements for electrons, and taus. The performance of the TMT design and the latency measurements and the algorithm performance which has been measured using data is also presented here.

  18. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury

    PubMed Central

    Nash, Mark S.; Cowan, Rachel E.; Kressler, Jochen

    2012-01-01

    Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuition-centered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives. PMID:23031165

  19. One Year of FOS Measurements in CMS Experiment at CERN

    NASA Astrophysics Data System (ADS)

    Szillási, Zoltán; Buontempo, Salvatore; Béni, Noémi; Breglio, Giovanni; Cusano, Andrea; Laudati, Armando; Giordano, Michele; Saccomanno, Andrea; Druzhkin, Dmitry; Tsirou, Andromachi

    Results are presented on the activity carried out by our research group, in collaboration with the SME Optosmart s.r.l. (an Italian spin-off company), on the application of Fiber Optic Sensor (FOS) techniques to monitor high-energy physics (HEP) detectors. Assuming that Fiber Bragg Grating sensors (FBGs) radiation hardness has been deeply studied for other field of application, we have applied the FBG technology to the HEP research domain. We present here the experimental evidences of the solid possibility to use such a class of sensors also in HEP detector very complex environmental side conditions. In particular we present more than one year data results of FBG measurements in the Compact Muon Solenoid (CMS) experiment set up at the CERN, where we have monitored temperatures (within CMS core) and strains in different locations by using FBG sensors during the detector operation with the Large Hadron Collider (LHC) collisions and high magnetic field. FOS data and FOS readout system stability and reliability is demonstrated, with continuous 24/24 h 7/7d data taking under severe and complex side conditions.

  20. Lessons learned from the National Medicare & You Education Program.

    PubMed

    Goldstein, E; Teichman, L; Crawley, B; Gaumer, G; Joseph, C; Reardon, L

    2001-01-01

    In fall 1998 CMS implemented the National Medicare Education Program (NMEP) to educate beneficiaries about their Medicare program benefits; health plan choices; supplemental health insurance; beneficiary rights, responsibilities, and protections; and health behaviors. CMS has been monitoring the implementation of the NMEP in six case study sites as well as monitoring each of the information channels for communicating with beneficiaries. This article describes select findings from the case studies, and highlights from assessment activities related to the Medicare & You handbook, the toll-free 1-800-MEDICARE Helpline, Internet, and Regional Education About Choices in Health (REACH).

  1. Lessons Learned from the National Medicare & You Education Program

    PubMed Central

    Goldstein, Elizabeth; Teichman, Lori; Crawley, Barbara; Gaumer, Gary; Joseph, Catherine; Reardon, Leo

    2001-01-01

    In fall 1998 CMS implemented the National Medicare Education Program (NMEP) to educate beneficiaries about their Medicare program benefits; health plan choices; supplemental health insurance; beneficiary rights, responsibilities, and protections; and health behaviors. CMS has been monitoring the implementation of the NMEP in six case study sites as well as monitoring each of the information channels for communicating with beneficiaries. This article describes select findings from the case studies, and highlights from assessment activities related to the Medicare & You handbook, the toll-free 1-800-MEDICARE Helpline, Internet, and Regional Education About Choices in Health (REACH). PMID:12500359

  2. Understanding user needs for carbon monitoring information

    NASA Astrophysics Data System (ADS)

    Duren, R. M.; Macauley, M.; Gurney, K. R.; Saatchi, S. S.; Woodall, C. W.; Larsen, K.; Reidmiller, D.; Hockstad, L.; Weitz, M.; Croes, B.; Down, A.; West, T.; Mercury, M.

    2015-12-01

    The objectives of the Understanding User Needs project for NASA's Carbon Monitoring System (CMS) program are to: 1) engage the user community and identify needs for policy-relevant carbon monitoring information, 2) evaluate current and planned CMS data products with regard to their value for decision making, and 3) explore alternative methods for visualizing and communicating carbon monitoring information and associated uncertainties to decision makers and other stakeholders. To meet these objectives and help establish a sustained link between science and decision-making we have established a multi-disciplinary team that combines expertise in carbon-cycle science, engineering, economics, and carbon management and policy. We will present preliminary findings regarding emerging themes and needs for carbon information that may warrant increased attention by the science community. We will also demonstrate a new web-based tool that offers a common framework for facilitating user evaluation of carbon data products from multiple CMS projects.

  3. W.K.H. Panofsky Prize: The Long Journey to the Higgs Boson: CMS

    NASA Astrophysics Data System (ADS)

    Virdee, Tejinder

    2017-01-01

    There has been a rich harvest of physics from the experiments at the Large Hadron Collider (LHC). In July 2012, the ground-breaking discovery of the Higgs boson was made by the ATLAS and CMS experiments. This boson is a long-sought particle expected from the mechanism for spontaneous symmetry breaking in the electro-weak sector that provides an explanation of how elementary particles acquire mass. The discovery required experiments of unprecedented capability and complexity. This talk, complementing that of Peter Jenni, will trace the background to the search for the Higgs boson at the LHC, the conception, the construction and the operation of the CMS experiment, and its subsequent discovery of the boson. The SM is considered to be a low energy manifestation of a more complete theory - physics beyond the SM is therefore widely anticipated. Selected CMS results will be presented from the search for physics beyond the SM from the 13 TeV Run-2 at the LHC.

  4. Society for Health Psychology (APA Division 38) and Society of Behavioral Medicine joint position statement on the Medicare Diabetes Prevention Program.

    PubMed

    Fitzpatrick, Stephanie L; Wilson, Dawn K; Pagoto, Sherry L

    2017-06-01

    Beginning in January 2018, the Centers for Medicare and Medicaid Services (CMS) plans to cover the Diabetes Prevention Program (DPP), also referred to as Medicare DPP. The American Psychological Association Society for Health Psychology (SfHP) and the Society for Behavioral Medicine (SBM) reviewed the proposed plan. SfHP and SBM are in support of the CMS decision to cover DPP for Medicare beneficiaries but have a significant concern that aspects of the proposal will limit the public health impact. Concerns include the emphasis on weight outcomes to determine continued coverage and the lack of details regarding requirements for coaches. SfHP and SBM are in strong support of modifications to the proposal that would remove the minimum weight loss stipulation to determine coverage and to specify type and qualifications of "coaches."

  5. CMS keeps raising the stakes on quality improvement.

    PubMed

    2014-10-01

    A significant portion of the Centers for Medicare & Medicaid Services (CMS) 2015 Inpatient Prospective Payment System final rule focuses on quality and raises the percentage of the Medicare base payment hospitals can lose if they perform poorly. Case managers must be involved with patients from the minute they come in the door, through the hospital stay, and after discharge, experts say. Reimbursement is affected by risk-adjustment, which means case managers must make sure the documentation is as complete and specific as possible to show the full picture of the patient's severity of illness as well as any conditions that were present on admission. As the readmission reduction program expands to add new diagnoses and the penalties for poor performance increase, case managers must change their focus from discharge planning to transition planning that takes into account what resources patients need after discharge, experts say.

  6. Simulation of strong ground motion parameters of the 1 June 2013 Gulf of Suez earthquake, Egypt

    NASA Astrophysics Data System (ADS)

    Toni, Mostafa

    2017-06-01

    This article aims to simulate the ground motion parameters of the moderate magnitude (ML 5.1) June 1, 2013 Gulf of Suez earthquake, which represents the largest instrumental earthquake to be recorded in the middle part of the Gulf of Suez up to now. This event was felt in all cities located on both sides of the Gulf of Suez, with minor damage to property near the epicenter; however, no casualties were observed. The stochastic technique with the site-dependent spectral model is used to simulate the strong ground motion parameters of this earthquake in the cities located at the western side of the Gulf of Suez and north Red Sea namely: Suez, Ain Sokhna, Zafarana, Ras Gharib, and Hurghada. The presence of many tourist resorts and the increase in land use planning in the considered cities represent the motivation of the current study. The simulated parameters comprise the Peak Ground Acceleration (PGA), Peak Ground Velocity (PGV), and Peak Ground Displacement (PGD), in addition to Pseudo Spectral Acceleration (PSA). The model developed for ground motion simulation is validated by using the recordings of three accelerographs installed around the epicenter of the investigated earthquake. Depending on the site effect that has been determined in the investigated areas by using geotechnical data (e.g., shear wave velocities and microtremor recordings), the investigated areas are classified into two zones (A and B). Zone A is characterized by higher site amplification than Zone B. The ground motion parameters are simulated at each zone in the considered areas. The results reveal that the highest values of PGA, PGV, and PGD are observed at Ras Gharib city (epicentral distance ∼ 11 km) as 67 cm/s2, 2.53 cm/s, and 0.45 cm respectively for Zone A, and as 26.5 cm/s2, 1.0 cm/s, and 0.2 cm respectively for Zone B, while the lowest values of PGA, PGV, and PGD are observed at Suez city (epicentral distance ∼ 190 km) as 3.0 cm/s2, 0.2 cm/s, and 0.05 cm/s respectively for Zone A, and as 1.3 cm/s2, 0.1 cm/s, and 0.024 cm respectively for Zone B. Also the highest PSA values are observed in Ras Gharib city as 200 cm/s2 and 78 cm/s2 for Zone A and Zone B respectively, while the lowest PSA values are observed in Suez city as 7 cm/s2 and 3 cm/s2 for Zone A and Zone B respectively. These results show a good agreement with the earthquake magnitude, epicentral distances, and site characterizations as well.

  7. A Low-Complexity Subgroup Formation with QoS-Aware for Enhancing Multicast Services in LTE Networks

    NASA Astrophysics Data System (ADS)

    Algharem, M.; Omar, M. H.; Rahmat, R. F.; Budiarto, R.

    2018-03-01

    The high demand of Multimedia services on in Long Term Evolution (LTE) and beyond networks forces the networks operators to find a solution that can handle the huge traffic. Along with this, subgroup formation techniques are introduced to overcome the limitations of the Conventional Multicast Scheme (CMS) by splitting the multicast users into several subgroups based on the users’ channels quality signal. However, finding the best subgroup configuration with low complexity is need more investigations. In this paper, an efficient and simple subgroup formation mechanisms are proposed. The proposed mechanisms take the transmitter MAC queue in account. The effectiveness of the proposed mechanisms is evaluated and compared with CMS in terms of throughput, fairness, delay, Block Error Rate (BLER).

  8. Model Updating of Complex Structures Using the Combination of Component Mode Synthesis and Kriging Predictor

    PubMed Central

    Li, Yan; Wang, Dejun; Zhang, Shaoyi

    2014-01-01

    Updating the structural model of complex structures is time-consuming due to the large size of the finite element model (FEM). Using conventional methods for these cases is computationally expensive or even impossible. A two-level method, which combined the Kriging predictor and the component mode synthesis (CMS) technique, was proposed to ensure the successful implementing of FEM updating of large-scale structures. In the first level, the CMS was applied to build a reasonable condensed FEM of complex structures. In the second level, the Kriging predictor that was deemed as a surrogate FEM in structural dynamics was generated based on the condensed FEM. Some key issues of the application of the metamodel (surrogate FEM) to FEM updating were also discussed. Finally, the effectiveness of the proposed method was demonstrated by updating the FEM of a real arch bridge with the measured modal parameters. PMID:24634612

  9. Legal Briefing: Medicare Coverage of Advance Care Planning.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  10. Complex aberrant splicing in the induced pluripotent stem cell-derived cardiomyocytes from a patient with long-QT syndrome carrying KCNQ1-A344Aspl mutation.

    PubMed

    Wuriyanghai, Yimin; Makiyama, Takeru; Sasaki, Kenichi; Kamakura, Tsukasa; Yamamoto, Yuta; Hayano, Mamoru; Harita, Takeshi; Nishiuchi, Suguru; Chen, Jiarong; Kohjitani, Hirohiko; Hirose, Sayako; Yokoi, Fumika; Gao, Jingshan; Chonabayashi, Kazuhisa; Watanabe, Ken; Ohno, Seiko; Yoshida, Yoshinori; Kimura, Takeshi; Horie, Minoru

    2018-05-29

    Long-QT syndrome type 1 (LQT1) is caused by mutations in KCNQ1, which encodes the α-subunit of the slow delayed rectifier potassium current (I Ks ) channel. We previously reported that a synonymous mutation, c.1032G>A, p.A344Aspl in KCNQ1 is most commonly identified in the genotyped LQT1 Japanese patients, and the aberrant splicing was analyzed in the lymphocytes isolated from patients' blood samples. However, the mechanisms underlying the observed processes in human cardiomyocytes remains unclear. To establish and analyze patient-specific human induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) model carrying KCNQ1-A344Aspl. We generated hiPSCs from the peripheral blood mononuclear cells obtained from an LQT1 patient carrying KCNQ1-A344Aspl. Using the differentiated cardiomyocytes, we analyzed splicing variants and performed electrophysiological studies. We identified seven aberrant RNA variants in A344Aspl-hiPSC-CMs, more complex compared with those in the peripheral lymphocytes. Multi-electrode array analysis revealed that 1 μM isoproterenol significantly prolonged the duration of corrected field potential in A344Aspl-hiPSC-CMs, compared with that in the controls. Additionally, 100 nM E-4031, I Kr blocker, was shown to induce early afterdepolarization-like waveforms in A344Aspl-hiPSC-CMs. Action potential durations (APDs) did not significantly differ between the hiPSC-CM groups. After administrating 500 nM isoproterenol, APDs of A344Aspl-hiPSC-CMs were significantly longer than those of the controls. ML277 and phenylboronic acid, I Ks activators, ameliorated the APDs of hiPSC-CMs. We identified complex aberrant mRNA variants in the A344Aspl-hiPSC-CM model, and successfully recapitulated the clinical phenotypes of the patient with concealed LQT1. This model allows the investigation of the underlying mechanisms and development of novel therapies. Copyright © 2018. Published by Elsevier Inc.

  11. Evaluation of nefazodone-induced cardiotoxicity in human induced pluripotent stem cell-derived cardiomyocytes

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

    Lee, Sujeong, E-mail: crystalee@gmail.com; Lee, Hyang-Ae, E-mail: hyangaelee@gmail.com; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 110-799

    2016-04-01

    The recent establishment of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), which express the major cardiac ion channels and recapitulate spontaneous mechanical and electrical activities, may provide a possible solution for the lack of in vitro human-based cardiotoxicity testing models. Cardiotoxicity induced by the antidepressant nefazodone was previously revealed to cause an acquired QT prolongation by hERG channel blockade. To elucidate the cellular mechanisms underlying the cardiotoxicity of nefazodone beyond hERG, its effects on cardiac action potentials (APs) and ion channels were investigated using hiPSC-CMs with whole-cell patch clamp techniques. In a proof of principle study, we examined the effectsmore » of cardioactive channel blockers on the electrophysiological profile of hiPSC-CMs in advance of the evaluation of nefazodone. Nefazodone dose-dependently prolonged the AP duration at 90% (APD{sub 90}) and 50% (APD{sub 50}) repolarization, reduced the maximum upstroke velocity (dV/dt{sub max}) and induced early after depolarizations. Voltage-clamp studies of hiPSC-CMs revealed that nefazodone inhibited various voltage-gated ion channel currents including I{sub Kr}, I{sub Ks}, I{sub Na}, and I{sub Ca}. Among them, I{sub Kr} and I{sub Na} showed relatively higher sensitivity to nefazodone, consistent with the changes in the AP parameters. In summary, hiPSC-CMs enabled an integrated approach to evaluate the complex interactions of nefazodone with cardiac ion channels. These results suggest that hiPSC-CMs can be an effective model for detecting drug-induced arrhythmogenicity beyond the current standard assay of heterologously expressed hERG K{sup +} channels. - Highlights: • Nefazodone prolonged APD and decreased upstroke velocity of APs in hiPSC-CMs. • Nefazodone inhibited cardiac ion channels, especially I{sub Kr} and I{sub Na}, in hiPSC-CMs. • Nefazodone-induced AP changes are mainly the result of I{sub Kr} and I{sub Na} inhibition. • hiPSC-CMs are sensitive model to validate nefazodone-induced cardiotoxicity. • hiPSC-CMs provide an integrated approach for evaluating mechanism of drug actions.« less

  12. 40 CFR 63.8810 - How do I monitor and collect data to demonstrate continuous compliance?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... data. Monitoring failures that are caused by poor maintenance or careless operation are not... performance evaluation of each CMS in accordance with your site-specific monitoring plan. (4) You must operate...

  13. Show them the money. Healthcare providers say it will take more than vision to turn the government's health IT plans into reality.

    PubMed

    Morrissey, John

    2004-07-26

    The much-anticipated healthcare IT plan laid out by David Brailer last week won some points for vision from providers, but they're still wondering where the money will come from. One possibility is incentives, like the "pay for performance" strategy being touted by the CMS' Mark McClellan, left.

  14. Novel high dose rate lip brachytherapy technique to improve dose homogeneity and reduce toxicity by customized mold.

    PubMed

    Feldman, Jon; Appelbaum, Limor; Sela, Mordechay; Voskoboinik, Ninel; Kadouri, Sarit; Weinberger, Jeffrey; Orion, Itzhak; Meirovitz, Amichay

    2014-12-23

    The purpose of this study is to describe a novel brachytherapy technique for lip Squamous Cell Carcinoma, utilizing a customized mold with embedded brachytherapy sleeves, which separates the lip from the mandible, and improves dose homogeneity. Seven patients with T2 lip cancer treated with a "sandwich" technique of High Dose Rate (HDR) brachytherapy to the lip, consisting of interstitial catheters and a customized mold with embedded catheters, were reviewed for dosimetry and outcome using 3D planning. Dosimetric comparison was made between the "sandwich" technique to "classic" - interstitial catheters only plan. We compared dose volume histograms for Clinical Tumor Volume (CTV), normal tissue "hot spots" and mandible dose. We are reporting according to the ICRU 58 and calculated the Conformal Index (COIN) to show the advantage of our technique. The seven patients (ages 36-81 years, male) had median follow-up of 47 months. Four patients received Brachytherapy and External Beam Radiation Therapy, 3 patients received brachytherapy alone. All achieved local control, with excellent esthetic and functional results. All patients are disease free. The Customized Mold Sandwich technique (CMS) reduced the high dose region receiving 150% (V150) by an average of 20% (range 1-47%), The low dose region (les then 90% of the prescribed dose) improved by 73% in average by using the CMS technique. The COIN value for the CMS was in average 0.92 as opposed to 0.88 for the interstitial catheter only. All differences (excluding the low dose region) were statistically significant. The CMS technique significantly reduces the high dose volume and increases treatment homogeneity. This may reduce the potential toxicity to the lip and adjacent mandible, and results in excellent tumor control, cosmetic and functionality.

  15. A simulation framework for the CMS Track Trigger electronics

    NASA Astrophysics Data System (ADS)

    Amstutz, C.; Magazzù, G.; Weber, M.; Palla, F.

    2015-03-01

    A simulation framework has been developed to test and characterize algorithms, architectures and hardware implementations of the vastly complex CMS Track Trigger for the high luminosity upgrade of the CMS experiment at the Large Hadron Collider in Geneva. High-level SystemC models of all system components have been developed to simulate a portion of the track trigger. The simulation of the system components together with input data from physics simulations allows evaluating figures of merit, like delays or bandwidths, under realistic conditions. The use of SystemC for high-level modelling allows co-simulation with models developed in Hardware Description Languages, e.g. VHDL or Verilog. Therefore, the simulation framework can also be used as a test bench for digital modules developed for the final system.

  16. The QuarkNet CMS masterclass: bringing the LHC to students

    NASA Astrophysics Data System (ADS)

    Cecire, Kenneth; McCauley, Thomas

    2016-04-01

    QuarkNet is an educational program which brings high school teachers and their students into the particle physics research community. The program supports research experiences and professional development workshops and provides inquiry-oriented investigations, some using real experimental data. The CMS experiment at the LHC has released several thousand proton-proton collision events for use in education and outreach. QuarkNet, in collaboration with CMS, has developed a physics masterclass and e-Lab based on this data. A masterclass is a day-long educational workshop where high school students travel to nearby universities and research laboratories. There they learn from LHC physicists about the basics of particle physics and detectors. They then perform a simple measurement using LHC data, and share their results with other students around the world via videoconference. Since 2011 thousands of students from over 25 countries have participated in the CMS masterclass as organized by QuarkNet and the International Particle Physics Outreach Group (IPPOG).We describe here the masterclass exercise: the physics, the online event display and database preparation behind it, the measurement the students undertake, their results and experiences, and future plans for the exercise.

  17. Grid site availability evaluation and monitoring at CMS

    DOE PAGES

    Lyons, Gaston; Maciulaitis, Rokas; Bagliesi, Giuseppe; ...

    2017-10-01

    The Compact Muon Solenoid (CMS) experiment at the Large Hadron Collider (LHC) uses distributed grid computing to store, process, and analyse the vast quantity of scientific data recorded every year. The computing resources are grouped into sites and organized in a tiered structure. Each site provides computing and storage to the CMS computing grid. Over a hundred sites worldwide contribute with resources from hundred to well over ten thousand computing cores and storage from tens of TBytes to tens of PBytes. In such a large computing setup scheduled and unscheduled outages occur continually and are not allowed to significantly impactmore » data handling, processing, and analysis. Unscheduled capacity and performance reductions need to be detected promptly and corrected. CMS developed a sophisticated site evaluation and monitoring system for Run 1 of the LHC based on tools of the Worldwide LHC Computing Grid. For Run 2 of the LHC the site evaluation and monitoring system is being overhauled to enable faster detection/reaction to failures and a more dynamic handling of computing resources. Furthermore, enhancements to better distinguish site from central service issues and to make evaluations more transparent and informative to site support staff are planned.« less

  18. Gait termination in individuals with multiple sclerosis.

    PubMed

    Roeing, Kathleen L; Wajda, Douglas A; Motl, Robert W; Sosnoff, Jacob J

    2015-09-01

    Despite the ubiquitous nature of gait impairment in multiple sclerosis (MS), there is limited information concerning the control of gait termination in individuals with MS. The purpose of this investigation was to examine planned gait termination in individuals with MS and healthy controls with and without cognitive distractors. Individuals with MS and age matched controls completed a series of gait termination tasks over a pressure sensitive walkway under non-distracting and cognitively distracting conditions. As expected the MS group had a lower velocity (89.9±33.3 cm/s) than controls (142.8±22.4 cm/s) and there was a significant reduction in velocity in both groups under the cognitive distracting conditions (MS: 73.9±30.7 cm/s; control: 120.0±25.9 cm/s). Although individuals with MS walked slower, there was no difference between groups in the rate a participant failed to stop at the target (i.e. failure rate). Overall failure rate had a 10-fold increase in the cognitively distracting condition across groups. Individuals with MS were more unstable during termination. Future research examining the neuromuscular mechanisms contributing to gait termination is warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Grid site availability evaluation and monitoring at CMS

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

    Lyons, Gaston; Maciulaitis, Rokas; Bagliesi, Giuseppe

    The Compact Muon Solenoid (CMS) experiment at the Large Hadron Collider (LHC) uses distributed grid computing to store, process, and analyse the vast quantity of scientific data recorded every year. The computing resources are grouped into sites and organized in a tiered structure. Each site provides computing and storage to the CMS computing grid. Over a hundred sites worldwide contribute with resources from hundred to well over ten thousand computing cores and storage from tens of TBytes to tens of PBytes. In such a large computing setup scheduled and unscheduled outages occur continually and are not allowed to significantly impactmore » data handling, processing, and analysis. Unscheduled capacity and performance reductions need to be detected promptly and corrected. CMS developed a sophisticated site evaluation and monitoring system for Run 1 of the LHC based on tools of the Worldwide LHC Computing Grid. For Run 2 of the LHC the site evaluation and monitoring system is being overhauled to enable faster detection/reaction to failures and a more dynamic handling of computing resources. Furthermore, enhancements to better distinguish site from central service issues and to make evaluations more transparent and informative to site support staff are planned.« less

  20. Grid site availability evaluation and monitoring at CMS

    NASA Astrophysics Data System (ADS)

    Lyons, Gaston; Maciulaitis, Rokas; Bagliesi, Giuseppe; Lammel, Stephan; Sciabà, Andrea

    2017-10-01

    The Compact Muon Solenoid (CMS) experiment at the Large Hadron Collider (LHC) uses distributed grid computing to store, process, and analyse the vast quantity of scientific data recorded every year. The computing resources are grouped into sites and organized in a tiered structure. Each site provides computing and storage to the CMS computing grid. Over a hundred sites worldwide contribute with resources from hundred to well over ten thousand computing cores and storage from tens of TBytes to tens of PBytes. In such a large computing setup scheduled and unscheduled outages occur continually and are not allowed to significantly impact data handling, processing, and analysis. Unscheduled capacity and performance reductions need to be detected promptly and corrected. CMS developed a sophisticated site evaluation and monitoring system for Run 1 of the LHC based on tools of the Worldwide LHC Computing Grid. For Run 2 of the LHC the site evaluation and monitoring system is being overhauled to enable faster detection/reaction to failures and a more dynamic handling of computing resources. Enhancements to better distinguish site from central service issues and to make evaluations more transparent and informative to site support staff are planned.

  1. [Study on incorporation of "management and guidance of home-visiting by a pharmacist" into a care plan -observation based on a survey of care managers-].

    PubMed

    Nanaumi, Yoko; Onda, Mitsuko; Sakurai, Hidehiko; Tanaka, Rie; Tsubota, Kenichi; Matoba, Shunya; Mukai, Yusuke; Arakawa, Yukio; Hayase, Yukitoshi

    2010-11-01

    A survey of care managers ("CMs") was conducted to identify top priority issues in promoting the management and guidance of home-visiting by a pharmacist ("management and guidance") by focusing on the experience in incorporating the management and guidance into a care plan and its relevant factors. Major survey items included (1) number of years working as a CM, (2) basic occupation, (3) experience in incorporating the management and guidance into care plans, (4) understanding the management and guidance content, and (5) an awareness of the need for pharmacists' involvement in care plans. A χ² test was conducted to determine if the experience in incorporating the management and guidance into care plans caused a difference in the distribution of the number of years as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans. A regression analysis was conducted to determine the degree of association between the incorporation experience and each item. The numbers of years working as a CM, the basic occupation, understanding of the management and guidance content, and an awareness of the need for pharmacists' involvement in care plans, were found to be associated with the experience in incorporating the management and guidance into care plans. Understanding of the management and guidance content was most closely associated. To promote pharmacists' management and guidance for home-based care, CMs need to deepen their understanding of this service.

  2. Development of CMS monitoring procedures : technical summary.

    DOT National Transportation Integrated Search

    1998-04-01

    This research study is concerned with the development of a set of procedures for monitoring congestion using GPS and GIS. These procedures are meant to be used more as a planning tool than for everyday traffic monitoring. Under this assumption, a ser...

  3. 77 FR 16551 - Early Retiree Reinsurance Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-21

    ...] Early Retiree Reinsurance Program AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice establishes a timeframe by which plan sponsors participating in the Early... Early Retiree Reinsurance Program (ERRP) which provides reimbursement to eligible sponsors of employment...

  4. 75 FR 43178 - Medicare Program; Solicitation for Proposals for the Medicare Imaging Demonstration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-23

    ..., medical specialty societies, physician groups, integrated health care delivery systems, independent practice associations, radiology benefit managers, health plans, information technology vendors, and... societies. The Centers for Medicare & Medicaid Services (CMS) worked with medical specialty societies and...

  5. Cytoplasmic male sterility (CMS) in hybrid breeding in field crops.

    PubMed

    Bohra, Abhishek; Jha, Uday C; Adhimoolam, Premkumar; Bisht, Deepak; Singh, Narendra P

    2016-05-01

    A comprehensive understanding of CMS/Rf system enabled by modern omics tools and technologies considerably improves our ability to harness hybrid technology for enhancing the productivity of field crops. Harnessing hybrid vigor or heterosis is a promising approach to tackle the current challenge of sustaining enhanced yield gains of field crops. In the context, cytoplasmic male sterility (CMS) owing to its heritable nature to manifest non-functional male gametophyte remains a cost-effective system to promote efficient hybrid seed production. The phenomenon of CMS stems from a complex interplay between maternally-inherited (mitochondrion) and bi-parental (nucleus) genomic elements. In recent years, attempts aimed to comprehend the sterility-inducing factors (orfs) and corresponding fertility determinants (Rf) in plants have greatly increased our access to candidate genomic segments and the cloned genes. To this end, novel insights obtained by applying state-of-the-art omics platforms have substantially enriched our understanding of cytoplasmic-nuclear communication. Concomitantly, molecular tools including DNA markers have been implicated in crop hybrid breeding in order to greatly expedite the progress. Here, we review the status of diverse sterility-inducing cytoplasms and associated Rf factors reported across different field crops along with exploring opportunities for integrating modern omics tools with CMS-based hybrid breeding.

  6. VIPRAM_L1CMS: a 2-Tier 3D Architecture for Pattern Recognition for Track Finding

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

    Hoff, J. R.; Joshi, Joshi,S.; Liu, Liu,

    In HEP tracking trigger applications, flagging an individual detector hit is not important. Rather, the path of a charged particle through many detector layers is what must be found. Moreover, given the increased luminosity projected for future LHC experiments, this type of track finding will be required within the Level 1 Trigger system. This means that future LHC experiments require not just a chip capable of high-speed track finding but also one with a high-speed readout architecture. VIPRAM_L1CMS is 2-Tier Vertically Integrated chip designed to fulfill these requirements. It is a complete pipelined Pattern Recognition Associative Memory (PRAM) architecture includingmore » pattern recognition, result sparsification, and readout for Level 1 trigger applications in CMS with 15-bit wide detector addresses and eight detector layers included in the track finding. Pattern recognition is based on classic Content Addressable Memories with a Current Race Scheme to reduce timing complexity and a 4-bit Selective Precharge to minimize power consumption. VIPRAM_L1CMS uses a pipelined set of priority-encoded binary readout structures to sparsify and readout active road flags at frequencies of at least 100MHz. VIPRAM_L1CMS is designed to work directly with the Pulsar2b Architecture.« less

  7. Enabling global collaborations through policy engagement and CMS applications

    NASA Astrophysics Data System (ADS)

    Escobar, V. M.; Sepulveda Carlo, E.; Delgado Arias, S.

    2015-12-01

    Different spatial scales prompt different discussions among carbon data stakeholders. NASA's Carbon Monitoring System (CMS) initiative has enabled collaboration opportunities with stakeholders whose data needs and requirements are unique to the spatial scope of their work: from county to the international scale. At the very local level, the Sonoma County Agricultural Preservation and Open Space District leverages CMS high-resolution biomass estimates to develop a Monitoring, Reporting, and Verification (MRV) system in support of the District's 10-year land stewardship plan and the California's Global Warming Solutions Act (AB32). On the eastern coast, at the state level, the Maryland Department of Natural Resources utilizes the same high-resolution biomass estimates on a larger scale to better strategize in achieving the goal of 40% canopy cover statewide by 2020. At a regional scale that encompasses the three states of Maryland, Delaware, and Pennsylvania, LiDAR data collection of the Chesapeake Bay watershed dominate the stakeholder discussions. By collaborating with the U.S. Geological Survey's 3-D Elevation Program (3DEP), high-resolution LiDAR data will fill critical data gaps to help implement watershed protection strategies such as increasing riparian forest buffers to reduce runoff. Outside of the U.S., the World Resources Institute seeks to harness CMS reforestation products and technical expertise in addressing land restoration priorities specific to each Latin American country. CMS applications efforts expand beyond forest carbon examples discussed above to include carbon markets, ocean acidification, national greenhouse gas inventory, and wetlands. The broad array of case studies and lessons learned through CMS Applications in scaling carbon science for policy development at different spatial scales is providing unique opportunities that leverage science through policy needs.

  8. The use of think-aloud protocols to identify a decision-making process of community pharmacists aimed at improving CMS Star Ratings scores.

    PubMed

    George, David L; Smith, Michael J; Draugalis, JoLaine R; Tolma, Eleni L; Keast, Shellie L; Wilson, Justin B

    2018-03-01

    The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions. To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures. Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator. A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings. TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting. Published by Elsevier Inc.

  9. 42 CFR 423.56 - Procedures to determine and document creditable status of prescription drug coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... under § 423.46. (e) Disclosure to CMS. With the exception of PDPs and MA-PD plans under § 423.56(b)(1... coverage is considered creditable if it meets the definition provided in paragraph (a) of this section: (1) Prescription drug coverage under a PDP or MA-PD plan. (2) Medicaid coverage under title XIX of the Act or under...

  10. 42 CFR 423.56 - Procedures to determine and document creditable status of prescription drug coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... under § 423.46. (e) Disclosure to CMS. With the exception of PDPs and MA-PD plans under § 423.56(b)(1... coverage is considered creditable if it meets the definition provided in paragraph (a) of this section: (1) Prescription drug coverage under a PDP or MA-PD plan. (2) Medicaid coverage under title XIX of the Act or under...

  11. 42 CFR 423.56 - Procedures to determine and document creditable status of prescription drug coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... under § 423.46. (e) Disclosure to CMS. With the exception of PDPs and MA-PD plans under § 423.56(b)(1... coverage is considered creditable if it meets the definition provided in paragraph (a) of this section: (1) Prescription drug coverage under a PDP or MA-PD plan. (2) Medicaid coverage under title XIX of the Act or under...

  12. Plan–Provider Integration, Premiums, and Quality in the Medicare Advantage Market

    PubMed Central

    Frakt, Austin B; Pizer, Steven D; Feldman, Roger

    2013-01-01

    Objective. To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. Data Source. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. Study Design. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan–provider integration. Data Collection. With the exception of Medigap premium data, all data were publicly available. We ascertained plan–provider integration through examination of plans’ websites and governance documents. Principal Findings. We found that integrated plan–providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Conclusions. Current policy encourages plan–provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). PMID:23800017

  13. CMS Readiness for Multi-Core Workload Scheduling

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

    Perez-Calero Yzquierdo, A.; Balcas, J.; Hernandez, J.

    In the present run of the LHC, CMS data reconstruction and simulation algorithms benefit greatly from being executed as multiple threads running on several processor cores. The complexity of the Run 2 events requires parallelization of the code to reduce the memory-per- core footprint constraining serial execution programs, thus optimizing the exploitation of present multi-core processor architectures. The allocation of computing resources for multi-core tasks, however, becomes a complex problem in itself. The CMS workload submission infrastructure employs multi-slot partitionable pilots, built on HTCondor and GlideinWMS native features, to enable scheduling of single and multi-core jobs simultaneously. This provides amore » solution for the scheduling problem in a uniform way across grid sites running a diversity of gateways to compute resources and batch system technologies. This paper presents this strategy and the tools on which it has been implemented. The experience of managing multi-core resources at the Tier-0 and Tier-1 sites during 2015, along with the deployment phase to Tier-2 sites during early 2016 is reported. The process of performance monitoring and optimization to achieve efficient and flexible use of the resources is also described.« less

  14. CMS readiness for multi-core workload scheduling

    NASA Astrophysics Data System (ADS)

    Perez-Calero Yzquierdo, A.; Balcas, J.; Hernandez, J.; Aftab Khan, F.; Letts, J.; Mason, D.; Verguilov, V.

    2017-10-01

    In the present run of the LHC, CMS data reconstruction and simulation algorithms benefit greatly from being executed as multiple threads running on several processor cores. The complexity of the Run 2 events requires parallelization of the code to reduce the memory-per- core footprint constraining serial execution programs, thus optimizing the exploitation of present multi-core processor architectures. The allocation of computing resources for multi-core tasks, however, becomes a complex problem in itself. The CMS workload submission infrastructure employs multi-slot partitionable pilots, built on HTCondor and GlideinWMS native features, to enable scheduling of single and multi-core jobs simultaneously. This provides a solution for the scheduling problem in a uniform way across grid sites running a diversity of gateways to compute resources and batch system technologies. This paper presents this strategy and the tools on which it has been implemented. The experience of managing multi-core resources at the Tier-0 and Tier-1 sites during 2015, along with the deployment phase to Tier-2 sites during early 2016 is reported. The process of performance monitoring and optimization to achieve efficient and flexible use of the resources is also described.

  15. Report: Clean Air Act Facility Evaluations Are Conducted, but Inaccurate Data Hinder EPA Oversight and Public Awareness

    EPA Pesticide Factsheets

    Report #16-P-0164, May 3, 2016. Accurate enforcement databases and updated CMS plans promote effective and efficient EPA oversight of compliance programs, and help to protect the public from harmful air pollutants.

  16. NASA's Carbon Monitoring System (CMS) Applications and Application Readiness Levels (ARLs)-An assessment of how all CMS ARLs provide societal benefit.

    NASA Astrophysics Data System (ADS)

    Escobar, V. M.; Sepulveda Carlo, E.; Delgado Arias, S.

    2016-12-01

    During the past six years, the NASA Carbon Monitoring System (CMS) Applications effort has been engaging with stakeholders in an effort to make the 52 CMS project user friendly and policy relevant. Congressionally directed, the CMS initiative is a NASA endeavor providing carbon data products that help characterize and understand carbon sources and sinks at local and international scales. All data are freely available, and scaled for local, state, regional, national and international-level resource management. To facilitate user feedback during development, as well as understanding for the type of use and application the CMS data products can provide, the Applications project utilizes the NASA Applied Sciences Program nine step Application Readiness Level (ARL) indices. These are used to track and manage the progression and distribution of funded projects. ARLs are an adaptation of NASA's technology readiness levels (TRLs) used for managing technology and risk and reflects the three main tiers of a project: research, development and deployment. The ARLs are scaled from 1 to 9, research and development (ARL1) to operational and/or decision making ready products (ARL9). The ARLS can be broken up into three phases: Phase 1, discovery and feasibility (ARL 1-3); Phase 2, development testing and validation (ARL 4-6); and Phase 3, integration into Partner's systems (ARL 7-9). The ARLs are designed to inform both scientist and end user of the product maturity and application capability. The CMS initiative has products that range across all ARLs, providing societal benefit at multiple scales. Lower ARLs contribute to formal documents such as the IPCC while others at higher levels provide decision support quantifying the value of carbon data for greenhouse gas (GHG) reduction planning. Most CMS products have an ARL 5, (validation of a product in a relevant environment), meaning the CMS carbon science is actively in a state of science-user engagement. For the user community, ARLs are a litmus test for knowing the type of user feedback and advocacy that can be implemented into the product design. For the scientist, ARLS help communicate (1) the maturity of their science to users who would like to use it for decision making and (2) the intended use of the product.

  17. CMS tier structure and operation of the experiment-specific tasks in Germany

    NASA Astrophysics Data System (ADS)

    Nowack, A.

    2008-07-01

    In Germany, several university institutes and research centres take part in the CMS experiment. Concerning the data analysis, a couple of computing centres at different Tier levels, ranging from Tier 1 to Tier 3, exists at these places. The German Tier 1 centre GridKa at the research centre at Karlsruhe serves all four LHC experiments as well as four non-LHC experiments. With respect to the CMS experiment, GridKa is mainly involved in central tasks. The Tier 2 centre in Germany consists of two sites, one at the research centre DESY at Hamburg and one at RWTH Aachen University, forming a federated Tier 2 centre. Both parts cover different aspects of a Tier 2 centre. The German Tier 3 centres are located at the research centre DESY at Hamburg, at RWTH Aachen University, and at the University of Karlsruhe. Furthermore the building of a German user analysis facility is planned. Since the CMS community in German is rather small, a good cooperation between the different sites is essential. This cooperation includes physical topics as well as technical and operational issues. All available communication channels such as email, phone, monthly video conferences, and regular personal meetings are used. For example, the distribution of data sets is coordinated globally within Germany. Also the CMS-specific services such as the data transfer tool PhEDEx or the Monte Carlo production are operated by people from different sites in order to spread the knowledge widely and increase the redundancy in terms of operators.

  18. CMS changes in reimbursement for HAIs: setting a research agenda.

    PubMed

    Stone, Patricia W; Glied, Sherry A; McNair, Peter D; Matthes, Nikolas; Cohen, Bevin; Landers, Timothy F; Larson, Elaine L

    2010-05-01

    The Centers for Medicare and Medicaid Services (CMS) promulgated regulations commencing October 1, 2008, which deny payment for selected conditions occurring during the hospital stay and are not present on admission. Three of the 10 hospital-acquired conditions covered by the new CMS policy involve healthcare-associated infections, which are a common, expensive, and often preventable cause of inpatient morbidity and mortality. To outline a research agenda on the impact of CMS's payment policy on the healthcare system and the prevention of healthcare-associated infections. An invitational day-long conference was convened in April 2009. Including the planning committee and speakers there were 41 conference participants who were national experts and senior researchers. Building upon a behavioral model and organizational theory and management research a conceptual framework was applied to organize the wide range of issues that arose. A broad array of research topics was identified. Thirty-two research agenda items were organized in the areas of incentives, environmental factors, organizational factors, clinical outcomes, staff outcomes, and financial outcomes. Methodological challenges are also discussed. This policy is a first significant step to move output-based inpatient funding to outcome-based funding, and this agenda is applicable to all hospital-acquired conditions. Studies beginning soon will have the best hope of capturing data for the years preceding the policy change, a key element in non-experimental research. The CMS payment policy offers an excellent opportunity to understand and influence the use of financial incentives for improving patient safety.

  19. A browser-based event display for the CMS Experiment at the LHC using WebGL

    NASA Astrophysics Data System (ADS)

    McCauley, T.

    2017-10-01

    Modern web browsers are powerful and sophisticated applications that support an ever-wider range of uses. One such use is rendering high-quality, GPU-accelerated, interactive 2D and 3D graphics in an HTML canvas. This can be done via WebGL, a JavaScript API based on OpenGL ES. Applications delivered via the browser have several distinct benefits for the developer and user. For example, they can be implemented using well-known and well-developed technologies, while distribution and use via a browser allows for rapid prototyping and deployment and ease of installation. In addition, delivery of applications via the browser allows for easy use on mobile, touch-enabled devices such as phones and tablets. iSpy WebGL is an application for visualization of events detected and reconstructed by the CMS Experiment at the Large Hadron Collider at CERN. The first event display developed for an LHC experiment to use WebGL, iSpy WebGL is a client-side application written in JavaScript, HTML, and CSS and uses the WebGL API three.js. iSpy WebGL is used for monitoring of CMS detector performance, for production of images and animations of CMS collisions events for the public, as a virtual reality application using Google Cardboard, and asa tool available for public education and outreach such as in the CERN Open Data Portal and the CMS masterclasses. We describe here its design, development, and usage as well as future plans.

  20. IMRT for Image-Guided Single Vocal Cord Irradiation

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

    Osman, Sarah O.S., E-mail: s.osman@erasmusmc.nl; Astreinidou, Eleftheria; Boer, Hans C.J. de

    2012-02-01

    Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRTmore » plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose {+-} standard deviation to the planning target volume was 67 {+-} 1 Gy. The contralateral vocal cord dose was reduced from 66 {+-} 1 Gy in the conventional plans to 39 {+-} 8 Gy and 36 {+-} 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.« less

  1. Differential proteomic analysis of the anti-depressive effects of oleamide in a rat chronic mild stress model of depression.

    PubMed

    Ge, Lin; Zhu, Ming-Ming; Yang, Jing-Yu; Wang, Fang; Zhang, Rong; Zhang, Jing-Hai; Shen, Jing; Tian, Hui-Fang; Wu, Chun-Fu

    2015-04-01

    Depression is a complex psychiatric disorder, and its etiology and pathophysiology are not completely understood. Depression involves changes in many biogenic amine, neuropeptide, and oxidative systems, as well as alterations in neuroendocrine function and immune-inflammatory pathways. Oleamide is a fatty amide which exhibits pharmacological effects leading to hypnosis, sedation, and anti-anxiety effects. In the present study, the chronic mild stress (CMS) model was used to investigate the antidepressant-like activity of oleamide. Rats were exposed to 10weeks of CMS or control conditions and were then subsequently treated with 2weeks of daily oleamide (5mg/kg, i.p.), fluoxetine (10mg/kg, i.p.), or vehicle. Protein extracts from the hippocampus were then collected, and hippocampal maps were generated by way of two-dimensional gel electrophoresis (2-DE). Altered proteins induced by CMS and oleamide were identified through mass spectrometry and database searches. Compared to the control group, the CMS rats exhibited significantly less body weight gain and decreased sucrose consumption. Treatment with oleamide caused a reversal of the CMS-induced deficit in sucrose consumption. In the proteomic analysis, 12 protein spots were selected and identified. CMS increased the levels of adenylate kinase isoenzyme 1 (AK1), nucleoside diphosphate kinase B (NDKB), histidine triad nucleotide-binding protein 1 (HINT1), acyl-protein thioesterase 2 (APT-2), and glutathione S-transferase A4 (GSTA4). Compared to the CMS samples, seven spots changed significantly following treatment with oleamide, including GSTA4, glutathione S-transferase A6 (GSTA6), GTP-binding nuclear protein Ran (Ran-GTP), ATP synthase subunit d, transgelin-3, small ubiquitin-related modifier 2 (SUMO2), and eukaryotic translation initiation factor 5A-1 (eIF5A1). Of these seven proteins, the level of eIF5A1 was up-regulated, whereas the remaining proteins were down-regulated. In conclusion, oleamide has antidepressant-like properties in the CMS rat model. The identification of proteins altered by CMS and oleamide treatment provides support for targeting these proteins in the development of novel therapies for depression. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Community pharmacists' beliefs regarding improvement of Star Ratings scores using the Theory of Planned Behavior.

    PubMed

    George, David L; Smith, Michael J; Draugalis, JoLaine R; Tolma, Eleni L; Keast, Shellie L; Wilson, Justin B

    The Centers for Medicare and Medicaid Services (CMS) is moving toward a value-based model, which includes the Five-Star Quality Rating System (Star Ratings). Prescription Drug Plans include multiple pharmacy measures associated with adherence and patient safety that contribute to CMS Star Ratings scores. This study, using the Theory of Planned Behavior (TPB), explored factors associated with community pharmacists' beliefs to improve Star Ratings scores. Exploratory, qualitative, use of focus groups, and the TPB. Focus groups were performed in conference rooms at the College of Pharmacy main and satellite campuses. Participants were community retail pharmacists with an active Oklahoma license and 1 year of work experience. Each focus group was audio recorded and the recording transcribed to documents and analyzed with the use of a hybrid deductive and inductive qualitative approach rooted in a constant comparative framework. Coding of the data back to the TPB constitutes a deductive approach. The generation of themes and subthemes from other coded nodes constitutes an inductive approach. Analysts agreed on common themes, differences in findings, and saturation of the data gathered. Four focus groups were conducted with 26 participants in 2 categories: pharmacists with and without experience improving Star Ratings. Pharmacists shared and contrasted in salient, normative, and control beliefs about patient outcomes, data, financial implications, staff, technology, and other stakeholders associated with performance of improving Star Ratings. Themes regarding medication adherence, patient safety, and intention were also found. The TPB was used to explore beliefs of community pharmacists about improving Star Ratings scores. Themes that were identified will assist in future research for measuring intention to improve CMS Star Ratings scores and the development of training and education programs. Published by Elsevier Inc.

  3. Evaluation of dosimetric effect caused by slowing with multi-leaf collimator (MLC) leaves for volumetric modulated arc therapy (VMAT)

    PubMed Central

    Wang, Iris Z.; Kumaraswamy, Lalith K.; Podgorsak, Matthew B.

    2016-01-01

    Background This study is to report 1) the sensitivity of intensity modulated radiation therapy (IMRT) QA method for clinical volumetric modulated arc therapy (VMAT) plans with multi-leaf collimator (MLC) leaf errors that will not trigger MLC interlock during beam delivery; 2) the effect of non-beam-hold MLC leaf errors on the quality of VMAT plan dose delivery. Materials and methods. Eleven VMAT plans were selected and modified using an in-house developed software. For each control point of a VMAT arc, MLC leaves with the highest speed (1.87-1.95 cm/s) were set to move at the maximal allowable speed (2.3 cm/s), which resulted in a leaf position difference of less than 2 mm. The modified plans were considered as ‘standard’ plans, and the original plans were treated as the ‘slowing MLC’ plans for simulating ‘standard’ plans with leaves moving at relatively lower speed. The measurement of each ‘slowing MLC’ plan using MapCHECK®2 was compared with calculated planar dose of the ‘standard’ plan with respect to absolute dose Van Dyk distance-to-agreement (DTA) comparisons using 3%/3 mm and 2%/2 mm criteria. Results All ‘slowing MLC’ plans passed the 90% pass rate threshold using 3%/3 mm criteria while one brain and three anal VMAT cases were below 90% with 2%/2 mm criteria. For ten out of eleven cases, DVH comparisons between ‘standard’ and ‘slowing MLC’ plans demonstrated minimal dosimetric changes in targets and organs-at-risk. Conclusions For highly modulated VMAT plans, pass rate threshold (90%) using 3%/3mm criteria is not sensitive in detecting MLC leaf errors that will not trigger the MLC leaf interlock. However, the consequential effects of non-beam hold MLC errors on target and OAR doses are negligible, which supports the reliability of current patient-specific IMRT quality assurance (QA) method for VMAT plans. PMID:27069458

  4. 42 CFR 423.34 - Enrollment of low-income subsidy eligible individuals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... unless they affirmatively enroll in a Part D plan or contact CMS and confirm that they wish to be auto-enrolled in a PDP. Individuals who elect not to be auto-enrolled, may enroll in Medicare Part D at a later...

  5. 42 CFR 417.598 - Annual enrollment reconciliation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Annual enrollment reconciliation. 417.598 Section 417.598 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.598 Annual enrollment reconciliation. CMS...

  6. 42 CFR 410.143 - Requirements for approved accreditation organizations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Requirements for approved accreditation organizations. 410.143 Section 410.143 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... decisions and any accreditation-related information that CMS may require (including corrective action plans...

  7. 42 CFR 423.34 - Enrollment of low-income subsidy eligible individuals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... unless they affirmatively enroll in a Part D plan or contact CMS and confirm that they wish to be auto-enrolled in a PDP. Individuals who elect not to be auto-enrolled, may enroll in Medicare Part D at a later...

  8. Impact of Appointment-Based Medication Synchronization on Proportion of Days Covered for Chronic Medications.

    PubMed

    Dao, Nancy; Lee, Sun; Hata, Micah; Sarino, Lord

    2018-05-22

    Appointment-based medication synchronization (ABMS) programs have been associated with increased adherence and persistence to chronic medications. Adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) are used to determine a health plan's Centers for Medicare and Medicaid Services (CMS) Star Rating under a pay-for-performance model. The objective of this study was to evaluate the impact of implementing an ABMS program on overall pharmacy adherence measures for statins, ACEI/ARBs, and NIDM, as presented through the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP©) platform. This retrospective, pre-post ABMS program study evaluated EQuIPP© generated adherence performance measures, represented as proportion of days covered (PDC), 6-months before and 6- and 12-months after the ABMS service for statin therapy, ACEIs/ARBs, and NIDM. All adherence measures showed statistically significant improvement in PDC percentage post ABMS implementation, except for NIDM percentage in 6-months post-ABMS service. This study shows that a comprehensive medication synchronization program can enhance adherence measures that are important to health plans to increase CMS Star Rating under a pay-for-performance model.

  9. Bringing the CMS distributed computing system into scalable operations

    NASA Astrophysics Data System (ADS)

    Belforte, S.; Fanfani, A.; Fisk, I.; Flix, J.; Hernández, J. M.; Kress, T.; Letts, J.; Magini, N.; Miccio, V.; Sciabà, A.

    2010-04-01

    Establishing efficient and scalable operations of the CMS distributed computing system critically relies on the proper integration, commissioning and scale testing of the data and workload management tools, the various computing workflows and the underlying computing infrastructure, located at more than 50 computing centres worldwide and interconnected by the Worldwide LHC Computing Grid. Computing challenges periodically undertaken by CMS in the past years with increasing scale and complexity have revealed the need for a sustained effort on computing integration and commissioning activities. The Processing and Data Access (PADA) Task Force was established at the beginning of 2008 within the CMS Computing Program with the mandate of validating the infrastructure for organized processing and user analysis including the sites and the workload and data management tools, validating the distributed production system by performing functionality, reliability and scale tests, helping sites to commission, configure and optimize the networking and storage through scale testing data transfers and data processing, and improving the efficiency of accessing data across the CMS computing system from global transfers to local access. This contribution reports on the tools and procedures developed by CMS for computing commissioning and scale testing as well as the improvements accomplished towards efficient, reliable and scalable computing operations. The activities include the development and operation of load generators for job submission and data transfers with the aim of stressing the experiment and Grid data management and workload management systems, site commissioning procedures and tools to monitor and improve site availability and reliability, as well as activities targeted to the commissioning of the distributed production, user analysis and monitoring systems.

  10. The phase 1 upgrade of the CMS Pixel Front-End Driver

    NASA Astrophysics Data System (ADS)

    Friedl, M.; Pernicka, M.; Steininger, H.

    2010-12-01

    The pixel detector of the CMS experiment at the LHC is read out by analog optical links, sending the data to 9U VME Front-End Driver (FED) boards located in the electronics cavern. There are plans for the phase 1 upgrade of the pixel detector (2016) to add one more layer, while significantly cutting down the overall material budget. At the same time, the optical data transmission will be replaced by a serialized digital scheme. A plug-in board solution with a high-speed digital optical receiver has been developed for the Pixel-FED readout boards and will be presented along with first tests of the future optical link.

  11. 42 CFR 431.992 - Corrective action plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CMS, designed to reduce improper payments in each program based on its analysis of the error causes in... State must take the following actions: (1) Data analysis. States must conduct data analysis such as reviewing clusters of errors, general error causes, characteristics, and frequency of errors that are...

  12. 42 CFR 431.992 - Corrective action plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CMS, designed to reduce improper payments in each program based on its analysis of the error causes in... State must take the following actions: (1) Data analysis. States must conduct data analysis such as reviewing clusters of errors, general error causes, characteristics, and frequency of errors that are...

  13. 77 FR 25181 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... for use in quality improvement activities, plan accountability, public reporting, and improving health... accountable for the quality of care they are delivering. This reporting requirement allows CMS to obtain the... 0938-0969); Frequency: Occasionally; Affected Public: Private Sector (Business or other for-profit and...

  14. 77 FR 70163 - Recognition of Entities for the Accreditation of Qualified Health Plans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-23

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES [CMS-9961-N] Recognition of Entities for the Accreditation... as recognized accrediting entities for the purposes of fulfilling the accreditation requirement as... a recognized accrediting entity on a uniform timeline established by the applicable Exchange. On...

  15. Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

    PubMed

    McLawhorn, Alexander S; Buller, Leonard T

    2017-09-01

    The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

  16. [Genetics of fertility restoration in the isocytoplasm allonuclear C-group of cytoplasmic male sterility in maize].

    PubMed

    Zhao, Zhuo Fan; Huang, Ling; Liu, Yong Ming; Zhang, Peng; Wei, Gui; Cao, Mo Ju

    2018-05-20

    Maize is one of the first crops to produce hybrids using cytoplasmic male sterile lines. The C-type cytoplasmic male sterile (CMS-C) line is vital for hybrid seed production, and the fertility-restoration reaction along with its stability has a direct bearing on its applications. However, fertility restoration mechanism of CMS-C is complex and is still not clear so far. To further explore the factors affecting the fertility restoration of maize CMS, a series of test crosses were carried out by pollinating the isocytoplasm allonuclear CMS-C lines C48-2, Chuangzaosi and C478 with the test lines 18 bai, zi 330, 5022 and the restorer line A619, respectively. Four F 2 populations and six double-cross combinations were obtained from the self-cross of fertility restored F 1 and pollinating male-sterility-maintained F 1 with the male-fertility-restored F 1 , respectively. Meanwhile, we developed the incomplete diallel-cross combinations using the isocytoplasm allonuclear male sterile lines as maternal parents and their respective maintainer lines 48-2, huangzaosi and 478 as paternal parents. All the F 1 , F 2 and double-cross populations were planted at distinct locations in different years, and the fertility-restoration reaction was scored by field investigation and pollen staining with I 2 -IK. The results were as follows: 1) The same test line could restore the CMS-C line at a certain genetic background, but failed to restore the CMS-C line at the other genetic backgrounds, suggesting that the genetic background of CMS-C lines plays an important role in the fertility restoration. 2) The fertile-to-sterile segregation ratio of (C48-2×A619) F 2 population planted in both Sichuan and Yunnan fited well to 15:1 by the χ 2 test. However, the fertility level of individuals in Yunnan mainly belonged to the 3 and 4grades, but which in Sichuan mainly belonged to the 5 grade, indicating the environmental factors had effect on the fertility-restoration reaction of (C48-2×A619) F 2 . 3) In our study, 18 bai could not restore C478, and 48-2 could not restore C478, but the fertile and sterile segregated plants were unexpectedly found in their double-cross population [(C478×18 bai) F 1S ×(C48-2×18 bai) F 1F ]. The similar case was also observed in the double-cross population [(C48-2 × zi 330) F 1S × (C478 × zi 330) F 1F ]. Therefore, we speculated that there are minor fertility restorer genes not only in the nuclear background of C48-2 and C478, but also in zi 330 and 18 bai, and when these minor genes were gathered by hybridization, they could restore the fertility of C478 and C48-2. This conforms to the restorer genes dose-effect for fertility restoration in the plant CMS system. These results not only contribute to our understanding of the complexity and diversity of CMS-C restoration mechanism, but also provide an important reference for the practical applications about maize CMS-C.

  17. A histological ontology of the human cardiovascular system.

    PubMed

    Mazo, Claudia; Salazar, Liliana; Corcho, Oscar; Trujillo, Maria; Alegre, Enrique

    2017-10-02

    In this paper, we describe a histological ontology of the human cardiovascular system developed in collaboration among histology experts and computer scientists. The histological ontology is developed following an existing methodology using Conceptual Models (CMs) and validated using OOPS!, expert evaluation with CMs, and how accurately the ontology can answer the Competency Questions (CQ). It is publicly available at http://bioportal.bioontology.org/ontologies/HO and https://w3id.org/def/System . The histological ontology is developed to support complex tasks, such as supporting teaching activities, medical practices, and bio-medical research or having natural language interactions.

  18. A Multichannel Medication Adherence Intervention Influences Patient and Prescriber Behavior.

    PubMed

    Leslie, R Scott; Gilmer, Todd; Natarajan, Loki; Hovell, Melbourne

    2016-05-01

    The Centers for Medicare & Medicaid Services (CMS) Medicare Health Plan Quality and Performance Ratings program, or Star Ratings program, includes 3 medication adherence outcome measures (Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension, and Medication Adherence for Cholesterol), which contribute to approximately 31% of a Medicare Advantage prescription drug (MA-PD) plan's Part D summary rating and 12% of its overall star rating (a weighted summary of a plan's Part C and Part D ratings). MA-PD plans have been increasing their adherence intervention efforts as an approach to improving beneficiaries' medication adherence and the plan's quality performance ratings. However, few evaluations have examined the effects of these interventions on medication adherence and performance ratings. To assess the impact of a quasi-experimental multichannel adherence intervention on beneficiaries' medication adherence and health plan quality performance measures for 2 MA-PD plans. The intervention included a daily prescriber-directed 90-day retail refill component and a weekly member-directed refill reminder component. Members filling 1 or more medications assessed by the 3 CMS star ratings adherence measures (oral antidiabetics [DM], antihypertensives [HTN], and statins [CHOL]) were identified for a 2-component intervention starting in April 2013. The retail-based 90-day refill component sent populated 90-day prescription letters via fax to prescribers of members who had filled a 30-day prescription. One fax per member-medication instance was sent and included the option to fax approval of a new 90-day prescription. For prescribers who approved, members were notified that a 90-day refill was available at their retail pharmacies. The refill reminder component used weekly scans of pharmacy claims to identify members' refill patterns. Reminder letters were sent to members 7 days late to refill. An intent-to-treat approach was used to assess intervention effectiveness. Pharmacy claims and health plan enrollment data were used to calculate adherence among members enrolled 1 year pre- and postintervention start (April 2013) for the intervention group and a comparator group that consisted of 4 MA-PD plans not implementing an adherence intervention. Adherence was estimated by the proportion of days covered (PDC) and generalized linear models were fit to calculate difference-in-difference (DID) estimators to control for demographics, comorbidity, and changes in adherence over the study period. To estimate the impact of the intervention on health plan quality performance, 2013 and 2014 CMS star ratings for the respective 2012 and 2013 measurement years were compared by group. During the first year of the intervention, 1,344 prescribers representing 6,701 members were faxed 15,284 populated prescription letters. Prescriber response rate was 53.7% and approval rate (approved letters of total sent) was 47.3%. An average of 539 refill reminder letters were sent per week. DID estimators showed positive influence of the intervention on adherence to HTN and CHOL. For the intervention group, adherence increased 2.0 percentage points (P < 0.001) for HTN and 1.8 percentage points (P < 0.001) for CHOL, relative to the control group. The odds of achieving adherence (PDC ≥ 80%) were greater in the intervention group compared with control for HTN (ratio of odds ratio [ROR] = 1.334; 95% CI = 1.203-1.479) and for CHOL (ROR = 1.247; 95% CI = 1.132-1.374). For the 2 plans implementing the intervention, CMS-published adherence rates for DM, HTN, and CHOL increased from 2012 to 2013 by an average 5.5, 6.0, and 7.0 percentage points, respectively, compared with the control group (3.5, 2.0, and 1.8 percentage points, respectively). This study found increases in adherence to HTN and CHOL in 2 MA-PD plans implementing a combined prescriber and patient-directed intervention. MA-PD plans can use broad multichannel interventions to address common adherence barriers and as an approach to improving members' adherence to maintenance medications and CMS quality performance ratings. No funding was received in return for conducting this research. Leslie is an employee of MedImpact Healthcare Systems. The authors report no conflicts of interest. Study concept was developed primarily by Leslie, along with Gilmer. Leslie took the lead in data collection, while data interpretation was performed by Leslie, Natarajan, and Gilmer. The manuscript was written primarily by Leslie, along with Gilmer and assisted by Hovell. Leslie, Gilmer, and Hovell revised the manuscript, with assistance from Natarajan.

  19. 42 CFR 423.265 - Submission of bids and related information.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... to offer in the subsequent calendar year. (2) Substantial differences between bids. Potential Part D sponsors' bid submissions must reflect differences in benefit packages or plan costs that CMS determines to...) Bid submission—(1) General. Not later than the first Monday in June, each potential Part D sponsor...

  20. 42 CFR 423.265 - Submission of bids and related information.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to offer in the subsequent calendar year. (2) Substantial differences between bids. Potential Part D sponsors' bid submissions must reflect differences in benefit packages or plan costs that CMS determines to...) Bid submission—(1) General. Not later than the first Monday in June, each potential Part D sponsor...

  1. 42 CFR 423.265 - Submission of bids and related information.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... to offer in the subsequent calendar year. (2) Substantial differences between bids. Potential Part D sponsors' bid submissions must reflect differences in benefit packages or plan costs that CMS determines to...) Bid submission—(1) General. Not later than the first Monday in June, each potential Part D sponsor...

  2. 42 CFR 423.265 - Submission of bids and related information.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... calendar year. (2) Substantial differences between bids. Potential Part D sponsors' bid submissions must reflect differences in benefit packages or plan costs that CMS determines to represent substantial...) General. Not later than the first Monday in June, each potential Part D sponsor must submit bids and...

  3. 42 CFR 423.265 - Submission of bids and related information.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... calendar year. (2) Substantial differences between bids. Potential Part D sponsors' bid submissions must reflect differences in benefit packages or plan costs that CMS determines to represent substantial...) General. Not later than the first Monday in June, each potential Part D sponsor must submit bids and...

  4. 45 CFR 150.325 - Settlement authority.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Settlement authority. 150.325 Section 150.325 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS... Governmental Plans-Civil Money Penalties § 150.325 Settlement authority. Nothing in §§ 150.315 through 150.323...

  5. 75 FR 3908 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-25

    ... Comparative Database.'' In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3520, AHRQ invites the... Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey Comparative Database. [[Page 3909..., and the Centers for Medicare & Medicaid Services (CMS) to provide comparative data to support public...

  6. 45 CFR 150.343 - Notice of proposed penalty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....343 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... Non-Federal Governmental Plans-Civil Money Penalties § 150.343 Notice of proposed penalty. If CMS... entity's right to a hearing. (f) A statement that failure to request a hearing within 30 days permits the...

  7. 45 CFR 150.347 - Failure to request a hearing.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....347 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... Non-Federal Governmental Plans-Civil Money Penalties § 150.347 Failure to request a hearing. If the....343, CMS may assess the proposed civil money penalty, a less severe penalty, or a more severe penalty...

  8. 45 CFR 150.347 - Failure to request a hearing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....347 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... Non-Federal Governmental Plans-Civil Money Penalties § 150.347 Failure to request a hearing. If the....343, CMS may assess the proposed civil money penalty, a less severe penalty, or a more severe penalty...

  9. 45 CFR 150.343 - Notice of proposed penalty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....343 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... Non-Federal Governmental Plans-Civil Money Penalties § 150.343 Notice of proposed penalty. If CMS... entity's right to a hearing. (f) A statement that failure to request a hearing within 30 days permits the...

  10. 45 CFR 150.347 - Failure to request a hearing.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....347 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... Non-Federal Governmental Plans-Civil Money Penalties § 150.347 Failure to request a hearing. If the....343, CMS may assess the proposed civil money penalty, a less severe penalty, or a more severe penalty...

  11. 45 CFR 150.347 - Failure to request a hearing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....347 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS... Non-Federal Governmental Plans-Civil Money Penalties § 150.347 Failure to request a hearing. If the....343, CMS may assess the proposed civil money penalty, a less severe penalty, or a more severe penalty...

  12. 77 FR 55216 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-07

    ..., due to technical difficulties, the documents associated with the information collection request were not made available to the public until August 14, 2012. Because of the technical difficulties, CMS is... Social Security Act (SSA) requires Medicare health plans to provide enrollees with a written notice in...

  13. 42 CFR 422.252 - Terminology.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... § 422.252 Terminology. Annual MA capitation rate means a county payment rate for an MA local area... to refer to the annual MA capitation rate. MA local area means a payment area consisting of county or equivalent area specified by CMS. MA monthly basic beneficiary premium means the premium amount an MA plan...

  14. 77 FR 291 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-04

    ... Verification System (IEVS) Reporting and Supporting Regulations Contained in 42 CFR 431.17, 431.306, 435.910... verifications; Form Number: CMS-R-74 (OCN 0938-0467); Frequency: Monthly; Affected Public: State, Local, or..., issuers offering group health insurance coverage, and self-insured nonfederal governmental plans (through...

  15. 42 CFR 422.264 - Calculation of savings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...), adjusted using the factors described in paragraph (c) of this section. (3) The risk adjusted MA region... the upcoming calendar year the risk adjustment factors described in paragraph (c)(1) or (c)(2) of this... of calculating savings for MA local plans CMS has the authority to apply risk adjustment factors that...

  16. 42 CFR 422.264 - Calculation of savings.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...), adjusted using the factors described in paragraph (c) of this section. (3) The risk adjusted MA region... the upcoming calendar year the risk adjustment factors described in paragraph (c)(1) or (c)(2) of this... of calculating savings for MA local plans CMS has the authority to apply risk adjustment factors that...

  17. 75 FR 21295 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-23

    ... Medicare Advantage Quality Improvement Project; Use: The Social Security Act, section 1852 e(1), (2) and (3)(a)(i), and CFR 42, 422.152 describe CMS' regulatory authority to require each Medicare Advantage...; Title of Information Collection: Medicare Prescription Drug Plan (PDP) and Medicare Advantage...

  18. 42 CFR 430.86 - Discovery.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Discovery. 430.86 Section 430.86 Public Health... Plans and Practice to Federal Requirements § 430.86 Discovery. CMS and any party named in the notice issued under § 430.70 has the right to conduct discovery (including depositions) against opposing parties...

  19. 42 CFR 430.86 - Discovery.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Discovery. 430.86 Section 430.86 Public Health... Plans and Practice to Federal Requirements § 430.86 Discovery. CMS and any party named in the notice issued under § 430.70 has the right to conduct discovery (including depositions) against opposing parties...

  20. 42 CFR 417.122 - Protection of enrollees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... insolvency. (iv) Any other arrangements acceptable to CMS. (2) The requirements of this paragraph do not... HMO becomes insolvent. The insolvency protection plan required under § 417.120(a) must provide for... payment has been made. (2) For enrollees who are in an inpatient facility on the date of insolvency, until...

  1. 42 CFR 430.86 - Discovery.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Discovery. 430.86 Section 430.86 Public Health... Plans and Practice to Federal Requirements § 430.86 Discovery. CMS and any party named in the notice issued under § 430.70 has the right to conduct discovery (including depositions) against opposing parties...

  2. 42 CFR 423.2266 - Deemed approval.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Deemed approval. If CMS has not disapproved the distribution of marketing materials or forms submitted by... distribution of the marketing material or form in all other Part D regions covered by the Part D plan, with the...

  3. 76 FR 44009 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-22

    ... the hospital to the community for high-risk Medicare beneficiaries. The Centers for Medicare... so for up to five years. The planned collection of a participant experience survey is part of the... survey. Form Number: CMS-10403 (OMB 0938-New); Frequency: Once; Affected Public: Individuals or...

  4. Plan Your Future! Career Management Skills for Students of Languages

    ERIC Educational Resources Information Center

    Randall, Laurence

    2016-01-01

    At the University of Westminster, the Department of Modern Languages and Cultures has developed a student employability and work-integrated learning project, "Career Management Skills" (CMS), for undergraduate language students. The main objective was to develop a comprehensive employability strategy for all students on all undergraduate…

  5. 40 CFR 63.2994 - How do I verify the performance of monitoring equipment?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... monitoring equipment. (2) Conduct a performance evaluation of the continuous monitoring system (CMS...-specific performance evaluation plan, conduct of the performance evaluation, and reporting of performance... 40 Protection of Environment 12 2010-07-01 2010-07-01 true How do I verify the performance of...

  6. Science on Drupal: An evaluation of CMS Technologies

    NASA Astrophysics Data System (ADS)

    Vinay, S.; Gonzalez, A.; Pinto, A.; Pascuzzi, F.; Gerard, A.

    2011-12-01

    We conducted an extensive evaluation of various Content Management System (CMS) technologies for implementing different websites supporting interdisciplinary science data and information. We chose two products, Drupal and Bluenog/Hippo CMS, to meet our specific needs and requirements. Drupal is an open source product that is quick and easy to setup and use. It is a very mature, stable, and widely used product. It has rich functionality supported by a large and active user base and developer community. There are many plugins available that provide additional features for managing citations, map gallery, semantic search, digital repositories (fedora), scientific workflows, collaborative authoring, social networking, and other functions. All of these work very well within the Drupal framework if minimal customization is needed. We have successfully implemented Drupal for multiple projects such as: 1) the Haiti Regeneration Initiative (http://haitiregeneration.org/); 2) the Consortium on Climate Risk in the Urban Northeast (http://beta.ccrun.org/); and 3) the Africa Soils Information Service (http://africasoils.net/). We are also developing two other websites, the Côte Sud Initiative (CSI) and Emerging Infectious Diseases, using Drupal. We are testing the Drupal multi-site install for managing different websites with one install to streamline the maintenance. In addition, paid support and consultancy for Drupal website development are available at affordable prices. All of these features make Drupal very attractive for implementing state-of-the-art scientific websites that do not have complex requirements. One of our major websites, the NASA Socioeconomic Data and Applications Center (SEDAC), has a very complex set of requirements. It has to easily re-purpose content across multiple web pages and sites with different presentations. It has to serve the content via REST or similar standard interfaces so that external client applications can access content in the CMS repository. This means the content repository and structure should be completely separated from the content presentation and site structure. In addition to the CMS repository, the front-end website has to be able to consume, integrate, and display diverse content flexibly from multiple back-end systems, including custom and legacy systems, such as Oracle, Geoserver, Flickr, Fedora, and other web services. We needed the ability to customize the workflow to author, edit, approve, and publish content based on different content types and project requirements. In addition, we required the ability to use the existing active directory for user management with support for roles and groups and permissions using Access Control List (ACL) model. The ability to version and lock content was also important. We determined that most of these capabilities are difficult to implement with Drupal and needed significant customization. The Bluenog eCMS (enterprise CMS) product satisfied most of these requirements. Bluenog eCMS is based on an open source product called Hippo with customizations and support provided by the vendor Bluenog. Our newly redesigned and recently released SEDAC website, http://sedac.ciesin.columbia.edu, is implemented using Bluenog eCMS. Other products we evaluated include WebLogic portal, Magnolia, Liferay portal, and Alfresco.

  7. The Effect of Plan Type and Comprehensive Medication Reviews on High-Risk Medication Use.

    PubMed

    Almodovar, Armando Silva; Axon, David Rhys; Coleman, Ashley M; Warholak, Terri; Nahata, Milap C

    2018-05-01

    In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers. To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use. This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years. Performance data were downloaded per Medicare contract from the CMS. We matched Medicare insurance provider performance data with the enrollment data of each contract. Mann Whitney U and Spearman rho tests and a hierarchical linear regression model assessed the relationship between provider characteristics, high-risk medication use, and CMR completion rate outcome measures. In 2014, an inverse correlation between CMR completion rate and high-risk medication use was identified among MAPD plan providers. This relationship was further strengthened in 2015. No correlation was detected between the CMR completion rate and high-risk medication use among PDP plan providers in either year. A multivariate regression found an inverse association with high-risk medication use among MAPD plan providers in comparison with PDP plan providers in 2014 (beta = -0.358, P < 0.001) and 2015 (beta = -0.350, P < 0.001), the CMR completion rate in 2015 (beta = -0.221, P < 0.001), and enrollee population size in 2015 (beta = -0.203, P = 0.001). This study found that MAPD plan providers and higher CMR completion rates were associated with lower use of high-risk medications among beneficiaries. No outside funding supported this study. Silva Almodovar reports a fellowship funded by SinfoniaRx, Tucson, Arizona, during the time of this study. The other authors have nothing to disclose.

  8. Effect of Wind Velocity on Flame Spread in Microgravity

    NASA Technical Reports Server (NTRS)

    Prasad, Kuldeep; Olson, Sandra L.; Nakamura, Yuji; Fujita, Osamu; Nishizawa, Katsuhiro; Ito, Kenichi; Kashiwagi, Takashi; Simons, Stephen N. (Technical Monitor)

    2002-01-01

    A three-dimensional, time-dependent model is developed describing ignition and subsequent transition to flame spread over a thermally thin cellulosic sheet heated by external radiation in a microgravity environment. A low Mach number approximation to the Navier Stokes equations with global reaction rate equations describing combustion in the gas phase and the condensed phase is numerically solved. The effects of a slow external wind (1-20 cm/s) on flame transition are studied in an atmosphere of 35% oxygen concentration. The ignition is initiated at the center part of the sample by generating a line-shape flame along the width of the sample. The calculated results are compared with data obtained in the 10s drop tower. Numerical results exhibit flame quenching at a wind speed of 1.0 cm/s, two localized flames propagating upstream along the sample edges at 1.5 cm/s, a single line-shape flame front at 5.0 cm/s, three flames structure observed at 10.0 cm/s (consisting of a single line-shape flame propagating upstream and two localized flames propagating downstream along sample edges) and followed by two line-shape flames (one propagating upstream and another propagating downstream) at 20.0 cm/s. These observations qualitatively compare with experimental data. Three-dimensional visualization of the observed flame complex, fuel concentration contours, oxygen and reaction rate isosurfaces, convective and diffusive mass flux are used to obtain a detailed understanding of the controlling mechanism, Physical arguments based on lateral diffusive flux of oxygen, fuel depletion, oxygen shadow of the flame and heat release rate are constructed to explain the various observed flame shapes.

  9. Fertility of CMS wheat is restored by two Rf loci located on a recombined acrocentric chromosome

    PubMed Central

    Castillo, Almudena; Atienza, Sergio G.; Martín, Azahara C.

    2014-01-01

    Cytoplasmic male sterility (CMS) results from incompatibility between nuclear and cytoplasmic genomes, and is characterized by the inability to produce viable pollen. The restoration of male fertility generally involves the introgression of nuclear genes, termed restorers of fertility (Rf). CMS has been widely used for hybrid seed production in many crops but not in wheat, partly owing to the complex genetics of fertility restoration. In this study, an acrocentric chromosome that restores pollen fertility of CMS wheat in Hordeum chilense cytoplasm (msH1 system) is studied. The results show that this chromosome, of H. chilense origin and named Hchac, originated from a complex reorganization of the short arm of chromosomes 1Hch (1HchS) and 6Hch (6HchS). Diversity arrays technology (DArT) markers and cytological analysis indicate that Hchac is a kind of `zebra-like′ chromosome composed of chromosome 1HchS and alternate fragments of interstitial and distal regions of chromosome 6HchS. PCR-based markers together with FISH, GISH, and meiotic pairing analysis support this result. A restorer of fertility gene, named Rf 6H ch S, has been identified on the short arm of chromosome 6HchS. Moreover, restoration by the addition of chromosome 1HchS has been observed at a very low frequency and under certain environmental conditions. Therefore, the results indicate the presence of two Rf genes on the acrocentric chromosome: Rf 6H ch S and Rf 1H ch S, the restoration potential of Rf 6H ch S being greater. The stable and high restoration of pollen fertility in the msH1 system is therefore the result of the interaction between these two restorer genes. PMID:25271260

  10. Responsiveness to Change of Functional Limitation Reporting: Cross-sectional Study Using the Intermountain ROMS Scale in Outpatient Rehabilitation.

    PubMed

    Brennan, Gerard P; Hunter, Stephen J; Snow, Greg; Minick, Kate I

    2017-12-01

    The Centers for Medicare and Medicaid Services (CMS) require physical therapists document patients' functional limitations. The process is not standardized. 
A systematic approach to determine a patient's functional limitations and responsiveness to change is needed. The purpose of this study is to compare patient-reported outcomes (PROs) responsiveness to change using 7-level severity/complexity modifier scale proposed by Medicare to a derived scale implemented by Intermountain Healthcare's Rehabilitation Outcomes Management System (ROMS). This was a retrospective, observational cohort design. 165,183 PROs prior to July 1, 2013, were compared to 46,334 records from July 1, 2013, to December 31, 2015. Histograms and ribbon plots illustrate distribution and change of patients' scores. ROMS raw score ranges were calculated and compared to CMS' severity/complexity levels based on score percentage. Distribution of the population was compared based on the 2 methods. Sensitivity and specificity were compared for responsiveness to change based on minimal clinically important difference (MCID). Histograms demonstrated few patient scores placed in CMS scale levels at the extremes, whereas the majority of scores placed in 2 middle levels (CJ, CK). ROMS distributed scores more evenly across levels. Ribbon plots illustrated advantage of ROMS' using narrower score ranges. Greater chance for patients to change levels was observed with ROMS when an MCID was achieved. ROMS narrower scale levels resulted in greater sensitivity and good specificity. Geographic representation for the United States was limited. Without patients' global rating of change, a reference standard to gauge validation of improvement could not be provided. ROMS provides a standard approach to identify accurately functional limitation modifier levels and to detect improvement more accurately than a straight across transposition using the CMS scale. © 2017 American Physical Therapy Association

  11. Cavernous malformations of the brainstem: three-dimensional-constructive interference in steady-state magnetic resonance imaging for improvement of surgical approach and clinical results.

    PubMed

    Zausinger, Stefan; Yousry, Indra; Brueckmann, Hartmut; Schmid-Elsaesser, Robert; Tonn, Joerg-Christian

    2006-02-01

    The indications for resection of cavernous malformations (CMs) of the brainstem include neurological deficits, (recurrent) hemorrhage, and surgically accessible location. In particular, knowledge of the thickness of the parenchymal layer and of the CM's spatial relation to nuclei, tracts, cranial nerves, and vessels is critical for planning the surgical approach. We reviewed the operative treatment of 13 patients with 14 brainstem CMs, with special regard to refined three-dimensional (3D)-constructive interference in steady-state (CISS) magnetic resonance imaging (MRI). Patients were evaluated neurologically and by conventional spin-echo/fast spin-echo and 3D-CISS MRI. Surgery was performed with the use of microsurgical techniques and neurophysiological monitoring. Eleven CMs were located in the pons/pontomedullary region; 10 of the 11 were operated on via the lateral suboccipital approach. Three CMs were located near the floor of the fourth ventricle and operated on via the median suboccipital approach, with total removal of all CMs. Results were excellent or good in 10 patients; one patient transiently required tracheostomy, and two patients developed new hemipareses/ataxia with subsequent improvement. Not only did 3D-CISS sequences allow improved judgment of the thickness of the parenchymal layer over the lesion compared with spin-echo/fast spin-echo MRI, but 3D-CISS imaging also proved particularly superior in demonstrating the spatial relation of the lesion to fairly "safe" entry zones (e.g., between the trigeminal nerve and the VIIth and VIIIth nerve groups) by displaying the cranial nerves and vessels within the cerebellopontine cistern more precisely. Surgical treatment of brainstem CMs is recommended in symptomatic patients. Especially in patients with lesions situated ventrolaterally, the 3D-CISS sequence seems to be a valuable method for identifying the CM's relation to safe entry zones, thereby facilitating the surgical approach.

  12. Calibration techniques and strategies for the present and future LHC electromagnetic calorimeters

    NASA Astrophysics Data System (ADS)

    Aleksa, M.

    2018-02-01

    This document describes the different calibration strategies and techniques applied by the two general purpose experiments at the LHC, ATLAS and CMS, and discusses them underlining their respective strengths and weaknesses from the view of the author. The resulting performances of both calorimeters are described and compared on the basis of selected physics results. Future upgrade plans for High Luminosity LHC (HL-LHC) are briefly introduced and planned calibration strategies for the upgraded detectors are shown.

  13. An expert system prototype for aiding in the development of software functional requirements for NASA Goddard's command management system: A case study and lessons learned

    NASA Technical Reports Server (NTRS)

    Liebowitz, Jay

    1986-01-01

    At NASA Goddard, the role of the command management system (CMS) is to transform general requests for spacecraft opeerations into detailed operational plans to be uplinked to the spacecraft. The CMS is part of the NASA Data System which entails the downlink of science and engineering data from NASA near-earth satellites to the user, and the uplink of command and control data to the spacecraft. Presently, it takes one to three years, with meetings once or twice a week, to determine functional requirements for CMS software design. As an alternative approach to the present technique of developing CMS software functional requirements, an expert system prototype was developed to aid in this function. Specifically, the knowledge base was formulated through interactions with domain experts, and was then linked to an existing expert system application generator called 'Knowledge Engineering System (Version 1.3).' Knowledge base development focused on four major steps: (1) develop the problem-oriented attribute hierachy; (2) determine the knowledge management approach; (3) encode the knowledge base; and (4) validate, test, certify, and evaluate the knowledge base and the expert system prototype as a whole. Backcasting was accomplished for validating and testing the expert system prototype. Knowledge refinement, evaluation, and implementation procedures of the expert system prototype were then transacted.

  14. A genetic algorithm for a bi-objective mathematical model for dynamic virtual cell formation problem

    NASA Astrophysics Data System (ADS)

    Moradgholi, Mostafa; Paydar, Mohammad Mahdi; Mahdavi, Iraj; Jouzdani, Javid

    2016-09-01

    Nowadays, with the increasing pressure of the competitive business environment and demand for diverse products, manufacturers are force to seek for solutions that reduce production costs and rise product quality. Cellular manufacturing system (CMS), as a means to this end, has been a point of attraction to both researchers and practitioners. Limitations of cell formation problem (CFP), as one of important topics in CMS, have led to the introduction of virtual CMS (VCMS). This research addresses a bi-objective dynamic virtual cell formation problem (DVCFP) with the objective of finding the optimal formation of cells, considering the material handling costs, fixed machine installation costs and variable production costs of machines and workforce. Furthermore, we consider different skills on different machines in workforce assignment in a multi-period planning horizon. The bi-objective model is transformed to a single-objective fuzzy goal programming model and to show its performance; numerical examples are solved using the LINGO software. In addition, genetic algorithm (GA) is customized to tackle large-scale instances of the problems to show the performance of the solution method.

  15. Concepts and design of the CMS high granularity calorimeter Level-1 trigger

    NASA Astrophysics Data System (ADS)

    Sauvan, Jean-Baptiste; CMS Collaboration

    2017-11-01

    The CMS experiment has chosen a novel high granularity calorimeter for the forward region as part of its planned upgrade for the high luminosity LHC. The calorimeter will have a fine segmentation in both the transverse and longitudinal directions and will be the first such calorimeter specifically optimised for particle flow reconstruction to operate at a colliding beam experiment. The high granularity results in around six million readout channels in total and so presents a significant challenge in terms of data manipulation and processing for the trigger; the trigger data volumes will be an order of magnitude above those currently handled at CMS. In addition, the high luminosity will result in an average of 140 to 200 interactions per bunch crossing, giving a huge background rate in the forward region that needs to be efficiently reduced by the trigger algorithms. Efficient data reduction and reconstruction algorithms making use of the fine segmentation of the detector have been simulated and evaluated. They provide an increase of the trigger rates with the luminosity significantly smaller than would be expected with the current trigger system.

  16. 42 CFR 422.100 - General requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... in the service area of the MA plan; (2) At a uniform premium, with uniform benefits and level of cost... review and approval of MA benefits and associated cost sharing. CMS reviews and approves MA benefits and... 42 Public Health 3 2010-10-01 2010-10-01 false General requirements. 422.100 Section 422.100...

  17. Putting the Pieces in Place: Charlotte-Mecklenburg Public Schools' Teacher Evaluation System

    ERIC Educational Resources Information Center

    Curtis, Rachel

    2012-01-01

    The first two goals of "Teaching Our Way to the Top, the Charlotte-Mecklenburg Public Schools" (CMS) Strategic Plan 2014,--Effective Teaching and Leadership and Performance Management--make clear that the district's top two priorities are ensuring excellent instruction districtwide and creating a performance culture organized on the…

  18. University ERP Implementation in Germany: Qualitative Exploratory Case Study of Administrative Staff Experiences

    ERIC Educational Resources Information Center

    Thelen, Anja

    2015-01-01

    Enterprise Resource Planning (ERP) implementations are expensive, time-consuming, and often do not lead to the expected outcome of integrated IT systems. Many German universities are implementing ERP systems as Campus Management Systems (CMS) and a solution to any problem, need, or requirement the organization has. This exploratory case study…

  19. 42 CFR 423.507 - Nonrenewal of contract.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... contract with CMS, effective at the end of the term of the contract for any reason provided it meets the... days before the date on which the nonrenewal is effective. The sponsor must also provide information... ensure beneficiaries know who to contact to learn about their enrollment options. (3) If a Part D plan...

  20. 42 CFR 423.507 - Nonrenewal of contract.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... contract with CMS, effective at the end of the term of the contract for any reason provided it meets the... days before the date on which the nonrenewal is effective. The sponsor must also provide information... ensure beneficiaries know who to contact to learn about their enrollment options. (3) If a Part D plan...

  1. 42 CFR 423.507 - Nonrenewal of contract.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CMS, effective at the end of the term of the contract for any reason provided it meets the timeframes... before the date on which the nonrenewal is effective. The sponsor must also provide information about... beneficiaries know who to contact to learn about their enrollment options. (3) If a Part D plan sponsor does not...

  2. 42 CFR 423.507 - Nonrenewal of contract.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... contract with CMS, effective at the end of the term of the contract for any reason provided it meets the... days before the date on which the nonrenewal is effective. The sponsor must also provide information... ensure beneficiaries know who to contact to learn about their enrollment options. (3) If a Part D plan...

  3. 42 CFR 423.507 - Nonrenewal of contract.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CMS, effective at the end of the term of the contract for any reason provided it meets the timeframes... before the date on which the nonrenewal is effective. The sponsor must also provide information about... beneficiaries know who to contact to learn about their enrollment options. (3) If a Part D plan sponsor does not...

  4. 42 CFR 423.750 - Types of intermediate sanctions and civil money penalties.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Types of intermediate sanctions and civil money... BENEFIT Intermediate Sanctions § 423.750 Types of intermediate sanctions and civil money penalties. (a... Medicare beneficiaries by a Part D plan sponsor. (b) CMS may impose civil money penalties as specified in...

  5. 42 CFR 423.750 - Types of intermediate sanctions and civil money penalties.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Types of intermediate sanctions and civil money... BENEFIT Intermediate Sanctions § 423.750 Types of intermediate sanctions and civil money penalties. (a... Medicare beneficiaries by a Part D plan sponsor. (b) CMS may impose civil money penalties as specified in...

  6. 42 CFR 423.329 - Determination of payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...—(1) Direct subsidy. CMS makes a direct subsidy payment for each Part D eligible beneficiary enrolled... for health status (as determined under § 423.329(b)(1)), and reduced by the base beneficiary premium for the plan (as determined under § 423.286(c) and adjusted in § 423.286(d)(1)). The direct subsidy...

  7. 42 CFR 423.329 - Determination of payments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...—(1) Direct subsidy. CMS makes a direct subsidy payment for each Part D eligible beneficiary enrolled... for health status (as determined under § 423.329(b)(1)), and reduced by the base beneficiary premium for the plan (as determined under § 423.286(c) and adjusted in § 423.286(d)(1)). The direct subsidy...

  8. 42 CFR 423.329 - Determination of payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...—(1) Direct subsidy. CMS makes a direct subsidy payment for each Part D eligible beneficiary enrolled... for health status (as determined under § 423.329(b)(1)), and reduced by the base beneficiary premium for the plan (as determined under § 423.286(c) and adjusted in § 423.286(d)(1)). The direct subsidy...

  9. 42 CFR 423.2262 - Review and distribution of marketing materials.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Review and distribution of marketing materials. 423... Marketing Requirements § 423.2262 Review and distribution of marketing materials. (a) CMS review of marketing materials. (1) Except as provided in paragraph (a)(2) of this section, a Part D plan may not...

  10. 78 FR 66653 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-06

    ... procedure, Adverse selection, Health care, Health insurance, Health records, Organization and functions... practice and procedure, Claims, Health care, Health insurance, Health plans, penalties, Reporting and... DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 153, 155, 156, 157, and 158 [CMS-9964-F3] RIN...

  11. 42 CFR 424.40 - Request for payment effective for more than one claim.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the first claim for home health services or outpatient physical therapy or speech pathology services... or outpatient physical therapy or speech pathology services furnished by the provider under that plan... for payment statement prescribed by CMS and signed by the beneficiary (or by his or her representative...

  12. Early detection of poor adherers to statins: applying individualized surveillance to pay for performance.

    PubMed

    Zimolzak, Andrew J; Spettell, Claire M; Fernandes, Joaquim; Fusaro, Vincent A; Palmer, Nathan P; Saria, Suchi; Kohane, Isaac S; Jonikas, Magdalena A; Mandl, Kenneth D

    2013-01-01

    Medication nonadherence costs $300 billion annually in the US. Medicare Advantage plans have a financial incentive to increase medication adherence among members because the Centers for Medicare and Medicaid Services (CMS) now awards substantive bonus payments to such plans, based in part on population adherence to chronic medications. We sought to build an individualized surveillance model that detects early which beneficiaries will fall below the CMS adherence threshold. This was a retrospective study of over 210,000 beneficiaries initiating statins, in a database of private insurance claims, from 2008-2011. A logistic regression model was constructed to use statin adherence from initiation to day 90 to predict beneficiaries who would not meet the CMS measure of proportion of days covered 0.8 or above, from day 91 to 365. The model controlled for 15 additional characteristics. In a sensitivity analysis, we varied the number of days of adherence data used for prediction. Lower adherence in the first 90 days was the strongest predictor of one-year nonadherence, with an odds ratio of 25.0 (95% confidence interval 23.7-26.5) for poor adherence at one year. The model had an area under the receiver operating characteristic curve of 0.80. Sensitivity analysis revealed that predictions of comparable accuracy could be made only 40 days after statin initiation. When members with 30-day supplies for their first statin fill had predictions made at 40 days, and members with 90-day supplies for their first fill had predictions made at 100 days, poor adherence could be predicted with 86% positive predictive value. To preserve their Medicare Star ratings, plan managers should identify or develop effective programs to improve adherence. An individualized surveillance approach can be used to target members who would most benefit, recognizing the tradeoff between improved model performance over time and the advantage of earlier detection.

  13. Spectrum-Malaria: a user-friendly projection tool for health impact assessment and strategic planning by malaria control programmes in sub-Saharan Africa.

    PubMed

    Hamilton, Matthew; Mahiane, Guy; Werst, Elric; Sanders, Rachel; Briët, Olivier; Smith, Thomas; Cibulskis, Richard; Cameron, Ewan; Bhatt, Samir; Weiss, Daniel J; Gething, Peter W; Pretorius, Carel; Korenromp, Eline L

    2017-02-10

    Scale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. This article presents a new modelling tool projecting malaria infection, cases and deaths to support impact evaluation, target setting and strategic planning. Nested in the Spectrum suite of programme planning tools, the model includes historic estimates of case incidence and deaths in groups aged up to 4, 5-14, and 15+ years, and prevalence of Plasmodium falciparum infection (PfPR) among children 2-9 years, for 43 sub-Saharan African countries and their 602 provinces, from the WHO and malaria atlas project. Impacts over 2016-2030 are projected for insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and effective management of uncomplicated cases (CMU) and severe cases (CMS), using statistical functions fitted to proportional burden reductions simulated in the P. falciparum dynamic transmission model OpenMalaria. In projections for Nigeria, ITNs, IRS, CMU, and CMS scale-up reduced health burdens in all age groups, with largest proportional and especially absolute reductions in children up to 4 years old. Impacts increased from 8 to 10 years following scale-up, reflecting dynamic effects. For scale-up of each intervention to 80% effective coverage, CMU had the largest impacts across all health outcomes, followed by ITNs and IRS; CMS and SMC conferred additional small but rapid mortality impacts. Spectrum-Malaria's user-friendly interface and intuitive display of baseline data and scenario projections holds promise to facilitate capacity building and policy dialogue in malaria programme prioritization. The module's linking to the OneHealth Tool for costing will support use of the software for strategic budget allocation. In settings with moderately low coverage levels, such as Nigeria, improving case management and achieving universal coverage with ITNs could achieve considerable burden reductions. Projections remain to be refined and validated with local expert input data and actual policy scenarios.

  14. CMS gives the RA program a makeover with more changes in store.

    PubMed

    2016-03-01

    CMS has made changes in the scope of work for the Recovery Auditor program and has proposed a number of other changes to be implemented when new RA contracts are issued. CMS has restricted the number of additional documentation requests, has shortened the "look-back" period for patient status reviews, and announced penalties for RAs with high error rates. The new contracts shorten the time RAs have to complete complex reviews, requires RAs to wait 30 days before referring cases to the Medicare Administrative Contractors, and postpones contingency payments to RAs until after the second level of appeals. The Audit and Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) bill, introduced in the Senate in December, revamps the appeals process, adding an Ombudsman for Medicare Reviews to assist in resolving complaints by hospitals that have appealed and those considering appeals, and establishes an Appeals Medicare Magistrate program with attorneys who will handle appeals of denials for $1,500 or less.

  15. Analysis of the Laser Calibration System for the CMS HCAL at CERN's Large Hadron Collider

    NASA Astrophysics Data System (ADS)

    Lebolo, Luis

    2005-11-01

    The European Organization for Nuclear Physics' (CERN) Large Hadron Collider uses the Compact Muon Solenoid (CMS) detector to measure collision products from proton-proton interactions. CMS uses a hadron calorimeter (HCAL) to measure the energy and position of quarks and gluons by reconstructing their hadronic decay products. An essential component of the detector is the calibration system, which was evaluated in terms of its misalignment, linearity, and resolution. In order to analyze the data, the authors created scripts in ROOT 5.02/00 and C++. The authors also used Mathematica 5.1 to perform complex mathematics and AutoCAD 2006 to produce optical ray traces. The misalignment of the optical components was found to be satisfactory; the Hybrid Photodiodes (HPDs) were confirmed to be linear; the constant, noise and stochastic contributions to its resolution were analyzed; and the quantum efficiency of most HPDs was determined to be approximately 40%. With a better understanding of the laser calibration system, one can further understand and improve the HCAL.

  16. Morphological and genetic characterization of a new cytoplasmic male sterility system (oxa CMS) in stem mustard (Brassica juncea).

    PubMed

    Heng, Shuangping; Liu, Sansan; Xia, Chunxiu; Tang, HongYu; Xie, Fei; Fu, Tingdong; Wan, Zhengjie

    2018-01-01

    KEY MESSAGE: oxa CMS is a new cytoplasmic male sterility type in Brassica juncea. oxa CMS is a cytoplasmic male sterility (CMS) line that has been widely used in the production and cultivation of stem mustard in the southwestern China. In this study, different CMS-type specific mitochondrial markers were used to confirm that oxa CMS is distinct from the pol CMS, ogu CMS, nap CMS, hau CMS, tour CMS, Moricandia arvensis CMS, orf220-type CMS, etc., that have been previously reported in Brassica crops. Pollen grains of the oxa CMS line are sterile with a self-fertility rate of almost 0% and the sterility strain rate and sterility degree of oxa CMS is 100% due to a specific flower structure and flowering habit. Scanning electron microscopy revealed that most pollen grains in mature anthers of the oxa CMS line are empty, flat and deflated. Semi-thin section further showed that the abortive stage of anther development in oxa CMS is initiated at the late uninucleate stage. Abnormally vacuolated microspores caused male sterility in the oxa CMS line. This cytological study combined with marker-assisted selection showed that oxa CMS is a novel CMS type in stem mustard (Brassica juncea). Interestingly, the abortive stage of oxa CMS is later than those in other CMS types reported in Brassica crops, and there is no negative effect on the oxa CMS line growth period. This study demonstrated that this novel oxa CMS has a unique flower structure with sterile pollen grains at the late uninucleate stage. Our results may help to uncover the mechanism of oxa CMS in Brassica juncea.

  17. The CMS Data Management System

    NASA Astrophysics Data System (ADS)

    Giffels, M.; Guo, Y.; Kuznetsov, V.; Magini, N.; Wildish, T.

    2014-06-01

    The data management elements in CMS are scalable, modular, and designed to work together. The main components are PhEDEx, the data transfer and location system; the Data Booking Service (DBS), a metadata catalog; and the Data Aggregation Service (DAS), designed to aggregate views and provide them to users and services. Tens of thousands of samples have been cataloged and petabytes of data have been moved since the run began. The modular system has allowed the optimal use of appropriate underlying technologies. In this contribution we will discuss the use of both Oracle and NoSQL databases to implement the data management elements as well as the individual architectures chosen. We will discuss how the data management system functioned during the first run, and what improvements are planned in preparation for 2015.

  18. 76 FR 49303 - Approval and Promulgation of Air Quality Implementation Plans; Minnesota; Rules Update

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-10

    ... design requirements for the monitoring systems. The revised CMS rules also delineate the recordkeeping..., [Insert page number where the document begins]. 7017.1140 CEMS design 03/01/99 08/10/11, [Insert page...]. 7017.1190 COMS design 03/01/99 08/10/11, [Insert page requirements. number where the document begins...

  19. 42 CFR 423.750 - Types of intermediate sanctions and civil money penalties.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Types of intermediate sanctions and civil money... Intermediate Sanctions § 423.750 Types of intermediate sanctions and civil money penalties. (a) The following... by a Part D plan sponsor. (b) CMS may impose civil money penalties as specified in 423.760. [72 FR...

  20. 42 CFR 422.106 - Coordination of benefits with employer or union group health plans and Medicaid.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... Jurisdiction regulating benefits under these circumstances is as follows: (1) All requirements of this part... the following: (1) Payment of a portion or all of the MA basic and supplemental premiums. (2) Payment... organizations. (1) MA organizations may request, in writing, from CMS, a waiver or modification of those...

  1. 42 CFR 422.106 - Coordination of benefits with employer or union group health plans and Medicaid.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... Jurisdiction regulating benefits under these circumstances is as follows: (1) All requirements of this part... the following: (1) Payment of a portion or all of the MA basic and supplemental premiums. (2) Payment... organizations. (1) MA organizations may request, in writing, from CMS, a waiver or modification of those...

  2. 42 CFR 422.106 - Coordination of benefits with employer or union group health plans and Medicaid.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    .... Jurisdiction regulating benefits under these circumstances is as follows: (1) All requirements of this part... the following: (1) Payment of a portion or all of the MA basic and supplemental premiums. (2) Payment... organizations. (1) MA organizations may request, in writing, from CMS, a waiver or modification of those...

  3. 42 CFR 430.63 - Filing and service of papers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Filing and service of papers. 430.63 Section 430.63... Conformity of State Medicaid Plans and Practice to Federal Requirements § 430.63 Filing and service of papers. (a) Filing. All papers in the proceedings are filed with the CMS Docket Clerk, in an original and two...

  4. 42 CFR 430.63 - Filing and service of papers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Filing and service of papers. 430.63 Section 430.63... Conformity of State Medicaid Plans and Practice to Federal Requirements § 430.63 Filing and service of papers. (a) Filing. All papers in the proceedings are filed with the CMS Docket Clerk, in an original and two...

  5. Directed fusion of cardiac spheroids into larger heterocellular microtissues enables investigation of cardiac action potential propagation via cardiac fibroblasts

    PubMed Central

    Markes, Alexander R.; Okundaye, Amenawon O.; Qu, Zhilin; Mende, Ulrike; Choi, Bum-Rak

    2018-01-01

    Multicellular spheroids generated through cellular self-assembly provide cytoarchitectural complexities of native tissue including three-dimensionality, extensive cell-cell contacts, and appropriate cell-extracellular matrix interactions. They are increasingly suggested as building blocks for larger engineered tissues to achieve shapes, organization, heterogeneity, and other biomimetic complexities. Application of these tissue culture platforms is of particular importance in cardiac research as the myocardium is comprised of distinct but intermingled cell types. Here, we generated scaffold-free 3D cardiac microtissue spheroids comprised of cardiac myocytes (CMs) and/or cardiac fibroblasts (CFs) and used them as building blocks to form larger microtissues with different spatial distributions of CMs and CFs. Characterization of fusing homotypic and heterotypic spheroid pairs revealed an important influence of CFs on fusion kinetics, but most strikingly showed rapid fusion kinetics between heterotypic pairs consisting of one CF and one CM spheroid, indicating that CMs and CFs self-sort in vitro into the intermixed morphology found in the healthy myocardium. We then examined electrophysiological integration of fused homotypic and heterotypic microtissues by mapping action potential propagation. Heterocellular elongated microtissues which recapitulate the disproportionate CF spatial distribution seen in the infarcted myocardium showed that action potentials propagate through CF volumes albeit with significant delay. Complementary computational modeling revealed an important role of CF sodium currents and the spatial distribution of the CM-CF boundary in action potential conduction through CF volumes. Taken together, this study provides useful insights for the development of complex, heterocellular engineered 3D tissue constructs and their engraftment via tissue fusion and has implications for arrhythmogenesis in cardiac disease and repair. PMID:29715271

  6. Detection of the Diversity of Cytoplasmic Male Sterility Sources in Broccoli (Brassica Oleracea var. Italica) Using Mitochondrial Markers.

    PubMed

    Shu, Jinshuai; Liu, Yumei; Li, Zhansheng; Zhang, Lili; Fang, Zhiyuan; Yang, Limei; Zhuang, Mu; Zhang, Yangyong; Lv, Honghao

    2016-01-01

    Broccoli (Brassica oleracea var. italica) is an important commercial vegetable crop. As part of an efficient pollination system, cytoplasmic male sterility (CMS) has been widely used for broccoli hybrid production. Identifying the original sources of CMS in broccoli accessions has become an important part of broccoli breeding. In this study, the diversity of the CMS sources of 39 broccoli accessions, including 19 CMS lines and 20 hybrids, were analyzed using mitochondrial markers. All CMS accessions contained the ogu orf138-related DNA fragment and the key genes of nap CMS, pol CMS, and tour CMS were not detected. The 39 CMS accessions were divided into five groups using six orf138-related and two simple sequence repeat markers. We observed that ogu CMS R3 constituted 79.49% of the CMS sources. CMS6 and CMS26 were differentiated from the other accessions using a specific primer. CMS32 was distinguished from the other accessions based on a 78-nucleotide deletion at the same locus as the orf138-related sequence. When the coefficient was about 0.90, five CMS accessions (13CMS6, 13CMS23, 13CMS24, 13CMS37, and 13CMS39) exhibiting abnormal floral organs with poor seed setting were grouped together. The polymerase chain reaction amplification profiles for these five accessions differed from those of the other accessions. We identified eight useful molecular markers that can be used to detect CMS types during broccoli breeding. Our data also provide important information relevant to future studies on the possible origins and molecular mechanisms of CMS in broccoli.

  7. Detection of the Diversity of Cytoplasmic Male Sterility Sources in Broccoli (Brassica Oleracea var. Italica) Using Mitochondrial Markers

    PubMed Central

    Shu, Jinshuai; Liu, Yumei; Li, Zhansheng; Zhang, Lili; Fang, Zhiyuan; Yang, Limei; Zhuang, Mu; Zhang, Yangyong; Lv, Honghao

    2016-01-01

    Broccoli (Brassica oleracea var. italica) is an important commercial vegetable crop. As part of an efficient pollination system, cytoplasmic male sterility (CMS) has been widely used for broccoli hybrid production. Identifying the original sources of CMS in broccoli accessions has become an important part of broccoli breeding. In this study, the diversity of the CMS sources of 39 broccoli accessions, including 19 CMS lines and 20 hybrids, were analyzed using mitochondrial markers. All CMS accessions contained the ogu orf138-related DNA fragment and the key genes of nap CMS, pol CMS, and tour CMS were not detected. The 39 CMS accessions were divided into five groups using six orf138-related and two simple sequence repeat markers. We observed that ogu CMS R3 constituted 79.49% of the CMS sources. CMS6 and CMS26 were differentiated from the other accessions using a specific primer. CMS32 was distinguished from the other accessions based on a 78-nucleotide deletion at the same locus as the orf138-related sequence. When the coefficient was about 0.90, five CMS accessions (13CMS6, 13CMS23, 13CMS24, 13CMS37, and 13CMS39) exhibiting abnormal floral organs with poor seed setting were grouped together. The polymerase chain reaction amplification profiles for these five accessions differed from those of the other accessions. We identified eight useful molecular markers that can be used to detect CMS types during broccoli breeding. Our data also provide important information relevant to future studies on the possible origins and molecular mechanisms of CMS in broccoli. PMID:27446156

  8. A study to establish reasonable action limits for patient-specific quality assurance in intensity-modulated radiation therapy.

    PubMed

    Both, Stefan; Alecu, Ionut M; Stan, Andrada R; Alecu, Marius; Ciura, Andrei; Hansen, Jeremy M; Alecu, Rodica

    2007-03-07

    An effective patient quality assurance (QA) program for intensity-modulated radiation therapy (IMRT) requires accurate and realistic plan acceptance criteria--that is, action limits. Based on dose measurements performed with a commercially available two-dimensional (2D) diode array, we analyzed 747 fluence maps resulting from a routine patient QA program for IMRT plans. The fluence maps were calculated by three different commercially available (ADAC, CMS, Eclipse) treatment planning systems (TPSs) and were delivered using 6-MV X-ray beams produced by linear accelerators. To establish reasonably achievable and clinically acceptable limits for the dose deviations, the agreement between the measured and calculated fluence maps was evaluated in terms of percent dose error (PDE) for a few points and percent of passing points (PPP) for the isodose distribution. The analysis was conducted for each TPS used in the study (365 ADAC, 162 CMS,220 Eclipse), for multiple treatment sites (prostate, pelvis, head and neck, spine, rectum, anus, lung, brain), at the normalization point for 3% percentage difference (%Diff) and 3-mm distance to agreement (DTA) criteria. We investigated the treatment-site dependency of PPP and PDE. The results show that, at 3% and 3-mm criteria, a 95% PPP and 3% PDE can be achieved for prostate treatments and a 90% PPP and 5% PDE are attainable for any treatment site.

  9. Identification of fertiity restores for S male-sterile maize: beyond PPRs

    USDA-ARS?s Scientific Manuscript database

    Nuclear genes are essential for expression of the mitochondrial genome and for the function of mitochondrial protein complexes. Interaction of the plant mitochondrial and nuclear genetic systems is exemplified by mitochondrial-encoded cytoplasmic male sterility (CMS) under the control of nuclear fe...

  10. Effects of Early Dual-Eligible Special Needs Plans on Health Expenditure.

    PubMed

    Zhang, Yongkang; Diana, Mark L

    2017-10-18

    To examine the effects of the penetration of dual-eligible special needs plans (D-SNPs) on health care spending. Secondary state-level panel data from Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) public use file and Special Needs Plan Comprehensive Reports, Area Health Resource Files, and Medicaid Managed Care Enrollment Report between 2007 and 2011. A difference-in-difference strategy that adjusts for dual-eligibles' demographic and socioeconomic characteristics, state health resources, beneficiaries' health risk factors, Medicare/Medicaid enrollment, and state- and year-fixed effects. Data from MMLEADS were summarized from Centers for Medicare and Medicaid Services (CMS)'s Chronic Conditions Data Warehouse, which contains 100 percent of Medicare enrollment data, claims for beneficiaries who are enrolled in the fee-for-service (FFS) program, and Medicaid Analytic Extract files. The MMLEADS public use file also includes payment information for managed care. Data in Special Needs Plan Comprehensive Reports were from CMS's Health Plan Management System. Results indicate that D-SNPs penetration was associated with reduced Medicare spending per dual-eligible beneficiary. Specifically, a 1 percent increase in D-SNPs penetration was associated with 0.2 percent reduction in Medicare spending per beneficiary. We found no association between D-SNPs penetration and Medicaid or total spending. Involving Medicaid services in D-SNPs may be crucial to improve coordination between Medicare and Medicaid programs and control Medicaid spending among dual-eligible beneficiaries. Starting from 2013, D-SNPs were mandated to have contracts with state Medicaid agencies. This change may introduce new effects of D-SNPs on health care spending. More research is needed to examine the impact of D-SNPs on dual-eligible spending. © Health Research and Educational Trust.

  11. Differences in Receipt of Three Preventive Health Care Services by Race/Ethnicity in Medicare Advantage Plans: Tracking the Impact of Pay for Performance, 2010 and 2013

    PubMed Central

    Palta, Mari; Smith, Maureen; Oliver, Thomas R.; DuGoff, Eva H.

    2016-01-01

    Introduction In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-for-performance (P4P) program, into Medicare Advantage plans. Previous studies documented racial/ethnic disparities in receipt of care among participants in these plans. The objective of this study was to determine whether P4P incentives have affected these disparities in Medicare Advantage plans. Methods We studied 411 Medicare Advantage health plans that participated in the Medicare Health Outcome Survey in 2010 and 2013. Preventive health care was defined as self-reported receipt of health care provider communication or treatment to reduce risk of falling, improve bladder control, and monitor physical activity among individuals reporting these problems. Logistic regression stratified by health care plan was used to examine racial/ethnic disparities in receipt of preventive health care before and after the introduction of the P4P program in 2012. Results We found similar racial/ethnic differences in receipt of preventive health care before and after the introduction of P4P. Blacks and Asians were less likely than whites to receive advice to improve bladder control and more likely to receive advice to reduce risk of falling and improve physical activity. Hispanics were more likely to report receiving advice about all 3 health issues than whites. After the introduction of P4P, the gap decreased between Hispanics and whites for improving bladder control and monitoring physical activity and increased between blacks and whites for monitoring physical activity. Conclusion Racial/ethnic differences in receipt of preventive health care are not always in the expected direction. CMS should consider developing a separate measure of equity in preventive health care services to encourage health plans to reduce gaps among racial/ethnic groups in receiving preventive care services. PMID:27609303

  12. Differences in Receipt of Three Preventive Health Care Services by Race/Ethnicity in Medicare Advantage Plans: Tracking the Impact of Pay for Performance, 2010 and 2013.

    PubMed

    Jung, Daniel H; Palta, Mari; Smith, Maureen; Oliver, Thomas R; DuGoff, Eva H

    2016-09-08

    In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-for-performance (P4P) program, into Medicare Advantage plans. Previous studies documented racial/ethnic disparities in receipt of care among participants in these plans. The objective of this study was to determine whether P4P incentives have affected these disparities in Medicare Advantage plans. We studied 411 Medicare Advantage health plans that participated in the Medicare Health Outcome Survey in 2010 and 2013. Preventive health care was defined as self-reported receipt of health care provider communication or treatment to reduce risk of falling, improve bladder control, and monitor physical activity among individuals reporting these problems. Logistic regression stratified by health care plan was used to examine racial/ethnic disparities in receipt of preventive health care before and after the introduction of the P4P program in 2012. We found similar racial/ethnic differences in receipt of preventive health care before and after the introduction of P4P. Blacks and Asians were less likely than whites to receive advice to improve bladder control and more likely to receive advice to reduce risk of falling and improve physical activity. Hispanics were more likely to report receiving advice about all 3 health issues than whites. After the introduction of P4P, the gap decreased between Hispanics and whites for improving bladder control and monitoring physical activity and increased between blacks and whites for monitoring physical activity. Racial/ethnic differences in receipt of preventive health care are not always in the expected direction. CMS should consider developing a separate measure of equity in preventive health care services to encourage health plans to reduce gaps among racial/ethnic groups in receiving preventive care services.

  13. Comparative Gene Expression Analyses Reveal Distinct Molecular Signatures between Differentially Reprogrammed Cardiomyocytes.

    PubMed

    Zhou, Yang; Wang, Li; Liu, Ziqing; Alimohamadi, Sahar; Yin, Chaoying; Liu, Jiandong; Qian, Li

    2017-09-26

    Cardiomyocytes derived from induced pluripotent stem cells (iPSC-CMs) or directly reprogrammed from non-myocytes (induced cardiomyocytes [iCMs]) are promising sources for heart regeneration or disease modeling. However, the similarities and differences between iPSC-CMs and iCMs are still unknown. Here, we performed transcriptome analyses of beating iPSC-CMs and iCMs generated from cardiac fibroblasts (CFs) of the same origin. Although both iPSC-CMs and iCMs establish CM-like molecular features globally, iPSC-CMs exhibit a relatively hyperdynamic epigenetic status, whereas iCMs exhibit a maturation status that more closely resembles that of adult CMs. Based on gene expression of metabolic enzymes, iPSC-CMs primarily employ glycolysis, whereas iCMs utilize fatty acid oxidation as the main pathway. Importantly, iPSC-CMs and iCMs exhibit different cell-cycle status, alteration of which influenced their maturation. Therefore, our study provides a foundation for understanding the pros and cons of different reprogramming approaches. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  14. 45 CFR 150.203 - Circumstances requiring CMS enforcement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Circumstances requiring CMS enforcement. 150.203... CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement Processes for... requiring CMS enforcement. CMS enforces HIPAA requirements to the extent warranted (as determined by CMS) in...

  15. Legacy2Drupal - Conversion of an existing oceanographic relational database to a semantically enabled Drupal content management system

    NASA Astrophysics Data System (ADS)

    Maffei, A. R.; Chandler, C. L.; Work, T.; Allen, J.; Groman, R. C.; Fox, P. A.

    2009-12-01

    Content Management Systems (CMSs) provide powerful features that can be of use to oceanographic (and other geo-science) data managers. However, in many instances, geo-science data management offices have previously designed customized schemas for their metadata. The WHOI Ocean Informatics initiative and the NSF funded Biological Chemical and Biological Data Management Office (BCO-DMO) have jointly sponsored a project to port an existing, relational database containing oceanographic metadata, along with an existing interface coded in Cold Fusion middleware, to a Drupal6 Content Management System. The goal was to translate all the existing database tables, input forms, website reports, and other features present in the existing system to employ Drupal CMS features. The replacement features include Drupal content types, CCK node-reference fields, themes, RDB, SPARQL, workflow, and a number of other supporting modules. Strategic use of some Drupal6 CMS features enables three separate but complementary interfaces that provide access to oceanographic research metadata via the MySQL database: 1) a Drupal6-powered front-end; 2) a standard SQL port (used to provide a Mapserver interface to the metadata and data; and 3) a SPARQL port (feeding a new faceted search capability being developed). Future plans include the creation of science ontologies, by scientist/technologist teams, that will drive semantically-enabled faceted search capabilities planned for the site. Incorporation of semantic technologies included in the future Drupal 7 core release is also anticipated. Using a public domain CMS as opposed to proprietary middleware, and taking advantage of the many features of Drupal 6 that are designed to support semantically-enabled interfaces will help prepare the BCO-DMO database for interoperability with other ecosystem databases.

  16. Mutations in nuclear genes alter post-transcriptional regulation of mitochondrial genes.

    USDA-ARS?s Scientific Manuscript database

    Nuclear gene products are required for the expression of mitochondrial genes and elaboration of functional mitochondrial protein complexes. To better understand the roles of these nuclear genes, we exploited the mitochondrial encoded S-type of cytoplasmic male sterility (CMS-S) and developed a nove...

  17. Exploiting multicore compute resources in the CMS experiment

    NASA Astrophysics Data System (ADS)

    Ramírez, J. E.; Pérez-Calero Yzquierdo, A.; Hernández, J. M.; CMS Collaboration

    2016-10-01

    CMS has developed a strategy to efficiently exploit the multicore architecture of the compute resources accessible to the experiment. A coherent use of the multiple cores available in a compute node yields substantial gains in terms of resource utilization. The implemented approach makes use of the multithreading support of the event processing framework and the multicore scheduling capabilities of the resource provisioning system. Multicore slots are acquired and provisioned by means of multicore pilot agents which internally schedule and execute single and multicore payloads. Multicore scheduling and multithreaded processing are currently used in production for online event selection and prompt data reconstruction. More workflows are being adapted to run in multicore mode. This paper presents a review of the experience gained in the deployment and operation of the multicore scheduling and processing system, the current status and future plans.

  18. HEP Data Grid Applications in Korea

    NASA Astrophysics Data System (ADS)

    Cho, Kihyeon; Oh, Youngdo; Son, Dongchul; Kim, Bockjoo; Lee, Sangsan

    2003-04-01

    We will introduce the national HEP Data Grid applications in Korea. Through a five-year HEP Data Grid project (2002-2006) for CMS, AMS, CDF, PHENIX, K2K and Belle experiments in Korea, the Center for High Energy Physics, Kyungpook National University in Korea will construct the 1,000 PC cluster and related storage system such as 1,200 TByte Raid disk system. This project includes one of the master plan to construct Asia Regional Data Center by 2006 for the CMS and AMS Experiments and DCAF(DeCentralized Analysis Farm) for the CDF Experiments. During the first year of the project, we have constructed a cluster of around 200 CPU's with a 50 TBytes of a storage system. We will present our first year's experience of the software and hardware applications for HEP Data Grid of EDG and SAM Grid testbeds.

  19. Improving the design of competitive bidding in Medicare Advantage.

    PubMed

    Cawley, John H; Whitford, Andrew B

    2007-04-01

    In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, which required that in 2006 the Centers for Medicare and Medicaid Services (CMS) implement a system of competitive bids to set payments for the Medicare Advantage program. Managed care plans now bid for the right to enroll Medicare beneficiaries. Data from the first year of bidding suggest that imperfect competition is limiting the success of the bidding system. This article offers suggestions to improve this system based on findings from auction theory and previous government-run auctions. In particular, CMS can benefit by adjusting its system of competitive bids in four ways: credibly committing to regulations governing bidding; limiting the scope for collusion, entry deterrence, and predatory behavior among bidders; adjusting how benchmark reimbursement rates are set; and accounting for asymmetric information among bidders.

  20. Treatment and outcomes of an Australian cohort of outpatients with bipolar I or schizoaffective disorder over twenty-four months: implications for clinical practice

    PubMed Central

    2012-01-01

    Background The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with ‘real-world’ treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication. Methods Participants prescribed either conventional mood stabilizers (CMS; n = 155) alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84) were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale – Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data. Results On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine ± CMS (61%;) cohorts. Conclusions Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome. PMID:23244301

  1. Mechanism-based facilitated maturation of human pluripotent stem cell-derived cardiomyocytes

    PubMed Central

    Lieu, Deborah K.; Fu, Ji-Dong; Chiamvimonvat, Nipavan; Chan Tung, Kelvin W.; McNerney, Gregory P.; Huser, Thomas; Keller, Gordon; Kong, Chi-Wing

    2013-01-01

    Background Human embryonic stem cells (hESCs) can be efficiently and reproducibly directed into cardiomyocytes (CMs) using stage-specific induction protocols. However, their functional properties and suitability for clinical and other applications have not been evaluated. Methods and Results Here we showed that CMs derived from multiple pluripotent human stem cell lines (hESC: H1, HES2) and types (induced pluripotent stem cell or iPSC) using different in vitro differentiation protocols (embryoid body formation, endodermal induction, directed differentiation) commonly displayed immature, pro-arrhythmic action potential (AP) properties such as high-degree of automaticity, depolarized resting membrane potential (RMP), Phase 4- depolarization and delayed after-depolarization (DAD). Among the panoply of sarcolemmal ionic currents investigated (INa+/ICaL2+/IKr+/INCX+/If+/Ito+/IK1-/IKs-), we pinpointed the lack of the Kir2.1-encoded inwardly rectifying K+ current (IK1) as the single mechanistic contributor to the observed immature electrophysiological properties in hESC-CMs. Forced expression of Kir2.1 in hESC-CMs led to robust expression of Ba2+-sensitive IK1 and more importantly, completely ablated all the pro-arrhythmic AP traits, rendering the electrophysiological phenotype indistinguishable from the adult counterparts. These results provided the first link of a complex developmentally arrested phenotype to a major effector gene, and importantly, further led us to develop a biomimetic culturing strategy for enhancing maturation. Conclusions By providing the environmental cues that are missing in conventional culturing method, this approach did not require any genetic or pharmacological interventions. Our findings can facilitate clinical applications, drug discovery and cardiotoxicity screening by improving the yield, safety and efficacy of derived CMs. PMID:23392582

  2. Muons in the CMS High Level Trigger System

    NASA Astrophysics Data System (ADS)

    Verwilligen, Piet; CMS Collaboration

    2016-04-01

    The trigger systems of LHC detectors play a fundamental role in defining the physics capabilities of the experiments. A reduction of several orders of magnitude in the rate of collected events, with respect to the proton-proton bunch crossing rate generated by the LHC, is mandatory to cope with the limits imposed by the readout and storage system. An accurate and efficient online selection mechanism is thus required to fulfill the task keeping maximal the acceptance to physics signals. The CMS experiment operates using a two-level trigger system. Firstly a Level-1 Trigger (L1T) system, implemented using custom-designed electronics, is designed to reduce the event rate to a limit compatible to the CMS Data Acquisition (DAQ) capabilities. A High Level Trigger System (HLT) follows, aimed at further reducing the rate of collected events finally stored for analysis purposes. The latter consists of a streamlined version of the CMS offline reconstruction software and operates on a computer farm. It runs algorithms optimized to make a trade-off between computational complexity, rate reduction and high selection efficiency. With the computing power available in 2012 the maximum reconstruction time at HLT was about 200 ms per event, at the nominal L1T rate of 100 kHz. An efficient selection of muons at HLT, as well as an accurate measurement of their properties, such as transverse momentum and isolation, is fundamental for the CMS physics programme. The performance of the muon HLT for single and double muon triggers achieved in Run I will be presented. Results from new developments, aimed at improving the performance of the algorithms for the harsher scenarios of collisions per event (pile-up) and luminosity expected for Run II will also be discussed.

  3. Chronic mild stress increases alcohol intake in mice with low dopamine D2 receptor levels.

    PubMed

    Delis, Foteini; Thanos, Panayotis K; Rombola, Christina; Rosko, Lauren; Grandy, David; Wang, Gene-Jack; Volkow, Nora D

    2013-02-01

    Alcohol use disorders emerge from a complex interaction between environmental and genetic factors. Stress and dopamine D2 receptor levels (DRD2) have been shown to play a central role in alcoholism. To better understand the interactions between DRD2 and stress in ethanol intake behavior, we subjected Drd2 wild-type (+/+), heterozygous (+/-), and knockout (-/-) mice to 4 weeks of chronic mild stress (CMS) and to an ethanol two-bottle choice during CMS weeks 2-4. Prior to and at the end of the experiment, the animals were tested in the forced swim and open field tests. We measured ethanol intake and preference, immobility in the force swim test, and activity in the open field. We show that under no CMS, Drd2+/- and Drd2-/- mice had lower ethanol intake and preference compared with Drd2+/+. Exposure to CMS decreased ethanol intake and preference in Drd2+/+ and increased them in Drd2+/- and Drd2-/- mice. At baseline, Drd2+/- and Drd2-/- mice had significantly lower activity in the open field than Drd2+/+, whereas no genotype differences were observed in the forced swim test. Exposure to CMS increased immobility during the forced swim test in Drd2+/- mice, but not in Drd2+/+ or Drd2-/- mice, and ethanol intake reversed this behavior. No changes were observed in open field test measures. These findings suggest that in the presence of a stressful environment, low DRD2 levels are associated with increased ethanol intake and preference and that under this condition, increased ethanol consumption could be used as a strategy to alleviate negative mood. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  4. Functional connectivity-based parcellation and connectome of cortical midline structures in the mouse: a perfusion autoradiography study

    PubMed Central

    Holschneider, Daniel P.; Wang, Zhuo; Pang, Raina D.

    2014-01-01

    Rodent cortical midline structures (CMS) are involved in emotional, cognitive and attentional processes. Tract tracing has revealed complex patterns of structural connectivity demonstrating connectivity-based integration and segregation for the prelimbic, cingulate area 1, retrosplenial dysgranular cortices dorsally, and infralimbic, cingulate area 2, and retrosplenial granular cortices ventrally. Understanding of CMS functional connectivity (FC) remains more limited. Here we present the first subregion-level FC analysis of the mouse CMS, and assess whether fear results in state-dependent FC changes analogous to what has been reported in humans. Brain mapping using [14C]-iodoantipyrine was performed in mice during auditory-cued fear conditioned recall and in controls. Regional cerebral blood flow (CBF) was analyzed in 3-D images reconstructed from brain autoradiographs. Regions-of-interest were selected along the CMS anterior-posterior and dorsal-ventral axes. In controls, pairwise correlation and graph theoretical analyses showed strong FC within each CMS structure, strong FC along the dorsal-ventral axis, with segregation of anterior from posterior structures. Seed correlation showed FC of anterior regions to limbic/paralimbic areas, and FC of posterior regions to sensory areas–findings consistent with functional segregation noted in humans. Fear recall increased FC between the cingulate and retrosplenial cortices, but decreased FC between dorsal and ventral structures. In agreement with reports in humans, fear recall broadened FC of anterior structures to the amygdala and to somatosensory areas, suggesting integration and processing of both limbic and sensory information. Organizational principles learned from animal models at the mesoscopic level (brain regions and pathways) will not only critically inform future work at the microscopic (single neurons and synapses) level, but also have translational value to advance our understanding of human brain architecture. PMID:24966831

  5. Functional connectivity-based parcellation and connectome of cortical midline structures in the mouse: a perfusion autoradiography study.

    PubMed

    Holschneider, Daniel P; Wang, Zhuo; Pang, Raina D

    2014-01-01

    Rodent cortical midline structures (CMS) are involved in emotional, cognitive and attentional processes. Tract tracing has revealed complex patterns of structural connectivity demonstrating connectivity-based integration and segregation for the prelimbic, cingulate area 1, retrosplenial dysgranular cortices dorsally, and infralimbic, cingulate area 2, and retrosplenial granular cortices ventrally. Understanding of CMS functional connectivity (FC) remains more limited. Here we present the first subregion-level FC analysis of the mouse CMS, and assess whether fear results in state-dependent FC changes analogous to what has been reported in humans. Brain mapping using [(14)C]-iodoantipyrine was performed in mice during auditory-cued fear conditioned recall and in controls. Regional cerebral blood flow (CBF) was analyzed in 3-D images reconstructed from brain autoradiographs. Regions-of-interest were selected along the CMS anterior-posterior and dorsal-ventral axes. In controls, pairwise correlation and graph theoretical analyses showed strong FC within each CMS structure, strong FC along the dorsal-ventral axis, with segregation of anterior from posterior structures. Seed correlation showed FC of anterior regions to limbic/paralimbic areas, and FC of posterior regions to sensory areas-findings consistent with functional segregation noted in humans. Fear recall increased FC between the cingulate and retrosplenial cortices, but decreased FC between dorsal and ventral structures. In agreement with reports in humans, fear recall broadened FC of anterior structures to the amygdala and to somatosensory areas, suggesting integration and processing of both limbic and sensory information. Organizational principles learned from animal models at the mesoscopic level (brain regions and pathways) will not only critically inform future work at the microscopic (single neurons and synapses) level, but also have translational value to advance our understanding of human brain architecture.

  6. Evaluation of an integrated adherence program aimed to increase Medicare Part D star rating measures.

    PubMed

    Leslie, R Scott; Tirado, Breanne; Patel, Bimal V; Rein, Philip J

    2014-12-01

    The Centers for Medicare Medicaid Services (CMS) Plan Quality and Performance Program, or Star Ratings Program, allows Medicare beneficiaries to compare quality of care among available Medicare Advantage prescription drug (MA-PD) plans and stand-alone prescription drug plans (PDPs). Health plans have increased intervention efforts and applied existing care management infrastructure as an approach to improving member medication adherence and subsequent Part D star rating performance. Independent Care Health Plan (iCare), an MA-PD plan; MedImpact Healthcare Systems, Inc. (MedImpact), a pharmacy benefits manager; and US MED, a mail order pharmacy, partnered to engage and enroll iCare's dual-eligible special needs population in an intervention designed to improve patient medication adherence and health plan performance for 3 Part D patient safety outcome measures: Medication Adherence for Oral Diabetes Medications (ODM), Medication Adherence for Hypertension (HTN), and Medication Adherence for Cholesterol (CHOL). To (a) assess the effectiveness of a coordinated member-directed medication adherence intervention and (b) determine the overall impact of the intervention on adherence rates and CMS Part D star rating adherence measures.  Administrative pharmacy claims and health plan eligibility data from MedImpact's databases were used to identify members using 3 target medication classes. Adherence was estimated by the proportion of days covered (PDC) for all members. Those members considered at high risk for nonadherence were prioritized for care management services. Risk factors were based on members' use of more than 1 target medication class, newly started therapy, and suboptimal adherence (PDC  less than  80%) in the most recent 6-month period. Data files listing member adherence rates and contact information were formatted and loaded monthly into iCare's care management system, which triggered an alert for care coordinators to counsel members on the importance of adherence and offer the members an option for monthly 30-day supply medication delivery via US MED. Member adherence rates were calculated 9 months pre- and postimplementation for all members and adjusted by length of member enrollment based on CMS technical specifications. Regression analysis assessed pre-post changes in rates comparing 2 intervention groups: (1) members receiving iCare counseling only (iCare-only) and (2) members receiving counseling and medication delivery (iCare + US MED). To evaluate the overall impact of the intervention, iCare's adherence rates and iCare's measure-specific star ratings for the 2011 and 2012 calendar years (CMS measurement years) were compared with the national MA-PD plan contract average and with a health plan similar in member characteristics but without adherence intervention exposure.  A total of 2,700 members were initially targeted for referral to iCare care management and US MED customer service specialist teams. Between April 2012 (implementation date) and January 2013, 1,302 (48.2%) members enrolled in the US MED component of the intervention. Seventy-six percent of identified members were nonadherent (PDC  less than  80%) to 1 of the 3 target medication classes, and 32% of members were nonadherent to more than 1 target medication class. Pre-post absolute average adherence rates increased for the iCare-only group (ODM = 15.1, HTN = 10.1, CHOL = 13.6) and the iCare-US MED group (ODM = 30.9, HTN = 25.5, CHOL = 29.4).  From 2011 to 2012, iCare adherence rates increased by absolute differences of 15.2, 9.2, and 10.1 percentage points for ODM, HTN, and CHOL measures, respectively, compared with the average MA-PD plan contract differences (1.1, 2.1, and 2.5) and the comparator health plan differences (-2.7, -1.4, and -4.1). Increases in iCare's adherence rates were associated with significant increases in iCare's 2014 adherence measure star ratings (1 star to 3 stars for ODM and CHOL, 1 star to 2 stars for HTN), which contributed to increases in the Drug Plan Quality Improvement measure (2 stars to 4 stars) and iCare's overall Part D star rating (3 to 3.5 stars).  Members in this MA-PD plan dual-eligible population benefited from multiple points of contact to achieve increased adherence. Health plans can use network pharmacies, care management staff, and their pharmacy benefits managers to collaborate and implement interventions aimed to improve members' adherence to targeted maintenance medications and overall health plan quality performance and star ratings.

  7. Dose-ranging pharmacokinetics of colistin methanesulphonate (CMS) and colistin in rats following single intravenous CMS doses.

    PubMed

    Marchand, Sandrine; Lamarche, Isabelle; Gobin, Patrice; Couet, William

    2010-08-01

    The aim of this study was to evaluate the effect of colistin methanesulphonate (CMS) dose on CMS and colistin pharmacokinetics in rats. Three rats per group received an intravenous bolus of CMS at a dose of 5, 15, 30, 60 or 120 mg/kg. Arterial blood samples were drawn at 0, 5, 15, 30, 60, 90, 120, 150 and 180 min. CMS and colistin plasma concentrations were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The pharmacokinetic parameters of CMS and colistin were calculated by non-compartmental analysis. Linear relationships were observed between CMS and colistin AUCs to infinity and CMS doses, as well as between CMS and colistin C(max) and CMS doses. CMS and colistin pharmacokinetics were linear for a range of colistin concentrations covering the range of values encountered and recommended in patients even during treatment with higher doses.

  8. Experimental High Energy Physics Research

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

    Hohlmann, Marcus

    This final report summarizes activities of the Florida Tech High Energy Physics group supported by DOE under grant #DE-SC0008024 during the period June 2012 – March 2015. We focused on one of the main HEP research thrusts at the Energy Frontier by participating in the CMS experiment. We were exploiting the tremendous physics opportunities at the Large Hadron Collider (LHC) and prepared for physics at its planned extension, the High-Luminosity LHC. The effort comprised a physics component with analysis of data from the first LHC run and contributions to the CMS Phase-2 upgrades in the muon endcap system (EMU) formore » the High-Luminosity LHC. The emphasis of our hardware work was the development of large-area Gas Electron Multipliers (GEMs) for the CMS forward muon upgrade. We built a production and testing site for such detectors at Florida Tech to complement future chamber production at CERN. The first full-scale CMS GE1/1 chamber prototype ever built outside of CERN was constructed at Florida Tech in summer 2013. We conducted two beam tests with GEM prototype chambers at CERN in 2012 and at FNAL in 2013 and reported the results at conferences and in publications. Principal Investigator Hohlmann served as chair of the collaboration board of the CMS GEM collaboration and as co-coordinator of the GEM detector working group. He edited and authored sections of the detector chapter of the Technical Design Report (TDR) for the GEM muon upgrade, which was approved by the LHCC and the CERN Research Board in 2015. During the course of the TDR approval process, the GEM project was also established as an official subsystem of the muon system by the CMS muon institution board. On the physics side, graduate student Kalakhety performed a Z' search in the dimuon channel with the 2011 and 2012 CMS datasets that utilized 20.6 fb⁻¹ of p-p collisions at √s = 8 TeV. For the dimuon channel alone, the 95% CL lower limits obtained on the mass of a Z' resonance are 2770 GeV for a Z' with the same standard-model couplings as the Z boson. Our student team operated a Tier-3 cluster on the Open Science Grid (OSG) to support local CMS physics analysis and remote OSG activity. As a service to the HEP community, Hohlmann participated in the Snowmass effort over the course of 2013. Specifically, he acted as a liaison for gaseous detectors between the Instrumentation Frontier and the Energy Frontier and contributed to five papers and reports submitted to the summer study.« less

  9. 76 FR 39110 - Medicare Program; Section 3113: The Treatment of Certain Complex Diagnostic Laboratory Tests...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-05

    ... access to care, quality of care, health outcomes, and expenditures. DATES: Supporting information to... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5058-N... Tests Demonstration. The Demonstration is mandated by section 3113 of the Affordable Care Act. This...

  10. Transmission Electron Microscopy of the Matrix Minerals in the Tagish Lake Carbonaceous Chondrite

    NASA Technical Reports Server (NTRS)

    Mikouchi, T.; Kasama, T.; Zolensky, M. E.; Tachikawa, O.

    2001-01-01

    We studied the Tagish Lake matrix minerals by TEM. The result shows similarities to CIs (and CRs) and differences from CMs, but its heterogeneity (e.g., carbonate abundance, saponite/serpentine ratio) suggests its complex history. Additional information is contained in the original extended abstract.

  11. Experience in using commercial clouds in CMS

    NASA Astrophysics Data System (ADS)

    Bauerdick, L.; Bockelman, B.; Dykstra, D.; Fuess, S.; Garzoglio, G.; Girone, M.; Gutsche, O.; Holzman, B.; Hufnagel, D.; Kim, H.; Kennedy, R.; Mason, D.; Spentzouris, P.; Timm, S.; Tiradani, A.; Vaandering, E.; CMS Collaboration

    2017-10-01

    Historically high energy physics computing has been performed on large purpose-built computing systems. In the beginning there were single site computing facilities, which evolved into the Worldwide LHC Computing Grid (WLCG) used today. The vast majority of the WLCG resources are used for LHC computing and the resources are scheduled to be continuously used throughout the year. In the last several years there has been an explosion in capacity and capability of commercial and academic computing clouds. Cloud resources are highly virtualized and intended to be able to be flexibly deployed for a variety of computing tasks. There is a growing interest amongst the cloud providers to demonstrate the capability to perform large scale scientific computing. In this presentation we will discuss results from the CMS experiment using the Fermilab HEPCloud Facility, which utilized both local Fermilab resources and Amazon Web Services (AWS). The goal was to work with AWS through a matching grant to demonstrate a sustained scale approximately equal to half of the worldwide processing resources available to CMS. We will discuss the planning and technical challenges involved in organizing the most IO intensive CMS workflows on a large-scale set of virtualized resource provisioned by the Fermilab HEPCloud. We will describe the data handling and data management challenges. Also, we will discuss the economic issues and cost and operational efficiency comparison to our dedicated resources. At the end we will consider the changes in the working model of HEP computing in a domain with the availability of large scale resources scheduled at peak times.

  12. Experience in Grid Site Testing for ATLAS, CMS and LHCb with HammerCloud

    NASA Astrophysics Data System (ADS)

    Elmsheuser, Johannes; Medrano Llamas, Ramón; Legger, Federica; Sciabà, Andrea; Sciacca, Gianfranco; Úbeda García, Mario; van der Ster, Daniel

    2012-12-01

    Frequent validation and stress testing of the network, storage and CPU resources of a grid site is essential to achieve high performance and reliability. HammerCloud was previously introduced with the goals of enabling VO- and site-administrators to run such tests in an automated or on-demand manner. The ATLAS, CMS and LHCb experiments have all developed VO plugins for the service and have successfully integrated it into their grid operations infrastructures. This work will present the experience in running HammerCloud at full scale for more than 3 years and present solutions to the scalability issues faced by the service. First, we will show the particular challenges faced when integrating with CMS and LHCb offline computing, including customized dashboards to show site validation reports for the VOs and a new API to tightly integrate with the LHCbDIRAC Resource Status System. Next, a study of the automatic site exclusion component used by ATLAS will be presented along with results for tuning the exclusion policies. A study of the historical test results for ATLAS, CMS and LHCb will be presented, including comparisons between the experiments’ grid availabilities and a search for site-based or temporal failure correlations. Finally, we will look to future plans that will allow users to gain new insights into the test results; these include developments to allow increased testing concurrency, increased scale in the number of metrics recorded per test job (up to hundreds), and increased scale in the historical job information (up to many millions of jobs per VO).

  13. Experience in using commercial clouds in CMS

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

    Bauerdick, L.; Bockelman, B.; Dykstra, D.

    Historically high energy physics computing has been performed on large purposebuilt computing systems. In the beginning there were single site computing facilities, which evolved into the Worldwide LHC Computing Grid (WLCG) used today. The vast majority of the WLCG resources are used for LHC computing and the resources are scheduled to be continuously used throughout the year. In the last several years there has been an explosion in capacity and capability of commercial and academic computing clouds. Cloud resources are highly virtualized and intended to be able to be flexibly deployed for a variety of computing tasks. There is amore » growing interest amongst the cloud providers to demonstrate the capability to perform large scale scientific computing. In this presentation we will discuss results from the CMS experiment using the Fermilab HEPCloud Facility, which utilized both local Fermilab resources and Amazon Web Services (AWS). The goal was to work with AWS through a matching grant to demonstrate a sustained scale approximately equal to half of the worldwide processing resources available to CMS. We will discuss the planning and technical challenges involved in organizing the most IO intensive CMS workflows on a large-scale set of virtualized resource provisioned by the Fermilab HEPCloud. We will describe the data handling and data management challenges. Also, we will discuss the economic issues and cost and operational efficiency comparison to our dedicated resources. At the end we will consider the changes in the working model of HEP computing in a domain with the availability of large scale resources scheduled at peak times.« less

  14. Value-based contracting innovated Medicare advantage healthcare delivery and improved survival.

    PubMed

    Mandal, Aloke K; Tagomori, Gene K; Felix, Randell V; Howell, Scott C

    2017-02-01

    In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area. Starting in 2009, for intervention-group MA enrollees, the MAO and a provider group agreed to full-risk capitation combined with a revenue gainshare. The gainshare was based on increases in the Risk Adjustment Factor (RAF), which modified the CMS-HCC payments. For the control group, the MAO continued to reimburse another provider group through fee-for-service. RAF, utilization, and survival were followed until December 31, 2012. The intervention group's mean RAF increased significantly (P <.001), estimating $2,519,544 per 1000 members of additional revenue. The intervention increased office-based visits (P <.001). Emergency department visits (P <.001) and inpatient hospital admissions (P = .002) decreased. This change in utilization saved $2,071,293 per 1000 enrollees. By intensifying office-based care for these MA enrollees with multiple comorbidities, a 6% survival benefit with a 32.8% lower hazard of death (P <.001) was achieved. Value-based contracting can drive utilization patterns and improve clinical outcomes among chronically ill, elderly MA members.

  15. Matrigel Mattress: A Method for the Generation of Single Contracting Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes.

    PubMed

    Feaster, Tromondae K; Cadar, Adrian G; Wang, Lili; Williams, Charles H; Chun, Young Wook; Hempel, Jonathan E; Bloodworth, Nathaniel; Merryman, W David; Lim, Chee Chew; Wu, Joseph C; Knollmann, Björn C; Hong, Charles C

    2015-12-04

    The lack of measurable single-cell contractility of human-induced pluripotent stem cell-derived cardiac myocytes (hiPSC-CMs) currently limits the utility of hiPSC-CMs for evaluating contractile performance for both basic research and drug discovery. To develop a culture method that rapidly generates contracting single hiPSC-CMs and allows quantification of cell shortening with standard equipment used for studying adult CMs. Single hiPSC-CMs were cultured for 5 to 7 days on a 0.4- to 0.8-mm thick mattress of undiluted Matrigel (mattress hiPSC-CMs) and compared with hiPSC-CMs maintained on a control substrate (<0.1-mm thick 1:60 diluted Matrigel, control hiPSC-CMs). Compared with control hiPSC-CMs, mattress hiPSC-CMs had more rod-shape morphology and significantly increased sarcomere length. Contractile parameters of mattress hiPSC-CMs measured with video-based edge detection were comparable with those of freshly isolated adult rabbit ventricular CMs. Morphological and contractile properties of mattress hiPSC-CMs were consistent across cryopreserved hiPSC-CMs generated independently at another institution. Unlike control hiPSC-CMs, mattress hiPSC-CMs display robust contractile responses to positive inotropic agents, such as myofilament calcium sensitizers. Mattress hiPSC-CMs exhibit molecular changes that include increased expression of the maturation marker cardiac troponin I and significantly increased action potential upstroke velocity because of a 2-fold increase in sodium current (INa). The Matrigel mattress method enables the rapid generation of robustly contracting hiPSC-CMs and enhances maturation. This new method allows quantification of contractile performance at the single-cell level, which should be valuable to disease modeling, drug discovery, and preclinical cardiotoxicity testing. © 2015 American Heart Association, Inc.

  16. Toward a rational, value-based drug benefit for Medicare.

    PubMed

    Lopert, Ruth; Moon, Marilyn

    2007-01-01

    A major challenge facing Congress is what changes, if any, to make to Medicare Part D. With the apparent failure of the Democrats' attempt to remove the prohibition on government intervention in drug price negotiations, the party's next steps are unclear. One suggested option is a plan administered by the Centers for Medicare and Medicaid Services (CMS), to compete with private plans and facilitate a transition to a more rational structure. We discuss issues surrounding the design of such a mechanism and how it might provide a transition toward a more rational and sustainable drug benefit in the longer term.

  17. Experimental Approach for the Uncertainty Assessment of 3D Complex Geometry Dimensional Measurements Using Computed Tomography at the mm and Sub-mm Scales

    PubMed Central

    Jiménez, Roberto; Torralba, Marta; Yagüe-Fabra, José A.; Ontiveros, Sinué; Tosello, Guido

    2017-01-01

    The dimensional verification of miniaturized components with 3D complex geometries is particularly challenging. Computed Tomography (CT) can represent a suitable alternative solution to micro metrology tools based on optical and tactile techniques. However, the establishment of CT systems’ traceability when measuring 3D complex geometries is still an open issue. In this work, an alternative method for the measurement uncertainty assessment of 3D complex geometries by using CT is presented. The method is based on the micro-CT system Maximum Permissible Error (MPE) estimation, determined experimentally by using several calibrated reference artefacts. The main advantage of the presented method is that a previous calibration of the component by a more accurate Coordinate Measuring System (CMS) is not needed. In fact, such CMS would still hold all the typical limitations of optical and tactile techniques, particularly when measuring miniaturized components with complex 3D geometries and their inability to measure inner parts. To validate the presented method, the most accepted standard currently available for CT sensors, the Verein Deutscher Ingenieure/Verband Deutscher Elektrotechniker (VDI/VDE) guideline 2630-2.1 is applied. Considering the high number of influence factors in CT and their impact on the measuring result, two different techniques for surface extraction are also considered to obtain a realistic determination of the influence of data processing on uncertainty. The uncertainty assessment of a workpiece used for micro mechanical material testing is firstly used to confirm the method, due to its feasible calibration by an optical CMS. Secondly, the measurement of a miniaturized dental file with 3D complex geometry is carried out. The estimated uncertainties are eventually compared with the component’s calibration and the micro manufacturing tolerances to demonstrate the suitability of the presented CT calibration procedure. The 2U/T ratios resulting from the validation workpiece are, respectively, 0.27 (VDI) and 0.35 (MPE), by assuring tolerances in the range of ± 20–30 µm. For the dental file, the EN < 1 value analysis is favorable in the majority of the cases (70.4%) and 2U/T is equal to 0.31 for sub-mm measurands (L < 1 mm and tolerance intervals of ± 40–80 µm). PMID:28509869

  18. Experimental Approach for the Uncertainty Assessment of 3D Complex Geometry Dimensional Measurements Using Computed Tomography at the mm and Sub-mm Scales.

    PubMed

    Jiménez, Roberto; Torralba, Marta; Yagüe-Fabra, José A; Ontiveros, Sinué; Tosello, Guido

    2017-05-16

    The dimensional verification of miniaturized components with 3D complex geometries is particularly challenging. Computed Tomography (CT) can represent a suitable alternative solution to micro metrology tools based on optical and tactile techniques. However, the establishment of CT systems' traceability when measuring 3D complex geometries is still an open issue. In this work, an alternative method for the measurement uncertainty assessment of 3D complex geometries by using CT is presented. The method is based on the micro-CT system Maximum Permissible Error (MPE) estimation, determined experimentally by using several calibrated reference artefacts. The main advantage of the presented method is that a previous calibration of the component by a more accurate Coordinate Measuring System (CMS) is not needed. In fact, such CMS would still hold all the typical limitations of optical and tactile techniques, particularly when measuring miniaturized components with complex 3D geometries and their inability to measure inner parts. To validate the presented method, the most accepted standard currently available for CT sensors, the Verein Deutscher Ingenieure/Verband Deutscher Elektrotechniker (VDI/VDE) guideline 2630-2.1 is applied. Considering the high number of influence factors in CT and their impact on the measuring result, two different techniques for surface extraction are also considered to obtain a realistic determination of the influence of data processing on uncertainty. The uncertainty assessment of a workpiece used for micro mechanical material testing is firstly used to confirm the method, due to its feasible calibration by an optical CMS. Secondly, the measurement of a miniaturized dental file with 3D complex geometry is carried out. The estimated uncertainties are eventually compared with the component's calibration and the micro manufacturing tolerances to demonstrate the suitability of the presented CT calibration procedure. The 2U/T ratios resulting from the validation workpiece are, respectively, 0.27 (VDI) and 0.35 (MPE), by assuring tolerances in the range of ± 20-30 µm. For the dental file, the E N < 1 value analysis is favorable in the majority of the cases (70.4%) and 2U/T is equal to 0.31 for sub-mm measurands (L < 1 mm and tolerance intervals of ± 40-80 µm).

  19. 77 FR 31618 - Medicaid Program; Announcement of Requirements and Registration for CMS Provider Screening...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services (CMS) [CMS-2382-N... Challenge AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: The Centers for Medicare & Medicaid Services (CMS), is announcing the launch of the ``CMS Provider Screening...

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

    Yang, K; Yu, Z; Chen, H

    Purpose: To implement VMAT in RayStation with the Elekta Synergy linac with the new Agility MLC, and to utilize the same vendor softwares to determine the optimum Elekta VMAT machine parameters in RayStation for accurate modeling and robust delivery. Methods: iCOMCat is utilized to create various beam patterns with user defined dose rate, gantry, MLC and jaw speed for each control point. The accuracy and stability of the output and beam profile are qualified for each isolated functional component of VMAT delivery using ion chamber and Profiler2 with isocentric mounting fixture. Service graphing on linac console is used to verifymore » the mechanical motion accuracy. The determined optimum Elekta VMAT machine parameters were configured in RayStation v4.5.1. To evaluate the system overall performance, TG-119 test cases and nine retrospective VMAT patients were planned on RayStation, and validated using both ArcCHECK (with plug and ion chamber) and MapCHECK2. Results: Machine output and profile varies <0.3% when only variable is dose rate (35MU/min-600MU/min). <0.9% output and <0.3% profile variation are observed with additional gantry motion (0.53deg/s–5.8deg/s both directions). The output and profile variation are still <1% with additional slow leaf motion (<1.5cm/s both direction). However, the profile becomes less symmetric, and >1.5% output and 7% profile deviation is seen with >2.5cm/s leaf motion. All clinical cases achieved comparable plan quality as treated IMRT plans. The gamma passing rate is 99.5±0.5% on ArcCheck (<3% iso center dose deviation) and 99.1±0.8% on MapCheck2 using 3%/3mm gamma (10% lower threshold). Mechanical motion accuracy in all VMAT deliveries is <1°/1mm. Conclusion: Accurate RayStation modeling and robust VMAT delivery is achievable on Elekta Agility for <2.5cm/s leaf motion and full range of dose rate and gantry speed determined by the same vendor softwares. Our TG-119 and patient results have provided us with the confidence to use VMAT clinically.« less

  1. A study to establish reasonable action limits for patient‐specific quality assurance in intensity‐modulated radiation therapy

    PubMed Central

    Alecu, Ionut M.; Stan, Andrada R.; Alecu, Marius; Ciura, Andrei; Hansen, Jeremy M.; Alecu, Rodica

    2007-01-01

    An effective patient quality assurance (QA) program for intensity‐modulated radiation therapy (IMRT) requires accurate and realistic plan acceptance criteria—that is, action limits. Based on dose measurements performed with a commercially available two‐dimensional (2D) diode array, we analyzed 747 fluence maps resulting from a routine patient QA program for IMRT plans. The fluence maps were calculated by three different commercially available (ADAC, CMS, Eclipse) treatment planning systems (TPSs) and were delivered using 6‐MV X‐ray beams produced by linear accelerators. To establish reasonably achievable and clinically acceptable limits for the dose deviations, the agreement between the measured and calculated fluence maps was evaluated in terms of percent dose error (PDE) for a few points and percent of passing points (PPP) for the isodose distribution. The analysis was conducted for each TPS used in the study (365 ADAC, 162 CMS, 220 Eclipse), for multiple treatment sites (prostate, pelvis, head and neck, spine, rectum, anus, lung, brain), at the normalization point for 3% percentage difference (%Diff) and 3‐mm distance to agreement (DTA) criteria. We investigated the treatment‐site dependency of PPP and PDE. The results show that, at 3% and 3‐mm criteria, a 95% PPP and 3% PDE can be achieved for prostate treatments and a 90% PPP and 5% PDE are attainable for any treatment site. PACS Numbers: 87.53Dq, 87.53Tf, 87.53Xd, 87.56Fc PMID:17592459

  2. Comprehensive Medication Reviews in Long-term Care Facilities: History of Process Implementation and 2015 Results.

    PubMed

    O'Shea, Terrence E; Zarowitz, Barbara J; Erwin, W Gary

    2017-01-01

    Since 2013, Part D sponsors have been required to offer comprehensive medication reviews (CMRs) to all beneficiaries enrolled in their medication therapy management (MTM) programs at least annually, including those in long-term care (LTC) settings. Since that time, MTM providers have found that accessing and completing CMRs with beneficiaries is frequently prohibitively complex, since the process often requires a live, face-to-face interactive interview where the beneficiary resides. However, with the migration of the CMR completion rate from a star ratings display measure to an active measure, coupled with the new CMR completion rate cutpoints for 2016, accessing this population for CMR completion has heightened importance. Our proprietary consultant pharmacist (CP) software was programmed in 2012 to produce a cover letter, medication action plan, and personal medication list per CMS standardized format specifications. Using this system, CPs were trained to perform and document CMRs and the interactive interviews. MTM-eligible Part D beneficiaries, identified by several contracted clients as residing in LTC serviced by Omnicare, were provided CMRs and summaries written in CMS standardized format by CPs. Residents with cognitive impairment were identified using 3 data elements in the Minimum Data Set (MDS). In 2015, 7,935 MTM-eligible beneficiaries were identified as receiving medications from an Omnicare pharmacy. After excluding those who were disenrolled by their prescription drug plans, discharged from the LTC facility, or resided in a LTC facility no longer serviced by Omnicare, 5,593 residents were available for CMR completion. Of these, only 3% refused the CMR offer, and 5,392 CMRs (96%) were completed successfully. Thirty-nine percent of residents had cognitive impairment per MDS assessments; in those instances, CMRs were conducted with someone other than the beneficiary. Based on the CMRs and interactive interviews, 7,527 drug therapy problem recommendations were made to prescribers, about 50% of which resulted in an alteration in therapy, including reductions in polypharmacy and high-risk medications. The CMR process and written summary in CMS standardized format works effectively for residents in LTC when performed by CPs in the facility, as evidenced by high completion rates and drug therapy problem identification/resolution. Part D plans should further consider using CPs to conduct CMRs in LTC settings. No outside funding supported this research. All authors are employees of Omnicare, a CVS Health Company, and are stockholders of CVS Health. O'Shea and Zarowitz have received research funding (unrelated to the submitted work) from Acadia, AstraZeneca, and Sunovion. The abstract for this article was presented as a research poster at the Academy of Managed Care and Specialty Pharmacy 2016 Annual Meeting; April 21, 2016; San Francisco, California. Study concept and design were contributed by O'Shea and Zarowitz, along with Erwin. O'Shea collected the data, and data interpretation was performed primarily by O'Shea, along with Zarowitz and Erwin. The manuscript was written by O'Shea, along with Zarowitz, and revised primarily by Zarowitz, along with O'Shea and Erwin.

  3. The upgraded ATLAS and CMS detectors and their physics capabilities.

    PubMed

    Wells, Pippa S

    2015-01-13

    The update of the European Strategy for Particle Physics from 2013 states that Europe's top priority should be the exploitation of the full potential of the LHC, including the high-luminosity upgrade of the machine and detectors with a view to collecting 10 times more data than in the initial design. The plans for upgrading the ATLAS and CMS detectors so as to maintain their performance and meet the challenges of increasing luminosity are presented here. A cornerstone of the physics programme is to measure the properties of the 125GeV Higgs boson with the highest possible precision, to test its consistency with the Standard Model. The high-luminosity data will allow precise measurements of the dominant production and decay modes, and offer the possibility of observing rare modes including Higgs boson pair production. Direct and indirect searches for additional Higgs bosons beyond the Standard Model will also continue.

  4. Web application for detailed real-time database transaction monitoring for CMS condition data

    NASA Astrophysics Data System (ADS)

    de Gruttola, Michele; Di Guida, Salvatore; Innocente, Vincenzo; Pierro, Antonio

    2012-12-01

    In the upcoming LHC era, database have become an essential part for the experiments collecting data from LHC, in order to safely store, and consistently retrieve, a wide amount of data, which are produced by different sources. In the CMS experiment at CERN, all this information is stored in ORACLE databases, allocated in several servers, both inside and outside the CERN network. In this scenario, the task of monitoring different databases is a crucial database administration issue, since different information may be required depending on different users' tasks such as data transfer, inspection, planning and security issues. We present here a web application based on Python web framework and Python modules for data mining purposes. To customize the GUI we record traces of user interactions that are used to build use case models. In addition the application detects errors in database transactions (for example identify any mistake made by user, application failure, unexpected network shutdown or Structured Query Language (SQL) statement error) and provides warning messages from the different users' perspectives. Finally, in order to fullfill the requirements of the CMS experiment community, and to meet the new development in many Web client tools, our application was further developed, and new features were deployed.

  5. Tracking at High Level Trigger in CMS

    NASA Astrophysics Data System (ADS)

    Tosi, M.

    2016-04-01

    The trigger systems of the LHC detectors play a crucial role in determining the physics capabilities of experiments. A reduction of several orders of magnitude of the event rate is needed to reach values compatible with detector readout, offline storage and analysis capability. The CMS experiment has been designed with a two-level trigger system: the Level-1 Trigger (L1T), implemented on custom-designed electronics, and the High Level Trigger (HLT), a streamlined version of the CMS offline reconstruction software running on a computer farm. A software trigger system requires a trade-off between the complexity of the algorithms, the sustainable output rate, and the selection efficiency. With the computing power available during the 2012 data taking the maximum reconstruction time at HLT was about 200 ms per event, at the nominal L1T rate of 100 kHz. Track reconstruction algorithms are widely used in the HLT, for the reconstruction of the physics objects as well as in the identification of b-jets and lepton isolation. Reconstructed tracks are also used to distinguish the primary vertex, which identifies the hard interaction process, from the pileup ones. This task is particularly important in the LHC environment given the large number of interactions per bunch crossing: on average 25 in 2012, and expected to be around 40 in Run II. We will present the performance of HLT tracking algorithms, discussing its impact on CMS physics program, as well as new developments done towards the next data taking in 2015.

  6. Genomic Conflicts that Cause Pollen Mortality and Raise Reproductive Barriers in Arabidopsis thaliana

    PubMed Central

    Simon, Matthieu; Durand, Stéphanie; Pluta, Natacha; Gobron, Nicolas; Botran, Lucy; Ricou, Anthony; Camilleri, Christine; Budar, Françoise

    2016-01-01

    Species differentiation and the underlying genetics of reproductive isolation are central topics in evolutionary biology. Hybrid sterility is one kind of reproductive barrier that can lead to differentiation between species. Here, we analyze the complex genetic basis of the intraspecific hybrid male sterility that occurs in the offspring of two distant natural strains of Arabidopsis thaliana, Shahdara and Mr-0, with Shahdara as the female parent. Using both classical and quantitative genetic approaches as well as cytological observation of pollen viability, we demonstrate that this particular hybrid sterility results from two causes of pollen mortality. First, the Shahdara cytoplasm induces gametophytic cytoplasmic male sterility (CMS) controlled by several nuclear loci. Second, several segregation distorters leading to allele-specific pollen abortion (pollen killers) operate in hybrids with either cytoplasm. The complete sterility of the hybrid with the Shahdara cytoplasm results from the genetic linkage of the two causes of pollen mortality, i.e., CMS nuclear determinants and pollen killers. Furthermore, natural variation at these loci in A. thaliana is associated with different male-sterility phenotypes in intraspecific hybrids. Our results suggest that the genomic conflicts that underlie segregation distorters and CMS can concurrently lead to reproductive barriers between distant strains within a species. This study provides a new framework for identifying molecular mechanisms and the evolutionary history of loci that contribute to reproductive isolation, and possibly to speciation. It also suggests that two types of genomic conflicts, CMS and segregation distorters, may coevolve in natural populations. PMID:27182945

  7. Unique and common elements of the role of peer support in the context of traditional mental health services.

    PubMed

    Crane, Dushka A; Lepicki, Traci; Knudsen, Kraig

    2016-09-01

    The goal of this report is to clarify the unique role of peer support providers (PSPs) and define peer support as a distinct occupation in the context of traditional mental health services. A systematic methodology was used to compare roles of PSPs with those of similarly situated case managers (CMs). Key informants including 12 incumbent CMs and 11 incumbent PSPs participated in focus groups and responded to a set of prompts based on the Discovering a Curriculum (DACUM) methodology (Norton & Moser, 2014), an innovative approach to identifying and comparing duties and tasks associated with distinct occupations. Task analyses were validated through a survey of 71 CM and 29 PSP subject matter experts, including workers, supervisors, trainers, and consumers. The results revealed a variety of duties and tasks specific to the PSP occupation, particularly within the domains of empowering consumers, promoting consumers' educational growth, and supporting personal development. The results also reveal areas of overlapping responsibility between PSPs and CMs, including aspects of each role that promote consumers' development, wellness and recovery, administrative tasks, and care coordination activities. These findings may address the role ambiguity that currently challenges efforts to establish peer support as a legitimate service in the field of behavioral health. In addition, the findings demonstrate how the roles of PSPs and CMs could be synergistic in complex organizational settings. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  8. Linear array measurements of enhanced dynamic wedge and treatment planning system (TPS) calculation for 15 MV photon beam and comparison with electronic portal imaging device (EPID) measurements.

    PubMed

    Petrovic, Borislava; Grzadziel, Aleksandra; Rutonjski, Laza; Slosarek, Krzysztof

    2010-09-01

    Enhanced dynamic wedges (EDW) are known to increase drastically the radiation therapy treatment efficiency. This paper has the aim to compare linear array measurements of EDW with the calculations of treatment planning system (TPS) and the electronic portal imaging device (EPID) for 15 MV photon energy. The range of different field sizes and wedge angles (for 15 MV photon beam) were measured by the linear chamber array CA 24 in Blue water phantom. The measurement conditions were applied to the calculations of the commercial treatment planning system XIO CMS v.4.2.0 using convolution algorithm. EPID measurements were done on EPID-focus distance of 100 cm, and beam parameters being the same as for CA24 measurements. Both depth doses and profiles were measured. EDW linear array measurements of profiles to XIO CMS TPS calculation differ around 0.5%. Profiles in non-wedged direction and open field profiles practically do not differ. Percentage depth doses (PDDs) for all EDW measurements show the difference of not more than 0.2%, while the open field PDD is almost the same as EDW PDD. Wedge factors for 60 deg wedge angle were also examined, and the difference is up to 4%. EPID to linear array differs up to 5%. The implementation of EDW in radiation therapy treatments provides clinicians with an effective tool for the conformal radiotherapy treatment planning. If modelling of EDW beam in TPS is done correctly, a very good agreement between measurements and calculation is obtained, but EPID cannot be used for reference measurements.

  9. 76 FR 38657 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-01

    ...: Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report. Use: Form CMS 2540... in the Medicare program to report the health care costs to determine the amount of reimbursable costs... settlement of costs for health care services rendered to Medicare beneficiaries. The revision is due to new...

  10. From CMS to SNS: Educational Networking for Urban Teachers

    ERIC Educational Resources Information Center

    Chen, Pearl

    2011-01-01

    A complex view of the socioeconomic digital divide in urban schools requires us to address not only the gaps in access to technology, but also inequities in access to human support, digital content, and "effective pedagogical" approaches to technology integration. This study explored the use of social networking site (SNS) as a platform…

  11. 42 CFR 493.1773 - Standard: Basic inspection requirements for all laboratories issued a CLIA certificate and CLIA...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... issued a certificate of accreditation, must permit CMS or a CMS agent to conduct validation and complaint inspections. (b) General requirements. As part of the inspection process, CMS or a CMS agent may require the... testing process (preanalytic, analytic, and postanalytic). (4) Permit CMS or a CMS agent access to all...

  12. 42 CFR 493.1773 - Standard: Basic inspection requirements for all laboratories issued a CLIA certificate and CLIA...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... issued a certificate of accreditation, must permit CMS or a CMS agent to conduct validation and complaint inspections. (b) General requirements. As part of the inspection process, CMS or a CMS agent may require the... testing process (preanalytic, analytic, and postanalytic). (4) Permit CMS or a CMS agent access to all...

  13. 42 CFR 493.1773 - Standard: Basic inspection requirements for all laboratories issued a CLIA certificate and CLIA...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... issued a certificate of accreditation, must permit CMS or a CMS agent to conduct validation and complaint inspections. (b) General requirements. As part of the inspection process, CMS or a CMS agent may require the... testing process (preanalytic, analytic, and postanalytic). (4) Permit CMS or a CMS agent access to all...

  14. 42 CFR 493.1773 - Standard: Basic inspection requirements for all laboratories issued a CLIA certificate and CLIA...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... issued a certificate of accreditation, must permit CMS or a CMS agent to conduct validation and complaint inspections. (b) General requirements. As part of the inspection process, CMS or a CMS agent may require the... testing process (preanalytic, analytic, and postanalytic). (4) Permit CMS or a CMS agent access to all...

  15. 42 CFR 493.1773 - Standard: Basic inspection requirements for all laboratories issued a CLIA certificate and CLIA...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... issued a certificate of accreditation, must permit CMS or a CMS agent to conduct validation and complaint inspections. (b) General requirements. As part of the inspection process, CMS or a CMS agent may require the... testing process (preanalytic, analytic, and postanalytic). (4) Permit CMS or a CMS agent access to all...

  16. 78 FR 32257 - Privacy Act of 1974; Report of a New Routine Use for Selected CMS Systems of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-29

    ... systems of records to assist in preventing and detecting fraud, waste and abuse. The new routine use will... for the purpose of preventing and detecting fraud, waste and abuse, pursuant to section 1128C(a)(2) of the Social Security Act (``the Act''). At section 1128C(c) of the Act, a health plan is defined as a...

  17. Effects of intravenous bolus injection of nicorandil on renal artery flow velocity assessed by color Doppler ultrasound.

    PubMed

    Shimamoto, Yukiko; Kubo, Takashi; Tanabe, Kazumi; Emori, Hiroki; Katayama, Yosuke; Nishiguchi, Tsuyoshi; Taruya, Akira; Kameyama, Takeyoshi; Orii, Makoto; Yamano, Takashi; Kuroi, Akio; Yamaguchi, Tomoyuki; Takemoto, Kazushi; Matsuo, Yoshiki; Ino, Yasushi; Tanaka, Atsushi; Hozumi, Takeshi; Terada, Masaki; Akasaka, Takashi

    2017-01-01

    Previous animal studies have shown that a potassium channel opener, nicorandil, provokes vasodilation in renal microvasculature and increases renal blood flow. We conducted a clinical study that aimed to evaluate the effect of nicorandil on renal artery blood flow in comparison with nitroglycerin by using color Doppler ultrasound. The present study enrolled 40 patients with stable coronary artery disease who had no renal arterial stenosis and renal parenchymal disease. The patients received intravenous administration of nicorandil (n=20) or nitroglycerin (n=20). Before and after the administration, renal artery blood flow velocity was measured by color-guided pulsed-wave Doppler. The peak-systolic, end-diastolic, and mean renal artery blood flow velocities before the administration were not different between the nicorandil group and the nitroglycerin group. The peak-systolic (79±15cm/s to 99±21cm/s, p<0.001; and 78±19cm/s to 85±19cm/s, p=0.004), end-diastolic (22±5cm/s to 28±8cm/s, p<0.001; and 24±6cm/s to 26±6cm/s, p=0.005) and mean (41±6cm/s to 49±9cm/s, p<0.001; and 43±9cm/s to 45±9cm/s, p=0.009) renal artery flow velocities increased significantly in either group. The nominal changes in the peak-systolic (20±10cm/s vs. 7±8cm/s, p<0.001), end-diastolic (5±4cm/s vs. 2±3cm/s, p=0.001), and mean (8±5cm/s vs. 2±2cm/s, p<0.001) renal artery blood flow velocities were significantly greater in the nicorandil group compared with the nitroglycerin group. Intravenous nicorandil increased renal artery blood flow velocity in comparison with nitroglycerin. Nicorandil has a significant effect on renal hemodynamics. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  18. Altered iPSC-derived neurons’ sodium channel properties in subjects with Monge's disease

    PubMed Central

    Zhao, Huiwen W.; Gu, Xiang Q.; Chailangkarn, Thanathom; Perkins, Guy; Callacondo, David; Appenzeller, Otto; Poulsen, Orit; Zhou, Dan; Muotri, Alysson R.; Haddad, Gabriel G.

    2015-01-01

    Monge's disease, also known as chronic mountain sickness (CMS), is a disease that potentially threatens more than 140 million highlanders during extended time living at a high altitude (over 2500m). The prevalence of CMS in Andeans is about 15-20%, suggesting that the majority of highlanders (non-CMS) are rather healthy at the high altitude; however, CMS subjects experience severe hypoxemia, erythrocytosis and many neurologic manifestations including migraine, headache, mental fatigue, confusion, and memory loss. The underlying mechanisms of CMS neuropathology are not well understood and no ideal treatment is available to prevent or cure CMS, except for phlebotomy. In the current study, we reprogrammed fibroblast cells from both CMS and non-CMS subjects’ skin biopsies into the induced pluripotent stem cells (iPSCs), then differentiated into neurons and compared their neuronal properties. We discovered that CMS neurons were much less excitable (higher rheobase) than non-CMS neurons. This decreased excitability was not caused by differences in passive neuronal properties, but instead by a significantly lowered Na+ channel current density and by a shift of the voltage-conductance curve in the depolarization direction. Our findings provide, for the first time, evidence of a neuronal abnormality in CMS subjects as compared to non-CMS subjects, hoping that such studies can pave the way to a better understanding of the neuropathology in CMS. PMID:25559931

  19. Monitoring data transfer latency in CMS computing operations

    DOE PAGES

    Bonacorsi, Daniele; Diotalevi, Tommaso; Magini, Nicolo; ...

    2015-12-23

    During the first LHC run, the CMS experiment collected tens of Petabytes of collision and simulated data, which need to be distributed among dozens of computing centres with low latency in order to make efficient use of the resources. While the desired level of throughput has been successfully achieved, it is still common to observe transfer workflows that cannot reach full completion in a timely manner due to a small fraction of stuck files which require operator intervention.For this reason, in 2012 the CMS transfer management system, PhEDEx, was instrumented with a monitoring system to measure file transfer latencies, andmore » to predict the completion time for the transfer of a data set. The operators can detect abnormal patterns in transfer latencies while the transfer is still in progress, and monitor the long-term performance of the transfer infrastructure to plan the data placement strategy.Based on the data collected for one year with the latency monitoring system, we present a study on the different factors that contribute to transfer completion time. As case studies, we analyze several typical CMS transfer workflows, such as distribution of collision event data from CERN or upload of simulated event data from the Tier-2 centres to the archival Tier-1 centres. For each workflow, we present the typical patterns of transfer latencies that have been identified with the latency monitor.We identify the areas in PhEDEx where a development effort can reduce the latency, and we show how we are able to detect stuck transfers which need operator intervention. Lastly, we propose a set of metrics to alert about stuck subscriptions and prompt for manual intervention, with the aim of improving transfer completion times.« less

  20. Monitoring data transfer latency in CMS computing operations

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

    Bonacorsi, Daniele; Diotalevi, Tommaso; Magini, Nicolo

    During the first LHC run, the CMS experiment collected tens of Petabytes of collision and simulated data, which need to be distributed among dozens of computing centres with low latency in order to make efficient use of the resources. While the desired level of throughput has been successfully achieved, it is still common to observe transfer workflows that cannot reach full completion in a timely manner due to a small fraction of stuck files which require operator intervention.For this reason, in 2012 the CMS transfer management system, PhEDEx, was instrumented with a monitoring system to measure file transfer latencies, andmore » to predict the completion time for the transfer of a data set. The operators can detect abnormal patterns in transfer latencies while the transfer is still in progress, and monitor the long-term performance of the transfer infrastructure to plan the data placement strategy.Based on the data collected for one year with the latency monitoring system, we present a study on the different factors that contribute to transfer completion time. As case studies, we analyze several typical CMS transfer workflows, such as distribution of collision event data from CERN or upload of simulated event data from the Tier-2 centres to the archival Tier-1 centres. For each workflow, we present the typical patterns of transfer latencies that have been identified with the latency monitor.We identify the areas in PhEDEx where a development effort can reduce the latency, and we show how we are able to detect stuck transfers which need operator intervention. Lastly, we propose a set of metrics to alert about stuck subscriptions and prompt for manual intervention, with the aim of improving transfer completion times.« less

  1. [Colistin: a review].

    PubMed

    Antonucci, Elio; Taccone, Fabio Silvio; Regolisti, Giuseppe; Cabassi, Aderville; Morabito, Santo; Pistolesi, Valentina; Di Motta, Tommaso; Fiaccadori, Enrico

    2014-01-01

    Colistin (CS) is a polymyxin with bactericidal activity, which is increasingly used in nosocomial infections associated with multidrug-resistant Gram-negative bacteria (MDR-GNB). Intravenous CS is usually administered as a less toxic pro-drug, i.e. colistin sodium methanesulfonate (CMS). In water-containing solutions, CMS undergoes a spontaneous hydrolysis to form a complex mixture of partially sulfomethylated derivatives and CS. Pharmacokinetic of CS is dependent on the route of administration, i.e. parenteral, intramuscular, nebulized, intrathecal/intraventricular. Renal toxicity is the most common adverse effect of CS treatment, as the drug is excreted primarily by the kidney and elevated levels of CS may further impair renal function, with a dose-dependent effect. Clinical manifestations of CS associated nephrotoxicity include acute kidney injury, proteinuria and tubular damage. Only few data are currently available on the effects of different renal replacement therapy modalities on CS pharmacokinetics. In patients undergoing the most efficient forms of renal replacement therapies, the extracorporeal clearance of CMS may result in a substantial removal of the antibiotic. Thus, in this setting, the recommended daily doses should be increased. Future studies should better explore CS pharmacokinetics in patients undergoing different modalities of renal replacement therapy.

  2. Fabrication of fibrillized collagen microspheres with the microstructure resembling an extracellular matrix.

    PubMed

    Matsuhashi, Aki; Nam, Kwangwoo; Kimura, Tsuyoshi; Kishida, Akio

    2015-04-14

    Microspheres using artificial or natural materials have been widely applied in the field of tissue engineering and drug delivery systems. Collagen is being widely used for microspheres because of its abundancy in the extracellular matrix (ECM), and its good biocompatibility. The purpose of this study is to establish the appropriate condition for preparing collagen microspheres (CMS) and fibrillized collagen microspheres (fCMS) using water-in-oil (W/O) emulsion. Collagen can be tailored to mimic the native cell environment possessing a similar microstructure to that of the ECM by conditioning the aqueous solution. We focused on the preparation of stable and injectable CMS and fCMS which is stable and would promote the healing response. Controlling the interfacial properties of hydrophilic-lipophilic balance (HLB), we obtained CMS and fCMS with various sizes and various morphologies. The microsphere prepared with wetting agents showed good microsphere formation, but too low or too high HLB value caused low yield and uncontrollable size distribution. The change in the surfactant amount and the rotor speed also affected the formation of the CMS and fCMS, where the low surfactant amount and fast rotor speed produced smaller CMS and fCMS. In the case of fCMS, the presence of NaCl made it possible to prepare stable fCMS without using any cross-linker due to fibrillogenesis and gelling of collagen molecules. The microstructure of fCMS was similar to that of the native tissue indicating that the fCMS would replicate its function in vivo.

  3. Penetration, Completeness, and Representativeness of The Society of Thoracic Surgeons Adult Cardiac Surgery Database.

    PubMed

    Jacobs, Jeffrey P; Shahian, David M; He, Xia; O'Brien, Sean M; Badhwar, Vinay; Cleveland, Joseph C; Furnary, Anthony P; Magee, Mitchell J; Kurlansky, Paul A; Rankin, J Scott; Welke, Karl F; Filardo, Giovanni; Dokholyan, Rachel S; Peterson, Eric D; Brennan, J Matthew; Han, Jane M; McDonald, Donna; Schmitz, DeLaine; Edwards, Fred H; Prager, Richard L; Grover, Frederick L

    2016-01-01

    The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) has been successfully linked to the Centers for Medicare and Medicaid (CMS) Medicare database, thereby facilitating comparative effectiveness research and providing information about long-term follow-up and cost. The present study uses this link to determine contemporary completeness, penetration, and representativeness of the STS ACSD. Using variables common to both STS and CMS databases, STS operations were linked to CMS data for all CMS coronary artery bypass graft (CABG) surgery hospitalizations discharged between 2000 and 2012, inclusive. For each CMS CABG hospitalization, it was determined whether a matching STS record existed. Center-level penetration (number of CMS sites with at least one matched STS participant divided by the total number of CMS CABG sites) increased from 45% in 2000 to 90% in 2012. In 2012, 973 of 1,081 CMS CABG sites (90%) were linked to an STS site. Patient-level penetration (number of CMS CABG hospitalizations done at STS sites divided by the total number of CMS CABG hospitalizations) increased from 51% in 2000 to 94% in 2012. In 2012, 71,634 of 76,072 CMS CABG hospitalizations (94%) occurred at an STS site. Completeness of case inclusion at STS sites (number of CMS CABG cases at STS sites linked to STS records divided by the total number of CMS CABG cases at STS sites) increased from 88% in 2000 to 98% in 2012. In 2012, 69,213 of 70,932 CMS CABG hospitalizations at STS sites (98%) were linked to an STS record. Linkage of STS and CMS databases demonstrates high and increasing penetration and completeness of the STS database. Linking STS and CMS data facilitates studying long-term outcomes and costs of cardiothoracic surgery. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

    PubMed

    O'Malley, Ann S; Sarwar, Rumin; Keith, Rosalind; Balke, Patrick; Ma, Sai; McCall, Nancy

    2017-12-01

    Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. Semi-structured telephone interviews from January to April 2016 with 71 respondents. Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices. Improving providers' experiences with and uptake of CCM will require addressing several challenges, including the upfront investment for CCM set-up and the time required to provide CCM to more complex patients.

  5. 78 FR 38986 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... that information was collected under Part B. The QIMS Account Registration and the ESRD Application..., CMS-1728-94, CMS-10174, CMS-10305 and CMS-10488] Agency Information Collection Activities: Proposed... comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of...

  6. 42 CFR 482.74 - Condition of participation: Notification to CMS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Notification to CMS... participation: Notification to CMS. (a) A transplant center must notify CMS immediately of any significant... conditions of participation. Instances in which CMS should receive information for follow up, as appropriate...

  7. Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice.

    PubMed

    Braun, Lesley A; Tiralongo, Evelin; Wilkinson, Jenny M; Spitzer, Ondine; Bailey, Michael; Poole, Susan; Dooley, Michael

    2010-07-20

    Complementary medicines (CMs) are popular amongst Australians and community pharmacy is a major supplier of these products. This study explores pharmacy customer use, attitudes and perceptions of complementary medicines, and their expectations of pharmacists as they relate to these products. Pharmacy customers randomly selected from sixty large and small, metropolitan and rural pharmacies in three Australian states completed an anonymous, self administered questionnaire that had been pre-tested and validated. 1,121 customers participated (response rate 62%). 72% had used CMs within the previous 12 months, 61% used prescription medicines daily and 43% had used both concomitantly. Multivitamins, fish oils, vitamin C, glucosamine and probiotics were the five most popular CMs. 72% of people using CMs rated their products as 'very effective' or 'effective enough'. CMs were as frequently used by customers aged 60 years or older as younger customers (69% vs. 72%) although the pattern of use shifted with older age. Most customers (92%) thought pharmacists should provide safety information about CMs, 90% thought they should routinely check for interactions, 87% thought they should recommend effective CMs, 78% thought CMs should be recorded in customer's medication profile and 58% thought pharmacies stocking CMs should also employ a complementary medicine practitioner. Of those using CMs, 93% thought it important for pharmacists to be knowledgeable about CMs and 48% felt their pharmacist provides useful information about CMs. CMs are widely used by pharmacy customers of all ages who want pharmacists to be more involved in providing advice about these products.

  8. Recombination Events Involving the atp9 Gene Are Associated with Male Sterility of CMS PET2 in Sunflower.

    PubMed

    Reddemann, Antje; Horn, Renate

    2018-03-11

    Cytoplasmic male sterility (CMS) systems represent ideal mutants to study the role of mitochondria in pollen development. In sunflower, CMS PET2 also has the potential to become an alternative CMS source for commercial sunflower hybrid breeding. CMS PET2 originates from an interspecific cross of H. petiolaris and H. annuus as CMS PET1, but results in a different CMS mechanism. Southern analyses revealed differences for atp6 , atp9 and cob between CMS PET2, CMS PET1 and the male-fertile line HA89. A second identical copy of atp6 was present on an additional CMS PET2-specific fragment. In addition, the atp9 gene was duplicated. However, this duplication was followed by an insertion of 271 bp of unknown origin in the 5' coding region of the atp9 gene in CMS PET2, which led to the creation of two unique open reading frames orf288 and orf231 . The first 53 bp of orf288 are identical to the 5' end of atp9 . Orf231 consists apart from the first 3 bp, being part of the 271-bp-insertion, of the last 228 bp of atp9 . These CMS PET2-specific orfs are co-transcribed. All 11 editing sites of the atp9 gene present in orf231 are fully edited. The anther-specific reduction of the co-transcript in fertility-restored hybrids supports the involvement in male-sterility based on CMS PET2.

  9. High payload nanostructured lipid carriers fabricated with alendronate/polyethyleneimine ion complexes.

    PubMed

    Abd El-Hamid, Basma N; Swarnakar, Nitin K; Soliman, Ghareb M; Attia, Mohamed A; Pauletti, Giovanni M

    2018-01-15

    Oral bioavailability of the anti-osteoporotic drug alendronate (AL) is limited to ≤ 1% due to unfavorable physicochemical properties. To augment absorption across the gastrointestinal mucosa, an ion pair complex between AL and polyethyleneimine (PEI) was formed and incorporated into nanostructured lipid carriers (NLCs) using a modified solvent injection method. When compared to free AL, ion pairing with PEI increased drug encapsulation efficiency in NLCs from 10% to 87%. Drug release from NLCs measured in vitro using fasted state simulated intestinal fluid, pH 6.5 (FaSSIF-V2) was significantly delayed after PEI complexation. Stability of AL/PEI was pH-dependent resulting in 10-fold faster dissociation of AL in FaSSIF-V2 than measured at pH 7.4. Intestinal permeation properties estimated in vitro across Caco-2 cell monolayers revealed a 3-fold greater flux of AL encapsulated as hydrophobic ion complex in NLCs when compared to AL solution (P app  = 8.43 ± 0.14 × 10 -6 cm/s and vs. 2.76 ± 0.42 × 10 -6 cm/s). Cellular safety of AL/PEI-containing NLCs was demonstrated up to an equivalent AL concentration of 2.5 mM. These results suggest that encapsulation of AL/PEI in NLCs appears a viable drug delivery strategy for augmenting oral bioavailability of this clinically relevant bisphosphonate drug and, simultaneously, increase gastrointestinal safety. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Biopharmaceutical characterization of praziquantel cocrystals and cyclodextrin complexes prepared by grinding.

    PubMed

    Cugovčan, Martina; Jablan, Jasna; Lovrić, Jasmina; Cinčić, Dominik; Galić, Nives; Jug, Mario

    2017-04-15

    Mechanochemical activation using several different co-grinding additives was applied as a green chemistry approach to improve physiochemical and biopharmaceutical properties of praziquantel (PZQ). Liquid assisted grinding with an equimolar amount of citric acid (CA), malic acid (MA), salicylic acid (SA) and tartaric acid (TA) gained in cocrystal formation, which all showed pH-dependent solubility and dissolution rate. However, the most soluble cocrystal of PZQ with MA was chemically unstable, as seen during the stability testing. Equimolar cyclodextrin complexes prepared by neat grinding with amorphous hydroxypropyl-β-cyclodextrin (HPβCD) and randomly methylated β-cyclodextrin (MEβCD) showed the highest improvement in drug solubility and the dissolution rate, but only PZQ/HPβCD product presented an acceptable chemical and photostability profile. A combined approach, by co-grinding the drug with both MA and HPβCD in equimolar ratio, also gave highly soluble amorphous product which again was chemical instable and therefore not suitable for the pharmaceutical use. Studies on Caco-2 monolayer confirmed the biocompatibility of PZQ/HPβCD complex and showed that complexation did not adversely affect the intrinsically high PZQ permeability (P app (PZQ)=(3.72±0.33)×10 -5 cms -1 and P app (PZQ/HPβCD)=(3.65±0.21)×10 -5 cms -1 ; p>0.05). All this confirmed that the co-grinding with the proper additive is as a promising strategy to improve biopharmaceutical properties of the drug. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. 42 CFR 423.2063 - Applicability of laws, regulations and CMS Rulings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Applicability of laws, regulations and CMS Rulings..., ALJ Hearings, MAC review, and Judicial Review § 423.2063 Applicability of laws, regulations and CMS... on ALJs and the MAC. (b) CMS Rulings are published under the authority of the CMS Administrator...

  12. 42 CFR 426.517 - CMS' statement regarding new evidence.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false CMS' statement regarding new evidence. 426.517... DETERMINATIONS Review of an NCD § 426.517 CMS' statement regarding new evidence. (a) CMS may review any new... experts; and (5) Presented during any hearing. (b) CMS may submit a statement regarding whether the new...

  13. 42 CFR 405.1063 - Applicability of laws, regulations and CMS Rulings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Applicability of laws, regulations and CMS Rulings... Medicare Coverage Policies § 405.1063 Applicability of laws, regulations and CMS Rulings. (a) All laws and... the MAC. (b) CMS Rulings are published under the authority of the Administrator, CMS. Consistent with...

  14. How to Spot Congenital Myasthenic Syndromes Resembling the Lambert-Eaton Myasthenic Syndrome? A Brief Review of Clinical, Electrophysiological, and Genetics Features.

    PubMed

    Lorenzoni, Paulo José; Scola, Rosana Herminia; Kay, Claudia Suemi Kamoi; Werneck, Lineu Cesar; Horvath, Rita; Lochmüller, Hanns

    2018-06-01

    Congenital myasthenic syndromes (CMS) are heterogeneous genetic diseases in which neuromuscular transmission is compromised. CMS resembling the Lambert-Eaton myasthenic syndrome (CMS-LEMS) are emerging as a rare group of distinct presynaptic CMS that share the same electrophysiological features. They have low compound muscular action potential amplitude that increment after brief exercise (facilitation) or high-frequency repetitive nerve stimulation. Although clinical signs similar to LEMS can be present, the main hallmark is the electrophysiological findings, which are identical to autoimmune LEMS. CMS-LEMS occurs due to deficits in acetylcholine vesicle release caused by dysfunction of different components in its pathway. To date, the genes that have been associated with CMS-LEMS are AGRN, SYT2, MUNC13-1, VAMP1, and LAMA5. Clinicians should keep in mind these newest subtypes of CMS-LEMS to achieve the correct diagnosis and therapy. We believe that CMS-LEMS must be included as an important diagnostic clue to genetic investigation in the diagnostic algorithms to CMS. We briefly review the main features of CMS-LEMS.

  15. A novel photo-grafting of acrylamide onto carboxymethyl starch. 1. Utilization of CMS-g-PAAm in easy care finishing of cotton fabrics.

    PubMed

    El-Sheikh, Manal A

    2016-11-05

    The photosensitized grafting of vinyl monomers onto a range of polymeric substrates has been the subject of particular interest in the recent past. Carboxymethyl starch (CMS)-poly acrylamide (PAAm) graft copolymer (CMS-g-PAAm) with high graft yield was successfully prepared by grafting of acrylamide onto CMS using UV irradiation in the presence of the water soluble 4-(trimethyl ammoniummethyl) benzophenone chloride photoinitiator. CMS-g-PAAm with nitrogen content of 8.3% and grafting efficiency up to 98.9% was obtained using 100% AAm, a material: liquor ratio of 1:14 and 1% photinitiator at 30°C for 1h of UV irradiation. The synthesis of CMS-g-PAAm was confirmed by FTIR and Nitrogen content (%). Surface morphology of CMS and surface morphological changes of CMS after grafting with AAm were studied using SEM. Thermal properties of both CMS and CMS-g-PAAm were studied using TGA and DSC. To impart easy care finishing to cotton fabrics, aqueous formulations of: CMS-g-PAAm, dimethylol dihydroxy ethylene urea (DMDHEU), CMS-g-PAAm-DMDHEU mixture or methylolated CMS-g-PAAm were used. Cotton fabrics were padded in these formulations, squeezed to a wet pick up 100%, dried at 100°C for 5min, cured at 150°C for 5min, washed at 50°C for 10min and air-dried. CRA (crease recovery angle) of untreated fabrics and fabrics finished with a mixture of 2% CMS-g-PAAm and 10% DMDHEU or methylolated CMS-g-PAAm (10% formaldehyde) were: 136°, 190°, 288° respectively. Increasing the number of washing cycles up to five cycles results in an insignificant decrease in the CRA and a significant decrease in RF (releasable formaldehyde) of finished fabric samples. The morphologies of the finished and unfinished cotton fabrics were performed by SEM. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice

    PubMed Central

    2010-01-01

    Background Complementary medicines (CMs) are popular amongst Australians and community pharmacy is a major supplier of these products. This study explores pharmacy customer use, attitudes and perceptions of complementary medicines, and their expectations of pharmacists as they relate to these products. Methods Pharmacy customers randomly selected from sixty large and small, metropolitan and rural pharmacies in three Australian states completed an anonymous, self administered questionnaire that had been pre-tested and validated. Results 1,121 customers participated (response rate 62%). 72% had used CMs within the previous 12 months, 61% used prescription medicines daily and 43% had used both concomitantly. Multivitamins, fish oils, vitamin C, glucosamine and probiotics were the five most popular CMs. 72% of people using CMs rated their products as 'very effective' or 'effective enough'. CMs were as frequently used by customers aged 60 years or older as younger customers (69% vs. 72%) although the pattern of use shifted with older age. Most customers (92%) thought pharmacists should provide safety information about CMs, 90% thought they should routinely check for interactions, 87% thought they should recommend effective CMs, 78% thought CMs should be recorded in customer's medication profile and 58% thought pharmacies stocking CMs should also employ a complementary medicine practitioner. Of those using CMs, 93% thought it important for pharmacists to be knowledgeable about CMs and 48% felt their pharmacist provides useful information about CMs. Conclusions CMs are widely used by pharmacy customers of all ages who want pharmacists to be more involved in providing advice about these products. PMID:20646290

  17. Recombination Events Involving the atp9 Gene Are Associated with Male Sterility of CMS PET2 in Sunflower

    PubMed Central

    Reddemann, Antje; Horn, Renate

    2018-01-01

    Cytoplasmic male sterility (CMS) systems represent ideal mutants to study the role of mitochondria in pollen development. In sunflower, CMS PET2 also has the potential to become an alternative CMS source for commercial sunflower hybrid breeding. CMS PET2 originates from an interspecific cross of H. petiolaris and H. annuus as CMS PET1, but results in a different CMS mechanism. Southern analyses revealed differences for atp6, atp9 and cob between CMS PET2, CMS PET1 and the male-fertile line HA89. A second identical copy of atp6 was present on an additional CMS PET2-specific fragment. In addition, the atp9 gene was duplicated. However, this duplication was followed by an insertion of 271 bp of unknown origin in the 5′ coding region of the atp9 gene in CMS PET2, which led to the creation of two unique open reading frames orf288 and orf231. The first 53 bp of orf288 are identical to the 5′ end of atp9. Orf231 consists apart from the first 3 bp, being part of the 271-bp-insertion, of the last 228 bp of atp9. These CMS PET2-specific orfs are co-transcribed. All 11 editing sites of the atp9 gene present in orf231 are fully edited. The anther-specific reduction of the co-transcript in fertility-restored hybrids supports the involvement in male-sterility based on CMS PET2. PMID:29534485

  18. 40 CFR Table 7 to Subpart Nnnnn of... - Applicability of General Provisions to Subpart NNNNN

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Operation and maintenance requirements Yes. § 63.6(e)(3) SSM plans Yes. § 63.6(f)(1) Compliance except during SSM Yes. § 63.6(f)(2)-(3) Methods for determining compliance Yes. § 63.6(g) Use of an alternative...) Records related to SSM periods and CMS Yes. § 63.10(b)(2)(xii) Records when under waiver Yes. § 63.10(b)(2...

  19. 40 CFR Table 7 to Subpart Nnnnn of... - Applicability of General Provisions to Subpart NNNNN

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Operation and maintenance requirements Yes. § 63.6(e)(3) SSM plans Yes. § 63.6(f)(1) Compliance except during SSM Yes. § 63.6(f)(2)-(3) Methods for determining compliance Yes. § 63.6(g) Use of an alternative...) Records related to SSM periods and CMS Yes. § 63.10(b)(2)(xii) Records when under waiver Yes. § 63.10(b)(2...

  20. 40 CFR Table 7 to Subpart Nnnnn of... - Applicability of General Provisions to Subpart NNNNN

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Operation and maintenance requirements Yes. § 63.6(e)(3) SSM plans Yes. § 63.6(f)(1) Compliance except during SSM Yes. § 63.6(f)(2)-(3) Methods for determining compliance Yes. § 63.6(g) Use of an alternative...) Records related to SSM periods and CMS Yes. § 63.10(b)(2)(xii) Records when under waiver Yes. § 63.10(b)(2...

  1. 40 CFR Table 7 to Subpart Nnnnn of... - Applicability of General Provisions to Subpart NNNNN

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Operation and maintenance requirements Yes. § 63.6(e)(3) SSM plans Yes. § 63.6(f)(1) Compliance except during SSM Yes. § 63.6(f)(2)-(3) Methods for determining compliance Yes. § 63.6(g) Use of an alternative...) Records related to SSM periods and CMS Yes. § 63.10(b)(2)(xii) Records when under waiver Yes. § 63.10(b)(2...

  2. Challenges to Software/Computing for Experimentation at the LHC

    NASA Astrophysics Data System (ADS)

    Banerjee, Sunanda

    The demands of future high energy physics experiments towards software and computing have led the experiments to plan the related activities as a full-fledged project and to investigate new methodologies and languages to meet the challenges. The paths taken by the four LHC experiments ALICE, ATLAS, CMS and LHCb are coherently put together in an LHC-wide framework based on Grid technology. The current status and understandings have been broadly outlined.

  3. Integration and validation testing for PhEDEx, DBS and DAS with the PhEDEx LifeCycle agent

    NASA Astrophysics Data System (ADS)

    Boeser, C.; Chwalek, T.; Giffels, M.; Kuznetsov, V.; Wildish, T.

    2014-06-01

    The ever-increasing amount of data handled by the CMS dataflow and workflow management tools poses new challenges for cross-validation among different systems within CMS experiment at LHC. To approach this problem we developed an integration test suite based on the LifeCycle agent, a tool originally conceived for stress-testing new releases of PhEDEx, the CMS data-placement tool. The LifeCycle agent provides a framework for customising the test workflow in arbitrary ways, and can scale to levels of activity well beyond those seen in normal running. This means we can run realistic performance tests at scales not likely to be seen by the experiment for some years, or with custom topologies to examine particular situations that may cause concern some time in the future. The LifeCycle agent has recently been enhanced to become a general purpose integration and validation testing tool for major CMS services. It allows cross-system integration tests of all three components to be performed in controlled environments, without interfering with production services. In this paper we discuss the design and implementation of the LifeCycle agent. We describe how it is used for small-scale debugging and validation tests, and how we extend that to large-scale tests of whole groups of sub-systems. We show how the LifeCycle agent can emulate the action of operators, physicists, or software agents external to the system under test, and how it can be scaled to large and complex systems.

  4. Blood flow velocity in the popliteal vein using transverse oscillation ultrasound

    NASA Astrophysics Data System (ADS)

    Bechsgaard, Thor; Hansen, Kristoffer Lindskov; Brandt, Andreas Hjelm; Holbek, Simon; Lönn, Lars; Strandberg, Charlotte; Bækgaard, Niels; Nielsen, Michael Bachmann; Jensen, Jørgen Arendt

    2016-04-01

    Chronic venous disease is a common condition leading to varicose veins, leg edema, post-thrombotic syndrome and venous ulcerations. Ultrasound (US) is the main modality for examination of venous disease. Color Doppler and occasionally spectral Doppler US (SDUS) are used for evaluation of the venous flow. Peak velocities measured by SDUS are rarely used in a clinical setting for evaluating chronic venous disease due to inadequate reproducibility mainly caused by the angle dependency of the estimate. However, estimations of blood velocities are of importance in characterizing venous disease. Transverse Oscillation US (TOUS), a non-invasive angle independent method, has been implemented on a commercial scanner. TOUS's advantage compared to SDUS is a more elaborate visualization of complex flow. The aim of this study was to evaluate, whether TOUS perform equal to SDUS for recording velocities in the veins of the lower limbs. Four volunteers were recruited for the study. A standardized flow was provoked with a cuff compression-decompression system placed around the lower leg. The average peak velocity in the popliteal vein of the four volunteers was 151.5 cm/s for SDUS and 105.9 cm/s for TOUS (p <0.001). The average of the peak velocity standard deviations (SD) were 17.0 cm/s for SDUS and 13.1 cm/s for TOUS (p <0.005). The study indicates that TOUS estimates lower peak velocity with improved SD when compared to SDUS. TOUS may be a tool for evaluation of venous disease providing quantitative measures for the evaluation of venous blood flow.

  5. Genomic Conflicts that Cause Pollen Mortality and Raise Reproductive Barriers in Arabidopsis thaliana.

    PubMed

    Simon, Matthieu; Durand, Stéphanie; Pluta, Natacha; Gobron, Nicolas; Botran, Lucy; Ricou, Anthony; Camilleri, Christine; Budar, Françoise

    2016-07-01

    Species differentiation and the underlying genetics of reproductive isolation are central topics in evolutionary biology. Hybrid sterility is one kind of reproductive barrier that can lead to differentiation between species. Here, we analyze the complex genetic basis of the intraspecific hybrid male sterility that occurs in the offspring of two distant natural strains of Arabidopsis thaliana, Shahdara and Mr-0, with Shahdara as the female parent. Using both classical and quantitative genetic approaches as well as cytological observation of pollen viability, we demonstrate that this particular hybrid sterility results from two causes of pollen mortality. First, the Shahdara cytoplasm induces gametophytic cytoplasmic male sterility (CMS) controlled by several nuclear loci. Second, several segregation distorters leading to allele-specific pollen abortion (pollen killers) operate in hybrids with either cytoplasm. The complete sterility of the hybrid with the Shahdara cytoplasm results from the genetic linkage of the two causes of pollen mortality, i.e., CMS nuclear determinants and pollen killers. Furthermore, natural variation at these loci in A. thaliana is associated with different male-sterility phenotypes in intraspecific hybrids. Our results suggest that the genomic conflicts that underlie segregation distorters and CMS can concurrently lead to reproductive barriers between distant strains within a species. This study provides a new framework for identifying molecular mechanisms and the evolutionary history of loci that contribute to reproductive isolation, and possibly to speciation. It also suggests that two types of genomic conflicts, CMS and segregation distorters, may coevolve in natural populations. Copyright © 2016 by the Genetics Society of America.

  6. Examination of unplanned 30-day readmissions to a comprehensive cancer hospital.

    PubMed

    Saunders, Neil David; Nichols, Shawnn D; Antiporda, Michael Alfredo; Johnson, Kristen; Walker, Kerri; Nilsson, Rhonda; Graham, Lisa; Old, Matt; Klisovic, Rebecca B; Penza, Sam; Schmidt, Carl R

    2015-03-01

    The Centers for Medicare and Medicaid Services (CMS), under the Hospitals Readmissions Reductions Program, may withhold regular reimbursements for excessive 30-day readmissions for select diagnoses. Such penalties imply that some readmissions reflect poor clinical decision making or care during the initial hospitalization. We examined factors related to potentially preventable readmissions in CMS patients at a tertiary cancer hospital. The medical records of all CMS patients with unplanned readmissions within 30 days of index admission were reviewed over 6 months (October 15, 2011-April 15, 2012). Each readmission was classified as not preventable or potentially preventable. Factors associated with potentially preventable readmissions were sought. Of 2,531 inpatient admissions in CMS patients over 6 months, 185 patients experienced at least one readmission for 282 total readmissions (11%). Median time to readmission was 9 days (range, 0 to 30 days). The most common causes for first readmission were new diagnoses not present at first admission (n = 43, 23%), new or worsening symptoms due to cancer progression (n = 40, 21%) and complications of procedures (n = 25, 13%). There were 38 (21%) initial readmissions classified as potentially preventable. Use of total parenteral nutrition at the time of discharge was associated with potentially preventable readmission (P = .028). Most unplanned readmissions to a tertiary cancer hospital are related to progression of disease, new diagnoses, and procedure complications. Minimizing readmissions in complex cancer patients is challenging. Larger multi-institutional datasets are needed to determine a reasonable standard for expected readmission rates. Copyright © 2015 by American Society of Clinical Oncology.

  7. Hybrid male sterility in Mimulus (Phrymaceae) is associated with a geographically restricted mitochondrial rearrangement.

    PubMed

    Case, Andrea L; Willis, John H

    2008-05-01

    Cytoplasmic male sterility (CMS) and nuclear fertility restoration (Rf) involves intergenomic coevolution. Although male-sterile phenotypes are rarely expressed in natural populations of angiosperms, CMS genes are thought to be common. The evolutionary dynamics of CMS/Rf systems are poorly understood, leaving gaps in our understanding of mechanisms and consequences of cytonuclear interactions. We characterized the molecular basis and geographic distribution of a CMS gene in Mimulus guttatus. We used outcrossing M. guttatus (with CMS and Rf) to self-fertilizing M. nasutus (lacking CMS and Rf) to generate hybrids segregating for CMS. Mitochondrial transcripts containing an essential gene (nad6) were perfectly associated with male sterility. The CMS mitotype was completely absent in M. nasutus, present in all genotypes collected from the original collection site, but in only two individuals from 34 other M. guttatus populations. This pattern suggests that the CMS likely originated at a single locality, spread to fixation within the population, but has not spread to other populations, indicating possible ecological or genetic constraints on dispersal of this CMS mitotype between populations. Extreme localization may be characteristic of CMS in hermaphroditic species, in contrast to geographically widespread mitotypes commonly found in gynodioecious species, and could directly contribute to hybrid incompatibilities in nature.

  8. Angle-corrected imaging transcranial doppler sonography versus imaging and nonimaging transcranial doppler sonography in children with sickle cell disease.

    PubMed

    Krejza, J; Rudzinski, W; Pawlak, M A; Tomaszewski, M; Ichord, R; Kwiatkowski, J; Gor, D; Melhem, E R

    2007-09-01

    Nonimaging transcranial Doppler sonography (TCD) and imaging TCD (TCDI) are used for determination of the risk of stroke in children with sickle cell disease (SCD). The purpose was to compare angle-corrected, uncorrected TCDI, and TCD blood flow velocities in children with SCD. A total of 37 children (mean age, 7.8 +/- 3.0 years) without intracranial arterial narrowing determined with MR angiography, were studied with use of TCD and TCDI at the same session. Depth of insonation and TCDI mean velocities with and without correction for the angle of insonation in the terminal internal carotid artery (ICA) and middle (MCA), anterior (ACA), and posterior (PCA) cerebral arteries were compared with TCD velocities with use of a paired t test. Two arteries were not found on TCDI compared with 15 not found on TCD. Average angle of insonation in the MCA, ACA, ICA, and PCA was 31 degrees , 44 degrees , 25 degrees , and 29 degrees , respectively. TCDI and TCD mean depth of insonation for all arteries did not differ significantly; however, individual differences varied substantially. TCDI velocities were significantly lower than TCD velocities, respectively, for the right and left sides (mean +/- SD): MCA, 106 +/- 22 cm/s and 111 +/- 33 cm/s versus 130 +/- 19 cm/s and 134 +/- 26 cm/s; ICA, 90 +/- 14 cm/s and 98 +/- 27 cm/s versus 117 +/- 18 cm/s and 119 +/- 23 cm/s; ACA, 74 +/- 24 cm/s and 88 +/- 25 cm/s versus 105 +/- 23 cm/s and 105 +/- 31 cm/s; and PCA, 84 +/- 27 cm/s and 82 +/- 21 cm/s versus 95 +/- 23 cm/s and 94 +/- 20 cm/s. TCD and angle-corrected TCDI velocities were not statistically different except for higher angle-corrected TCDI values in the left ACA and right PCA. TCD velocities are significantly higher than TCDI velocities but are not different from the angle-corrected TCDI velocities. TCDI identifies the major intracranial arteries more effectively than TCD.

  9. 42 CFR 488.417 - Denial of payment for all new admissions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... to CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State (for non-State operated NFs against which CMS is imposing no remedies); and (2) CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State...

  10. 42 CFR 488.417 - Denial of payment for all new admissions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... to CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State (for non-State operated NFs against which CMS is imposing no remedies); and (2) CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State...

  11. 42 CFR 488.417 - Denial of payment for all new admissions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... to CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State (for non-State operated NFs against which CMS is imposing no remedies); and (2) CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State...

  12. 42 CFR 488.417 - Denial of payment for all new admissions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... to CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State (for non-State operated NFs against which CMS is imposing no remedies); and (2) CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State...

  13. 42 CFR 488.417 - Denial of payment for all new admissions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... to CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State (for non-State operated NFs against which CMS is imposing no remedies); and (2) CMS (for all facilities except non-State operated NFs against which CMS is imposing no remedies) or the State...

  14. 40 CFR Table 1 to Subpart Qqqqq of... - Applicability of General Provisions to Subpart QQQQQ

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... § 63.8(e) CMS Performance Evaluation No Subpart QQQQQ does not require CMS performance evaluations... QQQQQ does not require performance tests or CMS performance evaluations. § 63.9(e) Notification of... CMS No Subpart QQQQQ does not require CMS performance evaluations. § 63.10(a), (b), (d)(1), (d)(4)-(5...

  15. 42 CFR 422.510 - Termination of contract by CMS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Application Procedures and Contracts for Medicare Advantage Organizations § 422.510 Termination of contract by CMS. (a) Termination by CMS. CMS may at any...

  16. The diverse use of clouds by CMS

    DOE PAGES

    Andronis, Anastasios; Bauer, Daniela; Chaze, Olivier; ...

    2015-12-23

    The resources CMS is using are increasingly being offered as clouds. In Run 2 of the LHC the majority of CMS CERN resources, both in Meyrin and at the Wigner Computing Centre, will be presented as cloud resources on which CMS will have to build its own infrastructure. This infrastructure will need to run all of the CMS workflows including: Tier 0, production and user analysis. In addition, the CMS High Level Trigger will provide a compute resource comparable in scale to the total offered by the CMS Tier 1 sites, when it is not running as part of themore » trigger system. During these periods a cloud infrastructure will be overlaid on this resource, making it accessible for general CMS use. Finally, CMS is starting to utilise cloud resources being offered by individual institutes and is gaining experience to facilitate the use of opportunistically available cloud resources. Lastly, we present a snap shot of this infrastructure and its operation at the time of the CHEP2015 conference.« less

  17. The Status of the Cms Experiment

    NASA Astrophysics Data System (ADS)

    Green, Dan

    The CMS experiment was completely assembled in the fall of 2008 after a decade of design, construction and installation. During the last two years, cosmic ray data were taken on a regular basis. These data have enabled CMS to align the detector components, both spatially and temporally. Initial use of muons has also established the relative alignment of the CMS tracking and muon systems. In addition, the CMS calorimetry has been crosschecked with test beam data, thus providing an initial energy calibration of CMS calorimetry to about 5%. The CMS magnet has been powered and field mapped. The trigger and data acquisition systems have been installed and run at full speed. The tiered data analysis system has been exercised at full design bandwidth for Tier0, Tier1 and Tier2 sites. Monte Carlo simulation of the CMS detector has been constructed at a detailed geometric level and has been tuned to test beam and other production data to provide a realistic model of the CMS detector prior to first collisions.

  18. Cardiotoxicity evaluation using human embryonic stem cells and induced pluripotent stem cell-derived cardiomyocytes.

    PubMed

    Zhao, Qi; Wang, Xijie; Wang, Shuyan; Song, Zheng; Wang, Jiaxian; Ma, Jing

    2017-03-09

    Cardiotoxicity remains an important concern in drug discovery. Human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) have become an attractive platform to evaluate cardiotoxicity. However, the consistency between human embryonic stem cell-derived cardiomyocytes (hESC-CMs) and human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) in prediction of cardiotoxicity has yet to be elucidated. Here we screened the toxicities of four representative drugs (E-4031, isoprenaline, quinidine, and haloperidol) using both hESC-CMs and hiPSC-CMs, combined with an impedance-based bioanalytical method. It showed that both hESC-CMs and hiPSC-CMs can recapitulate cardiotoxicity and identify the effects of well-characterized compounds. The combined platform of hPSC-CMs and an impedance-based bioanalytical method could improve preclinical cardiotoxicity screening, holding great potential for increasing drug development accuracy.

  19. Resident intruder paradigm-induced aggression relieves depressive-like behaviors in male rats subjected to chronic mild stress

    PubMed Central

    Wei, Sheng; Ji, Xiao-wei; Wu, Chun-ling; Li, Zi-fa; Sun, Peng; Wang, Jie-qiong; Zhao, Qi-tao; Gao, Jie; Guo, Ying-hui; Sun, Shi-guang; Qiao, Ming-qi

    2014-01-01

    Background Accumulating epidemiological evidence shows that life event stressors are major vulnerability factors for psychiatric diseases such as major depression. It is also well known that the resident intruder paradigm (RIP) results in aggressive behavior in male rats. However, it is not known how resident intruder paradigm-induced aggression affects depressive-like behavior in isolated male rats subjected to chronic mild stress (CMS), which is an animal model of depression. Material/Methods Male Wistar rats were divided into 3 groups: non-stressed controls, isolated rats subjected to the CMS protocol, and resident intruder paradigm-exposed rats subjected to the CMS protocol. Results In the sucrose intake test, ingestion of a 1% sucrose solution by rats in the CMS group was significantly lower than in control and CMS+RIP rats after 3 weeks of stress. In the open-field test, CMS rats had significantly lower open-field scores compared to control rats. Furthermore, the total scores given the CMS group were significantly lower than in the CMS+RIP rats. In the forced swimming test (FST), the immobility times of CMS rats were significantly longer than those of the control or CMS+RIP rats. However, no differences were observed between controls and CMS+RIP rats. Conclusions Our data show that aggressive behavior evoked by the resident intruder paradigm could relieve broad-spectrum depressive-like behaviors in isolated adult male rats subjected to CMS. PMID:24911067

  20. Relative amino acid concentrations as a signature for parent body processes of carbonaceous chondrites.

    PubMed

    Botta, Oliver; Glavin, Daniel P; Kminek, Gerhard; Bada, Jeffrey L

    2002-04-01

    Most meteorites are thought to have originated from objects in the asteroid belt. Carbonaceous chondrites, which contain significant amounts of organic carbon including complex organic compounds, have also been suggested to be derived from comets. The current model for the synthesis of organic compounds found in carbonaceous chondrites includes the survival of interstellar organic compounds and the processing of some of these compounds on the meteoritic parent body. The amino acid composition of five CM carbonaceous chondrites, two CIs, one CR, and one CV3 have been measured using hot water extraction-vapor hydrolysis, OPA/NAC derivatization and high-performance liquid chromatography (HPLC). Total amino acid abundances in the bulk meteorites as well as the amino acid concentrations relative to glycine = 1.0 for beta-alanine, alpha-aminoisobutyric acid and D-alanine were determined. Additional data for three Antarctic CM meteorites were obtained from the literature. All CM meteorites analyzed in this study show a complex distribution of amino acids and a high variability in total concentration ranging from approximately 15,300 to approximately 5800 parts per billion (ppb), while the CIs show a total amino acid abundance of approximately 4300 ppb. The relatively (compared to glycine) high AIB content found in all the CMs is a strong indicator that Strecker-cyanohydrin synthesis is the dominant pathway for the formation of amino acids found in these meteorites. The data from the Antarctic CM carbonaceous chondrites are inconsistent with the results from the other CMs, perhaps due to influences from the Antarctic ice that were effective during their residence time. In contrast to CMs, the data from the CI carbonaceous chondrites indicate that the Strecker synthesis was not active on their parent bodies.

  1. Relative Amino Acid Concentrations as a Signature for Parent Body Processes of Carbonaceous Chondrites

    NASA Technical Reports Server (NTRS)

    Botta, Oliver; Glavin, Daniel P.; Kminek, Gerhard; Bada, Jeffrey L.

    2002-01-01

    Most meteorites are thought to have originated from objects in the asteroid belt. Carbonaceous chondrites, which contain significant amounts of organic carbon including complex organic compounds, have also been suggested to be derived from comets. The current model for the synthesis of organic compounds found in carbonaceous chondrites includes the survival of interstellar organic compounds and the processing of some of these compounds on the meteoritic parent body. The amino acid composition of five CM carbonaceous chondrites, two CIs, one CR, and one CV3 have been measured using hot water extraction-vapor hydrolysis, OPA/NAC derivatization and high-performance liquid chromatography (HPLC). Total amino acid abundances in the bulk meteorites as well as the amino acid concentrations relative to glycine = 1.0 for beta-alanine, alpha-aminoisobutyric acid and D-alanine were determined. Additional data for three Antarctic CM meteorites were obtained from the literature. All CM meteorites analyzed in this study show a complex distribution of amino acids and a high variability in total concentration ranging from approx. 15,300 to approx. 5800 parts per billion (ppb), while the CIs show a total amino acid abundance of approx. 4300 ppb. The relatively (compared to glycine) high AIB content found in all the CMs is a strong indicator that Strecker-cyanohydrin synthesis is the dominant pathway for the formation of amino acids found in these meteorites. The data from the Antarctic CM carbonaceous chondrites are inconsistent with the results from the other CMs, perhaps due to influences from the Antarctic ice that were effective during their residence time. In contrast to CMs, the data from the CI carbonaceous chondrites indicate that the Strecker synthesis was not active on their parent bodies.

  2. 42 CFR 426.415 - CMS' role in the LCD review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false CMS' role in the LCD review. 426.415 Section 426... Review of an LCD § 426.415 CMS' role in the LCD review. CMS may provide to the ALJ, and all parties to the LCD review, information identifying the person who represents the contractor or CMS, if necessary...

  3. CMS-Wave

    DTIC Science & Technology

    2015-10-30

    Coastal Inlets Research Program CMS -Wave CMS -Wave is a two-dimensional spectral wind-wave generation and transformation model that employs a forward...marching, finite-difference method to solve the wave action conservation equation. Capabilities of CMS -Wave include wave shoaling, refraction... CMS -Wave can be used in either on a half- or full-plane mode, with primary waves propagating from the seaward boundary toward shore. It can

  4. A net-shaped multicellular formation facilitates the maturation of hPSC-derived cardiomyocytes through mechanical and electrophysiological stimuli

    PubMed Central

    Liu, Taoyan; Huang, Chengwu; Li, Hongxia; Wu, Fujian; Luo, Jianwen; Lu, Wenjing

    2018-01-01

    The use of human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) is limited in drug discovery and cardiac disease mechanism studies due to cell immaturity. Although many approaches have been reported to improve the maturation of hiPSC-CMs, the elucidation of the process of maturation is crucial. We applied a small-molecule-based differentiation method to generate cardiomyocytes (CMs) with multiple aggregation forms. The motion analysis revealed significant physical differences in the differently shaped CMs, and the net-shaped CMs had larger motion amplitudes and faster velocities than the sheet-shaped CMs. The net-shaped CMs displayed accelerated maturation at the transcriptional level and were more similar to CMs with a prolonged culture time (30 days) than to sheet-d15. Ion channel genes and gap junction proteins were up-regulated in net-shaped CMs, indicating that robust contraction was coupled with enhanced ion channel and connexin expression. The net-shaped CMs also displayed improved myofibril ultrastructure under transmission electron microscopy. In conclusion, different multicellular hPSC-CM structures, such as the net-shaped pattern, are formed using the conditioned induction method, providing a useful tool to improve cardiac maturation. PMID:29661985

  5. Human renal adipose tissue induces the invasion and progression of renal cell carcinoma.

    PubMed

    Campo-Verde-Arbocco, Fiorella; López-Laur, José D; Romeo, Leonardo R; Giorlando, Noelia; Bruna, Flavia A; Contador, David E; López-Fontana, Gastón; Santiano, Flavia E; Sasso, Corina V; Zyla, Leila E; López-Fontana, Constanza M; Calvo, Juan C; Carón, Rubén W; Creydt, Virginia Pistone

    2017-11-07

    We evaluated the effects of conditioned media (CMs) of human adipose tissue from renal cell carcinoma located near the tumor (hRATnT) or farther away from the tumor (hRATfT), on proliferation, adhesion and migration of tumor (786-O and ACHN) and non-tumor (HK-2) human renal epithelial cell lines. Human adipose tissues were obtained from patients with renal cell carcinoma (RCC) and CMs from hRATnT and hRATfT incubation. Proliferation, adhesion and migration were quantified in 786-O, ACHN and HK-2 cell lines incubated with hRATnT-, hRATfT- or control-CMs. We evaluated versican, adiponectin and leptin expression in CMs from hRATnT and hRATfT. We evaluated AdipoR1/2, ObR, pERK, pAkt y pPI3K expression on cell lines incubated with CMs. No differences in proliferation of cell lines was found after 24 h of treatment with CMs. All cell lines showed a significant decrease in cell adhesion and increase in cell migration after incubation with hRATnT-CMs vs. hRATfT- or control-CMs. hRATnT-CMs showed increased levels of versican and leptin, compared to hRATfT-CMs. AdipoR2 in 786-O and ACHN cells decreased significantly after incubation with hRATfT- and hRATnT-CMs vs. control-CMs. We observed a decrease in the expression of pAkt in HK-2, 786-O and ACHN incubated with hRATnT-CMs. This result could partially explain the observed changes in migration and cell adhesion. We conclude that hRATnT released factors, such as leptin and versican, could enhance the invasive potential of renal epithelial cell lines and could modulate the progression of the disease.

  6. Down-regulation of Inwardly Rectifying K+ Currents in Astrocytes Derived from Patients with Monge's Disease.

    PubMed

    Wu, Wei; Yao, Hang; Zhao, Helen W; Wang, Juan; Haddad, Gabriel G

    2018-03-15

    Chronic mountain sickness (CMS) or Monge's disease is a disease in highlanders. These patients have a variety of neurologic symptoms such as migraine, mental fatigue, confusion, dizziness, loss of appetite, memory loss and neuronal degeneration. The cellular and molecular mechanisms underlying CMS neuropathology is not understood. In the previous study, we demonstrated that neurons derived from CMS patients' fibroblasts have a decreased expression and altered gating properties of voltage-gated sodium channel. In this study, we further characterize the electrophysiological properties of iPSC-derived astrocytes from CMS patients. We found that the current densities of the inwardly rectifying potassium (Kir) channels in CMS astrocytes (-5.7 ± 2.2 pA/pF at -140 mV) were significantly decreased as compared to non-CMS (-28.4 ± 3.4 pA/pF at -140 mV) and sea level subjects (-28.3 ± 5.3 pA/pF at -140 mV). We further demonstrated that the reduced Kir current densities in CMS astrocytes were caused by their decreased protein expression of Kir4.1 and Kir2.3 channels, while single channel properties (i.e., P o , conductance) of Kir channel in CMS astrocytes were not altered. In addition, we found no significant differences of outward potassium currents between CMS and non-CMS astrocytes. As compared to non-CMS and sea level subjects, the K + uptake ability in CMS astrocytes was significantly decreased. Taken together, our results suggest that down-regulation of Kir channels and the resulting decreased K + uptake ability in astrocytes could be one of the major molecular mechanisms underlying the neurologic manifestations in CMS patients. Published by Elsevier Ltd.

  7. From Early Embryonic to Adult Stage: Comparative Study of Action Potentials of Native and Pluripotent Stem Cell-Derived Cardiomyocytes.

    PubMed

    Peinkofer, Gabriel; Burkert, Karsten; Urban, Katja; Krausgrill, Benjamin; Hescheler, Jürgen; Saric, Tomo; Halbach, Marcel

    2016-10-01

    Cardiomyocytes (CMs) derived from induced pluripotent stem cells (iPS-CMs) are promising candidates for cell therapy, drug screening, and developmental studies. It is known that iPS-CMs possess immature electrophysiological properties, but an exact characterization of their developmental stage and subtype differentiation is hampered by a lack of knowledge of electrophysiological properties of native CMs from different developmental stages and origins within the heart. Thus, we sought to systematically investigate action potential (AP) properties of native murine CMs and to establish a database that allows classification of stem cell-derived CMs. Hearts from 129S2PasCrl mice were harvested at days 9-10, 12-14, and 16-18 postcoitum, as well as 1 day, 3-4 days, 1-2 weeks, 3-4 weeks, and 6 weeks postpartum. AP recordings in left and right atria and at apical, medial, and basal left and right ventricles were performed with sharp glass microelectrodes. Measurements revealed significant changes in AP morphology during pre- and postnatal murine development and significant differences between atria and ventricles, enabling a classification of developmental stage and subtype differentiation of stem cell-derived CMs based on their AP properties. For iPS-CMs derived from cell line TiB7.4, a typical ventricular phenotype was demonstrated at later developmental stages, while there were electrophysiological differences from atrial as well as ventricular native CMs at earlier stages. This finding supports that iPS-CMs can develop AP properties similar to native CMs, but points to differences in the maturation process between iPS-CMs and native CMs, which may be explained by dissimilar conditions during in vitro differentiation and in vivo development.

  8. Pharmacokinetics of colistin methanesulfonate (CMS) in healthy Chinese subjects after single and multiple intravenous doses.

    PubMed

    Zhao, Miao; Wu, Xiao-Jie; Fan, Ya-Xin; Zhang, Ying-Yuan; Guo, Bei-Ning; Yu, Ji-Cheng; Cao, Guo-Ying; Chen, Yuan-Cheng; Wu, Ju-Fang; Shi, Yao-Guo; Li, Jian; Zhang, Jing

    2018-05-01

    The high prevalence of extensively drug-resistant Gram-negative pathogens has forced clinicians to use colistin as a last-line therapy. Knowledge on the pharmacokinetics of colistin methanesulfonate (CMS), an inactive prodrug, and colistin has increased substantially; however, the pharmacokinetics in the Chinese population is still unknown due to lack of a CMS product in China. This study aimed to evaluate the pharmacokinetics of a new CMS product developed in China in order to optimise dosing regimens. A total of 24 healthy subjects (12 female, 12 male) were enrolled in single- and multiple-dose pharmacokinetic (PK) studies. Concentrations of CMS and formed colistin in plasma and urine were measured, and PK analysis was conducted using a non-compartmental approach. Following a single CMS dose [2.36 mg colistin base activity (CBA) per kg, 1 h infusion], peak concentrations (C max ) of CMS and formed colistin were 18.0 mg/L and 0.661 mg/L, respectively. The estimated half-life (t 1/2 ) of CMS and colistin were 1.38 h and 4.49 h, respectively. Approximately 62.5% of the CMS dose was excreted via urine within 24 h after dosing, whilst only 1.28% was present in the form of colistin. Following multiple CMS doses, colistin reached steady-state within 24 h; there was no accumulation of CMS, but colistin accumulated slightly (R AUC  = 1.33). This study provides the first PK data in the Chinese population and is essential for designing CMS dosing regimens for use in Chinese hospitals. The urinary PK data strongly support the use of intravenous CMS for serious urinary tract infections. Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  9. Differences in pharmacokinetics and pharmacodynamics of colistimethate sodium (CMS) and colistin between three different CMS dosage regimens in a critically ill patient infected by a multidrug-resistant Acinetobacter baumannii.

    PubMed

    Luque, Sònia; Grau, Santiago; Valle, Marta; Sorlí, Luisa; Horcajada, Juan Pablo; Segura, Concha; Alvarez-Lerma, Francisco

    2013-08-01

    Use of colistin has re-emerged for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria, but information on its pharmacokinetics and pharmacodynamics is limited, especially in critically ill patients. Recent data from pharmacokinetic/pharmacodynamic (PK/PD) population studies have suggested that this population could benefit from administration of higher than standard doses of colistimethate sodium (CMS), but the relationship between administration of incremental doses of CMS and corresponding PK/PD parameters as well as its efficacy and toxicity have not yet been investigated in a clinical setting. The objective was to study the PK/PD differences of CMS and colistin between three different CMS dosage regimens in the same critically ill patient. A critically ill patient with nosocomial pneumonia caused by a MDR Acinetobacter baumannii received incremental doses of CMS. During administration of the different CMS dosage regimens, CMS and colistin plasma concentrations were determined and PK/PD indexes were calculated. With administration of the highest CMS dose once daily (720 mg every 24h), the peak plasma concentration of CMS and colistin increased to 40.51 mg/L and 1.81 mg/L, respectively, and the AUC0-24/MIC of colistin was 184.41. This dosage regimen was efficacious, and no nephrotoxicity or neurotoxicity was observed. In conclusion, a higher and extended-interval CMS dosage made it possible to increase the exposure of CMS and colistin in a critically ill patient infected by a MDR A. baumannii and allowed a clinical and microbiological optimal response to be achieved without evidence of toxicity. Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  10. Hospital and Health Plan Partnerships: The Affordable Care Act's Impact on Promoting Health and Wellness.

    PubMed

    Vu, Michelle; White, Annesha; Kelley, Virginia P; Hopper, Jennifer Kuca; Liu, Cathy

    2016-07-01

    The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms "corporate," "health and wellness program," "health plan," "insurance plan," "hospital," "joint venture," and "vertical merger." Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness programs have varying components, but all include monetary incentives and documented outcomes. The concurrent growth of hospital health plans (especially those emerging from vertical mergers and partnerships) and wellness programs in the United States provides a unique opportunity for employees and patient populations to promote wellness and achieve the Triple Aim goals as initiated by CMS.

  11. Hospital and Health Plan Partnerships: The Affordable Care Act's Impact on Promoting Health and Wellness

    PubMed Central

    Vu, Michelle; White, Annesha; Kelley, Virginia P.; Hopper, Jennifer Kuca; Liu, Cathy

    2016-01-01

    Background The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. Objective To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. Method We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms “corporate,” “health and wellness program,” “health plan,” “insurance plan,” “hospital,” “joint venture,” and “vertical merger.” Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. Results A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness programs have varying components, but all include monetary incentives and documented outcomes. Conclusion The concurrent growth of hospital health plans (especially those emerging from vertical mergers and partnerships) and wellness programs in the United States provides a unique opportunity for employees and patient populations to promote wellness and achieve the Triple Aim goals as initiated by CMS. PMID:27625744

  12. Structural and Functional Maturation of Cardiomyocytes Derived from Human Pluripotent Stem Cells

    PubMed Central

    Lundy, Scott D.; Zhu, Wei-Zhong

    2013-01-01

    Despite preclinical studies demonstrating the functional benefit of transplanting human pluripotent stem cell-derived cardiomyocytes (PSC-CMs) into damaged myocardium, the ability of these immature cells to adopt a more adult-like cardiomyocyte (CM) phenotype remains uncertain. To address this issue, we tested the hypothesis that prolonged in vitro culture of human embryonic stem cell (hESC)- and human induced pluripotent stem cell (hiPSC)-derived CMs would result in the maturation of their structural and contractile properties to a more adult-like phenotype. Compared to their early-stage counterparts (PSC-CMs after 20–40 days of in vitro differentiation and culture), late-stage hESC-CMs and hiPSC-CMs (80–120 days) showed dramatic differences in morphology, including increased cell size and anisotropy, greater myofibril density and alignment, sarcomeres visible by bright-field microscopy, and a 10-fold increase in the fraction of multinucleated CMs. Ultrastructural analysis confirmed improvements in the myofibrillar density, alignment, and morphology. We measured the contractile performance of late-stage hESC-CMs and hiPSC-CMs and noted a doubling in shortening magnitude with slowed contraction kinetics compared to the early-stage cells. We then examined changes in the calcium-handling properties of these matured CMs and found an increase in calcium release and reuptake rates with no change in the maximum amplitude. Finally, we performed electrophysiological assessments in hESC-CMs and found that late-stage myocytes have hyperpolarized maximum diastolic potentials, increased action potential amplitudes, and faster upstroke velocities. To correlate these functional changes with gene expression, we performed qPCR and found a robust induction of the key cardiac structural markers, including β-myosin heavy chain and connexin-43, in late-stage hESC-CMs and hiPSC-CMs. These findings suggest that PSC-CMs are capable of slowly maturing to more closely resemble the phenotype of adult CMs and may eventually possess the potential to regenerate the lost myocardium with robust de novo force-producing tissue. PMID:23461462

  13. CMS Connect

    NASA Astrophysics Data System (ADS)

    Balcas, J.; Bockelman, B.; Gardner, R., Jr.; Hurtado Anampa, K.; Jayatilaka, B.; Aftab Khan, F.; Lannon, K.; Larson, K.; Letts, J.; Marra Da Silva, J.; Mascheroni, M.; Mason, D.; Perez-Calero Yzquierdo, A.; Tiradani, A.

    2017-10-01

    The CMS experiment collects and analyzes large amounts of data coming from high energy particle collisions produced by the Large Hadron Collider (LHC) at CERN. This involves a huge amount of real and simulated data processing that needs to be handled in batch-oriented platforms. The CMS Global Pool of computing resources provide +100K dedicated CPU cores and another 50K to 100K CPU cores from opportunistic resources for these kind of tasks and even though production and event processing analysis workflows are already managed by existing tools, there is still a lack of support to submit final stage condor-like analysis jobs familiar to Tier-3 or local Computing Facilities users into these distributed resources in an integrated (with other CMS services) and friendly way. CMS Connect is a set of computing tools and services designed to augment existing services in the CMS Physics community focusing on these kind of condor analysis jobs. It is based on the CI-Connect platform developed by the Open Science Grid and uses the CMS GlideInWMS infrastructure to transparently plug CMS global grid resources into a virtual pool accessed via a single submission machine. This paper describes the specific developments and deployment of CMS Connect beyond the CI-Connect platform in order to integrate the service with CMS specific needs, including specific Site submission, accounting of jobs and automated reporting to standard CMS monitoring resources in an effortless way to their users.

  14. Ogura-CMS in Chinese cabbage (Brassica rapa ssp. pekinensis) causes delayed expression of many nuclear genes.

    PubMed

    Dong, Xiangshu; Kim, Wan Kyu; Lim, Yong-Pyo; Kim, Yeon-Ki; Hur, Yoonkang

    2013-02-01

    We investigated the mechanism regulating cytoplasmic male sterility (CMS) in Brassica rapa ssp. pekinensis using floral bud transcriptome analyses of Ogura-CMS Chinese cabbage and its maintainer line in B. rapa 300-K oligomeric probe (Br300K) microarrays. Ogura-CMS Chinese cabbage produced few and infertile pollen grains on indehiscent anthers. Compared to the maintainer line, CMS plants had shorter filaments and plant growth, and delayed flowering and pollen development. In microarray analysis, 4646 genes showed different expression, depending on floral bud size, between Ogura-CMS and its maintainer line. We found 108 and 62 genes specifically expressed in Ogura-CMS and its maintainer line, respectively. Ogura-CMS line-specific genes included stress-related, redox-related, and B. rapa novel genes. In the maintainer line, genes related to pollen coat and germination were specifically expressed in floral buds longer than 3mm, suggesting insufficient expression of these genes in Ogura-CMS is directly related to dysfunctional pollen. In addition, many nuclear genes associated with auxin response, ATP synthesis, pollen development and stress response had delayed expression in Ogura-CMS plants compared to the maintainer line, which is consistent with the delay in growth and development of Ogura-CMS plants. Delayed expression may reduce pollen grain production and/or cause sterility, implying that mitochondrial, retrograde signaling delays nuclear gene expression. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Phospholipase A2 activity-dependent and -independent fusogenic activity of Naja nigricollis CMS-9 on zwitterionic and anionic phospholipid vesicles.

    PubMed

    Chiou, Yi-Ling; Chen, Ying-Jung; Lin, Shinne-Ren; Chang, Long-Sen

    2011-11-01

    CMS-9, a phospholipase A(2) (PLA(2)) from Naja nigricollis venom, induced the death of human breast cancer MCF-7 cells accompanied with the formation of cell clumps without clear boundaries between cells. Annexin V-FITC staining indicated that abundant phosphatidylserine appeared on the outer membrane of MCF-7 cell clumps, implying the possibility that CMS-9 may promote membrane fusion via anionic phospholipids. To validate this proposition, fusogenic activity of CMS-9 on vesicles composed of zwitterionic phospholipid alone or a combination of zwitterionic and anionic phospholipids was examined. Although CMS-9-induced fusion of zwitterionic phospholipid vesicles depended on PLA(2) activity, CMS-9-induced fusion of vesicles containing anionic phospholipids could occur without the involvement of PLA(2) activity. Membrane-damaging activity of CMS-9 was associated with its fusogenicity. Moreover, CMS-9 induced differently membrane leakage and membrane fusion of vesicles with different compositions. Membrane fluidity and binding capability with phospholipid vesicles were not related to the fusogenicity of CMS-9. However, membrane-bound conformation and mode of CMS-9 depended on phospholipid compositions. Collectively, our data suggest that PLA(2) activity-dependent and -independent fusogenicity of CMS-9 are closely related to its membrane-bound modes and targeted membrane compositions. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Simulations of Sea Level Rise Effects on Complex Coastal Systems

    NASA Astrophysics Data System (ADS)

    Niedoroda, A. W.; Ye, M.; Saha, B.; Donoghue, J. F.; Reed, C. W.

    2009-12-01

    It is now established that complex coastal systems with elements such as beaches, inlets, bays, and rivers adjust their morphologies according to time-varying balances in between the processes that control the exchange of sediment. Accelerated sea level rise introduces a major perturbation into the sediment-sharing systems. A modeling framework based on a new SL-PR model which is an advanced version of the aggregate-scale CST Model and the event-scale CMS-2D and CMS-Wave combination have been used to simulate the recent evolution of a portion of the Florida panhandle coast. This combination of models provides a method to evaluate coefficients in the aggregate-scale model that were previously treated as fitted parameters. That is, by carrying out simulations of a complex coastal system with runs of the event-scale model representing more than a year it is now possible to directly relate the coefficients in the large-scale SL-PR model to measureable physical parameters in the current and wave fields. This cross-scale modeling procedure has been used to simulate the shoreline evolution at the Santa Rosa Island, a long barrier which houses significant military infrastructure at the north Gulf Coast. The model has been used to simulate 137 years of measured shoreline change and to extend these to predictions of future rates of shoreline migration.

  17. 42 CFR 411.382 - CMS's right to rescind advisory opinions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... rescind advisory opinions. Any advice CMS gives in an opinion does not prejudice its right to reconsider... faith reliance upon CMS's advice under this part, provided— (a) The requestor presented to CMS a full...

  18. 42 CFR 411.382 - CMS's right to rescind advisory opinions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... rescind advisory opinions. Any advice CMS gives in an opinion does not prejudice its right to reconsider... faith reliance upon CMS's advice under this part, provided— (a) The requestor presented to CMS a full...

  19. Dendritic Core-Multishell Nanocarriers in Murine Models of Healthy and Atopic Skin

    NASA Astrophysics Data System (ADS)

    Radbruch, Moritz; Pischon, Hannah; Ostrowski, Anja; Volz, Pierre; Brodwolf, Robert; Neumann, Falko; Unbehauen, Michael; Kleuser, Burkhard; Haag, Rainer; Ma, Nan; Alexiev, Ulrike; Mundhenk, Lars; Gruber, Achim D.

    2017-01-01

    Dendritic hPG-amid-C18-mPEG core-multishell nanocarriers (CMS) represent a novel class of unimolecular micelles that hold great potential as drug transporters, e.g., to facilitate topical therapy in skin diseases. Atopic dermatitis is among the most common inflammatory skin disorders with complex barrier alterations which may affect the efficacy of topical treatment.

  20. Regulatory controls on the hydrogeological characterization of a mixed waste disposal site, Radioactive Waste Management Complex, Idaho National Engineering Laboratory

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

    Ruebelmann, K.L.

    1990-01-01

    Following the detection of chlorinated volatile organic compounds in the groundwater beneath the SDA in the summer of 1987, hydrogeological characterization of the Radioactive Waste Management Complex (RWMC), Idaho National Engineering Laboratory (INEL) was required by the Resource Conservation and Recovery Act (RCRA). The waste site, the Subsurface Disposal Area (SDA), is the subject of a RCRA Corrective Action Program. Regulatory requirements for the Corrective Action Program dictate a phased approach to evaluation of the SDA. In the first phase of the program, the SDA is the subject of a RCRA Facility Investigation (RIF), which will obtain information to fullymore » characterize the physical properties of the site, determine the nature and extent of contamination, and identify pathways for migration of contaminants. If the need for corrective measures is identified during the RIF, a Corrective Measures Study (CMS) will be performed as second phase. Information generated during the RIF will be used to aid in the selection and implementation of appropriate corrective measures to correct the release. Following the CMS, the final phase is the implementation of the selected corrective measures. 4 refs., 1 fig.« less

  1. HEPCloud, a New Paradigm for HEP Facilities: CMS Amazon Web Services Investigation

    DOE PAGES

    Holzman, Burt; Bauerdick, Lothar A. T.; Bockelman, Brian; ...

    2017-09-29

    Historically, high energy physics computing has been performed on large purpose-built computing systems. These began as single-site compute facilities, but have evolved into the distributed computing grids used today. Recently, there has been an exponential increase in the capacity and capability of commercial clouds. Cloud resources are highly virtualized and intended to be able to be flexibly deployed for a variety of computing tasks. There is a growing interest among the cloud providers to demonstrate the capability to perform large-scale scientific computing. In this paper, we discuss results from the CMS experiment using the Fermilab HEPCloud facility, which utilized bothmore » local Fermilab resources and virtual machines in the Amazon Web Services Elastic Compute Cloud. We discuss the planning, technical challenges, and lessons learned involved in performing physics workflows on a large-scale set of virtualized resources. Additionally, we will discuss the economics and operational efficiencies when executing workflows both in the cloud and on dedicated resources.« less

  2. Quality control for the first large areas of triple-GEM chambers for the CMS endcaps

    NASA Astrophysics Data System (ADS)

    Abbaneo, D.; Abbas, M.; Abbrescia, M.; Abi Akl, M.; Aboamer, O.; Acosta, D.; Ahmad, A.; Ahmed, W.; Aleksandrov, A.; Altieri, P.; Asawatangtrakuldee, C.; Aspell, P.; Assran, Y.; Awan, I.; Bally, S.; Ban, Y.; Banerjee, S.; Barashko, V.; Barria, P.; Bencze, G.; Beni, N.; Benussi, L.; Bhopatkar, V.; Bianco, S.; Bos, J.; Bouhali, O.; Braghieri, A.; Braibant, S.; Buontempo, S.; Calabria, C.; Caponero, M.; Caputo, C.; Cassese, F.; Castaneda, A.; Cauwenbergh, S.; Cavallo, F. R.; Celik, A.; Choi, M.; Choi, S.; Christiansen, J.; Cimmino, A.; Colafranceschi, S.; Colaleo, A.; Conde Garcia, A.; Czellar, S.; Dabrowski, M. M.; De Lentdecker, G.; De Oliveira, R.; de Robertis, G.; Dildick, S.; Dorney, B.; Endroczi, G.; Errico, F.; Fenyvesi, A.; Ferry, S.; Furic, I.; Giacomelli, P.; Gilmore, J.; Golovtsov, V.; Guiducci, L.; Guilloux, F.; Gutierrez, A.; Hadjiiska, R. M.; Hauser, J.; Hoepfner, K.; Hohlmann, M.; Hoorani, H.; Iaydjiev, P.; Jeng, Y. G.; Kamon, T.; Karchin, P.; Korytov, A.; Krutelyov, S.; Kumar, A.; Kim, H.; Lee, J.; Lenzi, T.; Litov, L.; Loddo, F.; Madorsky, A.; Maerschalk, T.; Maggi, M.; Magnani, A.; Mal, P. K.; Mandal, K.; Marchioro, A.; Marinov, A.; Majumdar, N.; Merlin, J. A.; Mitselmakher, G.; Mohanty, A. K.; Mohapatra, A.; Molnar, J.; Muhammad, S.; Mukhopadhyay, S.; Naimuddin, M.; Nuzzo, S.; Oliveri, E.; Pant, L. M.; Paolucci, P.; Park, I.; Passeggio, G.; Pavlov, B.; Philipps, B.; Piccolo, D.; Postema, H.; Puig Baranac, A.; Radi, A.; Radogna, R.; Raffone, G.; Ranieri, A.; Rashevski, G.; Riccardi, C.; Rodozov, M.; Rodrigues, A.; Ropelewski, L.; RoyChowdhury, S.; Ryu, G.; Ryu, M. S.; Safonov, A.; Salva, S.; Saviano, G.; Sharma, A.; Sharma, A.; Sharma, R.; Shah, A. H.; Shopova, M.; Sturdy, J.; Sultanov, G.; Swain, S. K.; Szillasi, Z.; Talvitie, J.; Tatarinov, A.; Tuuva, T.; Tytgat, M.; Vai, I.; Van Stenis, M.; Venditti, R.; Verhagen, E.; Verwilligen, P.; Vitulo, P.; Volkov, S.; Vorobyev, A.; Wang, D.; Wang, M.; Yang, U.; Yang, Y.; Yonamine, R.; Zaganidis, N.; Zenoni, F.; Zhang, A.

    2018-02-01

    The CMS Collaboration plans to equip the very forward muon system with triple-GEM detectors that can withstand the environment of the High-Luminosity LHC. This project is at the final stages of R&D and moving to production. An unprecedented large area of several 100 m2 are to be instrumented with GEM detectors which will be produced in six different sites around the world. A common construction and quality control procedure is required to ensure the performance of each detector. The quality control steps will include optical inspection, cleaning and baking of all materials and parts used to build the detector, leakage current tests of the GEM foils, high voltage tests, gas leak tests of the chambers and monitoring pressure drop vs. time, gain calibration to know the optimal operation region of the detector, gain uniformity tests, and studying the efficiency, noise and tracking performance of the detectors in a cosmic stand using scintillators.

  3. HEPCloud, a New Paradigm for HEP Facilities: CMS Amazon Web Services Investigation

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

    Holzman, Burt; Bauerdick, Lothar A. T.; Bockelman, Brian

    Historically, high energy physics computing has been performed on large purpose-built computing systems. These began as single-site compute facilities, but have evolved into the distributed computing grids used today. Recently, there has been an exponential increase in the capacity and capability of commercial clouds. Cloud resources are highly virtualized and intended to be able to be flexibly deployed for a variety of computing tasks. There is a growing interest among the cloud providers to demonstrate the capability to perform large-scale scientific computing. In this paper, we discuss results from the CMS experiment using the Fermilab HEPCloud facility, which utilized bothmore » local Fermilab resources and virtual machines in the Amazon Web Services Elastic Compute Cloud. We discuss the planning, technical challenges, and lessons learned involved in performing physics workflows on a large-scale set of virtualized resources. Additionally, we will discuss the economics and operational efficiencies when executing workflows both in the cloud and on dedicated resources.« less

  4. Comparative analysis of mitochondrial genomes between the hau cytoplasmic male sterility (CMS) line and its iso-nuclear maintainer line in Brassica juncea to reveal the origin of the CMS-associated gene orf288.

    PubMed

    Heng, Shuangping; Wei, Chao; Jing, Bing; Wan, Zhengjie; Wen, Jing; Yi, Bin; Ma, Chaozhi; Tu, Jinxing; Fu, Tingdong; Shen, Jinxiong

    2014-04-30

    Cytoplasmic male sterility (CMS) is not only important for exploiting heterosis in crop plants, but also as a model for investigating nuclear-cytoplasmic interaction. CMS may be caused by mutations, rearrangement or recombination in the mitochondrial genome. Understanding the mitochondrial genome is often the first and key step in unraveling the molecular and genetic basis of CMS in plants. Comparative analysis of the mitochondrial genome of the hau CMS line and its maintainer line in B. juneca (Brassica juncea) may help show the origin of the CMS-associated gene orf288. Through next-generation sequencing, the B. juncea hau CMS mitochondrial genome was assembled into a single, circular-mapping molecule that is 247,903 bp in size and 45.08% in GC content. In addition to the CMS associated gene orf288, the genome contains 35 protein-encoding genes, 3 rRNAs, 25 tRNA genes and 29 ORFs of unknown function. The mitochondrial genome sizes of the maintainer line and another normal type line "J163-4" are both 219,863 bp and with GC content at 45.23%. The maintainer line has 36 genes with protein products, 3 rRNAs, 22 tRNA genes and 31 unidentified ORFs. Comparative analysis the mitochondrial genomes of the hau CMS line and its maintainer line allowed us to develop specific markers to separate the two lines at the seedling stage. We also confirmed that different mitotypes coexist substoichiometrically in hau CMS lines and its maintainer lines in B. juncea. The number of repeats larger than 100 bp in the hau CMS line (16 repeats) are nearly twice of those found in the maintainer line (9 repeats). Phylogenetic analysis of the CMS-associated gene orf288 and four other homologous sequences in Brassicaceae show that orf288 was clearly different from orf263 in Brassica tournefortii despite of strong similarity. The hau CMS mitochondrial genome was highly rearranged when compared with its iso-nuclear maintainer line mitochondrial genome. This study may be useful for studying the mechanism of natural CMS in B. juncea, performing comparative analysis on sequenced mitochondrial genomes in Brassicas, and uncovering the origin of the hau CMS mitotype and structural and evolutionary differences between different mitotypes.

  5. Opportunistic Resource Usage in CMS

    NASA Astrophysics Data System (ADS)

    Kreuzer, Peter; Hufnagel, Dirk; Dykstra, D.; Gutsche, O.; Tadel, M.; Sfiligoi, I.; Letts, J.; Wuerthwein, F.; McCrea, A.; Bockelman, B.; Fajardo, E.; Linares, L.; Wagner, R.; Konstantinov, P.; Blumenfeld, B.; Bradley, D.; Cms Collaboration

    2014-06-01

    CMS is using a tiered setup of dedicated computing resources provided by sites distributed over the world and organized in WLCG. These sites pledge resources to CMS and are preparing them especially for CMS to run the experiment's applications. But there are more resources available opportunistically both on the GRID and in local university and research clusters which can be used for CMS applications. We will present CMS' strategy to use opportunistic resources and prepare them dynamically to run CMS applications. CMS is able to run its applications on resources that can be reached through the GRID, through EC2 compliant cloud interfaces. Even resources that can be used through ssh login nodes can be harnessed. All of these usage modes are integrated transparently into the GlideIn WMS submission infrastructure, which is the basis of CMS' opportunistic resource usage strategy. Technologies like Parrot to mount the software distribution via CVMFS and xrootd for access to data and simulation samples via the WAN are used and will be described. We will summarize the experience with opportunistic resource usage and give an outlook for the restart of LHC data taking in 2015.

  6. 42 CFR 405.1012 - When CMS or its contractors may be a party to a hearing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false When CMS or its contractors may be a party to a... Hearings § 405.1012 When CMS or its contractors may be a party to a hearing. (a) CMS and/or one or more of... unrepresented beneficiary. (b) CMS and/or the contractor(s) advises the ALJ, appellant, and all other parties...

  7. Development of Cytoplasmic Male Sterile IR24 and IR64 Using CW-CMS/Rf17 System.

    PubMed

    Toriyama, Kinya; Kazama, Tomohiko

    2016-12-01

    A wild-abortive-type (WA) cytoplasmic male sterility (CMS) has been almost exclusively used for breeding three-line hybrid rice. Many indica cultivars are known to carry restorer genes for WA-CMS lines and cannot be used as maintainer lines. Especially elite indica cultivars IR24 and IR64 are known to be restorer lines for WA-CMS lines, and are used as male parents for hybrid seed production. If we develop CMS IR24 and CMS IR64, the combination of F1 pairs in hybrid rice breeding programs will be greatly broadened. For production of CMS lines and restorer lines of IR24 and IR64, we employed Chinese wild rice (CW)-type CMS/Restorer of fertility 17 (Rf17) system, in which fertility is restored by a single nuclear gene, Rf17. Successive backcrossing and marker-assisted selection of Rf17 succeeded to produce completely male sterile CMS lines and fully restored restorer lines of IR24 and IR64. CW-cytoplasm did not affect agronomic characteristics. Since IR64 is one of the most popular mega-varieties and used for breeding of many modern varieties, the CW-CMS line of IR64 will be useful for hybrid rice breeding.

  8. Stocks, Flows, and Distribution of Critical Metals in Embedded Electronics in Passenger Vehicles.

    PubMed

    Restrepo, Eliette; Løvik, Amund N; Wäger, Patrick; Widmer, Rolf; Lonka, Radek; Müller, Daniel B

    2017-02-07

    One of the major applications of critical metals (CMs) is in electrical and electronic equipment (EEE), which is increasingly embedded in other products, notably passenger vehicles. However, recycling strategies for future CM quantities in end-of-life vehicles (ELVs) are poorly understood, mainly due to a limited understating of the complexity of automotive embedded EEE. We introduce a harmonization of the network structure of automotive electronics that enables a comprehensive quantification of CMs in all embedded EEE in a vehicle. This network is combined with a material flow analysis along the vehicle lifecycle in Switzerland to quantify the stocks and flows of Ag, Au, Pd, Ru, Dy, La, Nd, and Co in automotive embedded EEE. In vehicles in use, we calculated 5 -2 +3 t precious metals in controllers embedded in all vehicle types and 220 -60 +90 t rare earth elements (REE); found mainly in five electric motors: alternator, starter, radiator-fan and electronic power steering motor embedded in conventional passenger vehicles and drive motor/generator embedded in hybrid and electric vehicles. Dismantling these devices before ELV shredding, as well as postshredder treatment of automobile shredder residue may increase the recovery of CMs from ELVs. Environmental and economic implications of such recycling strategies must be considered.

  9. 42 CFR 414.68 - Imaging accreditation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Computed tomography. (iii) Nuclear medicine. (iv) Positron emission tomography. CMS-approved accreditation... if CMS takes an adverse action based on accreditation findings. (vi) Notify CMS, in writing... organization must permit its surveyors to serve as witnesses if CMS takes an adverse action based on...

  10. 42 CFR 414.68 - Imaging accreditation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Computed tomography. (iii) Nuclear medicine. (iv) Positron emission tomography. CMS-approved accreditation... if CMS takes an adverse action based on accreditation findings. (vi) Notify CMS, in writing... organization must permit its surveyors to serve as witnesses if CMS takes an adverse action based on...

  11. 42 CFR 414.68 - Imaging accreditation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Computed tomography. (iii) Nuclear medicine. (iv) Positron emission tomography. CMS-approved accreditation... if CMS takes an adverse action based on accreditation findings. (vi) Notify CMS, in writing... organization must permit its surveyors to serve as witnesses if CMS takes an adverse action based on...

  12. 78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

  13. Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

    PubMed

    2013-02-27

    This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

  14. Human embryonic and induced pluripotent stem cell-derived cardiomyocytes exhibit beat rate variability and power-law behavior.

    PubMed

    Mandel, Yael; Weissman, Amir; Schick, Revital; Barad, Lili; Novak, Atara; Meiry, Gideon; Goldberg, Stanislav; Lorber, Avraham; Rosen, Michael R; Itskovitz-Eldor, Joseph; Binah, Ofer

    2012-02-21

    The sinoatrial node is the main impulse-generating tissue in the heart. Atrioventricular conduction block and arrhythmias caused by sinoatrial node dysfunction are clinically important and generally treated with electronic pacemakers. Although an excellent solution, electronic pacemakers incorporate limitations that have stimulated research on biological pacing. To assess the suitability of potential biological pacemakers, we tested the hypothesis that the spontaneous electric activity of human embryonic stem cell-derived cardiomyocytes (hESC-CMs) and induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) exhibit beat rate variability and power-law behavior comparable to those of human sinoatrial node. We recorded extracellular electrograms from hESC-CMs and iPSC-CMs under stable conditions for up to 15 days. The beat rate time series of the spontaneous activity were examined in terms of their power spectral density and additional methods derived from nonlinear dynamics. The major findings were that the mean beat rate of hESC-CMs and iPSC-CMs was stable throughout the 15-day follow-up period and was similar in both cell types, that hESC-CMs and iPSC-CMs exhibited intrinsic beat rate variability and fractal behavior, and that isoproterenol increased and carbamylcholine decreased the beating rate in both hESC-CMs and iPSC-CMs. This is the first study demonstrating that hESC-CMs and iPSC-CMs exhibit beat rate variability and power-law behavior as in humans, thus supporting the potential capability of these cell sources to serve as biological pacemakers. Our ability to generate sinoatrial-compatible spontaneous cardiomyocytes from the patient's own hair (via keratinocyte-derived iPSCs), thus eliminating the critical need for immunosuppression, renders these myocytes an attractive cell source as biological pacemakers.

  15. Human renal adipose tissue induces the invasion and progression of renal cell carcinoma

    PubMed Central

    Campo-Verde-Arbocco, Fiorella; López-Laur, José D.; Romeo, Leonardo R.; Giorlando, Noelia; Bruna, Flavia A.; Contador, David E.; López-Fontana, Gastón; Santiano, Flavia E.; Sasso, Corina V.; Zyla, Leila E.; López-Fontana, Constanza M.; Calvo, Juan C.; Carón, Rubén W.; Creydt, Virginia Pistone

    2017-01-01

    We evaluated the effects of conditioned media (CMs) of human adipose tissue from renal cell carcinoma located near the tumor (hRATnT) or farther away from the tumor (hRATfT), on proliferation, adhesion and migration of tumor (786-O and ACHN) and non-tumor (HK-2) human renal epithelial cell lines. Human adipose tissues were obtained from patients with renal cell carcinoma (RCC) and CMs from hRATnT and hRATfT incubation. Proliferation, adhesion and migration were quantified in 786-O, ACHN and HK-2 cell lines incubated with hRATnT-, hRATfT- or control-CMs. We evaluated versican, adiponectin and leptin expression in CMs from hRATnT and hRATfT. We evaluated AdipoR1/2, ObR, pERK, pAkt y pPI3K expression on cell lines incubated with CMs. No differences in proliferation of cell lines was found after 24 h of treatment with CMs. All cell lines showed a significant decrease in cell adhesion and increase in cell migration after incubation with hRATnT-CMs vs. hRATfT- or control-CMs. hRATnT-CMs showed increased levels of versican and leptin, compared to hRATfT-CMs. AdipoR2 in 786-O and ACHN cells decreased significantly after incubation with hRATfT- and hRATnT-CMs vs. control-CMs. We observed a decrease in the expression of pAkt in HK-2, 786-O and ACHN incubated with hRATnT-CMs. This result could partially explain the observed changes in migration and cell adhesion. We conclude that hRATnT released factors, such as leptin and versican, could enhance the invasive potential of renal epithelial cell lines and could modulate the progression of the disease. PMID:29212223

  16. Mitochondrial nad2 gene is co-transcripted with CMS-associated orfB gene in cytoplasmic male-sterile stem mustard (Brassica juncea).

    PubMed

    Yang, Jing-Hua; Zhang, Ming-Fang; Yu, Jing-Quan

    2009-02-01

    The transcriptional patterns of mitochondrial respiratory related genes were investigated in cytoplasmic male-sterile and fertile maintainer lines of stem mustard, Brassica juncea. There were numerous differences in nad2 (subunit 2 of NADH dehydrogenase) between stem mustard CMS and its maintainer line. One novel open reading frame, hereafter named orfB gene, was located at the downstream of mitochondrial nad2 gene in the CMS. The novel orfB gene had high similarity with YMF19 family protein, orfB in Raphanus sativus, Helianthus annuus, Nicotiana tabacum and Beta vulgaris, orfB-CMS in Daucus carota, atp8 gene in Arabidopsis thaliana, 5' flanking of orf224 in B. napus (nap CMS) and 5' flanking of orf220 gene in CMS Brassica juncea. Three copies probed by specific fragment (amplified by primers of nad2F and nad2R from CMS) were found in the CMS line following Southern blotting digested with HindIII, but only a single copy in its maintainer line. Meanwhile, two transcripts were shown in the CMS line following Northern blotting while only one transcript was detected in the maintainer line, which were probed by specific fragment (amplified by primers of nad2F and nad2R from CMS). Meanwhile, the expression of nad2 gene was reduced in CMS bud compared to that in its maintainer line. We thus suggested that nad2 gene may be co-transcripted with CMS-associated orfB gene in the CMS. In addition, the specific fragment that was amplified by primers of nad2F and nad2R just spanned partial sequences of nad2 gene and orfB gene. Such alterations in the nad2 gene would impact the activity of NADH dehydrogenase, and subsequently signaling, inducing the expression of nuclear genes involved in male sterility in this type of cytoplasmic male sterility.

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

    Bauer, Gerry; et al.

    The DAQ system of the CMS experiment at CERN collects data from more than 600 custom detector Front-End Drivers (FEDs). During 2013 and 2014 the CMS DAQ system will undergo a major upgrade to address the obsolescence of current hardware and the requirements posed by the upgrade of the LHC accelerator and various detector components. For a loss-less data collection from the FEDs a new FPGA based card implementing the TCP/IP protocol suite over 10Gbps Ethernet has been developed. To limit the TCP hardware implementation complexity the DAQ group developed a simplified and unidirectional but RFC 793 compliant version ofmore » the TCP protocol. This allows to use a PC with the standard Linux TCP/IP stack as a receiver. We present the challenges and protocol modifications made to TCP in order to simplify its FPGA implementation. We also describe the interaction between the simplified TCP and Linux TCP/IP stack including the performance measurements.« less

  18. Challenges of Particle Flow reconstruction in the CMS High-Granularity Calorimeter at the High-Luminosity LHC

    NASA Astrophysics Data System (ADS)

    Chlebana, Frank; CMS Collaboration

    2017-11-01

    The challenges of the High-Luminosity LHC (HL-LHC) are driven by the large number of overlapping proton-proton collisions (pileup) in each bunch-crossing and the extreme radiation dose to detectors at high pseudorapidity. To overcome this challenge CMS is developing an endcap electromagnetic+hadronic sampling calorimeter employing silicon sensors in the electromagnetic and front hadronic sections, comprising over 6 million channels, and highly-segmented plastic scintillators in the rear part of the hadronic section. This High- Granularity Calorimeter (HGCAL) will be the first of its kind used in a colliding beam experiment. Clustering deposits of energy over many cells and layers is a complex and challenging computational task, particularly in the high-pileup environment of HL-LHC. Baseline detector performance results are presented for electromagnetic and hadronic objects, and studies demonstrating the advantages of fine longitudinal and transverse segmentation are explored.

  19. Web Based Monitoring in the CMS Experiment at CERN

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

    Badgett, William; Borrello, Laura; Chakaberia, Irakli

    2014-09-03

    The Compact Muon Solenoid (CMS) is a large and complex general purpose experiment at the CERN Large Hadron Collider (LHC), built and maintained by many collaborators from around the world. Efficient operation of the detector requires widespread and timely access to a broad range of monitoring and status information. To this end the Web Based Monitoring (WBM) system was developed to present data to users located anywhere from many underlying heterogeneous sources, from real time messaging systems to relational databases. This system provides the power to combine and correlate data in both graphical and tabular formats of interest to themore » experimenters, including data such as beam conditions, luminosity, trigger rates, detector conditions, and many others, allowing for flexibility on the user side. This paper describes the WBM system architecture and describes how the system was used during the first major data taking run of the LHC.« less

  20. Responding to GPs' information resource needs: implementation and evaluation of a complementary medicines information resource in Queensland general practice

    PubMed Central

    2011-01-01

    Background Australian General Practitioners (GPs) are in the forefront of primary health care and in an excellent position to communicate with their patients and educate them about Complementary Medicines (CMs) use. However previous studies have demonstrated that GPs lack the knowledge required about CMs to effectively communicate with patients about their CMs use and they perceive a need for information resources on CMs to use in their clinical practice. This study aimed to develop, implement, and evaluate a CMs information resource in Queensland (Qld) general practice. Methods The results of the needs assessment survey of Qld general practitioners (GPs) informed the development of a CMs information resource which was then put through an implementation and evaluation cycle in Qld general practice. The CMs information resource was a set of evidence-based herbal medicine fact sheets. This resource was utilised by 100 Qld GPs in their clinical practice for four weeks and was then evaluated. The evaluation assessed GPs' (1) utilisation of the resource (2) perceived quality, usefulness and satisfaction with the resource and (3) perceived impact of the resource on their knowledge, attitudes, and practice of CMs. Results Ninety two out of the 100 GPs completed the four week evaluation of the fact sheets and returned the post-intervention survey. The herbal medicine fact sheets produced by this study were well accepted and utilised by Qld GPs. The majority of GPs perceived that the fact sheets were a useful resource for their clinical practice. The fact sheets improved GPs' attitudes towards CMs, increased their knowledge of those herbal medicines and improved their communication with their patients about those specific herbs. Eighty-six percent of GPs agreed that if they had adequate resources on CMs, like the herbal medicine fact sheets, then they would communicate more to their patients about their use of CMs. Conclusion Further educational interventions on CMs need to be provided to GPs to increase their knowledge of CMs and to improve their communication with patients about their CMs use. PMID:21933434

  1. Opportunistic Resource Usage in CMS

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

    Kreuzer, Peter; Hufnagel, Dirk; Dykstra, D.

    2014-01-01

    CMS is using a tiered setup of dedicated computing resources provided by sites distributed over the world and organized in WLCG. These sites pledge resources to CMS and are preparing them especially for CMS to run the experiment's applications. But there are more resources available opportunistically both on the GRID and in local university and research clusters which can be used for CMS applications. We will present CMS' strategy to use opportunistic resources and prepare them dynamically to run CMS applications. CMS is able to run its applications on resources that can be reached through the GRID, through EC2 compliantmore » cloud interfaces. Even resources that can be used through ssh login nodes can be harnessed. All of these usage modes are integrated transparently into the GlideIn WMS submission infrastructure, which is the basis of CMS' opportunistic resource usage strategy. Technologies like Parrot to mount the software distribution via CVMFS and xrootd for access to data and simulation samples via the WAN are used and will be described. We will summarize the experience with opportunistic resource usage and give an outlook for the restart of LHC data taking in 2015.« less

  2. Home-Based Primary Care: Beyond Extension of the Independence at Home Demonstration.

    PubMed

    Rotenberg, James; Kinosian, Bruce; Boling, Peter; Taler, George

    2018-04-01

    The Independence at Home (IAH) Demonstration Year 2 results confirmed that the first-year savings were 10 times as great as those of the pioneer accountable care organizations during their initial 2 years. We update projected savings from nationwide conversion of the IAH demonstration, incorporating Year 2 results and improving attribution of IAH-qualified (IAH-Q) Medicare beneficiaries to home-based primary care (HBPC) practices. Applying IAH qualifying criteria to beneficiaries in the Medicare 5% claims file, the effect of expanding HBPC to the 2.4 million IAH-Q beneficiaries is projected using various growth rates. Total 10-year system-wide savings (accounting for IAH implementation but before excluding shared savings) range from $2.6 billion to $27.8 billion, depending on how many beneficiaries receive HBPC on conversion to a Medicare benefit, mix of clinical practice success, and growth rate of IAH practices. Net projected savings to the Centers for Medicare and Medicaid Services (CMS) after routine billing for IAH services and distribution of shared savings ranges from $1.8 billion to $10.9 billion. If aligning IAH with other advanced alternative payment models achieved at least 35% penetration of the eligible population in 10 years, CMS savings would exceed savings with the current IAH design and HBPC growth rate. If the demonstration were simply extended 2 years with a beneficiary cap of 50,000 instead of 15,000 (as currently proposed), CMS would save an additional $46 million. The recent extension of IAH, a promising person-centered CMS program for managing medically complex and frail elderly adults, offers the chance to evaluate modifications to promote more rapid HBPC growth. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  3. Orthognathic Surgery in Patients With Congenital Myopathies and Congenital Muscular Dystrophies: Case Series and Review of the Literature.

    PubMed

    Bezak, Brett J; Arce, Kevin A; Jacob, Adam; Van Ess, James

    2016-03-01

    This case series examined preoperative findings and the surgical, anesthetic, and postoperative management of 6 patients with congenital myopathies (CMs) and congenital muscular dystrophies (CMDs) treated at a tertiary medical institution with orthognathic surgery over 15 years to describe pertinent considerations for performing orthognathic surgery in these complex patients. According to the institutional review board-approved protocol, chart records were reviewed for all orthognathic surgical patients with a clinical, genetic, or muscle biopsy-proved diagnosis of CM or CMD. Six patients (5 male, 1 female) qualified, and they were treated by 4 surgeons in the division of oral and maxillofacial surgery from 1992 through 2007. Average age was 19.5 years at the time of orthognathic surgery. Five patients had Class III malocclusions and 1 patient had Class II malocclusion. All 6 patients had apertognathia with lip incompetence. Nasoendotracheal intubation with a difficulty of 0/3 (0=easiest, 3=most difficult) was performed in all cases. Routine induction and maintenance anesthetics, including halogenated agents and nondepolarizing muscle relaxants, were administered without malignant hyperthermia. All 6 patients underwent Le Fort level osteotomies; 4 also had mandibular setback surgery with or without balancing mandibular inferior border osteotomies. Five patients required planned intensive care unit care postoperatively (average, 18.4 days; range, 4 to 65 days). Postoperative respiratory complications resulting in major blood oxygen desaturations occurred in 5 patients; 4 of these patients required reintubation during emergency code response. Five patients required extended postoperative intubation (average, 4.2 days; range, 3 to 6 days) and ventilatory support. Average hospital length of stay was 21.8 days (range, 6 to 75 days). Average postoperative follow-up interval was 29.8 weeks (range, 6 to 128 weeks). Patients with CMs or CMDs often have characteristic dentofacial malocclusions that contribute to functional problems with feeding and drooling and psychosocial problems. Orthognathic surgery, usually bimaxillary, can be judiciously considered in these patients; these procedures typically require multidisciplinary pre- and postoperative evaluation and care over lengthy hospital stays with a high risk of respiratory complications that bear consideration in treatment planning. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. 42 CFR 423.890 - Appeals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... sponsor or by CMS before notice of the reconsidered determination is made. (6) Decision of the informal written reconsideration. CMS informs the sponsor of the decision orally or through electronic mail. CMS sends a written decision to the sponsor on the sponsor's request. (7) Effect of CMS informal written...

  5. 45 CFR 150.221 - Transition to State enforcement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement Processes for... State enforcement. (a) If CMS determines that a State for which it has assumed enforcement authority has... appropriate to return enforcement authority to the State, CMS will enter into discussions with State officials...

  6. 45 CFR 150.213 - Form and content of notice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement Processes for Determining... consequence of a State's failure to substantially enforce HIPAA requirements is that CMS enforces them. (d... information that the State wishes CMS to consider in making the preliminary determination described in § 150...

  7. 45 CFR 150.321 - Determining the amount of penalty-aggravating circumstances.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... RELATING TO HEALTH CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement..., if there are substantial or several aggravating circumstances, CMS sets the aggregate amount of the.... CMS considers the following circumstances to be aggravating circumstances: (a) The frequency of...

  8. Cardiometabolic syndrome and its association with education, smoking, diet, physical activity, and social support: findings from the Pennsylvania 2007 BRFSS Survey.

    PubMed

    Liu, Longjian; Núñez, Ana E

    2010-07-01

    The authors aimed to examine the prevalence of cardiometabolic syndrome (CMS) and its association with education, smoking, diet, physical activity, and social support among white, black, and Hispanic adults using data from the 2007 Pennsylvania Behavior Risk Factor Surveillance System (BRFSS) survey, the largest population-based survey in the state. The authors examined associations between CMS and associated factors cross-sectionally using univariate and multivariate methods. The study included a representative sample of 12,629 noninstitutionalized Pennsylvanians aged > or =18. Components of CMS included obesity, hypercholesterolemia, angina (as a surrogate for decreased high-density lipoprotein), prehypertension or hypertension, and prediabetes or diabetes. CMS was identified as the presence of > or =3 CMS components. The results show that the prevalence of CMS was 20.48% in blacks, followed by Hispanics (19.14%) and whites (12.26%), (P<.01). Multivariate logistic regression analyses indicated that physical inactivity, lower educational levels, smoking, daily consumption of vegetables and/or fruits <3 servings, and lack of social support were significantly associated with the odds of having CMS. In conclusion, black and Hispanic adults have a significantly higher prevalence of CMS than whites. The significant association between CMS and risk factors provides new insights in the direction of health promotion to prevent and control CMS in those who are at high risk.

  9. The mitochondrial gene orfH79 plays a critical role in impairing both male gametophyte development and root growth in CMS-Honglian rice.

    PubMed

    Peng, Xiaojue; Wang, Kun; Hu, Chaofeng; Zhu, Youlin; Wang, Ting; Yang, Jing; Tong, Jiping; Li, Shaoqing; Zhu, Yingguo

    2010-06-24

    Cytoplasmic male sterility (CMS) has often been associated with abnormal mitochondrial open reading frames. The mitochondrial gene orfH79 is a candidate gene for causing the CMS trait in CMS-Honglian (CMS-HL) rice. However, whether the orfH79 expression can actually induce CMS in rice remains unclear. Western blot analysis revealed that the ORFH79 protein is mainly present in mitochondria of CMS-HL rice and is absent in the fertile line. To investigate the function of ORFH79 protein in mitochondria, this gene was fused to a mitochondrial transit peptide sequence and used to transform wild type rice, where its expression induced the gametophytic male sterile phenotype. In addition, excessive accumulation of reactive oxygen species (ROS) in the microspore, a reduced ATP/ADP ratio, decreased mitochondrial membrane potential and a lower respiration rate in the transgenic plants were found to be similar to those in CMS-HL rice. Moreover, retarded growth of primary and lateral roots accompanied by abnormal accumulation of ROS in the root tip was observed in both transgenic rice and CMS-HL rice (YTA). These results suggest that the expression of orfH79 in mitochondria impairs mitochondrial function, which affects the development of both male gametophytes and the roots of CMS-HL rice.

  10. CDX2 prognostic value in stage II/III resected colon cancer is related to CMS classification.

    PubMed

    Pilati, C; Taieb, J; Balogoun, R; Marisa, L; de Reyniès, A; Laurent-Puig, P

    2017-05-01

    Caudal-type homeobox transcription factor 2 (CDX2) is involved in colon cancer (CC) oncogenesis and has been proposed as a prognostic biomarker in patients with stage II or III CC. We analyzed CDX2 expression in a series of 469 CC typed for the new international consensus molecular subtype (CMS) classification, and we confirmed results in a series of 90 CC. Here, we show that lack of CDX2 expression is only present in the mesenchymal subgroup (CMS4) and in MSI-immune tumors (CMS1) and not in CMS2 and CMS3 colon cancer. Although CDX2 expression was a globally independent prognostic factor, loss of CDX2 expression is not associated with a worse prognosis in the CMS1 group, but is highly prognostic in CMS4 patients for both relapse free and overall survival. Similarly, lack of CDX2 expression was a bad prognostic factor in MSS patients, but not in MSI. Our work suggests that combination of the consensual CMS classification and lack of CDX2 expression could be a useful marker to identify CMS4/CDX2-negative patients with a very poor prognosis. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  11. Senp1 drives hypoxia-induced polycythemia via GATA1 and Bcl-xL in subjects with Monge’s disease

    PubMed Central

    Azad, Priti; Zhao, Huiwen W.; Ronen, Roy; Zhou, Dan; Poulsen, Orit; Hsiao, Yu Hsin; Bafna, Vineet

    2016-01-01

    In this study, because excessive polycythemia is a predominant trait in some high-altitude dwellers (chronic mountain sickness [CMS] or Monge’s disease) but not others living at the same altitude in the Andes, we took advantage of this human experiment of nature and used a combination of induced pluripotent stem cell technology, genomics, and molecular biology in this unique population to understand the molecular basis for hypoxia-induced excessive polycythemia. As compared with sea-level controls and non-CMS subjects who responded to hypoxia by increasing their RBCs modestly or not at all, respectively, CMS cells increased theirs remarkably (up to 60-fold). Although there was a switch from fetal to adult HgbA0 in all populations and a concomitant shift in oxygen binding, we found that CMS cells matured faster and had a higher efficiency and proliferative potential than non-CMS cells. We also established that SENP1 plays a critical role in the differential erythropoietic response of CMS and non-CMS subjects: we can convert the CMS phenotype into that of non-CMS and vice versa by altering SENP1 levels. We also demonstrated that GATA1 is an essential downstream target of SENP1 and that the differential expression and response of GATA1 and Bcl-xL are a key mechanism underlying CMS pathology. PMID:27821551

  12. Senp1 drives hypoxia-induced polycythemia via GATA1 and Bcl-xL in subjects with Monge's disease.

    PubMed

    Azad, Priti; Zhao, Huiwen W; Cabrales, Pedro J; Ronen, Roy; Zhou, Dan; Poulsen, Orit; Appenzeller, Otto; Hsiao, Yu Hsin; Bafna, Vineet; Haddad, Gabriel G

    2016-11-14

    In this study, because excessive polycythemia is a predominant trait in some high-altitude dwellers (chronic mountain sickness [CMS] or Monge's disease) but not others living at the same altitude in the Andes, we took advantage of this human experiment of nature and used a combination of induced pluripotent stem cell technology, genomics, and molecular biology in this unique population to understand the molecular basis for hypoxia-induced excessive polycythemia. As compared with sea-level controls and non-CMS subjects who responded to hypoxia by increasing their RBCs modestly or not at all, respectively, CMS cells increased theirs remarkably (up to 60-fold). Although there was a switch from fetal to adult HgbA0 in all populations and a concomitant shift in oxygen binding, we found that CMS cells matured faster and had a higher efficiency and proliferative potential than non-CMS cells. We also established that SENP1 plays a critical role in the differential erythropoietic response of CMS and non-CMS subjects: we can convert the CMS phenotype into that of non-CMS and vice versa by altering SENP1 levels. We also demonstrated that GATA1 is an essential downstream target of SENP1 and that the differential expression and response of GATA1 and Bcl-xL are a key mechanism underlying CMS pathology. © 2016 Azad et al.

  13. Enabling opportunistic resources for CMS Computing Operations

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

    Hufnagel, Dirk

    With the increased pressure on computing brought by the higher energy and luminosity from the LHC in Run 2, CMS Computing Operations expects to require the ability to utilize opportunistic resources resources not owned by, or a priori configured for CMS to meet peak demands. In addition to our dedicated resources we look to add computing resources from non CMS grids, cloud resources, and national supercomputing centers. CMS uses the HTCondor/glideinWMS job submission infrastructure for all its batch processing, so such resources will need to be transparently integrated into its glideinWMS pool. Bosco and parrot wrappers are used to enablemore » access and bring the CMS environment into these non CMS resources. Finally, we describe our strategy to supplement our native capabilities with opportunistic resources and our experience so far using them.« less

  14. Enabling opportunistic resources for CMS Computing Operations

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

    Hufnagel, Dick

    With the increased pressure on computing brought by the higher energy and luminosity from the LHC in Run 2, CMS Computing Operations expects to require the ability to utilize “opportunistic” resources — resources not owned by, or a priori configured for CMS — to meet peak demands. In addition to our dedicated resources we look to add computing resources from non CMS grids, cloud resources, and national supercomputing centers. CMS uses the HTCondor/glideinWMS job submission infrastructure for all its batch processing, so such resources will need to be transparently integrated into its glideinWMS pool. Bosco and parrot wrappers are usedmore » to enable access and bring the CMS environment into these non CMS resources. Here we describe our strategy to supplement our native capabilities with opportunistic resources and our experience so far using them.« less

  15. Enabling opportunistic resources for CMS Computing Operations

    DOE PAGES

    Hufnagel, Dirk

    2015-12-23

    With the increased pressure on computing brought by the higher energy and luminosity from the LHC in Run 2, CMS Computing Operations expects to require the ability to utilize opportunistic resources resources not owned by, or a priori configured for CMS to meet peak demands. In addition to our dedicated resources we look to add computing resources from non CMS grids, cloud resources, and national supercomputing centers. CMS uses the HTCondor/glideinWMS job submission infrastructure for all its batch processing, so such resources will need to be transparently integrated into its glideinWMS pool. Bosco and parrot wrappers are used to enablemore » access and bring the CMS environment into these non CMS resources. Finally, we describe our strategy to supplement our native capabilities with opportunistic resources and our experience so far using them.« less

  16. [Recognition of psychiatric disorders with a religious content by members of the clergy of different denominations in the Netherlands].

    PubMed

    Noort, A; Braam, A W; van Gool, A R; Verhagen, P J; Beekman, A T F

    2012-01-01

    Clergy members (CMS) frequently provide support and counselling for people with psychological and psychiatric disorders. There is evidence in the literature that CMS consider themselves to be inadequately trained to recognise psychiatric disorders. To investigate to what extent CMS are able to recognise psychiatric symptoms. CMS were recruited in the south-west of the Netherlands among various denominations (Roman Catholic, strict (orthodox) Protestant, moderate Protestant and Evangelical; n = 143) by means of a regional sampling method. The participating CMS (n = 143) and a control group consisting of mental health care professionals MPHS; n = 73) evaluated four vignettes of psychiatric problems with a religious content: two were about a psychiatric disorder (a psychotic state and a psychotic depression/melancholic state), and two concerned non-psychiatric states (a spiritual/religious experience and a mourning reaction with a religious dilemma). For each vignette the respondents scored the suitability of psychiatric medication, the desirability of mental health care, the severity of the disorder and whether there was a religious or spiritual aetiology. Some CMS were able to recognise psychiatric problems almost as well as the MHPS, but among the CMS the degree of recognition varied according to the denomination. Recognition was relatively poor among Evangelical CMS, but was best among the strict Protestant CMS. Evangelical pastors and strict Protestant CMS tended to interpret the non-psychiatric states as pathological. The findings of this study emphasise the need for collaboration between MHPS and CMS and stress the importance of consultation.

  17. 78 FR 56710 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-13

    ... the following transmissions: OMB, Office of Information and Regulatory Affairs Attention: CMS Desk... Identifiers: CMS-10199 and CMS-10266] Agency Information Collection Activities: Submission for OMB Review... an opportunity for the public to comment on CMS' intention to collect information from the public...

  18. 42 CFR 422.510 - Termination of contract by CMS.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...: (1) Termination of contract by CMS. (i) CMS notifies the MA organization in writing 90 days before... organization; or (B) The MA organization experiences financial difficulties so severe that its ability to make...) of this section. (ii) CMS notifies the MA organization in writing that its contract will be...

  19. 42 CFR 422.510 - Termination of contract by CMS.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...: (1) Termination of contract by CMS. (i) CMS notifies the MA organization in writing 90 days before... organization; or (B) The MA organization experiences financial difficulties so severe that its ability to make...) of this section. (ii) CMS notifies the MA organization in writing that its contract will be...

  20. 42 CFR 422.510 - Termination of contract by CMS.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Termination of contract by CMS. (i) CMS notifies the MA organization in writing 90 days before the intended...; or (B) The MA organization experiences financial difficulties so severe that its ability to make...) of this section. (ii) CMS notifies the MA organization in writing that its contract will be...

  1. 42 CFR 401.108 - CMS rulings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false CMS rulings. 401.108 Section 401.108 Public Health... GENERAL ADMINISTRATIVE REQUIREMENTS Confidentiality and Disclosure § 401.108 CMS rulings. (a) After... regulations, but which has been adopted by CMS as having precedent, may be published in the Federal Register...

  2. 45 CFR 150.319 - Determining the amount of the penalty-mitigating circumstances.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... RELATING TO HEALTH CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement... guidelines for taking into account the factors listed in § 150.317, CMS considers the following: (a) Record... noncompliance without notice from CMS and voluntarily reported that noncompliance, provided that the responsible...

  3. 42 CFR 401.625 - Effect of CMS claims collection decisions on appeals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of CMS claims collection decisions on... Compromise § 401.625 Effect of CMS claims collection decisions on appeals. Any action taken under this..., is not an initial determination for purposes of CMS appeal procedures. ...

  4. 42 CFR 403.248 - Administrative review of CMS determinations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Administrative review of CMS determinations. 403... Certification Program: General Provisions § 403.248 Administrative review of CMS determinations. (a) This section provides for administrative review if CMS determines— (1) Not to certify a policy; or (2) That a...

  5. 78 FR 67149 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-08

    ... Identifier: CMS-R-216] Agency Information Collection Activities: Proposed Collection; Comment Request AGENCY... & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect... accepting comments. 2. By regular mail. You may mail written comments to the following address: CMS, Office...

  6. How Patronage Politics Undermines Parental Participation and Accountability: Community-Managed Schools in Honduras and Guatemala

    ERIC Educational Resources Information Center

    Altschuler, Daniel

    2013-01-01

    This article shows how patronage politics affects a popular international education model: community-managed schools (CMS). Focusing on Honduras's CMS initiative, PROHECO (Programa Hondureno de Educacion Comunitaria), I demonstrate how patronage can undermine CMS accountability. Whereas supporters argue that CMS increases accountability, partisan…

  7. 42 CFR 493.571 - Disclosure of accreditation, State and CMS validation inspection results.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... validation inspection results. 493.571 Section 493.571 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Program § 493.571 Disclosure of accreditation, State and CMS validation inspection results. (a... licensure program, in accordance with State law. (c) CMS validation inspection results. CMS may disclose the...

  8. 42 CFR 493.571 - Disclosure of accreditation, State and CMS validation inspection results.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... validation inspection results. 493.571 Section 493.571 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Program § 493.571 Disclosure of accreditation, State and CMS validation inspection results. (a... licensure program, in accordance with State law. (c) CMS validation inspection results. CMS may disclose the...

  9. 42 CFR 493.571 - Disclosure of accreditation, State and CMS validation inspection results.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... validation inspection results. 493.571 Section 493.571 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Program § 493.571 Disclosure of accreditation, State and CMS validation inspection results. (a... licensure program, in accordance with State law. (c) CMS validation inspection results. CMS may disclose the...

  10. 42 CFR 493.571 - Disclosure of accreditation, State and CMS validation inspection results.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... validation inspection results. 493.571 Section 493.571 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Program § 493.571 Disclosure of accreditation, State and CMS validation inspection results. (a... licensure program, in accordance with State law. (c) CMS validation inspection results. CMS may disclose the...

  11. 42 CFR 493.571 - Disclosure of accreditation, State and CMS validation inspection results.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... validation inspection results. 493.571 Section 493.571 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Program § 493.571 Disclosure of accreditation, State and CMS validation inspection results. (a... licensure program, in accordance with State law. (c) CMS validation inspection results. CMS may disclose the...

  12. Registration of cytoplasmic male-sterile oilseed sunflower genetic stocks CMS GIG2 and CMS GIG2-RV, and fertility restoration lines RF GIG2-MAX 1631 and RF GIG2-MAX 1631-RV

    USDA-ARS?s Scientific Manuscript database

    Two cytoplasmic male-sterile (CMS) oilseed sunflower (Helianthus annuus L.) genetic stocks, CMS GIG2 (Reg. No. xxx, PI xxxx), and CMS GIG2-RV (Reg. No. xxx, PI xxxx), and corresponding fertility restoration lines RF GIG2-MAX 1631 (Reg. No. xxx, PI xxxx) and RF GIG2-MAX 1631-RV (Reg. No. xxx, PI xxx...

  13. CMS Nonpayment Policy, Quality Improvement, and Hospital-Acquired Conditions: An Integrative Review.

    PubMed

    Bae, Sung-Heui

    This integrative review synthesized evidence on the consequences of the Centers for Medicare & Medicaid Services (CMS) nonpayment policy on quality improvement initiatives and hospital-acquired conditions. Fourteen articles were included. This review presents strong evidence that the CMS policy has spurred quality improvement initiatives; however, the relationships between the CMS policy and hospital-acquired conditions are inconclusive. In future research, a comprehensive model of implementation of the CMS nonpayment policy would help us understand the effectiveness of this policy.

  14. CMS Centres Worldwide - a New Collaborative Infrastructure

    NASA Astrophysics Data System (ADS)

    Taylor, Lucas

    2011-12-01

    The CMS Experiment at the LHC has established a network of more than fifty inter-connected "CMS Centres" at CERN and in institutes in the Americas, Asia, Australasia, and Europe. These facilities are used by people doing CMS detector and computing grid operations, remote shifts, data quality monitoring and analysis, as well as education and outreach. We present the computing, software, and collaborative tools and videoconferencing systems. These include permanently running "telepresence" video links (hardware-based H.323, EVO and Vidyo), Webcasts, and generic Web tools such as CMS-TV for broadcasting live monitoring and outreach information. Being Web-based and experiment-independent, these systems could easily be extended to other organizations. We describe the experiences of using CMS Centres Worldwide in the CMS data-taking operations as well as for major media events with several hundred TV channels, radio stations, and many more press journalists simultaneously around the world.

  15. Relations between the Test of Variables of Attention (TOVA) and the Children's Memory Scale (CMS).

    PubMed

    Riccio, Cynthia A; Garland, Beth H; Cohen, Morris J

    2007-09-01

    There is considerable overlap in the constructs of attention and memory. The objective of this study was to examine the relationship between the Test of Variables of Attention (TOVA), a measure of attention, to components of memory and learning as measured by the Children's Memory Scale (CMS). Participants (N = 105) were consecutive referrals to an out-patient facility, generally for learning or behavior problems, who were administered both the TOVA and the CMS. Significant correlations were found between the omissions score on the TOVA and subscales of the CMS. TOVA variability and TOVA reaction time correlated significantly with subscales of the CMS as well. TOVA commission errors did not correlate significantly with any CMS Index. Although significant, the correlation coefficients indicate that the CMS and TOVA are measuring either different constructs or similar constructs but in different ways. As such, both measures may be useful in distinguishing memory from attention problems.

  16. 77 FR 70445 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ...-wide set of credentials and single sign-on capability for multiple CMS applications. In order to prove... and answers); 4. Provide the user a single sign-on, federated CMS EIDM ID and Password; 5... Terms of Service and CMS Privacy Statement on the Web. Form Numbers: CMS-10452 (OCN: 0938-New...

  17. Increasing Honest Responding on Cognitive Distortions in Child Molesters: The Bogus Pipeline Procedure

    ERIC Educational Resources Information Center

    Gannon, Theresa A.

    2006-01-01

    Professionals conclude that child molesters (CMs) hold offense-supportive beliefs (or cognitive distortions) from CMs' questionnaire responses. Because questionnaires are easily faked, we asked 32 CMs to complete a cognitive distortion scale under standard conditions (Time 1). A week later (Time 2), the same CMs completed the scale again. This…

  18. 45 CFR 150.347 - Failure to request a hearing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS Enforcement With Respect to Issuers and....343, CMS may assess the proposed civil money penalty, a less severe penalty, or a more severe penalty. CMS notifies the responsible entity in writing of any penalty that has been assessed and of the means...

  19. 42 CFR 411.379 - When CMS accepts a request.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false When CMS accepts a request. 411.379 Section 411.379... Physicians and Entities Furnishing Designated Health Services § 411.379 When CMS accepts a request. (a) Upon receiving a request for an advisory opinion, CMS promptly makes an initial determination of whether the...

  20. 42 CFR 405.1834 - CMS reviewing official procedure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false CMS reviewing official procedure. 405.1834 Section... Determinations and Appeals § 405.1834 CMS reviewing official procedure. (a) Scope. A provider that is a party to... Administrator by a designated CMS reviewing official who considers whether the decision of the intermediary...

  1. 42 CFR 457.1003 - CMS review of waiver requests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false CMS review of waiver requests. 457.1003 Section 457.1003 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Waivers: General Provisions § 457.1003 CMS review of waiver requests. CMS will review the waiver requests...

  2. 42 CFR 421.114 - Assignment and reassignment of providers by CMS.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Assignment and reassignment of providers by CMS. 421.114 Section 421.114 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... Assignment and reassignment of providers by CMS. CMS may assign or reassign any provider to any intermediary...

  3. 45 CFR 150.209 - Verification of exhaustion of remedies and contact with State officials.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS... § 150.209 Verification of exhaustion of remedies and contact with State officials. If CMS receives a complaint or other information indicating that a State is failing to enforce HIPAA requirements, CMS...

  4. Sleep disturbances in long-term immigrants with chronic mountain sickness: a comparison with healthy immigrants at high altitude.

    PubMed

    Guan, Wei; Ga, Qin; Li, Rong; Bai, Zhen-Zhong; Wuren, Tana; Wang, Jin; Yang, Ying-Zhong; Li, Yu-Hong; Ge, Ri-Li

    2015-01-15

    The aim of this study was to examine sleep disturbances in patients with chronic mountain sickness (CMS). The sleep of 14 patients with CMS and 11 healthy controls with or without sleep disorders (control N: without sleep disorders; control D: with sleep disorders) was studied by polysomnography. Hypopnea was the sleep disorder most commonly suffered by CMS patients and control D subjects. No major differences were observed in sleep structure between CMS and control groups, with the exception of shorter rapid eye movement latency in controls and increased deep non-rapid eye movement in the control N group. Periodic breathing was observed in only two study participants, one each in the CMS and control D groups. The level of saturated oxygen was significantly lower in the CMS group during sleep than the control groups (P<0.05). CMS scores were positively correlated with the apnea-hypopnea index, and negatively correlated with saturated oxygen levels. These results demonstrate that sleep disorders and nocturnal hypoxia are important in the development of CMS. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Altered calcium handling and increased contraction force in human embryonic stem cell derived cardiomyocytes following short term dexamethasone exposure

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

    Kosmidis, Georgios; Bellin, Milena; Ribeiro, Marcelo C.

    One limitation in using human pluripotent stem cell derived cardiomyocytes (hPSC-CMs) for disease modeling and cardiac safety pharmacology is their immature functional phenotype compared with adult cardiomyocytes. Here, we report that treatment of human embryonic stem cell derived cardiomyocytes (hESC-CMs) with dexamethasone, a synthetic glucocorticoid, activated glucocorticoid signaling which in turn improved their calcium handling properties and contractility. L-type calcium current and action potential properties were not affected by dexamethasone but significantly faster calcium decay, increased forces of contraction and sarcomeric lengths, were observed in hESC-CMs after dexamethasone exposure. Activating the glucocorticoid pathway can thus contribute to mediating hPSC-CMs maturation.more » - Highlights: • Dexamethasone accelerates Ca{sup 2+} transient decay in hESC-CMs. • Dexamethasone enhances SERCA and NCX function in hESC-CMs. • Dexamethasone increases force of contraction and sarcomere length in hESC-CMs. • Dexamethasone does not alter I{sub Ca,L} and action potential characteristics in hESC-CMs.« less

  6. Pharmacokinetics of Colistin Methansulphonate (CMS) and Colistin after CMS Nebulisation in Baboon Monkeys.

    PubMed

    Marchand, Sandrine; Bouchene, Salim; de Monte, Michèle; Guilleminault, Laurent; Montharu, Jérôme; Cabrera, Maria; Grégoire, Nicolas; Gobin, Patrice; Diot, Patrice; Couet, William; Vecellio, Laurent

    2015-10-01

    The objective of this study was to compare two different nebulizers: Eflow rapid® and Pari LC star® by scintigraphy and PK modeling to simulate epithelial lining fluid concentrations from measured plasma concentrations, after nebulization of CMS in baboons. Three baboons received CMS by IV infusion and by 2 types of aerosols generators and colistin by subcutaneous infusion. Gamma imaging was performed after nebulisation to determine colistin distribution in lungs. Blood samples were collected during 9 h and colistin and CMS plasma concentrations were measured by LC-MS/MS. A population pharmacokinetic analysis was conducted and simulations were performed to predict lung concentrations after nebulization. Higher aerosol distribution into lungs was observed by scintigraphy, when CMS was nebulized with Pari LC® star than with Eflow Rapid® nebulizer. This observation was confirmed by the fraction of CMS deposited into the lung (respectively 3.5% versus 1.3%).CMS and colistin simulated concentrations in epithelial lining fluid were higher after using the Pari LC star® than the Eflow rapid® system. A limited fraction of CMS reaches lungs after nebulization, but higher colistin plasma concentrations were measured and higher intrapulmonary colistin concentrations were simulated with the Pari LC Star® than with the Eflow Rapid® system.

  7. Impact of chronic maternal stress during early gestation on maternal-fetal stress transfer and fetal stress sensitivity in sheep.

    PubMed

    Dreiling, Michelle; Schiffner, Rene; Bischoff, Sabine; Rupprecht, Sven; Kroegel, Nasim; Schubert, Harald; Witte, Otto W; Schwab, Matthias; Rakers, Florian

    2018-01-01

    Acute stress-induced reduction of uterine blood flow (UBF) is an indirect mechanism of maternal-fetal stress transfer during late gestation. Effects of chronic psychosocial maternal stress (CMS) during early gestation, as may be experienced by many working women, on this stress signaling mechanism are unclear. We hypothesized that CMS in sheep during early gestation augments later acute stress-induced decreases of UBF, and aggravates the fetal hormonal, cardiovascular, and metabolic stress responses during later development. Six pregnant ewes underwent repeated isolation stress (CMS) between 30 and 100 days of gestation (dGA, term: 150 dGA) and seven pregnant ewes served as controls. At 110 dGA, ewes were chronically instrumented and underwent acute isolation stress. The acute stress decreased UBF by 19% in both the CMS and control groups (p < .05), but this was prolonged in CMS versus control ewes (74 vs. 30 min, p < .05). CMS increased fetal circulating baseline and stress-induced cortisol and norepinephrine concentrations indicating a hyperactive hypothalamus-pituitary-adrenal (HPA)-axis and sympathetic-adrenal-medullary system. Increased fetal norepinephrine is endogenous as maternal catecholamines do not cross the placenta. Cortisol in the control but not in the CMS fetuses was correlated with maternal cortisol blood concentrations; these findings indicate: (1) no increased maternal-fetal cortisol transfer with CMS, (2) cortisol production in CMS fetuses when the HPA-axis is normally inactive, due to early maturation of the fetal HPA-axis. CMS fetuses were better oxygenated, without shift towards acidosis compared to the controls, potentially reflecting adaptation to repeated stress. Hence, CMS enhances maternal-fetal stress transfer by prolonged reduction in UBF and increased fetal HPA responsiveness.

  8. Blockade of AT1 type receptors for angiotensin II prevents cardiac microvascular fibrosis induced by chronic stress in Sprague-Dawley rats.

    PubMed

    Firoozmand, Lília Taddeo; Sanches, Andrea; Damaceno-Rodrigues, Nilsa Regina; Perez, Juliana Dinéia; Aragão, Danielle Sanches; Rosa, Rodolfo Mattar; Marcondes, Fernanda Klein; Casarini, Dulce Elena; Caldini, Elia Garcia; Cunha, Tatiana Sousa

    2018-04-20

    To test the effects of chronic-stress on the cardiovascular system, the model of chronic mild unpredictable stress (CMS) has been widely used. The CMS protocol consists of the random, intermittent, and unpredictable exposure of laboratory animals to a variety of stressors, during 3 consecutive weeks. In this study, we tested the hypothesis that exposure to the CMS protocol leads to left ventricle microcirculatory remodeling that can be attenuated by angiotensin II receptor blockade. Male Sprague-Dawley rats were randomly assigned into four groups: Control, Stress, Control + losartan, and Stress + losartan (N = 6, each group, losartan: 20 mg/kg/day). The rats were euthanized 15 days after CMS exposure, and blood samples and left ventricle were collected. Rats submitted to CMS presented increased glycemia, corticosterone, noradrenaline and adrenaline concentration, and losartan reduced the concentration of the circulating amines. Cardiac angiotensin II, measured by high-performance liquid chromatography (HPLC), was significantly increased in the CMS group, and losartan treatment reduced it, while angiotensin 1-7 was significantly higher in the CMS losartan-treated group as compared with CMS. Histological analysis, verified by transmission electron microscopy, showed that rats exposed to CMS presented increased perivascular collagen and losartan effectively prevented the development of this process. Hence, CMS induced a state of microvascular disease, with increased perivascular collagen deposition, that may be the trigger for further development of cardiovascular disease. In this case, CMS fibrosis is associated with increased production of catecholamines and with a disruption of renin-angiotensin system balance, which can be prevented by angiotensin II receptor blockade.

  9. Stability of colistin methanesulfonate in pharmaceutical products and solutions for administration to patients.

    PubMed

    Wallace, Stephanie J; Li, Jian; Rayner, Craig R; Coulthard, Kingsley; Nation, Roger L

    2008-09-01

    Colistin methanesulfonate (CMS) has the potential to hydrolyze in aqueous solution to liberate colistin, its microbiologically active and more toxic parent compound. While conversion of CMS to colistin in vivo is important for bactericidal activity, liberation of colistin during storage and/or use of pharmaceutical formulations may potentiate the toxicity of CMS. To date, there has been no information available regarding the stability of CMS in pharmaceutical preparations. Two commercial CMS formulations were investigated for stability with respect to colistin content, which was measured by a specific high-performance liquid chromatography method. Coly-Mycin M Parenteral (colistimethate lyophilized powder) was stable (<0.1% of CMS present as colistin) for at least 20 weeks at 4 degrees C and 25 degrees C at 60% relative humidity. When Coly-Mycin M was reconstituted with 2 ml of water to a CMS concentration of 200 mg/ml for injection, Coly-Mycin M was stable (<0.1% colistin formed) for at least 7 days at both 4 degrees C and 25 degrees C. When further diluted to 4 mg/ml in a glucose (5%) or saline (0.9%) infusion solution as directed, CMS hydrolyzed faster at 25 degrees C (<4% colistin formed after 48 h) than at 4 degrees C (0.3% colistin formed). The second formulation, CMS Solution for Inhalation (77.5 mg/ml), was stable at 4 degrees C and 25 degrees C for at least 12 months, as determined based on colistin content (<0.1%). This study demonstrated the concentration- and temperature-dependent hydrolysis of CMS. The information provided by this study has important implications for the formulation and clinical use of CMS products.

  10. Evaluation of Flagging Criteria of United States Kidney Transplant Center Performance: How to Best Define Outliers?

    PubMed

    Schold, Jesse D; Miller, Charles M; Henry, Mitchell L; Buccini, Laura D; Flechner, Stuart M; Goldfarb, David A; Poggio, Emilio D; Andreoni, Kenneth A

    2017-06-01

    Scientific Registry of Transplant Recipients report cards of US organ transplant center performance are publicly available and used for quality oversight. Low center performance (LP) evaluations are associated with changes in practice including reduced transplant rates and increased waitlist removals. In 2014, Scientific Registry of Transplant Recipients implemented new Bayesian methodology to evaluate performance which was not adopted by Center for Medicare and Medicaid Services (CMS). In May 2016, CMS altered their performance criteria, reducing the likelihood of LP evaluations. Our aims were to evaluate incidence, survival rates, and volume of LP centers with Bayesian, historical (old-CMS) and new-CMS criteria using 6 consecutive program-specific reports (PSR), January 2013 to July 2015 among adult kidney transplant centers. Bayesian, old-CMS and new-CMS criteria identified 13.4%, 8.3%, and 6.1% LP PSRs, respectively. Over the 3-year period, 31.9% (Bayesian), 23.4% (old-CMS), and 19.8% (new-CMS) of centers had 1 or more LP evaluation. For small centers (<83 transplants/PSR), there were 4-fold additional LP evaluations (52 vs 13 PSRs) for 1-year mortality with Bayesian versus new-CMS criteria. For large centers (>183 transplants/PSR), there were 3-fold additional LP evaluations for 1-year mortality with Bayesian versus new-CMS criteria with median differences in observed and expected patient survival of -1.6% and -2.2%, respectively. A significant proportion of kidney transplant centers are identified as low performing with relatively small survival differences compared with expected. Bayesian criteria have significantly higher flagging rates and new-CMS criteria modestly reduce flagging. Critical appraisal of performance criteria is needed to assess whether quality oversight is meeting intended goals and whether further modifications could reduce risk aversion, more efficiently allocate resources, and increase transplant opportunities.

  11. Substantial Targeting Advantage Achieved by Pulmonary Administration of Colistin Methanesulfonate in a Large-Animal Model

    PubMed Central

    Nguyen, Tri-Hung; Lieu, Linh Thuy; Nguyen, Gary; Bischof, Robert J.; Meeusen, Els N.; Li, Jian; Nation, Roger L.

    2016-01-01

    ABSTRACT Colistin, administered as its inactive prodrug colistin methanesulfonate (CMS), is often used in multidrug-resistant Gram-negative pulmonary infections. The CMS and colistin pharmacokinetics in plasma and epithelial lining fluid (ELF) following intravenous and pulmonary dosing have not been evaluated in a large-animal model with pulmonary architecture similar to that of humans. Six merino sheep (34 to 43 kg body weight) received an intravenous or pulmonary dose of 4 to 8 mg/kg CMS (sodium) or 2 to 3 mg/kg colistin (sulfate) in a 4-way crossover study. Pulmonary dosing was achieved via jet nebulization through an endotracheal tube cuff. CMS and colistin were quantified in plasma and bronchoalveolar lavage fluid (BALF) samples by high-performance liquid chromatography (HPLC). ELF concentrations were calculated via the urea method. CMS and colistin were comodeled in S-ADAPT. Following intravenous CMS or colistin administration, no concentrations were quantifiable in BALF samples. Elimination clearance was 1.97 liters/h (4% interindividual variability) for CMS (other than conversion to colistin) and 1.08 liters/h (25%) for colistin. On average, 18% of a CMS dose was converted to colistin. Following pulmonary delivery, colistin was not quantifiable in plasma and CMS was detected in only one sheep. Average ELF concentrations (standard deviations [SD]) of formed colistin were 400 (243), 384 (187), and 184 (190) mg/liter at 1, 4, and 24 h after pulmonary CMS administration. The population pharmacokinetic model described well CMS and colistin in plasma and ELF following intravenous and pulmonary administration. Pulmonary dosing provided high ELF and low plasma colistin concentrations, representing a substantial targeting advantage over intravenous administration. Predictions from the pharmacokinetic model indicate that sheep are an advantageous model for translational research. PMID:27821445

  12. Characterization and classification of one new cytoplasmic male sterility (CMS) line based on morphological, cytological and molecular markers in non-heading Chinese cabbage (Brassica rapa L.).

    PubMed

    Heng, Shuangping; Shi, Dianyi; Hu, Zhenhua; Huang, Tao; Li, Jinping; Liu, Liyan; Xia, Chunxiu; Yuan, Zhenzhen; Xu, Yuejin; Fu, Tingdong; Wan, Zhengjie

    2015-09-01

    A new non-heading Chinese cabbage CMS line M119A was characterized and specific molecular markers were developed to classify different CMS types. One new non-heading Chinese cabbage (Brassica rapa L.) cytoplasmic male sterile (CMS) line M119A was obtained by interspecific crosses between the recently discovered hau CMS line of Brassica juncea and B. rapa. Furthermore, the line was characterized and compared with other five isonuclear-alloplasmic CMS lines. The M119A line produced six stamens without pollen and only two stamen fused together in fewer flowers. Tissue section indicated that anther abortion in M119A may have occurred during differentiation of the archesporial cells without pollen sac. All the six CMS lines were grouped into three types based on the presence of three PCR fragments of 825, 465 and 772 bp amplified with different mitochondrial genes specific primers. The 825-bp fragment was amplified both in 09-10A and H201A using the specific primer pair P-orf224-atp6, and showed 100 % identity with the mitochondrial gene of pol CMS. The 465-bp fragment was amplified in 30A and 105A using the primer pair P-orf138 and shared 100 % identity with the mitochondrial gene of ogu CMS. The 772-bp fragment was amplified in M119A and H203A using the primer pair P-orf288 and showed 100 % identity with the mitochondrial gene of hau CMS. Therefore, these markers could efficiently distinguish different types of isonuclear-alloplasmic CMS lines of non-heading Chinese cabbage, which were useful for improving the efficiency of cross-breeding and heterosis utilization in cruciferous vegetables.

  13. Stability of Colistin Methanesulfonate in Pharmaceutical Products and Solutions for Administration to Patients▿

    PubMed Central

    Wallace, Stephanie J.; Li, Jian; Rayner, Craig. R.; Coulthard, Kingsley; Nation, Roger L.

    2008-01-01

    Colistin methanesulfonate (CMS) has the potential to hydrolyze in aqueous solution to liberate colistin, its microbiologically active and more toxic parent compound. While conversion of CMS to colistin in vivo is important for bactericidal activity, liberation of colistin during storage and/or use of pharmaceutical formulations may potentiate the toxicity of CMS. To date, there has been no information available regarding the stability of CMS in pharmaceutical preparations. Two commercial CMS formulations were investigated for stability with respect to colistin content, which was measured by a specific high-performance liquid chromatography method. Coly-Mycin M Parenteral (colistimethate lyophilized powder) was stable (<0.1% of CMS present as colistin) for at least 20 weeks at 4°C and 25°C at 60% relative humidity. When Coly-Mycin M was reconstituted with 2 ml of water to a CMS concentration of 200 mg/ml for injection, Coly-Mycin M was stable (<0.1% colistin formed) for at least 7 days at both 4°C and 25°C. When further diluted to 4 mg/ml in a glucose (5%) or saline (0.9%) infusion solution as directed, CMS hydrolyzed faster at 25°C (<4% colistin formed after 48 h) than at 4°C (0.3% colistin formed). The second formulation, CMS Solution for Inhalation (77.5 mg/ml), was stable at 4°C and 25°C for at least 12 months, as determined based on colistin content (<0.1%). This study demonstrated the concentration- and temperature-dependent hydrolysis of CMS. The information provided by this study has important implications for the formulation and clinical use of CMS products. PMID:18606838

  14. Burden of disease resulting from chronic mountain sickness among young Chinese male immigrants in Tibet

    PubMed Central

    2012-01-01

    Background In young Chinese men of the highland immigrant population, chronic mountain sickness (CMS) is a major public health problem. The aim of this study was to measure the disease burden of CMS in this population. Methods We used disability-adjusted life years (DALYs) to estimate the disease burden of CMS. Disability weights were derived using the person trade-off methodology. CMS diagnoses, symptom severity, and individual characteristics were obtained from surveys collected in Tibet in 2009 and 2010. The DALYs of individual patients and the DALYs/1,000 were calculated. Results Disability weights were obtained for 21 CMS health stages. The results of the analyses of the two surveys were consistent with each other. At different altitudes, the CMS rates ranged from 2.1-37.4%; the individual DALYs of patients ranged from 0.13-0.33, and the DALYs/1,000 ranged from 3.60-52.78. The age, highland service years, blood pressure, heart rate, smoking rate, and proportion of the sample working in engineering or construction were significantly higher in the CMS group than in the non-CMS group (p < 0.05). These variables were also positively associated with the individual DALYs (p < 0.05). Among the symptoms, headaches caused the largest proportion of DALYs. Conclusion The results show that CMS imposes a considerable burden on Chinese immigrants to Tibet. Immigrants with characteristics such as a higher residential altitude, more advanced age, longer highland service years, being a smoker, and working in engineering or construction were more likely to develop CMS and to increase the disease burden. Higher blood pressure and heart rate as a result of CMS were also positively associated with the disease burden. The authorities should pay attention to the highland disease burden and support the development and application of DALYs studies of CMS and other highland diseases. PMID:22672510

  15. Human adipose tissue from normal and tumoral breast regulates the behavior of mammary epithelial cells.

    PubMed

    Pistone Creydt, Virginia; Fletcher, Sabrina Johanna; Giudice, Jimena; Bruzzone, Ariana; Chasseing, Norma Alejandra; Gonzalez, Eduardo Gustavo; Sacca, Paula Alejandra; Calvo, Juan Carlos

    2013-02-01

    Stromal-epithelial interactions mediate both breast development and breast cancer progression. In the present work, we evaluated the effects of conditioned media (CMs) of human adipose tissue explants from normal (hATN) and tumor (hATT) breast on proliferation, adhesion, migration and metalloproteases activity on tumor (MCF-7 and IBH-7) and non-tumor (MCF-10A) human breast epithelial cell lines. Human adipose tissues were obtained from patients and the conditioned medium from hATN and hATT collected after 24 h of incubation. MCF-10A, MCF-7 and IBH-7 cells were grown and incubated with CMs and proliferation and adhesion, as well as migration ability and metalloprotease activity, of epithelial cells after exposing cell cultures to hATN- or hATT-CMs were quantified. The statistical significance between different experimental conditions was evaluated by one-way ANOVA. Tukey's post hoc tests were performed. Tumor and non-tumor breast epithelial cells significantly increased their proliferation activity after 24 h of treatment with hATT-CMs compared to control-CMs. Furthermore, cellular adhesion of these two tumor cell lines was significantly lower with hATT-CMs than with hATN-CMs. Therefore, hATT-CMs seem to induce significantly lower expression or less activity of the components involved in cellular adhesion than hATN-CMs. In addition, hATT-CMs induced pro-MMP-9 and MMP-9 activity and increased the migration of MCF-7 and IBH-7 cells compared to hATN-CMs. We conclude that the microenvironment of the tumor interacts in a dynamic way with the mutated epithelium. This evidence leads to the possibility to modify the tumor behavior/phenotype through the regulation or modification of its microenvironment. We developed a model in which we obtained CMs from adipose tissue explants completely, either from normal or tumor breast. In this way, we studied the contribution of soluble factors independently of the possible effects of direct cell contact.

  16. SU-E-T-598: Clinical Experience of Configuration, Commission and Implementation for SmartArc with MOSAIQ R&V System.

    PubMed

    Kong, X; Clausen, C; Wang, S

    2012-06-01

    Clinical experience for configuration, commission and implementation of SmartArc with MOSAIQ R&V system. SmartArc is Pinnacle's solution for VMAT. On July 2011 we updated to Pinnacle 9.0 and purchased SmartArc. A standalone Eclipse workstation has been used 3 years for VMAT planning. Our clinical setting: Mosaiq 2.2; Varian Trilogy driven by 4DiTC and Varian 21ex driven by sequencer. Some key physics parameters have been studied: machine dose rate; MLC leaf speed; Leaf motion per gantry rotation. Tabletop was created by user to improve the dose accuracy for planning. In-house sandwich phantom was used with MapCheck for planner dose verification. A PTW 0.6cc ion chamber was included for absolute dose comparison. A copy of current machine data with default highest dose rate is recommended. It is due to after 10th iteration of optimization, the default dose rate will kick in. 2.5cm/s is the constraint for Varian Millennium 120 MLC; a buffer zone of 10% is suggested to reduce the MLC error on treatment. 2.25cm/s is used in our configuration. This results in MLC interlock if not configured correct. Maximum leaf motion per gantry rotation of 0.46cm/degree has to be checked for planning with Mosaiq R&V. Otherwise, undeliverable plan will show up sometimes on 4DiTC.Tabletop was exported as a DICOM structure from Eclipse to Pinnacle; we created a ROI template based on the matched tabletop.QA using in-house phantom for different sites were tested. Results for both planner dose and absolute chamber measurement are satisfactory. Special attentions need to be paid for dose rate, MLC leaf speed, leaf motion per gantry rotation when configuring SmartArc. Varian 21ex is supported but is slow for clinical delivery. Users need to create your own tabletop to improve planning accuracy. Conventional commission procedures for RapidArc also apply for SmartArc. © 2012 American Association of Physicists in Medicine.

  17. 42 CFR 422.758 - Collection of civil money penalties imposed by CMS.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Collection of civil money penalties imposed by CMS... Sanctions § 422.758 Collection of civil money penalties imposed by CMS. (a) When an MA organization does not request a hearing, CMS initiates collection of the civil money penalty following the expiration of the...

  18. 42 CFR 422.758 - Collection of civil money penalties imposed by CMS.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Collection of civil money penalties imposed by CMS... § 422.758 Collection of civil money penalties imposed by CMS. (a) When an MA organization does not request a hearing, CMS initiates collection of the civil money penalty following the expiration of the...

  19. 42 CFR 422.758 - Collection of civil money penalties imposed by CMS.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Collection of civil money penalties imposed by CMS... Sanctions § 422.758 Collection of civil money penalties imposed by CMS. (a) When an MA organization does not request a hearing, CMS initiates collection of the civil money penalty following the expiration of the...

  20. 45 CFR 150.303 - Basis for initiating an investigation of a potential violation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REQUIREMENTS RELATING TO HEALTH CARE ACCESS CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS CMS... may be failing to meet an applicable HIPAA requirement, may warrant an investigation. CMS may consider... acting on that individual's behalf, may file a complaint with CMS if he or she believes that a right to...

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