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

PubMed

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

2014-06-01

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

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

PubMed

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

2017-01-01

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

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

NASA Astrophysics Data System (ADS)

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

2017-10-01

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

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

PubMed Central

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

2014-01-01

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

Susceptibility to false memories in patients with ACoA aneurysm.

PubMed

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

2010-08-01

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

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

PubMed Central

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

2016-01-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

PubMed

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

2016-08-01

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

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

PubMed

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

2014-06-19

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

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

PubMed

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

2016-09-01

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

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

NASA Technical Reports Server (NTRS)

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

2012-01-01

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

42 CFR 425.316 - Monitoring of ACOs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality measurement data reported by the ACO as well as aggregate annual and quarterly reports. (ii... described in paragraph (a)(2) of this section (as appropriate) to identify trends and patterns suggesting... quality performance standards or fails to report on one or more quality measures, in addition to actions...

42 CFR 425.316 - Monitoring of ACOs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality measurement data reported by the ACO as well as aggregate annual and quarterly reports. (ii... described in paragraph (a)(2) of this section (as appropriate) to identify trends and patterns suggesting... quality performance standards or fails to report on one or more quality measures, in addition to actions...

42 CFR 425.316 - Monitoring of ACOs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... quality measurement data reported by the ACO as well as aggregate annual and quarterly reports. (ii... described in paragraph (a)(2) of this section (as appropriate) to identify trends and patterns suggesting... quality performance standards or fails to report on one or more quality measures, in addition to actions...

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2016-07-01

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

PCMHs, ACOs, and medication management: lessons learned from early research partnerships.

PubMed

Schnur, Evan S; Adams, Alex J; Klepser, Donald G; Doucette, William R; Scott, David M

2014-02-01

The Patient Protection and Affordable Care Act has greatly accelerated the formation of team-based models of care delivery, primarily accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).  Many have written about the need to incorporate medication management services into these systems in order to improve care and reduce total health care costs. Two primary ways of doing so have emerged: (1) an embedded model, whereby pharmacists are employed directly by a physician practice, or (2) a "virtual care team" model, whereby a PCMH or ACO develops an arrangement with external pharmacists in community settings to provide coordinated services.

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

PubMed

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

2018-05-15

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

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

PubMed

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

2017-05-01

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

Lower-tropospheric CO 2 from near-infrared ACOS-GOSAT observations

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

Kulawik, Susan S.; O'Dell, Chris; Payne, Vivienne H.

We present two new products from near-infrared Greenhouse Gases Observing Satellite (GOSAT) observations: lowermost tropospheric (LMT, from 0 to 2.5 km) and upper tropospheric–stratospheric ( U, above 2.5 km) carbon dioxide partial column mixing ratios. We compare these new products to aircraft profiles and remote surface flask measurements and find that the seasonal and year-to-year variations in the new partial column mixing ratios significantly improve upon the Atmospheric CO 2 Observations from Space (ACOS) and GOSAT (ACOS-GOSAT) initial guess and/or a priori, with distinct patterns in the LMT and U seasonal cycles that match validation data. For land monthly averages,more » we find errors of 1.9, 0.7, and 0.8 ppm for retrieved GOSAT LMT, U, and XCO 2; for ocean monthly averages, we find errors of 0.7, 0.5, and 0.5 ppm for retrieved GOSAT LMT, U, and XCO 2. In the southern hemispheric biomass burning season, the new partial columns show similar patterns to MODIS fire maps and MOPITT multispectral CO for both vertical levels, despite a flat ACOS-GOSAT prior, and a CO–CO 2 emission factor comparable to published values. The difference of LMT and U, useful for evaluation of model transport error, has also been validated with a monthly average error of 0.8 (1.4) ppm for ocean (land). LMT is more locally influenced than U, meaning that local fluxes can now be better separated from CO 2 transported from far away.« less

Lower-tropospheric CO 2 from near-infrared ACOS-GOSAT observations

DOE PAGES

Kulawik, Susan S.; O'Dell, Chris; Payne, Vivienne H.; ...

2017-04-27

We present two new products from near-infrared Greenhouse Gases Observing Satellite (GOSAT) observations: lowermost tropospheric (LMT, from 0 to 2.5 km) and upper tropospheric–stratospheric ( U, above 2.5 km) carbon dioxide partial column mixing ratios. We compare these new products to aircraft profiles and remote surface flask measurements and find that the seasonal and year-to-year variations in the new partial column mixing ratios significantly improve upon the Atmospheric CO 2 Observations from Space (ACOS) and GOSAT (ACOS-GOSAT) initial guess and/or a priori, with distinct patterns in the LMT and U seasonal cycles that match validation data. For land monthly averages,more » we find errors of 1.9, 0.7, and 0.8 ppm for retrieved GOSAT LMT, U, and XCO 2; for ocean monthly averages, we find errors of 0.7, 0.5, and 0.5 ppm for retrieved GOSAT LMT, U, and XCO 2. In the southern hemispheric biomass burning season, the new partial columns show similar patterns to MODIS fire maps and MOPITT multispectral CO for both vertical levels, despite a flat ACOS-GOSAT prior, and a CO–CO 2 emission factor comparable to published values. The difference of LMT and U, useful for evaluation of model transport error, has also been validated with a monthly average error of 0.8 (1.4) ppm for ocean (land). LMT is more locally influenced than U, meaning that local fluxes can now be better separated from CO 2 transported from far away.« less

Processing time tolerance-based ACO algorithm for solving job-shop scheduling problem

NASA Astrophysics Data System (ADS)

Luo, Yabo; Waden, Yongo P.

2017-06-01

Ordinarily, Job Shop Scheduling Problem (JSSP) is known as NP-hard problem which has uncertainty and complexity that cannot be handled by a linear method. Thus, currently studies on JSSP are concentrated mainly on applying different methods of improving the heuristics for optimizing the JSSP. However, there still exist many problems for efficient optimization in the JSSP, namely, low efficiency and poor reliability, which can easily trap the optimization process of JSSP into local optima. Therefore, to solve this problem, a study on Ant Colony Optimization (ACO) algorithm combined with constraint handling tactics is carried out in this paper. Further, the problem is subdivided into three parts: (1) Analysis of processing time tolerance-based constraint features in the JSSP which is performed by the constraint satisfying model; (2) Satisfying the constraints by considering the consistency technology and the constraint spreading algorithm in order to improve the performance of ACO algorithm. Hence, the JSSP model based on the improved ACO algorithm is constructed; (3) The effectiveness of the proposed method based on reliability and efficiency is shown through comparative experiments which are performed on benchmark problems. Consequently, the results obtained by the proposed method are better, and the applied technique can be used in optimizing JSSP.

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

PubMed

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

2018-05-01

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

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2014 CFR

2014-10-01

... four domains: (i) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... a point scale for the measures. (2)(i) CMS will define the quality benchmarks using fee-for-service...

Topology in two dimensions. II - The Abell and ACO cluster catalogues

NASA Astrophysics Data System (ADS)

Plionis, Manolis; Valdarnini, Riccardo; Coles, Peter

1992-09-01

We apply a method for quantifying the topology of projected galaxy clustering to the Abell and ACO catalogues of rich clusters. We use numerical simulations to quantify the statistical bias involved in using high peaks to define the large-scale structure, and we use the results obtained to correct our observational determinations for this known selection effect and also for possible errors introduced by boundary effects. We find that the Abell cluster sample is consistent with clusters being identified with high peaks of a Gaussian random field, but that the ACO shows a slight meatball shift away from the Gaussian behavior over and above that expected purely from the high-peak selection. The most conservative explanation of this effect is that it is caused by some artefact of the procedure used to select the clusters in the two samples.

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii) Preventative health. (iv) At... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... defined by CMS based on national Medicare fee-for-service rates, national MA quality measure rates, or a...

42 CFR 425.502 - Calculating the ACO quality performance score.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Patient/care giver experience. (ii) Care coordination/Patient safety. (iii) Preventative health. (iv) At... year. (1) For the first performance year of an ACO's agreement, CMS defines the quality performance... defined by CMS based on national Medicare fee-for-service rates, national MA quality measure rates, or a...

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

PubMed

Kutscher, Beth

2013-07-01

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

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

PubMed

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

2016-03-01

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

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

PubMed

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

2016-12-01

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

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

PubMed

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

2004-05-01

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

Implementation of a Pilot ACO Payment Model and the Use of Discretionary and Non-Discretionary Cardiovascular Care

PubMed Central

Colla, Carrie. H.; Goodney, Philip P.; Lewis, Valerie A.; Nallamothu, Brahmajee K.; Gottlieb, Daniel J.; Meara, Ellen R.

2014-01-01

Background Accountable care organizations (ACOs) seek to reduce growth in healthcare spending while ensuring high-quality care. We hypothesized that ACO implementation would selectively limit utilization of discretionary cardiovascular care (defined as care occurring in the absence of indications such as myocardial infarction or stroke), while maintaining high-quality care such as non-discretionary cardiovascular imaging and procedures. Methods and Results The intervention group was composed of fee-for-service Medicare patients (n=819,779) from 10 groups participating in a Medicare pilot ACO, the Physician Group Practice Demonstration (PGPD). Matched controls were patients (n=934,621) from non-participating groups in the same regions. We compared utilization of cardiovascular care before (2002-2004) and after (2005-2009) PGPD implementation, studying both discretionary and non-discretionary carotid and coronary imaging and procedures. Our main outcome measure was the difference in the proportion of patients treated with imaging and procedures, among patients of PGPD practices compared to patients in control practices, before and after PGPD implementation (difference-in-difference). For discretionary imaging, the difference-in-difference between PGPD practices and controls was not statistically significant for discretionary carotid imaging (0.17%; 95% CI -0.51% to 0.85%, p=0.595) or discretionary coronary imaging (-0.19%; 95% CI -0.73% to 0.35%, p=0.468). Similarly, the difference-in-difference was also minimal for discretionary carotid revascularization (0.003%; 95% CI -0.008% to 0.002%, p=0.705) and coronary revascularization (-0.02%, 95% CI -0.11% to 0.07%, p=0.06). The difference-in-difference associated with PGPD implementation was also essentially zero for non-discretionary cardiovascular imaging or procedures. Conclusions Implementation of a pilot ACO did not limit the utilization of discretionary or non-discretionary cardiovascular care in ten large health

Application of GA, PSO, and ACO algorithms to path planning of autonomous underwater vehicles

NASA Astrophysics Data System (ADS)

Aghababa, Mohammad Pourmahmood; Amrollahi, Mohammad Hossein; Borjkhani, Mehdi

2012-09-01

In this paper, an underwater vehicle was modeled with six dimensional nonlinear equations of motion, controlled by DC motors in all degrees of freedom. Near-optimal trajectories in an energetic environment for underwater vehicles were computed using a numerical solution of a nonlinear optimal control problem (NOCP). An energy performance index as a cost function, which should be minimized, was defined. The resulting problem was a two-point boundary value problem (TPBVP). A genetic algorithm (GA), particle swarm optimization (PSO), and ant colony optimization (ACO) algorithms were applied to solve the resulting TPBVP. Applying an Euler-Lagrange equation to the NOCP, a conjugate gradient penalty method was also adopted to solve the TPBVP. The problem of energetic environments, involving some energy sources, was discussed. Some near-optimal paths were found using a GA, PSO, and ACO algorithms. Finally, the problem of collision avoidance in an energetic environment was also taken into account.

Citrus CitNAC62 cooperates with CitWRKY1 to participate in citric acid degradation via up-regulation of CitAco3.

PubMed

Li, Shao-Jia; Yin, Xue-Ren; Wang, Wen-Li; Liu, Xiao-Fen; Zhang, Bo; Chen, Kun-Song

2017-06-15

Citric acid is the predominant organic acid of citrus fruit. Degradation of citric acid occurs during fruit development, influencing fruit acidity. Associations of CitAco3 transcripts and citric acid degradation have been reported for citrus fruit. Here, transient overexpression of CitAco3 significantly reduced the citric acid content of citrus leaves and fruits. Using dual luciferase assays, it was shown that CitNAC62 and CitWRKY1 could transactivate the promoter of CitAco3. Subcellular localization results showed that CitWRKY1 was located in the nucleus and CitNAC62 was not. Yeast two-hybrid analysis and bimolecular fluorescence complementation (BiFC) assays indicated that the two differently located transcription factors could interact with each other. Furthermore, BiFC showed that the protein-protein interaction occurred only in the nucleus, indicating the potential mobility of CitNAC62 in plant cells. A synergistic effect on citrate content was observed between CitNAC62 and CitWRKY1. Transient overexpression of CitNAC62 or CitWRKY1 led to significantly lower citrate content in citrus fruit. The combined expression of CitNAC62 and CitWRKY1 resulted in lower citrate content compared with the expression of CitNAC62 or CitWRKY1 alone. The transcript abundance of CitAco3 was consistent with the citrate content. Thus, we propose that a complex of CitWRKY1 and CitNAC62 contributes to citric acid degradation in citrus fruit, potentially via modulation of CitAco3. © The Author 2017. Published by Oxford University Press on behalf of the Society for Experimental Biology.

Second-Line Therapy of Small-Cell Lung Cancer: Topotecan Compared to a Combination Treatment with Adriamycin, Cyclophosphamide And Vincristine (ACO) - a Single Center Experience

PubMed Central

Hagmann, Raphael; Hess, Viviane; Zippelius, Alfred; Rothschild, Sacha I.

2015-01-01

Background: Randomized trials established topotecan and the combination of adriamycin, cyclophosphamide and vincristine (ACO) as second-line therapy options for small-cell lung cancer. We retrospectively evaluated the outcome of SCLC patients undergoing second-line chemotherapy. Patients and Methods: 92 consecutive patients with a diagnosis of SCLC between 2000 and 2010 were analyzed. Results: 86 patients (93.5%) were evaluable for outcome analysis. All patients diagnosed with limited disease (LD) SCLC received platinum-based chemotherapy as first-line treatment. 69 patients (98.6%) diagnosed with extensive disease (ED) SCLC received first-line palliative chemotherapy. In the total cohort, the median overall survival (OS) was 10.3 months (19.2 months and 9.2 months for LD-SCLC and ED-SCLC, respectively). 42 patients received second-line therapy (ACO in 47.6% and topotecan in 31.0% of patients, respectively). Eight patients (19.0%) were re-challenged with platinum/etoposide. Neither the overall response rate (52.9% vs. 22.2%; p=0.128) nor progression-free survival (2.4 vs. 2.4 months; p=0.794) or OS (5.5 vs. 5.0 months; p=0.997) were significantly different between ACO and topotecan. ACO-treated patients showed a trend towards a longer duration of inpatient care. Conclusion: We showed similar outcomes as reported in clinical trials. Second-line combination chemotherapy with ACO did not show superiority to intravenous topotecan, but was associated with a clinically relevant longer hospitalization time. PMID:26516363

A Family of ACO Routing Protocols for Mobile Ad Hoc Networks

PubMed Central

Rupérez Cañas, Delfín; Sandoval Orozco, Ana Lucila; García Villalba, Luis Javier; Kim, Tai-hoon

2017-01-01

In this work, an ACO routing protocol for mobile ad hoc networks based on AntHocNet is specified. As its predecessor, this new protocol, called AntOR, is hybrid in the sense that it contains elements from both reactive and proactive routing. Specifically, it combines a reactive route setup process with a proactive route maintenance and improvement process. Key aspects of the AntOR protocol are the disjoint-link and disjoint-node routes, separation between the regular pheromone and the virtual pheromone in the diffusion process and the exploration of routes, taking into consideration the number of hops in the best routes. In this work, a family of ACO routing protocols based on AntOR is also specified. These protocols are based on protocol successive refinements. In this work, we also present a parallelized version of AntOR that we call PAntOR. Using programming multiprocessor architectures based on the shared memory protocol, PAntOR allows running tasks in parallel using threads. This parallelization is applicable in the route setup phase, route local repair process and link failure notification. In addition, a variant of PAntOR that consists of having more than one interface, which we call PAntOR-MI (PAntOR-Multiple Interface), is specified. This approach parallelizes the sending of broadcast messages by interface through threads. PMID:28531159

A Family of ACO Routing Protocols for Mobile Ad Hoc Networks.

PubMed

Rupérez Cañas, Delfín; Sandoval Orozco, Ana Lucila; García Villalba, Luis Javier; Kim, Tai-Hoon

2017-05-22

In this work, an ACO routing protocol for mobile ad hoc networks based on AntHocNet is specified. As its predecessor, this new protocol, called AntOR, is hybrid in the sense that it contains elements from both reactive and proactive routing. Specifically, it combines a reactive route setup process with a proactive route maintenance and improvement process. Key aspects of the AntOR protocol are the disjoint-link and disjoint-node routes, separation between the regular pheromone and the virtual pheromone in the diffusion process and the exploration of routes, taking into consideration the number of hops in the best routes. In this work, a family of ACO routing protocols based on AntOR is also specified. These protocols are based on protocol successive refinements. In this work, we also present a parallelized version of AntOR that we call PAntOR. Using programming multiprocessor architectures based on the shared memory protocol, PAntOR allows running tasks in parallel using threads. This parallelization is applicable in the route setup phase, route local repair process and link failure notification. In addition, a variant of PAntOR that consists of having more than one interface, which we call PAntOR-MI (PAntOR-Multiple Interface), is specified. This approach parallelizes the sending of broadcast messages by interface through threads.

PSO/ACO algorithm-based risk assessment of human neural tube defects in Heshun County, China.

PubMed

Liao, Yi Lan; Wang, Jin Feng; Wu, Ji Lei; Wang, Jiao Jiao; Zheng, Xiao Ying

2012-10-01

To develop a new technique for assessing the risk of birth defects, which are a major cause of infant mortality and disability in many parts of the world. The region of interest in this study was Heshun County, the county in China with the highest rate of neural tube defects (NTDs). A hybrid particle swarm optimization/ant colony optimization (PSO/ACO) algorithm was used to quantify the probability of NTDs occurring at villages with no births. The hybrid PSO/ACO algorithm is a form of artificial intelligence adapted for hierarchical classification. It is a powerful technique for modeling complex problems involving impacts of causes. The algorithm was easy to apply, with the accuracy of the results being 69.5%±7.02% at the 95% confidence level. The proposed method is simple to apply, has acceptable fault tolerance, and greatly enhances the accuracy of calculations. Copyright © 2012 The Editorial Board of Biomedical and Environmental Sciences. Published by Elsevier B.V. All rights reserved.

Eight reasons payer interoperability and data sharing are essential in ACOs. Interoperability standards could be a prerequisite to measuring care.

PubMed

Mookencherry, Shefali

2012-01-01

It makes strategic and business sense for payers and providers to collaborate on how to take substantial cost out of the healthcare delivery system. Acting independently, neither medical groups, hospitals nor health plans have the optimal mix of resources and incentives to significantly reduce costs. Payers have core assets such as marketing, claims data, claims processing, reimbursement systems and capital. It would be cost prohibitive for all but the largest providers to develop these capabilities in order to compete directly with insurers. Likewise, medical groups and hospitals are positioned to foster financial interdependence among providers and coordinate the continuum of patient illnesses and care settings. Payers and providers should commit to reasonable clinical and cost goals, and share resources to minimize expenses and financial risks. It is in the interest of payers to work closely with providers on risk-management strategies because insurers need synergy with ACOs to remain cost competitive. It is in the interest of ACOs to work collaboratively with payers early on to develop reasonable and effective performance benchmarks. Hence, it is essential to have payer interoperability and data sharing integrated in an ACO model.

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Measures to assess the quality of care furnished by an ACO. 425.500 Section 425.500 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... success in promoting the aims of better care for individuals, better health for populations, and lower...

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Measures to assess the quality of care furnished by an ACO. 425.500 Section 425.500 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... success in promoting the aims of better care for individuals, better health for populations, and lower...

42 CFR 425.500 - Measures to assess the quality of care furnished by an ACO.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Measures to assess the quality of care furnished by an ACO. 425.500 Section 425.500 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... success in promoting the aims of better care for individuals, better health for populations, and lower...

The New Jersey Medicaid ACO Demonstration Project: seeking opportunities for better care and lower costs among complex low-income patients.

PubMed

Cantor, Joel C; Chakravarty, Sujoy; Tong, Jian; Yedidia, Michael J; Lontok, Oliver; DeLia, Derek

2014-12-01

A small but growing number of states are turning to accountable care concepts to improve their Medicaid programs. In 2011 New Jersey enacted the Medicaid Accountable Care Organization (ACO) Demonstration Project to offer local provider coalitions the opportunity to share any savings they generate. Impetus came from initiatives in Camden that aim to reduce costs through improved care coordination among hospital high users and that have received considerable media attention and substantial federal and private grant support. Though broadly similar to Medicare and commercial ACOs, the New Jersey demonstration addresses the unique concerns faced by Medicaid populations. Using hospital all-payer billing data, we estimate savings from care improvement efforts among inpatient and emergency department high users in thirteen communities that are candidates for participation in the New Jersey demonstration. We also examine their characteristics to inform Medicaid accountable care strategies. We find substantial variation in the share of high-user hospital patients across the study communities and high rates of avoidable use and costs among these patients. The potential savings among Medicaid enrollees are considerable, particularly if Medicaid ACOs can develop ways to successfully address the high burden of chronic illness and behavioral health conditions prevalent in the prospective demonstration communities. Copyright © 2014 by Duke University Press.

Getting up to speed. Execs detail IT needs, investments required to support an ACO.

PubMed

Evans, Melanie

2012-02-20

The push for accountable care organizations means a push for more information technology that allows the sharing of data. So hospitals and other providers that are forming ACOs are feeling new urgency to ramp up their IT improvements. At Banner Health it means figuring out how to deal with independent physicians' "mishmash" of systems. "There has been an acceleration of interest," says Dr. John Hensing, left, Banner's chief medical officer.

Patient Engagement in ACO Practices and Patient-reported Outcomes Among Adults With Co-occurring Chronic Disease and Mental Health Conditions.

PubMed

Ivey, Susan L; Shortell, Stephen M; Rodriguez, Hector P; Wang, Yue Emily

2018-05-12

Accountable care organizations (ACOs) have increased their use of patient activation and engagement strategies, but it is unknown whether they achieve better outcomes for patients with comorbid chronic physical and mental health conditions. To assess the extent to which practices with patient-centered cultures, greater shared decision-making strategies, and better coordination among team members have better patient-reported outcomes (PROs) for patients with diabetes and/or cardiovascular and comorbid mental health diagnoses. Sixteen practices randomly selected from top and bottom quartiles of a 39-item patient activation/engagement implementation survey of primary care team members (n=411) to assess patient-centered culture, shared decision-making, and relational coordination among team members. These data were linked to survey data on patient engagement and on emotional, physical, and social patient-reported health outcomes. Adult patients (n=606) with diabetes, cardiovascular, and comorbid mental health conditions who had at least 1 visit at participating primary care practices of 2 ACOs. Depression/anxiety, physical functioning, social functioning; patient-centered culture, patient activation/engagement implementation, relational coordination. Patients receiving care from practices with high patient-centered cultures reported better physical functioning (0.025) and borderline better emotional functioning (0.059) compared with less patient-centered practices. More activated patients reported better PROs, with higher activation levels partially mediating the relationship of patient-centered culture and better PROs. ACO patients with comorbid physical and mental health diagnoses report better physical functioning when practices have patient-centered cultures. More activated/engaged patients report better patient emotional, physical, and social health outcomes.

Validation of OCO-2 and ACOS-GOSAT using HIPPO and TCCON

NASA Technical Reports Server (NTRS)

Kulawik, Susan S.; Wunch, Debra; O'Dell, Christopher; Miller, Charles; Osterman, Greg; Wennberg, Paul; Griffith, David; Sherlock, Vanessa; Deutscher, Nicholas M.; Notholt, Justus;

An 8-Year, High-Resolution Reanalysis of Atmospheric CO2 Mixing Ratios Based on OCO-2 and GOSAT-ACOS Retrievals

NASA Technical Reports Server (NTRS)

Weir, B.; Chatterjee, A.; Ott, L. E.; Pawson, S.

2017-01-01

The NASA GMAO (Global Modeling and Assimilation Office) reanalysis blends OCO-2 (Orbiting Carbon Observatory 2) and GOSAT-ACOS (Greenhouse Gases Observing Satellite-Atmospheric Carbon Observations from Space) retrievals (top) with GEOS (Goddard Earth Observing System) model predictions (bottom) to estimate the full 3D (three-dimensional) state of CO2 every 3 hours (middle). This poster describes monthly atmospheric growth rates derived from the reanalysis and an application to aircraft data with the potential to aid bias correction.

Investigating fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO): a scoping review protocol.

PubMed

Mostafavi-Pour-Manshadi, Seyed-Mohammad-Yousof; Naderi, Nafiseh; Barrecheguren, Miriam; Dehghan, Abolfazl; Bourbeau, Jean

2017-12-21

During the last decade, many articles have been published, including reviews on fractional exhaled nitric oxide (FeNO) use and utility in clinical practice and for monitoring and identifying eosinophilic airway inflammation, especially in asthma, and evaluating corticosteroid responsiveness. However, the exact role of FeNO in patients with chronic obstructive pulmonary disease (COPD) and its ability to distinguish patients with COPD and those having concomitant asthma, that is, asthma-COPD overlap (ACO) is still unclear and needs to be defined. Due to the broad topics of FeNO in chronic airway disease, we undertook a scoping review. The present article describes the protocol of a scoping review of peer-reviewed published literature specific to FeNO in COPD/ACO over the last decade. We used Joanna Briggs Institute Reviewers' Manual scoping review methodology as well as Levac et al 's and Arksey et al 's framework as guides. We searched a variety of databases, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and BioSciences Information Service (BIOSIS) on 29 June 2016. Additional studies will be recognised by exploring the reference list of identified eligible studies. Screening of eligible studies will be independently performed by two reviewers and any disagreement will be solved by the third reviewer. We will analyse the gathered data from article bibliographies and abstracts. To investigate the body of published studies regarding the role of FeNO in patients with COPD and its usefulness in the clinical setting, a scoping review can be used as a modern and pioneer model, which does not need ethics approval. By this review, new insights for conducting new research specific to FeNO in COPD/ACO population will emerge. The results of this study will be reported in the scientific meetings and conferences, which aim to provide information to the clinicians, primary care providers and basic

Is photography-based taxonomy really inadequate, unnecessary, and potentially harmful for biological sciences? A reply to Ceríaco et al. (2016).

PubMed

Thorpe, Stephen E

2017-01-26

An opinion piece was recently published in this journal which, remarkably, is less than one page in length, but has 493 authors (signatories) and has gained over 15 thousand reads on ResearchGate in a very short time. Ceríaco et al. (2016) argue for a blanket ban to be imposed on the uncommon practice of basing new species descriptions in zoology on photographic evidence only of the animal. I herein aim to show that their argument is a non sequitur, i.e. their stated reasons do not support their desired conclusion.

MGA trajectory planning with an ACO-inspired algorithm

NASA Astrophysics Data System (ADS)

Ceriotti, Matteo; Vasile, Massimiliano

2010-11-01

Given a set of celestial bodies, the problem of finding an optimal sequence of swing-bys, deep space manoeuvres (DSM) and transfer arcs connecting the elements of the set is combinatorial in nature. The number of possible paths grows exponentially with the number of celestial bodies. Therefore, the design of an optimal multiple gravity assist (MGA) trajectory is a NP-hard mixed combinatorial-continuous problem. Its automated solution would greatly improve the design of future space missions, allowing the assessment of a large number of alternative mission options in a short time. This work proposes to formulate the complete automated design of a multiple gravity assist trajectory as an autonomous planning and scheduling problem. The resulting scheduled plan will provide the optimal planetary sequence and a good estimation of the set of associated optimal trajectories. The trajectory model consists of a sequence of celestial bodies connected by two-dimensional transfer arcs containing one DSM. For each transfer arc, the position of the planet and the spacecraft, at the time of arrival, are matched by varying the pericentre of the preceding swing-by, or the magnitude of the launch excess velocity, for the first arc. For each departure date, this model generates a full tree of possible transfers from the departure to the destination planet. Each leaf of the tree represents a planetary encounter and a possible way to reach that planet. An algorithm inspired by ant colony optimization (ACO) is devised to explore the space of possible plans. The ants explore the tree from departure to destination adding one node at the time: every time an ant is at a node, a probability function is used to select a feasible direction. This approach to automatic trajectory planning is applied to the design of optimal transfers to Saturn and among the Galilean moons of Jupiter. Solutions are compared to those found through more traditional genetic-algorithm techniques.

Biaxial seismic behaviour of reinforced concrete columns =

NASA Astrophysics Data System (ADS)

Rodrigues, Hugo Filipe Pinheiro

A analise dos efeitos dos sismos mostra que a investigacao em engenharia sismica deve dar especial atencao a avaliacao da vulnerabilidade das construcoes existentes, frequentemente desprovidas de adequada resistencia sismica tal como acontece em edificios de betao armado (BA) de muitas cidades em paises do sul da Europa, entre os quais Portugal. Sendo os pilares elementos estruturais fundamentais na resistencia sismica dos edificios, deve ser dada especial atencao a sua resposta sob acoes ciclicas. Acresce que o sismo e um tipo de acao cujos efeitos nos edificios exige a consideracao de duas componentes horizontais, o que tem exigencias mais severas nos pilares comparativamente a acao unidirecional. Assim, esta tese centra-se na avaliacao da resposta estrutural de pilares de betao armado sujeitos a acoes ciclicas horizontais biaxiais, em tres linhas principais. Em primeiro lugar desenvolveu-se uma campanha de ensaios para o estudo do comportamento ciclico uniaxial e biaxial de pilares de betao armado com esforco axial constante. Para tal foram construidas quatro series de pilares retangulares de betao armado (24 no total) com diferentes caracteristicas geometricas e quantidades de armadura longitudinal, tendo os pilares sido ensaiados para diferentes historias de carga. Os resultados experimentais obtidos sao analisados e discutidos dando particular atencao a evolucao do dano, a degradacao de rigidez e resistencia com o aumento das exigencias de deformacao, a energia dissipada, ao amortecimento viscoso equivalente; por fim e proposto um indice de dano para pilares solicitados biaxialmente. De seguida foram aplicadas diferentes estrategias de modelacao nao-linear para a representacao do comportamento biaxial dos pilares ensaiados, considerando nao-linearidade distribuida ao longo dos elementos ou concentrada nas extremidades dos mesmos. Os resultados obtidos com as varias estrategias de modelacao demonstraram representar adequadamente a resposta em termos das curvas

NASA GES DISC support of CO2 Data from OCO-2, ACOS, and AIRS

NASA Technical Reports Server (NTRS)

Wei, Jennifer C; Vollmer, Bruce E.; Savtchenko, Andrey K.; Hearty, Thomas J; Albayrak, Rustem Arif; Deshong, Barbara E.

2013-01-01

NASA Goddard Earth Sciences Data and Information Services Centers (GES DISC) is the data center assigned to archive and distribute current AIRS, ACOS data and data from the upcoming OCO-2 mission. The GES DISC archives and supports data containing information on CO2 as well as other atmospheric composition, atmospheric dynamics, modeling and precipitation. Along with the data stewardship, an important mission of GES DISC is to facilitate access to and enhance the usability of data as well as to broaden the user base. GES DISC strives to promote the awareness of science content and novelty of the data by working with Science Team members and releasing news articles as appropriate. Analysis of events that are of interest to the general public, and that help in understanding the goals of NASA Earth Observing missions, have been among most popular practices.Users have unrestricted access to a user-friendly search interface, Mirador, that allows temporal, spatial, keyword and event searches, as well as an ontology-driven drill down. Variable subsetting, format conversion, quality screening, and quick browse, are among the services available in Mirador. The majority of the GES DISC data are also accessible through OPeNDAP (Open-source Project for a Network Data Access Protocol) and WMS (Web Map Service). These services add more options for specialized subsetting, format conversion, image viewing and contributing to data interoperability.

Changes in oxidative stress in transgenic RNAi ACO1 tomato fruit during ripening

NASA Astrophysics Data System (ADS)

Eglous, Najat Mohamed; Ali, Zainon Mohd; Hassan, Maizom; Zainal, Zamri

2013-11-01

Tomato (Solanum Lycopersicum L.) is the second most cultivated vegetable in the world and widely used as a system for studying the role of ethylene during fruit ripening. Our objective was to study the oxidative stress and antioxidative metabolism during ripening of non transgenic tomato and transgenic line-21 tomato which reduced ethylene. The line-21 of transgenic tomato plants (RNAi ACO1) had lower ethylene production and longer shelf-life more than 32 days as compared to the wild-type fruits which have very short shelf-life. In this study, tomato fruit were divided into five different stages (MG: mature green 5%, B: breaker 25%, T: turning 50%, O: orange75%, RR: red ripe100%). The activity of lipoxygenase (LOX) and lipid peroxidation (MDA) were measured to assess changes in oxidative stress. The LOX activity and MDA content decreased significantly obtaining 2.6-fold and 1.2-fold, respectively, as compared to the wild type fruit. However, superoxide dismutase (SOD) and catalase (CAT) activities were increased to 1.9 and 1.2 folds from the mature green to the fully ripe stage in transgenic tomatoes. Furthermore, the wild type tomato increases 1.3 in SOD and 1.6 in CAT activities. The overall results indicate that the wild type tomato fruit showed a faster rate of ripening, parallel to decline in the rate of enzymatic antioxidative systems as compared to the transgenic line-21 tomato fruit. In addition, the results show that the antioxidant capacity is improved during the ripening process and is accompanied by an increase in the oxidative stress.

Parylene supported 20um*20um uncooled thermoelectric infrared detector with high fill factor

NASA Astrophysics Data System (ADS)

Modarres-Zadeh, Mohammad J.; Carpenter, Zachary S.; Rockley, Mark G.; Abdolvand, Reza

2012-06-01

Presented is a novel design for an uncooled surface-micromachined thermoelectric (TE) infrared (IR) detector. The detector features a P-doped polysilicon/Nichrome (Cr20-Ni80) thermocouple, which is embedded into a thin layer of Parylene-N to provide structural support. The low thermal conductivity (~0.1W/m.K), chemical resistance, and ease of deposition/patterning of Parylene-N make it an excellent choice of material for use in MEMS thermal detectors. This detector also features an umbrella-like IR absorber composed of a three layer stack of NiCr/SiN/NiCr to optimize IR absorption. The total device area is 20 um * 20 um per pixel with an absorber area of ~19 um * 19 um resulting in a fill factor of 90%. At room temperature, a DC responsivity of ~170V/W with a rise time of less than 8 ms is measured from the fabricated devices in vacuum when viewing a 500K blackbody without any concentrating optics. The dominant source of noise in thermoelectric IR detectors is typically Johnson noise when the detectors are operating in an open circuit condition. The fabricated detectors have resistances about 85KOhm which results in Johnson noise of about 38nV/Hz^0.5. The D* is calculated to be 9 * 106 cm*Hz0.5/ W. Preliminary finite element analysis indicates that the thermal conduction from the hot junction to the substrate through the TE wires is dominant ( GTE >> Gparylene) considering the fabricated dimensions of the parylene film and the TE wires. Thus, by further reducing the size of the TE wires, GTE can be decreased and hence, responsivity can be improved while the parylene film sustains the structural integrity of the cell.

Multi-objective ACO algorithms to minimise the makespan and the total rejection cost on BPMs with arbitrary job weights

NASA Astrophysics Data System (ADS)

Jia, Zhao-hong; Pei, Ming-li; Leung, Joseph Y.-T.

2017-12-01

In this paper, we investigate the batch-scheduling problem with rejection on parallel machines with non-identical job sizes and arbitrary job-rejected weights. If a job is rejected, the corresponding penalty has to be paid. Our objective is to minimise the makespan of the processed jobs and the total rejection cost of the rejected jobs. Based on the selected multi-objective optimisation approaches, two problems, P1 and P2, are considered. In P1, the two objectives are linearly combined into one single objective. In P2, the two objectives are simultaneously minimised and the Pareto non-dominated solution set is to be found. Based on the ant colony optimisation (ACO), two algorithms, called LACO and PACO, are proposed to address the two problems, respectively. Two different objective-oriented pheromone matrices and heuristic information are designed. Additionally, a local optimisation algorithm is adopted to improve the solution quality. Finally, simulated experiments are conducted, and the comparative results verify the effectiveness and efficiency of the proposed algorithms, especially on large-scale instances.

Genome analysis of Daldinia eschscholtzii strains UM 1400 and UM 1020, wood-decaying fungi isolated from human hosts

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

Chan, Chai Ling; Yew, Su Mei; Ngeow, Yun Fong

Background: Daldinia eschscholtzii is a wood-inhabiting fungus that causes wood decay under certain conditions. It has a broad host range and produces a large repertoire of potentially bioactive compounds. However, there is no extensive genome analysis on this fungal species. Results: Two fungal isolates (UM 1400 and UM 1020) from human specimens were identified as Daldinia eschscholtzii by morphological features and ITS-based phylogenetic analysis. Both genomes were similar in size with 10,822 predicted genes in UM 1400 (35.8 Mb) and 11,120 predicted genes in UM 1020 (35.5 Mb). A total of 751 gene families were shared among both UM isolates,more » including gene families associated with fungus-host interactions. In the CAZyme comparative analysis, both genomes were found to contain arrays of CAZyme related to plant cell wall degradation. Genes encoding secreted peptidases were found in the genomes, which encode for the peptidases involved in the degradation of structural proteins in plant cell wall. In addition, arrays of secondary metabolite backbone genes were identified in both genomes, indicating of their potential to produce bioactive secondary metabolites. Both genomes also contained an abundance of gene encoding signaling components, with three proposed MAPK cascades involved in cell wall integrity, osmoregulation, and mating/filamentation. Besides genomic evidence for degrading capability, both isolates also harbored an array of genes encoding stress response proteins that are potentially significant for adaptation to living in the hostile environments. In conclusion: Our genomic studies provide further information for the biological understanding of the D. eschscholtzii and suggest that these wood-decaying fungi are also equipped for adaptation to adverse environments in the human host.« less

Genome analysis of Daldinia eschscholtzii strains UM 1400 and UM 1020, wood-decaying fungi isolated from human hosts

DOE PAGES

Chan, Chai Ling; Yew, Su Mei; Ngeow, Yun Fong; ...

2015-11-18

Background: Daldinia eschscholtzii is a wood-inhabiting fungus that causes wood decay under certain conditions. It has a broad host range and produces a large repertoire of potentially bioactive compounds. However, there is no extensive genome analysis on this fungal species. Results: Two fungal isolates (UM 1400 and UM 1020) from human specimens were identified as Daldinia eschscholtzii by morphological features and ITS-based phylogenetic analysis. Both genomes were similar in size with 10,822 predicted genes in UM 1400 (35.8 Mb) and 11,120 predicted genes in UM 1020 (35.5 Mb). A total of 751 gene families were shared among both UM isolates,more » including gene families associated with fungus-host interactions. In the CAZyme comparative analysis, both genomes were found to contain arrays of CAZyme related to plant cell wall degradation. Genes encoding secreted peptidases were found in the genomes, which encode for the peptidases involved in the degradation of structural proteins in plant cell wall. In addition, arrays of secondary metabolite backbone genes were identified in both genomes, indicating of their potential to produce bioactive secondary metabolites. Both genomes also contained an abundance of gene encoding signaling components, with three proposed MAPK cascades involved in cell wall integrity, osmoregulation, and mating/filamentation. Besides genomic evidence for degrading capability, both isolates also harbored an array of genes encoding stress response proteins that are potentially significant for adaptation to living in the hostile environments. In conclusion: Our genomic studies provide further information for the biological understanding of the D. eschscholtzii and suggest that these wood-decaying fungi are also equipped for adaptation to adverse environments in the human host.« less

The International Space Station Urine Monitoring System (UMS)

NASA Technical Reports Server (NTRS)

Feeback, Daniel L.; Cibuzar, Branelle R.; Milstead, Jeffery R.; Pietrzyk,, Robert A.; Clark, Mark S.F.

2009-01-01

A device capable of making in-flight volume measurements of single void urine samples, the Urine Monitoring System (UMS), was developed and flown on seven U.S. Space Shuttle missions. This device provided volume data for each urine void from multiple crewmembers and allowed samples of each to be taken and returned to Earth for post-flight analysis. There were a number of design flaws in the original instrument including the presence of liquid carry-over producing invalid "actual" micturition volumes and cross-contamination between successive users from residual urine in "dead" spots". Additionally, high or low volume voids could not be accurately measured, the on-orbit calibration and nominal use sequence was time intensive, and the unit had to be returned and disassembled to retrieve the volume data. These problems have been resolved in a new version, the International Space Station (ISS) UMS, that has been designed to provide real-time in-flight volume data with accuracy and precision equivalent to measurements made on Earth and the ability to provide urine samples that are unadulterated by the device. Originally conceived to be interfaced with a U.S.-built Waste Collection System (WCS), the unit now has been modified to interface with the Russian-supplied Sanitary Hygiene Device (ASY). The ISS UMS provides significant advantages over the current method of collecting urine samples into Urine Collection Devices (UCDs), from which samples are removed and returned to Earth for analyses. A significant future advantage of the UMS is that it can provide an interface to analytical instrumentation that will allow real-time measurement of urine bioanalytes allowing monitoring of crewmember health status during flight and the ability to provide medical interventions based on the results of these measurements. Currently, the ISS UMS is scheduled to launch along with Node-3 on STS-130 (20A) in December 2009. UMS will be installed and scientific/functional verification

Recovery Act: Novel Kerf-Free PV Wafering that provides a low-cost approach to generate wafers from 150um to 50um in thickness

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

Fong, Theodore E.

2013-05-06

The technical paper summarizes the project work conducted in the development of Kerf-Free silicon wafering equipment for silicon solar wafering. This new PolyMax technology uses a two step process of implantation and cleaving to exfoliate 50um to 120um wafers with thicknesses ranging from 50um to 120um from a 125mm or 156mm pseudo-squared silicon ingot. No kerf is generated using this method of wafering. This method of wafering contrasts with the current method of making silicon solar wafers using the industry standard wire saw equipment. The report summarizes the activity conducted by Silicon Genesis Corporation in working to develop this technologymore » further and to define the roadmap specifications for the first commercial proto-type equipment for high volume solar wafer manufacturing using the PolyMax technology.« less

Uh and um revisited: are they interjections for signaling delay?

PubMed

O'Connell, Daniel C; Kowal, Sabine

2005-11-01

Clark and Fox Tree (2002) have presented empirical evidence, based primarily on the London-Lund corpus (LL; Svartvik & Quirk, 1980), that the fillers uh and um are conventional English words that signal a speaker's intention to initiate a minor and a major delay, respectively. We present here empirical analyses of uh and um and of silent pauses (delays) immediately following them in six media interviews of Hillary Clinton. Our evidence indicates that uh and um cannot serve as signals of upcoming delay, let alone signal it differentially: In most cases, both uh and um were not followed by a silent pause, that is, there was no delay at all; the silent pauses that did occur after um were too short to be counted as major delays; finally, the distributions of durations of silent pauses after uh and um were almost entirely overlapping and could therefore not have served as reliable predictors for a listener. The discrepancies between Clark and Fox Tree's findings and ours are largely a consequence of the fact that their LL analyses reflect the perceptions of professional coders, whereas our data were analyzed by means of acoustic measurements with the PRAAT software (www.praat.org). A comparison of our findings with those of O'Connell, Kowal, and Ageneau (2005) did not corroborate the hypothesis of Clark and Fox Tree that uh and um are interjections: Fillers occurred typically in initial, interjections in medial positions; fillers did not constitute an integral turn by themselves, whereas interjections did; fillers never initiated cited speech, whereas interjections did; and fillers did not signal emotion, whereas interjections did. Clark and Fox Tree's analyses were embedded within a theory of ideal delivery that we find inappropriate for the explication of these phenomena.

Spitzer/IRS spectroscopy of the 12um Seyferts

NASA Astrophysics Data System (ADS)

Wu, Yanling; Charmandaris, V.; Huang, J.; Houck, J.

2009-01-01

The extended 12um galaxy sample is a flux-limited sample of 893 galaxies selected from the IRAS Faint Source Catalog 2. A total of 118 objects from this sample have been classified optically as Seyfert galaxies, providing one of the largest infrared selected unbiased sample of active galactic nuclei (AGN). We present our prelimary results from our analysis of mid-infrared Spitzer/IRS spectra of 102 12um Seyferts (that is 86 % of the 12um Seyfert sample) which have been observed by various Spitzer programs and are available in the Spitzer archive. A number of mid-infared diagnostics have been developed to study the nature of nuclear dust enshrouded emission from AGNs, in order to disentangle the starburst-AGN connection. Since PAH emission is a tracer of star formation activity we have measured the 11.3um PAH feature for our Seyfert sample. We find that as the strength of the radiation field in AGNs increases the PAH molecules are destroyed, while the PAH EWs increase with the IRAS f60/f25 ratios of the host galaxies. We further probe this warm/cold color diagnostic, by contrasting our findings with those of we starbust galaxies, ULIRGs, as well as blue compact dwarf galaxies.

The Hidden Roles That Management Partners Play In Accountable Care Organizations.

PubMed

Lewis, Valerie A; D'Aunno, Thomas; Murray, Genevra F; Shortell, Stephen M; Colla, Carrie H

2018-02-01

Accountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs. We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94 percent had data services provided by the partner, 87 percent received administrative services, 68 percent received educational services, and 66 percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.

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

PubMed

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

2014-01-01

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

"Uh" and "Um" Revisited: Are They Interjections for Signaling Delay?

ERIC Educational Resources Information Center

O'Connell, Daniel C.; Kowal, Sabine

2005-01-01

Clark and Fox Tree (2002) have presented empirical evidence, based primarily on the London-Lund corpus (LL; Svartvik & Quirk, 1980), that the fillers "uh" and "um" are conventional English words that signal a speaker's intention to initiate a minor and a major delay, respectively. We present here empirical analyses of "uh" and "um" and of silent…

Accountable Care Organizations in California: Market Forces at Work?

PubMed

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

2015-08-01

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

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

PubMed

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

2018-01-31

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

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

PubMed

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

2014-11-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

PubMed

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

2018-05-16

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

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

PubMed

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

2017-01-05

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

Statistical uncertainty in the Medicare shared savings program.

PubMed

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

2012-01-01

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

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

PubMed

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

2014-06-01

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

Cytoplasmic CopZ-Like Protein and Periplasmic Rusticyanin and AcoP Proteins as Possible Copper Resistance Determinants in Acidithiobacillus ferrooxidans ATCC 23270.

PubMed

Navarro, Claudio A; von Bernath, Diego; Martínez-Bussenius, Cristóbal; Castillo, Rodrigo A; Jerez, Carlos A

2016-02-15

Acidophilic organisms, such as Acidithiobacillus ferrooxidans, possess high-level resistance to copper and other metals. A. ferrooxidans contains canonical copper resistance determinants present in other bacteria, such as CopA ATPases and RND efflux pumps, but these components do not entirely explain its high metal tolerance. The aim of this study was to find other possible copper resistance determinants in this bacterium. Transcriptional expression of A. ferrooxidans genes coding for a cytoplasmic CopZ-like copper-binding chaperone and the periplasmic copper-binding proteins rusticyanin and AcoP, which form part of an iron-oxidizing supercomplex, was found to increase when the microorganism was grown in the presence of copper. All of these proteins conferred more resistance to copper when expressed heterologously in a copper-sensitive Escherichia coli strain. This effect was absent when site-directed-mutation mutants of these proteins with altered copper-binding sites were used in this metal sensitivity assay. These results strongly suggest that the three copper-binding proteins analyzed here are copper resistance determinants in this extremophile and contribute to the high-level metal resistance of this industrially important biomining bacterium. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Cytoplasmic CopZ-Like Protein and Periplasmic Rusticyanin and AcoP Proteins as Possible Copper Resistance Determinants in Acidithiobacillus ferrooxidans ATCC 23270

PubMed Central

Navarro, Claudio A.; von Bernath, Diego; Martínez-Bussenius, Cristóbal; Castillo, Rodrigo A.

2015-01-01

Acidophilic organisms, such as Acidithiobacillus ferrooxidans, possess high-level resistance to copper and other metals. A. ferrooxidans contains canonical copper resistance determinants present in other bacteria, such as CopA ATPases and RND efflux pumps, but these components do not entirely explain its high metal tolerance. The aim of this study was to find other possible copper resistance determinants in this bacterium. Transcriptional expression of A. ferrooxidans genes coding for a cytoplasmic CopZ-like copper-binding chaperone and the periplasmic copper-binding proteins rusticyanin and AcoP, which form part of an iron-oxidizing supercomplex, was found to increase when the microorganism was grown in the presence of copper. All of these proteins conferred more resistance to copper when expressed heterologously in a copper-sensitive Escherichia coli strain. This effect was absent when site-directed-mutation mutants of these proteins with altered copper-binding sites were used in this metal sensitivity assay. These results strongly suggest that the three copper-binding proteins analyzed here are copper resistance determinants in this extremophile and contribute to the high-level metal resistance of this industrially important biomining bacterium. PMID:26637599

The Economics of Medicare Accountable Care Organizations

PubMed Central

Blackstone, Erwin A.; Fuhr, Joseph P.

2016-01-01

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

The Economics of Medicare Accountable Care Organizations.

PubMed

Blackstone, Erwin A; Fuhr, Joseph P

2016-02-01

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

STS-40 Exp. No. 192 urine monitoring system (UMS) on OV-102's middeck

NASA Technical Reports Server (NTRS)

1991-01-01

STS-40 Experiment No. 192, Fluid-Electrolyte Regulation During Space Flight, urine monitoring system (UMS) is set up on the middeck of Columbia, Orbiter Vehicle (OV) 102, at the side hatch. The UMS is attached to OV-102's waste collection system (WCS). The urine specimen tray with sample tubes appears to the right of the UMS equipment.

Ethical challenges for accountable care organizations: a structured review.

PubMed

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

2014-10-01

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

Statistical Uncertainty in the Medicare Shared Savings Program

PubMed Central

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

2012-01-01

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

Private sector accountable care organization development: a qualitative study.

PubMed

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

2017-03-01

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

Primary Care Clinics and Accountable Care Organizations

PubMed Central

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

2015-01-01

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

Clinical coordination in accountable care organizations: A qualitative study.

PubMed

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

2016-12-06

Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts. We conducted semistructured interviews between July and December 2013. Our sample includes ACOs that began performance contracts in 2012, including Medicare Shared Savings Program and Pioneer participants, stratified across key factors. In total, we conducted interviews with executives from 30 ACOs. Iterative qualitative analysis identified common patterns and themes. ACOs in the first year of performance contracts are commonly focusing on four areas: first, transforming primary care through increased access and team-based care; second, reducing avoidable emergency department use; third, strengthening practice-based care management; and fourth, developing new boundary spanner roles and activities. ACOs were doing little around transforming specialty care, acute and postacute care, or standardizing care across practices during the first 18 months of ACO performance contracts. Results suggest that cost reductions associated with ACOs in the first years of contracts may be related to primary care. Although in the long term many hope ACOs will achieve coordination across a wide array of care settings and providers, in the short term providers under ACO contracts are focused largely on primary care-related strategies. Our work provides a template of the common areas of clinical activity in the first years of ACO contracts, which may be informative to providers considering becoming an ACO. Further research will be needed to

Quality Improvement Strategies in Accountable Care Organization Hospitals.

PubMed

Mora, Arthur M; Walker, Daniel

2016-01-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2017-12-06

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

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

PubMed

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

2016-06-20

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

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

PubMed

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

2013-12-01

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

High Frequency GaAs Bulk Acousto-Optic Devices For Modulators And Frequency Shifters At 1.3um And 1.5um In Fiber-Optics

NASA Astrophysics Data System (ADS)

Soos, J. I.; Rosemeier, R. G.

1989-02-01

The edge of a transmission window for a GaAs Bragg cell starts about lum, which allows this material to be used for infrared fiber-optic applications, especially at 1.3um and 1.5um. The single crystal of GaAs is acoustically anisotropic and has the highest figure of merit, M2, along <111> direction for a longitudinal mode sound wave. Recently, Brimrose has designed and fabricated an acousto-optic modulator from GaAs operating at a carrier frequency of 2.3 GHz with a diffraction efficiency of 4%/RF watt.

Early Performance of Accountable Care Organizations in Medicare

PubMed Central

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

2016-01-01

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

Performance Differences in Year 1 of Pioneer Accountable Care Organizations

PubMed Central

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

2015-01-01

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

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

PubMed

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

2018-06-06

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

Unit 5, STA. 50+00+RB, Orner Building, First U.M. Church Rectory, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Unit 5, STA. 50+00+RB, Orner Building, First U.M. Church Rectory, & First U.M. Church-context - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

UM-PRS: An implementation of the procedural reasoning system for multirobot applications

NASA Technical Reports Server (NTRS)

Lee, Jaeho; Huber, Marcus J.; Durfee, Edmund H.; Kenny, Patrick G.

1994-01-01

The Procedural Reasoning System (PRS) is used in applications where predetermined situations might arise. The UM-PRS provides a reasoning system that represents robotic applications even in unpredictable domains, such as the robotic reconnaissance task domain outlined here. UM-PRS incorporates a changing context, rather than relying solely on a prearranged plan. The UM-PRS here provides representation important in the reasoning and interface between a mission plan and the executable map of an outdoor vehicle that changes its behavior based on what it comes in contact with in its environment. PRS is thus used in the dynamic control of such a vehicle, providing the basis for coordinating the joint task of multiple robotic vehicles by the their individual observations and representation.

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

PubMed

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

2017-01-01

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

A taxonomy of hospitals participating in Medicare accountable care organizations.

PubMed

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

2017-03-03

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

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

NASA Astrophysics Data System (ADS)

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

2014-10-01

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

Pediatric Accountable Care Organizations: Insight From Early Adopters.

PubMed

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

2017-02-01

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

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

PubMed

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

2012-11-01

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

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

PubMed Central

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

2006-01-01

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

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

PubMed

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

2018-06-01

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

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

PubMed

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

2013-01-01

Rural Health Clinics (RHCs) have served the primary healthcare needs of the medically underserved in US rural areas for more than 30 years. As a new model of healthcare delivery, the Accountable Care Organization (ACO) offers potential opportunities for addressing the healthcare needs of rural populations, yet little is known about how the ACO model will meet the needs of RHCs. This article reports on the results of a survey, focus groups, and phone interviews with RHC management personnel on the subject of benefits of and barriers to RHC participation in ACOs. Survey research, focus groups, and phone interviews were used to gather and analyze the opinions of RHCs' management about the benefits of and barriers to ACO participation. The study population consisted of all 2011 RHCs in Region 4 (Southeastern USA; as designated by the Department of Health and Human Services). California RHCs were used for comparison. Themes and concepts for the survey questionnaire were developed from recent literature. The survey data were analyzed in two stages: (1) analyses of the characteristics of the RHCs and their responses; and (2) bivariate analyses of several relationships using a variety of statistics including analysis of variance, Pearson's χ² and likelihood χ². Relationships were examined between the RHCs' willingness to join ACOs and the respondent clinic's classification (as provider-based or independent). In addition, willingness to join ACOs among Region 4 RHCs was compared with those in California. Finally, in order to gain a broader understanding of the results of the survey, focus groups and phone interviews were conducted with RHC personnel. It was found that the ACO model is generally unfamiliar to RHCs. Approximately 48% of the survey respondents reported having little knowledge of ACOs; the focus group participants and interviewees likewise reported a lack of knowledge. Among respondents who were knowledgeable about ACOs, the most frequently citied

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

PubMed

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

2017-01-01

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

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

PubMed

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

2016-08-15

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

VizieR Online Data Catalog: Draco nebula Herschel 250um map (Miville-Deschenes+, 2017)

NASA Astrophysics Data System (ADS)

Miville-Deschenes, M.-A.; Salome, Q.; Martin, P. G.; Joncas, G.; Blagrave, K.; Dassas, K.; Abergel, A.; Beelen, A.; Boulanger, F.; Lagache, G.; Lockman, F. J.; Marshall, D. J.

2017-03-01

Draco was observed with Herschel PACS (110 and 170um) and SPIRE (250, 350 and 500um) as part of the open-time program "First steps toward star formation: unveiling the atomic to molecular transition in the diffuse interstellar medium" (P.I. M-A Miville-Deschenes). A field of 3.85x3.85 was observed in parallel mode. Unfortunately, an error occurred during the acquisition of the PACS data making them unusable. Therefore, the results presented here are solely based on SPIRE data, especially the 250um map that has the highest angular resolution. (2 data files).

Ultramicronized palmitoylethanolamide (PEA-um(®)) in the treatment of idiopathic pulmonary fibrosis.

PubMed

Di Paola, Rosanna; Impellizzeri, Daniela; Fusco, Roberta; Cordaro, Marika; Siracusa, Rosalba; Crupi, Rosalia; Esposito, Emanuela; Cuzzocrea, Salvatore

2016-09-01

Pulmonary fibrosis is a chronic condition characterized by progressive scarring of lung parenchyma. The aim of this study was to examine the effects of an ultramicronized preparation of palmitoylethanolamide (PEA-um(®)), an endogenous fatty acid amide, in mice subjected to idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis was induced in male mice by a single intratracheal administration of saline with bleomycin sulphate (1mg/kg body weight) in a volume of 100μL. PEA-um(®) was injected intraperitoneally at 1, 3 or 10mg/kg 1h after bleomycin instillation and daily thereafter. Animals were sacrificed after 7 and 21days by pentobarbitone overdose. One cohort of mice was sacrificed after seven days of bleomycin administration, followed by bronchoalveloar lavage and determination of myeloperoxidase activity, lung edema and histopathology features. In the 21-day cohort, mortality was assessed daily, and surviving mice were sacrificed followed by the above analyses together with immunohistochemical localization of CD8, tumor necrosis factor-α, CD4, interleukin-1β, transforming growth factor-β, inducible nitric oxide synthase and basic fibroblast growth factor. Compared to bleomycin-treated mice, animals that received also PEA-um(®) (3 or 10mg/kg) had significantly decreased weight loss, mortality, inflammation, lung damage at the histological level, and lung fibrosis at 7 and 21days. PEA-um(®) (1mg/kg) did not significantly inhibit the inflammation response and lung fibrosis. This study demonstrates that PEA-um(®) (3 and 10mg/kg) reduces the extent of lung inflammation in a mouse model of idiopathic pulmonary fibrosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

Structuring payment to medical homes after the affordable care act.

PubMed

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

2014-10-01

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

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

PubMed

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

2014-01-01

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

Optimization on Paddy Crops in Central Java (with Solver, SVD on Least Square and ACO (Ant Colony Algorithm))

NASA Astrophysics Data System (ADS)

Parhusip, H. A.; Trihandaru, S.; Susanto, B.; Prasetyo, S. Y. J.; Agus, Y. H.; Simanjuntak, B. H.

2017-03-01

Several algorithms and objective functions on paddy crops have been studied to get optimal paddy crops in Central Java based on the data given from Surakarta and Boyolali. The algorithms are linear solver, least square and Ant Colony Algorithms (ACO) to develop optimization procedures on paddy crops modelled with Modified GSTAR (Generalized Space-Time Autoregressive) and nonlinear models where the nonlinear models are quadratic and power functions. The studied data contain paddy crops from Surakarta and Boyolali determining the best period of planting in the year 1992-2012 for Surakarta where 3 periods for planting are known and the optimal amount of paddy crops in Boyolali in the year 2008-2013. Having these analyses may guide the local agriculture government to give a decision on rice sustainability in its region. The best period for planting in Surakarta is observed, i.e. the best period is in September-December based on the data 1992-2012 by considering the planting area, the cropping area, and the paddy crops are the most important factors to be taken into account. As a result, we can refer the paddy crops in this best period (about 60.4 thousand tons per year) as the optimal results in 1992-2012 where the used objective function is quadratic. According to the research, the optimal paddy crops in Boyolali about 280 thousand tons per year where the studied factors are the amount of rainfalls, the harvested area and the paddy crops in 2008-2013. In this case, linear and power functions are studied to be the objective functions. Compared to all studied algorithms, the linear solver is still recommended to be an optimization tool for a local agriculture government to predict paddy crops in future.

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

PubMed

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

2015-08-01

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

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

PubMed

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

2017-06-01

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

Accountable care organization hospitals differ in health IT capabilities.

PubMed

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

2016-12-01

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

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

PubMed

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

2016-07-01

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

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

PubMed

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

2012-01-15

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

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

PubMed

Hofler, Richard A; Ortiz, Judith

2016-07-28

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

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

PubMed

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

2015-01-01

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

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

PubMed

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

2018-03-02

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

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

PubMed

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

2016-03-01

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

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2018-04-03

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

Accountable Care Organizations: The National Landscape.

PubMed

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

2015-08-01

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

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

PubMed

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

2016-06-13

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

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

PubMed

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

2018-02-02

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

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

PubMed

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

2011-10-15

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

Accountable care organization readiness and academic medical centers.

PubMed

Berkowitz, Scott A; Pahira, Jennifer J

2014-09-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2016-09-01

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

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

PubMed

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

2017-06-01

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

VizieR Online Data Catalog: 24um excesses in clusters & membership of NGC2244 (Meng+, 2017)

NASA Astrophysics Data System (ADS)

Meng, H. Y. A.; Rieke, G. H.; Su, K. Y. L.; Gaspar, A.

2017-09-01

We re-measured the Spitzer/MIPS 24um photometry for all the clusters except for a few noted in Appendix A. We obtained the 24um data from the Spitzer Heritage Archive between 2004 Jan 28 and 2008 Oct 23. (3 data files).

Accountable Care Organizations and Transaction Cost Economics.

PubMed

Mick, Stephen S Farnsworth; Shay, Patrick D

2016-12-01

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

Protective Effects of Ultramicronized Palmitoylethanolamide (PEA-um) in Myocardial Ischaemia and Reperfusion Injury in VIVO.

PubMed

Di Paola, Rosanna; Cordaro, Marika; Crupi, Rosalia; Siracusa, Rosalba; Campolo, Michela; Bruschetta, Giuseppe; Fusco, Roberta; Pugliatti, Pietro; Esposito, Emanuela; Cuzzocrea, Salvatore

2016-08-01

Myocardial infarction is the leading cause of death, occurs after prolonged ischemia of the coronary arteries. Restore blood flow is the first intervention help against heart attack. However, reperfusion of the arteries leads to ischemia/reperfusion injury (I/R). The fatty acid amide palmitoylethanolamide (PEA) is an endogenous compound widely present in living organisms, with analgesic and anti-inflammatory properties. The present study evaluated the effect of ultramicronized palmitoylethanolamide (PEA-um) treatment on the inflammatory process associated with myocardial I/R. Myocardial ischemia reperfusion injury was induced by occlusion of the left anterior descending coronary artery for 30 min followed by 2 h of reperfusion. PEA-um, was administered (10 mg/kg) 15 min after ischemia and 1 h after reperfusion. In this study, we demonstrated that PEA-um treatment reduces myocardial tissue injury, neutrophil infiltration, adhesion molecules (ICAM-1, P-selectin) expression, proinflammatory cytokines (TNF-α, IL-1β) production, nitrotyrosine and PAR formation, nuclear factor kB expression, and apoptosis (Fas-L, Bcl-2) activation. In addition to study whether the protective effect of PEA-um on myocardial ischemia reperfusion injury is also related to the activation of PPAR-α, in a separate set of experiments it has been performed myocardial I/R in PPARα mice. Genetic ablation of peroxisome proliferator activated receptor (PPAR)-α in PPAR-αKO mice exacerbated Myocardial ischemia reperfusion injury when compared with PPAR-αWT mice. PEA-um induced cardioprotection in PPAR-α wild-type mice, but the same effect cannot be observed in PPAR-αKO mice. Our results have clearly shown a modulation of the inflammatory process, associated with myocardial ischemia reperfusion injury, following administration of PEA-um.

42 CFR 425.700 - General rules.

Code of Federal Regulations, 2014 CFR

2014-10-01

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

42 CFR 425.304 - Other program requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

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

42 CFR 425.304 - Other program requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

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

42 CFR 425.304 - Other program requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

PubMed Central

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

2017-01-01

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

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2013 CFR

2013-10-01

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

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2014 CFR

2014-10-01

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

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

NASA Astrophysics Data System (ADS)

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

2018-03-01

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

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

PubMed

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

2016-09-01

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

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

PubMed

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

2014-01-01

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

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

PubMed

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

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

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

PubMed Central

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

2017-01-01

Importance Post-acute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit post-acute spending has implications for the importance and design of other payment models that include post-acute care. Objective To assess changes in post-acute spending and utilization associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. Design and Setting Using fee-for-service Medicare claims from 2009–2014, we conducted difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO providers (control group) before vs. after entry into the MSSP. We estimated differential changes separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. Participants Random 20% sample of beneficiaries with 25,544,650 patient-years, 8,395,426 hospital admissions, and 1,595,352 SNF stays from 2009–2014. Exposure Patient attribution to an ACO in the MSSP. Main Outcomes and Measures Post-acute spending, discharge to a facility, length of SNF stays, readmissions, use of highly-rated SNFs, and mortality, adjusted for patient characteristics. Results For the 2012 cohort of ACOs, MSSP participation was associated with an overall reduction in post-acute spending (differential change in 2014 for ACOs vs. control group: −$106/beneficiary or −9.0%; P=0.003) that was driven by differential reductions in inpatient utilization, discharges to facilities rather than home (−0.6 percentage points or −2.7%; P=0.03), and length of SNF stays (−0.60 days/stay or −2.2%; P=0.002). Reductions in SNF use and length of stay were due largely to within-hospital or within-SNF changes in care specifically for ACO patients. MSSP participation was associated with smaller significant reductions in SNF spending in 2014 for the 2013 ACO cohort but not in the 2013 or 2014 cohort’s first year of participation

VizieR Online Data Catalog: A dust model for bet Pic from 0.58 to 870um (Ballering+, 2016)

NASA Astrophysics Data System (ADS)

Ballering, N. P.; Su, K. Y. L.; Rieke, G. H.; Gaspar, A.

2016-08-01

β Pic was imaged with the HST/STIS CCD in coronagraphic (50CORON) mode under program GO-12551 (PI: Apai), and the results of these observations were published in Apai et al. (2015ApJ...800..136A). The instrument bandpass is set by the response of the CCD and centered at 0.58um. We searched the HST archive and found previously unpublished observations of β Pic with the WFC3 instrument in the IR channel (filter F110W at ~1.16um) from program GO-11150 (PI: Graham). The Spitzer/MIPS observations of β Pic were taken under the Spitzer Guaranteed Time Observing Program 90 (PI: M. Werner). The data at all three bands (24, 70, and 160um) are published here for the first time. Two sets of 24um observations were obtained. The first set was obtained on 2004 March 20, the second set of data was obtained on 2004 April 11. Two sets of 70um observations were obtained. The first set was obtained on 2004 April 12. The second set was obtained on 2005 April 4. Herschel/PACS 70um scan map observations of β Pic (PI G. Olofsson, observation IDs 1342186612 and 1342186613) were published by Vandenbussche et al. (2010A&A...518L.133V). We used the ALMA 870um continuum image previously published by Dent et al. (2014Sci...343.1490D). (1 data file).

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

PubMed

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

Surgeon Participation in Early Accountable Care Organizations.

PubMed

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

2018-03-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2017-06-01

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

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

PubMed

Keren, Ron; Littlejohns, Peter

2012-01-01

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

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

PubMed

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

2012-03-01

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

Roles for specialty societies and vascular surgeons in accountable care organizations

PubMed Central

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

2012-01-01

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

42 CFR 425.104 - Legal entity.

Code of Federal Regulations, 2012 CFR

2012-10-01

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

42 CFR 425.104 - Legal entity.

Code of Federal Regulations, 2014 CFR

2014-10-01

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

42 CFR 425.104 - Legal entity.

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

PubMed

Liu, Pai; Wu, Shinyi

2016-03-01

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

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

PubMed Central

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

2016-01-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2014-01-01

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

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

PubMed

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

2016-03-01

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

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

PubMed

Shortell, Stephen M

2016-12-01

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

The aconitate hydratase family from Citrus

PubMed Central

2010-01-01

Background Research on citrus fruit ripening has received considerable attention because of the importance of citrus fruits for the human diet. Organic acids are among the main determinants of taste and organoleptic quality of fruits and hence the control of fruit acidity loss has a strong economical relevance. In citrus, organic acids accumulate in the juice sac cells of developing fruits and are catabolized thereafter during ripening. Aconitase, that transforms citrate to isocitrate, is the first step of citric acid catabolism and a major component of the citrate utilization machinery. In this work, the citrus aconitase gene family was first characterized and a phylogenetic analysis was then carried out in order to understand the evolutionary history of this family in plants. Gene expression analyses of the citrus aconitase family were subsequently performed in several acidic and acidless genotypes to elucidate their involvement in acid homeostasis. Results Analysis of 460,000 citrus ESTs, followed by sequencing of complete cDNA clones, identified in citrus 3 transcription units coding for putatively active aconitate hydratase proteins, named as CcAco1, CcAco2 and CcAco3. A phylogenetic study carried on the Aco family in 14 plant species, shows the presence of 5 Aco subfamilies, and that the ancestor of monocot and dicot species shared at least one Aco gene. Real-time RT-PCR expression analyses of the three aconitase citrus genes were performed in pulp tissues along fruit development in acidic and acidless citrus varieties such as mandarins, oranges and lemons. While CcAco3 expression was always low, CcAco1 and CcAco2 genes were generally induced during the rapid phase of fruit growth along with the maximum in acidity and the beginning of the acid reduction. Two exceptions to this general pattern were found: 1) Clemenules mandarin failed inducing CcAco2 although acid levels were rapidly reduced; and 2) the acidless "Sucreña" orange showed unusually high levels

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

PubMed

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

2016-01-01

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

Breast Imaging: A Paradigm for Accountable Care Organizations.

PubMed

Parikh, Jay R; Yang, Wei T

2016-02-01

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

42 CFR 425.20 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

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

42 CFR 425.20 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

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

Variability of the broad absorption lines in the QSO UM 232

NASA Technical Reports Server (NTRS)

Barlow, Thomas A.; Junkkarinen, Vesa T.; Burbidge, E. Margaret

1989-01-01

Low-resolution spectra of UM 232 taken in 1978, 1979, and 1988 at Lick Observatory are presented. Large changes in the Si IV lambda 1397, CIV lambda 1549, and Al III lambda 1857 broad absorption lines are apparent. The decrease in column density in all three ions and an observed brightening of the QSO suggests that these changes are due to an increase in the ionization level driven by an increase in the central source luminosity. This mechanism has been proposed by Smith and Penston to explain small changes in the absorption spectrum of the QSO 1246-057. The spectra of UM 232 show that the fractional decrease in optical depth is smaller at higher outflow velocies. The structure of the broad absorption-line region (BALR) is investigted by estimating an ionization parameter for each ion species as a function of velocity.

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

PubMed

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

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

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

PubMed

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

2017-01-01

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

Ant algorithms for discrete optimization.

PubMed

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

1999-01-01

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

Accountable Care Organizations: how to dress for success.

PubMed

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

2013-06-01

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

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

PubMed

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

2017-01-01

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

Aconitase couples metabolic regulation to mitochondrial DNA maintenance.

PubMed

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

2005-02-04

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

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

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

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

2015-09-30

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

Activation pathways of synovial T lymphocytes. Expression and function of the UM4D4/CDw60 antigen.

PubMed Central

Fox, D A; Millard, J A; Kan, L; Zeldes, W S; Davis, W; Higgs, J; Emmrich, F; Kinne, R W

1990-01-01

Accumulating evidence implicates a central role for synovial T cells in the pathogenesis of rheumatoid arthritis, but the activation pathways that drive proliferation and effector function of these cells are not known. We have recently generated a novel monoclonal antibody against a rheumatoid synovial T cell line that recognizes an antigen termed UM4D4 (CDw60). This antigen is expressed on a minority of peripheral blood T cells, and represents the surface component of a distinct pathway of human T cell activation. The current studies were performed to examine the expression and function of UM4D4 on T cells obtained from synovial fluid and synovial membranes of patients with rheumatoid arthritis and other forms of inflammatory joint disease. The UM4D4 antigen is expressed at high surface density on about three-fourths of synovial fluid T cells and on a small subset of synovial fluid natural killer cells; in synovial tissue it is present on more than 90% of T cells in lymphoid aggregates, and on approximately 50% of T cells in stromal infiltrates In addition, UM4D4 is expressed in synovial tissue on a previously undescribed population of HLA-DR/DP-negative non-T cells with a dendritic morphology. Anti-UM4D4 was co-mitogenic for both RA and non-RA synovial fluid mononuclear cells, and induced IL-2 receptor expression. The UM4D4/CDw60 antigen may represent a functional activation pathway for synovial compartment T cells, which could play an important role in the pathogenesis of inflammatory arthritis. Images PMID:2212003

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

PubMed

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

2016-09-01

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

Annealing Ant Colony Optimization with Mutation Operator for Solving TSP

PubMed Central

2016-01-01

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

Annealing Ant Colony Optimization with Mutation Operator for Solving TSP.

PubMed

Mohsen, Abdulqader M

2016-01-01

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

How "accountable" are accountable care organizations?

PubMed

Addicott, Rachael; Shortell, Stephen M

2014-01-01

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

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

PubMed

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

2016-01-01

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

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

PubMed

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

2015-11-01

Wasteful practices are widespread in the US health care system. It is unclear if payment models intended to improve health care efficiency, such as the Medicare accountable care organization (ACO) programs, discourage the provision of low-value services. To assess whether the first year of the Medicare Pioneer ACO program was associated with a reduction in use of low-value services. In a difference-in-differences analysis, we compared use of low-value services between Medicare fee-for-service beneficiaries attributed to health care provider groups that entered the Pioneer program (ACO group) and beneficiaries attributed to other health care providers (control group) before (2009-2011) vs after (2012) Pioneer ACO contracts began. Data analysis was conducted from December 1, 2014, to June 27, 2015. Comparisons were adjusted for beneficiaries' sociodemographic and clinical characteristics as well as for geography. We decomposed estimates according to service characteristics (clinical category, price, and sensitivity to patient preferences) and compared estimates between subgroups of ACOs with higher vs lower baseline use of low-value services. Use of, and spending on, 31 services in instances that provide minimal clinical benefit, measured as annual service counts per 100 beneficiaries and price-standardized annual service spending per 100 beneficiaries. During the precontract period, trends in the use of low-value services were similar for the ACO and control groups. The first year of ACO contracts was associated with a differential reduction (95% CI) of 0.8 low-value services per 100 beneficiaries for the ACO group (-1.2 to -0.4; P < .001), corresponding to a 1.9% differential reduction in service quantity (-2.9% to -0.9%) and a 4.5% differential reduction in spending on low-value services (-7.5% to -1.4%; P = .004). Differential reductions were similar for services less sensitive vs more sensitive to patient preferences and for higher- vs lower-priced services

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

NASA Astrophysics Data System (ADS)

Ge, Junwei; Cai, Yu; Fang, Yiqiu

2018-05-01

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

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

PubMed

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

2007-08-21

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

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

NASA Astrophysics Data System (ADS)

Prayuni, Kinasih; Dwivany, Fenny M.

2015-09-01

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

Implementação de um algoritmo para a limpeza de mapas da RCFM

NASA Astrophysics Data System (ADS)

Souza, C. L.; Wuensche, C. A.

2003-08-01

A Radiação Cósmica de Fundo em Microondas (RCFM), descoberta por Penzias e Wilson em 1965, é uma das ferramentas mais poderosas para o estudo da cosmologia. Com a descoberta de flutuações de temperatura na RCFM, da ordem de uma parte em 105, pelo COBE (1992), uma nova era teve início. Nos últimos onze anos, diversos instrumentos fizeram novas medidas de alta precisão, refinando os resultados apresentados pelo COBE, culminando com os resultados recentes do satélite WMAP. A análise de dados da RCFM, especialmente no caso de experimentos com pequena cobertura do céu, apresenta uma série de dificuldades devido a emissões de contaminantes externos, tais como a emissão da Galáxia e de fontes pontuais, e de ruídos intrínsecos tanto ao sistema de detecção quanto à estratégia de observação do céu. Uma das soluções típicas para a filtragem de dados brutos de um experimento para medir flutuações de temperatura é aplicar um gabarito (template) e um filtro passa alta ao produzir mapas simplificados (sem considerar matrizes de correlação ou covariância). No caso de experimentos que utilizam detectores HEMT, essa combinação de filtros remove, satisfatoriamente, ruídos do tipo 1/f gerados pela instabilidade no ganho do detector acoplado ao movimento do instrumento, definido pela estratégia de observação. Entretanto, o sinal resultante medido, tanto em simulações quanto em séries temporais reais, sugere que parte do sinal cosmológico pode estar sendo removido junto com o ruído dos detectores. Este trabalho descreve as etapas para a produção de um mapa típico (simulado) e os testes preliminares de um algoritmo para remover ruídos do tipo 1/f introduzidos pela estratégia de observação sem prejudicar a qualidade do sinal cosmológico presente no mapa.

Use of "um" in the Deceptive Speech of a Convicted Murderer

ERIC Educational Resources Information Center

Villar, Gina; Arciuli, Joanne; Mallard, David

2012-01-01

Previous studies have demonstrated a link between language behaviors and deception; however, questions remain about the role of specific linguistic cues, especially in real-life high-stakes lies. This study investigated use of the so-called filler, "um," in externally verifiable truthful versus deceptive speech of a convicted murderer. The data…

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

PubMed

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

2012-12-01

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

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

PubMed

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

2010-07-01

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

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

PubMed

Kumari, Sumita; Agrawal, Madhoolika

2014-03-01

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

Optimization of Medication Use at Accountable Care Organizations.

PubMed

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

2017-10-01

Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use. To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use. This cross-sectional study consisted of a survey and interviews that gathered information on the perceptions of ACO leadership. The survey contained a medication practices inventory (MPI) composed of 38 capabilities across 6 functional domains related to optimizing medication use. ACOs completed self-assessments that included rating each component of the MPI on a scale of 1 to 10. Fisher's exact tests, 2-proportions tests, t-tests, and logistic regression were used to test for associations between ACO scores on the MPI and performance on financial and quality metrics, and on ACO descriptive characteristics. Of the 847 ACOs that were contacted, 49 provided usable survey data. These ACOs rated their own system's ability to manage the quality and costs of optimizing medication use, providing a 64% and 31% affirmative response, respectively. Three ACOs achieved an overall MPI score of 8 or higher, 45 scored between 4 and 7.9, and 1 scored between 0 and 3.9. Using the 3 score groups, the study did not identify a relationship between MPI scores and achievement on financial or quality benchmarks, ACO provider type, member volume, date of ACO creation, or the presence of a pharmacist in a leadership position. Barriers to optimizing medication use relate to reimbursement for pharmacist integration, lack of health information technology interoperability, lack of data, feasibility issues, and physician buy

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

PubMed Central

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

2016-01-01

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

Lifecycle Greenhouse Gas Analysis of an Anaerobic Codigestion Facility Processing Dairy Manure and Industrial Food Waste.

PubMed

Ebner, Jacqueline H; Labatut, Rodrigo A; Rankin, Matthew J; Pronto, Jennifer L; Gooch, Curt A; Williamson, Anahita A; Trabold, Thomas A

2015-09-15

Anaerobic codigestion (AcoD) can address food waste disposal and manure management issues while delivering clean, renewable energy. Quantifying greenhouse gas (GHG) emissions due to implementation of AcoD is important to achieve this goal. A lifecycle analysis was performed on the basis of data from an on-farm AcoD in New York, resulting in a 71% reduction in GHG, or net reduction of 37.5 kg CO2e/t influent relative to conventional treatment of manure and food waste. Displacement of grid electricity provided the largest reduction, followed by avoidance of alternative food waste disposal options and reduced impacts associated with storage of digestate vs undigested manure. These reductions offset digester emissions and the net increase in emissions associated with land application in the AcoD case relative to the reference case. Sensitivity analysis showed that using feedstock diverted from high impact disposal pathways, control of digester emissions, and managing digestate storage emissions were opportunities to improve the AcoD GHG benefits. Regional and parametrized emissions factors for the storage emissions and land application phases would reduce uncertainty.

Uh and um in Children With Autism Spectrum Disorders or Language Impairment

PubMed Central

Gorman, Kyle; Olson, Lindsay; Presmanes Hill, Alison; Lunsford, Rebecca; Heeman, Peter A.; van Santen, Jan P. H.

2016-01-01

Atypical pragmatic language is often present in individuals with autism spectrum disorders (ASD), along with delays or deficits in structural language. This study investigated the use of the “fillers” uh and um by children ages 4–8 during the autism diagnostic observation schedule. Fillers reflect speakers’ difficulties with planning and delivering speech, but they also serve communicative purposes, such as negotiating control of the floor or conveying uncertainty. We hypothesized that children with ASD would use different patterns of fillers compared to peers with typical development or with specific language impairment (SLI), reflecting differences in social ability and communicative intent. Regression analyses revealed that children in the ASD group were much less likely to use um than children in the other two groups. Filler use is an easy-to-quantify feature of behavior that, in concert with other observations, may help to distinguish ASD from SLI. PMID:26800246

The merging dwarf galaxy UM 448: chemodynamics of the ionized gas from VLT integral field spectroscopy

NASA Astrophysics Data System (ADS)

James, B. L.; Tsamis, Y. G.; Barlow, M. J.; Walsh, J. R.; Westmoquette, M. S.

2013-01-01

Using Very Large Telescope/Fibre Large Array Multi Element Spectrograph optical integral field unit observations, we present a detailed study of UM 448, a nearby blue compact galaxy (BCG) previously reported to have an anomalously high N/O abundance ratio. New Technology Telescope/Superb-Seeing Imager images reveal a morphology suggestive of a merger of two systems of contrasting colour, whilst our Hα emission maps resolve UM 448 into three separate regions that do not coincide with the stellar continuum peaks. UM 448 exhibits complex emission line profiles, with most lines consisting of a narrow [full width at half-maximum (FWHM) ≲ 100 km s-1], central component, an underlying broad component (FWHM ˜ 150-300 km s-1) and a third, narrow blueshifted component. Radial velocity maps of all three components show signs of solid body rotation across UM 448, with a projected rotation axis that correlates with the continuum morphology of the galaxy. A spatially resolved, chemodynamical analysis, based on the [O iii] λλ4363, 4959, [N ii] λ6584, [S ii] λλ6716, 6731 and [Ne iii] λ3868 line maps, is presented. Whilst the eastern tail of UM 448 has electron temperatures (Te) that are typical of BCGs, we find a region within the main body of the galaxy where the narrow and broad [O iii] λ4363 line components trace temperatures differing by 5000 K and oxygen abundances differing by 0.4 dex. We measure spatially resolved and integrated ionic and elemental abundances for O, N, S and Ne throughout UM 448, and find that they do not agree, possibly due the flux weighting of Te from the integrated spectrum. This has significant implications for abundances derived from long-slit and integrated spectra of star-forming galaxies in the nearby and distant universe. A region of enhanced N/O ratio is indeed found, extended over a ˜0.6 kpc2 region within the main body of the galaxy. Contrary to previous studies, however, we do not find evidence for a large Wolf-Rayet (WR

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

PubMed

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

2014-10-01

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

Accountable care organizations: impact on pharmacy.

PubMed

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

2014-03-01

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

An Institutional Perspective on Accountable Care Organizations.

PubMed

Goodrick, Elizabeth; Reay, Trish

2016-12-01

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

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

PubMed

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

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

Nursing Diagnoses of hospitalized patients with heart failure: a longitudinal study.

PubMed

Pereira, Juliana de Melo Vellozo; Flores, Paula Vanessa Peclat; Figueiredo, Lyvia da Silva; Arruda, Cristina Silva; Cassiano, Keila Mara; Vieira, Gláucia Cristina Andrade; Guerra, Thais de Rezende Bessa; Silva, Vanessa Alves da; Cavalcanti, Ana Carla Dantas

2016-01-01

, respectivamente. Fadiga apareceu somente em um paciente. Intolerância à atividade foi o diagnóstico que teve maior discordância entre os peritos. Débito cardíaco diminuído foi associado às características definidoras dispneia, edema, distensão da veia jugular e fração de ejeção diminuída nas três semanas de avaliação. Débito cardíaco diminuído esteve mais prevalente em pacientes com insuficiência cardíaca hospitalizados, sendo as características definidoras associadas determinantes para este diagnóstico de enfermagem.

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

PubMed

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

2017-04-01

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

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

PubMed

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

2017-07-01

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

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

PubMed

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

2015-01-01

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

A Transition from Localized to Strongly Correlated Electron Behavior and Mixed Valence Driven by Physical or Chemical Pressure in ACo 2As 2 (A = Eu and Ca)

DOE PAGES

Tan, Xiaoyan; Fabbris, Gilberto; Haskel, Daniel; ...

2016-02-03

In this paper, we demonstrate that the action of physical pressure, chemical compression, or aliovalent substitution in ACo 2As 2 (A = Eu and Ca) has a general consequence of causing these antiferromagnetic materials to become ferromagnets. In all cases, the mixed valence triggered at the electropositive A site results in the increase of the Co 3d density of states at the Fermi level. Remarkably, the dramatic alteration of magnetic behavior results from the very minor (<0.15 electron) change in the population of the 3d orbitals. The mixed valence state of Eu observed in the high-pressure (HP) form of EuComore » 2As 2 exhibits a remarkable stability, achieving the average oxidation state of +2.25 at 12.6 GPa. In the case of CaCo 2As 2, substituting even 10% of Eu or La into the Ca site causes ferromagnetic ordering of Co moments. Similar to HP-EuCo 2As 2, the itinerant 3d ferromagnetism emerges from electronic doping into the Co layer because of chemical compression of Eu sites in Ca 0.9Eu 0.1Co 1.91As 2 or direct electron doping in Ca 0.85La 0.15Co 1.89As 2. Finally, the results reported herein demonstrate the general possibility of amplifying minor localized electronic effects to achieve major changes in material’s properties via involvement of strongly correlated electrons.« less

Observations of the new gravitational lens system UM 673 = Q 0142-100

NASA Astrophysics Data System (ADS)

Surdej, J.; Magain, P.; Swings, J.-P.; Borgeest, U.; Courvoisier, T. J.-L.; Kayer, R.; Kellermann, K. I.; Kuhr, H.; Refsdal, S.

1988-06-01

The authors have recently initiated a high resolution direct imaging survey of a selected sample of highly luminous quasars (HLQs). The observations are carried out with the 2.2 m telescope at ESO, and with the VLA at the NRAO, New Mexico. Following the first observing run at ESO, the authors have reported the discovery of a new gravitational lens system for the HLQ UM 673 = Q 0142-100. Additional observations supporting this interpretation are discussed here. Application of gravitational optometry to this system is given: a value of M0 = 2.4×1011M_sun; is derived for the mass of the lensing galaxy located between UM 673 A and B and a most likely estimate of Δt = 7 weeks is found for the expected delay between the arrival times of a similar variability event in the two lensed images of the quasar (H0 = 75 km s-1Mpc-1, q0 = 0).

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

PubMed

Rosenkrantz, Andrew B; Duszak, Richard

2018-03-01

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

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

PubMed

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

2017-07-01

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

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

PubMed

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

2015-09-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2012-09-01

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

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

PubMed

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

2017-09-01

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

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

NASA Astrophysics Data System (ADS)

Liu, Shuang; Hu, Xiangyun; Liu, Tianyou

2014-07-01

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

Personnel in blue and white FCR bldg 30 during STS-106

NASA Image and Video Library

2000-09-19

JSC2000-E-22832 (13 September 2000) --- Gary Ford intently watches a monitor at the Assembly and Checkout Officer (ACO) console in Houston's Mission Control Center (MCC). The ACO is responsible for station assembly, activation and checkout operations.

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

PubMed

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

2015-08-01

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

Accountable Care Organizations and Population Health Organizations.

PubMed

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

2015-08-01

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

Unit 5, STA. 50+00+RB, retaining wall at First U.M. Churchdetail ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Unit 5, STA. 50+00+RB, retaining wall at First U.M. Church-detail - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Microwave-Assisted Extraction, Chemical Structures, and Chain Conformation of Polysaccharides from a Novel Cordyceps Sinensis Fungus UM01.

PubMed

Cheong, Kit-Leong; Wang, Lan-Ying; Wu, Ding-Tao; Hu, De-Jun; Zhao, Jing; Li, Shao-Ping

2016-09-01

Cordyceps sinensis is a well-known tonic food with broad medicinal properties. The aim of the present study was to investigate the optimization of microwave-assisted extraction (MAE) and characterize chemical structures and chain conformation of polysaccharides from a novel C. sinensis fungus UM01. Ion-exchange and gel filtration chromatography were used to purify the polysaccharides. The chemical structure of purified polysaccharide was determined through gas chromatography-mass spectrometry. Moreover, high performance size exclusion chromatography combined with refractive index detector and multiangle laser light scattering were conducted to analyze the molecular weight (Mw ) and chain conformation of purified polysaccharide. Based on the orthogonal design L9 , optimal MAE conditions could be obtained through 1300 W of microwave power, with a 5-min irradiation time at a solid to water ratio of 1:60, generating the highest extraction yield of 6.20%. Subsequently, the polysaccharide UM01-S1 was purified. The UM01-S1 is a glucan-type polysaccharide with a (1→4)-β-d-glucosyl backbone and branching points located at O-3 of Glcp with a terminal-d-Glcp. The Mw , radius of gyration (Rg ) and hydrodynamic radius (Rh ) of UM01-S1 were determined as 5.442 × 10(6)  Da, 21.8 and 20.2 nm, respectively. Using the polymer solution theory, the exponent (ν) value of the power law function was calculated as 0.38, and the shape factor (ρ = Rg /Rh ) was 1.079, indicating that UM01-S1 has a sphere-like conformation with a branched structure in an aqueous solution. These results provide fundamental information for the future application of polysaccharides from cultured C. sinensis in health and functional food area. © 2016 Institute of Food Technologists®

76 FR 67991 - Medicare Program; Final Waivers in Connection With the Shared Savings Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-02

... governance, management, and leadership of the ACO, as well as program integrity, transparency, compliance... ACOs to promote accountability for individual Medicare beneficiaries and population health management...-kickback statute safe harbors include, among others, those for employment, personal services and management...

Resultados do desenvolvimento de um propulsor à plasma no Brasil

NASA Astrophysics Data System (ADS)

Ferreira, I. S.; Ferreira, J. L.

2003-08-01

Uma das partes mais importantes de um satélite é o controle de atitude do mesmo. E se tratando de um satélite científico, a atenção para este sistema deve ser redobrada. Uma possibilidade atraente para executar esta tarefa é a propulsão elétrica. Aqui, mostraremos resultados obtidos pelo propulsor à plasma PHALL-01, desenvolvido na Universidade de Brasília entre 2000 e 2003. Este é derivado do propulsor russo SPT-100 (Stationary Plasma Thruster), mas com o emprego inovador de um arranjo de imãs permanentes como fonte do campo magnético, este último o agente da aceleração do plasma. Esta alteração foi motivada pelo objetivo de que o mesmo operasse com o mínimo de potência elétrica. A partir da formulação teórica do mecanismo de aceleração, tendo como base as equações da magnetohidrodinâmica, pode-se obter vínculos sob os quais o propulsor pudesse ser construído. O mais forte destes é o que dita a topologia do campo magnético. Sendo assim, foram realizadas simulações computacionais, que definiram a geometria do propulsor. Após construído, este foi diagnosticado usando-se sondas de Langmuir e analisadores de energia. Como resultados, obtivemos a distribuição espacial da temperatura, densidade e potencial do plasma, bem como a distribuição angular do feixe produzido pelo mesmo em vários regimes de operação. O espectro de energia do feixe de plasma também foi medido, indicando íons de até 560eV. Combinando estes resultados, calculou-se o empuxo do propulsor: 84mN; e o impulso específico: 1083s. Estes demonstram que o mesmo estará qualificado, num futuro próximo, para o emprego no controle de atitude de satélites científicos, ou até mesmo como parte do conjunto propulsor primário, responsáveis pela transferência de órbitas.

The effects of triazophos applied to transgenic Bt rice on the nutritional indexes, Nlvg expression, and population growth of Nilaparvata lugens Stål under elevated CO₂.

PubMed

Ge, Lin-Quan; Sun, Yu-Cheng; Ouyang, Fang; Wu, Jin-Cai; Ge, Feng

2015-02-01

The brown planthopper, Nilaparvata lugens (Stål) (Hemiptera: Delphacidae), is a typical pest in which population resurgence can be induced by insecticides. Warmer global temperatures, associated with anthropogenic climate change, are likely to have marked ecological effects on terrestrial ecosystems. However, the effects of elevated CO2 (eCO2) concentrations on the resurgence of N. lugens that have been treated with pesticides used for transgenic Bt rice cultivation are not fully understood. The present study investigated changes in the protein content, soluble sugar content, free amino acid level, vitellogenin (Nlvg) mRNA expression, and the population growth of N. lugens on transgenic Bt rice (TT51) following triazaophos foliar spray under conditions of eCO2. The results showed that the protein content in the fat bodies and ovaries of N. lugens adult females in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under ambient CO2 (aCO2) and was also higher than that in females feeding on the non-transgenic parent (MH63) under aCO2 at different days after emergence (DAEs). The soluble sugar content and free amino level of adult females in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under aCO2 and was also higher than in MH63 under aCO2 at 1 and 3 DAE. The Nlvg mRNA expression level of N. lugens adult females in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under aCO2 and was also higher than in MH63 under aCO2 at 1 and 3 DAE. The population number of N. lugens in TT51 treated with 40 ppm triazophos under eCO2 was significantly higher than under aCO2 and was also higher than in MH63 under aCO2. The present findings provide important information for integrated pest management with transgenic varieties and a better understanding of the resurgence mechanism of N. lugens under eCO2. Copyright © 2014 Elsevier Inc. All rights reserved.

Hiperplasia angiolinfoide com eosinofilia: um caso raro em cavidade oral

PubMed Central

Tenório, Jefferson da Rocha; Gonzaga, Amanda Katarinny Goes; Gonçalves, Patrícia Guerra Peixe; de Oliveira, Denise Hélen Imaculada Pereira; Queiroz, Lélia Maria Guedes

2016-01-01

Resumo A hiperplasia angiolinfoide com eosinofilia (HALE) é considerada uma lesão vascular benigna rara que acomete, principalmente, o tecido cutâneo e subcutâneo da região de cabeça e pescoço, mas incomum na cavidade oral. Sua etiopatogenia permanece indefinida, sendo descrita como proliferação vascular reacional, malformação vascular ou neoplasia. Tem como principal diagnóstico diferencial a doença de Kimura. Este trabalho relata um caso de um paciente do sexo masculino, de 50 anos, que exibia aumento de volume nodular na mucosa do lábio superior, com 3 cm de dimensão e 7 anos de evolução. Após a biópsia excisional, o exame histopatológico mostrou lesão bem encapsulada multilobulada com proliferação de capilares sanguíneos com células endoteliais de aspecto epitelioide, infiltrado inflamatório difuso com linfócitos, plasmócitos, inúmeros eosinófilos e presença de folículos linfoides. A análise imuno-histoquímica revelou positividade para CD34 e Ki-67, o que, juntamente com o exame morfológico, direcionou o diagnóstico para HALE. PMID:29930611

Sustainable competitive advantage for accountable care organizations.

PubMed

Macfarlane, Michael Alex

2014-01-01

In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.

Low-peak-to-average power ratio and low-complexity asymmetrically clipped optical orthogonal frequency-division multiplexing uplink transmission scheme for long-reach passive optical network.

PubMed

Zhou, Ji; Qiao, Yaojun

2015-09-01

In this Letter, we propose a discrete Hartley transform (DHT)-spread asymmetrically clipped optical orthogonal frequency-division multiplexing (DHT-S-ACO-OFDM) uplink transmission scheme in which the multiplexing/demultiplexing process also uses the DHT algorithm. By designing a simple encoding structure, the computational complexity of the transmitter can be reduced from O(Nlog(2)(N)) to O(N). At the probability of 10(-3), the peak-to-average power ratio (PAPR) of 2-ary pulse amplitude modulation (2-PAM)-modulated DHT-S-ACO-OFDM is approximately 9.7 dB lower than that of 2-PAM-modulated conventional ACO-OFDM. To verify the feasibility of the proposed scheme, a 4-Gbit/s DHT-S-ACO-OFDM uplink transmission scheme with a 1∶64 way split has been experimentally implemented using 100-km standard single-mode fiber (SSMF) for a long-reach passive optical network (LR-PON).

Creating Highly Reliable Accountable Care Organizations.

PubMed

Vogus, Timothy J; Singer, Sara J

2016-12-01

Accountable Care Organizations' (ACOs) pursuit of the triple aim of higher quality, lower cost, and improved population health has met with mixed results. To improve the design and implementation of ACOs we look to organizations that manage similarly complex, dynamic, and tightly coupled conditions while sustaining exceptional performance known as high-reliability organizations. We describe the key processes through which organizations achieve reliability, the leadership and organizational practices that enable it, and the role that professionals can play when charged with enacting it. Specifically, we present concrete practices and processes from health care organizations pursuing high-reliability and from early ACOs to illustrate how the triple aim may be met by cultivating mindful organizing, practicing reliability-enhancing leadership, and identifying and supporting reliability professionals. We conclude by proposing a set of research questions to advance the study of ACOs and high-reliability research. © The Author(s) 2016.

Fermentation optimization for the production of bioactive polysaccharides from Cordyceps sinensis fungus UM01.

PubMed

Wang, Lan-Ying; Cheong, Kit-Leong; Wu, Ding-Tao; Meng, Lan-Zhen; Zhao, Jing; Li, Shao-Ping

2015-08-01

The optimal fermentation conditions and medium for the production of bioactive polysaccharides from the mycelium of Cordyceps sinensis fungus UM01 were investigated by using orthogonal design and high performance size exclusion chromatography coupled with multi-angel laser light scattering and refractive index detector (HPSEC-MALLS-RID). Results showed that the optimal temperature, initial pH, rotation speed, medium capacity (ratio of medium volume to the volume of flask bottle) and inoculums volume for the mycelium growth were 15 °C, pH 6.0, 150 rpm, 2/5 (v/v), and 3% (v/v), respectively. Furthermore, bioactive polysaccharides from the mycelium of C. sinensis fungus UM01 were determined as polysaccharide fractions with the molecular weight above 10 kDa. The optimal fermentation medium was determined as a composition of glucose 30.0 g/L, sucrose 30.0 g/L, KH2PO4 1.0 g/L, CaCl2 0.5 g/L, yeast extract 3.0 g/L, and MgCl2 0.1g/L according to the maximum amount of the bioactive polysaccharides (486.16±19.60 mg/L) measured by HPSEC-MALLS/RID. Results are helpful to establish an efficient and controllable fermentation process for the industrial production of bioactive polysaccharides from C. sinensis UM01, and beneficial to develop a unique health and functional product in future. Copyright © 2015 Elsevier B.V. All rights reserved.

Interpretations of integration in early accountable care organizations.

PubMed

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

2012-09-01

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

Characterization of electrochemically deposited films from aqueous and ionic liquid cobalt precursors toward hydrogen evolution reactions

NASA Astrophysics Data System (ADS)

Dushatinski, Thomas; Huff, Clay; Abdel-Fattah, Tarek M.

2016-11-01

Electrodepositions of cobalt films were achieved using an aqueous or an ethylene glycol based non-aqueous solution containing choline chloride (vitamin B4) with cobalt chloride hexahydrate precursor toward hydrogen evolution reactions from sodium borohydride (NaBH4) as solid hydrogen feedstock (SHF). The resulting cobalt films had reflectivity at 550 nm of 2.2% for aqueously deposited films (ACoF) and 1.3% for non-aqueously deposited films (NCoF). Surface morphology studied by scanning electron microscopy showed a positive correlation between particle size and thickness. The film thicknesses were tunable between >100 μm and <300 μm for each film. The roughness (Ra) value measurements by Dektak surface profiling showed that the NCoF (Ra = 165 nm) was smoother than the ACoF (Ra = 418 nm). The NCoFs and ACoFs contained only α phase (FCC) crystallites. The NCoFs were crystalline while the ACoFs were largely amorphous from X-ray diffraction analysis. The NCoF had an average Vickers hardness value of 84 MPa as compared to 176 MPa for ACoF. The aqueous precursor has a single absorption maximum at 510 nm and the non-aqueous precursor had three absorption maxima at 630, 670, and 695 nm. The hydrogen evolution reactions over a 1 cm2 catalytic surface with aqueous NaBH4 solutions generated rate constants (K) = equal to 4.9 × 10-3 min-1, 4.6 × 10-3 min-1, and 3.3 × 10-3 min-1 for ACoF, NCoF, and copper substrate respectively.

The role of behavioral health services in accountable care organizations.

PubMed

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

2015-02-01

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

Colorimetric anion sensors based on positional effect of nitro group for recognition of biologically relevant anions in organic and aqueous medium, insight real-life application and DFT studies

NASA Astrophysics Data System (ADS)

Singh, Archana; Sahoo, Suban K.; Trivedi, Darshak R.

2018-01-01

A new six colorimetric receptors A1-A6 were designed and synthesized, characterized by typical common spectroscopic techniques like FT-IR, UV-Visible, 1H NMR, 13C NMR and ESI-MS. The receptor A1 and A2 exhibit a significant naked-eye response towards F- and AcO- ions in DMSO. Due to presences of the NO2 group at para and ortho position with extended π-conjugation of naphthyl group carrying sbnd OH as a binding site. Compared to receptor A2, A1 is extremely capable of detecting F- and AcO- ions present in the form of sodium salts in an aqueous medium. This is owed to the occurrence of sbnd NO2 group at para position induced in increasing the acidity of sbnd OH proton. Consequently, it easily gets deprotonated in aqueous media. The detection limit of receptor A1 was turned out to be 0.40 and 0.35 ppm for F- and AcO- ions which is beneath WHO permission level (1.0 ppm). Receptor A1 shows a solitary property of solvatochromism in different aprotic solvents in presence of AcO- ion. Receptor A1 depicts high selectivity towards AcO- ion in DMSO: HEPES buffer (9:1, v/v). Receptor A1 proved itself for real life application by detecting anion in solution and solid state. The binding mechanism of receptor A1 with AcO- and F- ions was monitored from 1HNMR titration and DFT study.

Colorimetric anion sensors based on positional effect of nitro group for recognition of biologically relevant anions in organic and aqueous medium, insight real-life application and DFT studies.

PubMed

Singh, Archana; Sahoo, Suban K; Trivedi, Darshak R

2018-01-05

A new six colorimetric receptors A1-A6 were designed and synthesized, characterized by typical common spectroscopic techniques like FT-IR, UV-Visible, 1 H NMR, 13 C NMR and ESI-MS. The receptor A1 and A2 exhibit a significant naked-eye response towards F - and AcO - ions in DMSO. Due to presences of the NO 2 group at para and ortho position with extended π-conjugation of naphthyl group carrying OH as a binding site. Compared to receptor A2, A1 is extremely capable of detecting F - and AcO - ions present in the form of sodium salts in an aqueous medium. This is owed to the occurrence of NO 2 group at para position induced in increasing the acidity of OH proton. Consequently, it easily gets deprotonated in aqueous media. The detection limit of receptor A1 was turned out to be 0.40 and 0.35ppm for F - and AcO - ions which is beneath WHO permission level (1.0ppm). Receptor A1 shows a solitary property of solvatochromism in different aprotic solvents in presence of AcO - ion. Receptor A1 depicts high selectivity towards AcO - ion in DMSO: HEPES buffer (9:1, v/v). Receptor A1 proved itself for real life application by detecting anion in solution and solid state. The binding mechanism of receptor A1 with AcO - and F - ions was monitored from 1 HNMR titration and DFT study. Copyright © 2017 Elsevier B.V. All rights reserved.

Interpretations of Integration in Early Accountable Care Organizations

PubMed Central

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

2012-01-01

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

Mental health problems of undocumented migrants (UMs) in the Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care

PubMed Central

Teunissen, Erik; Sherally, Jamilah; van den Muijsenbergh, Maria; Dowrick, Chris; van Weel-Baumgarten, Evelyn; van Weel, Chris

2014-01-01

Objective To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems. Design Qualitative study using semistructured interviews and thematic analysis. Participants 15 UMs in the Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached. Setting 4 cities in the Netherlands. Results UMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the attitude of the GPs and the effectiveness of the treatment. Reasons for dissatisfaction with GP care are an experienced lack of time, lack of personal attention and absence of physical examination. Expectations of the GP vary, medication for mental health problems is not necessarily seen as a good practice. Conclusions UMs often see their precarious living conditions as an important determinant of their mental health; they do not easily seek help for mental health problems and various barriers hamper access to healthcare for them. Rather than for medication, UMs are looking for encouragement and support from their GP. We recommend that barriers experienced in seeking professional care are tackled at an institutional level as well as at the level of GP. PMID:25416057

76 FR 82205 - Airworthiness Directives; Cessna Aircraft Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... (ACO), 1801 Airport Road, Room 100, Mid- Continent Airport, Wichita, Kansas 67209; phone: (316) 946-4154; fax: (316) 946-4107; email: [email protected] . SUPPLEMENTARY INFORMATION: Comments Invited... (ACO), 1801 Airport Road, Room 100, Mid-Continent Airport, Wichita, Kansas 67209; phone: (316) 946-4154...

The Need for Dynamic Airspace Management in Coalition Operations (The International C2 Journal, Volume 5, Number 3, 2011)

DTIC Science & Technology

2011-01-01

Automated Deep Operations Coordination System (JADOCS), Theater Battle Management Core System ( TBMCS ), and Air Defense System Integrator (ADSI). NATO’s...be submitted to TBMCS at the AOC for inclusion in the daily ACO or change ACO. Missions requiring rapid response, such as MEDEVACs, fire missions

Acetate selective fluorescent turn-on sensors derived using vitamin B6 cofactor pyridoxal-5-phosphate

NASA Astrophysics Data System (ADS)

Sharma, Darshna; Kuba, Aman; Thomas, Rini; Ashok Kumar, S. K.; Kuwar, Anil; Choi, Heung-Jin; Sahoo, Suban K.

2016-03-01

Two new Schiff base receptors have been synthesized by condensation of pyridoxal-5-phosphate with 2-aminophenol (L1) or aniline (L2). In DMSO, the receptors showed both chromogenic and 'turn-on' fluorescence responses selectively in the presence of AcO- and F-. However, in mixed DMSO-H2O medium, the receptors showed AcO- selective 'turn-on' fluorescence without any interference from other tested anions including F-. The detection limit for AcO- was found to be 7.37 μM and 22.9 μM using the receptors L1 and L2, respectively.

Carbonylation of Mitochondrial Aconitase with 4-Hydroxy-2-(E)-nonenal: Localization and Relative Reactivity of Addition Sites

PubMed Central

Liu, Qingyuan; Simpson, David C.; Gronert, Scott

2013-01-01

Mass spectrometry was used to investigate the effects of exposing mitochondrial aconitase (ACO2) to the membrane lipid peroxidation product, 4-hydroxy-2-(E)-nonenal (HNE). ACO2 was selected for this study because (1) it is known to be inactivated by HNE, (2) elevated concentrations of HNE-adducted ACO2 have been associated with disease states, (3) extensive structural information is available, and (4) the iron-sulfur cluster in ACO2 offers a critical target for HNE adduction. The aim of this study was to relate the inactivation of ACO2 by HNE to structural features. Initially, western blotting and an enzyme activity assay were used to assess aggregate effects and then gel electrophoresis, in-gel digestion, and tandem mass spectrometry were used to identify HNE addition sites. HNE addition reaction rates were determined for the most significant sites using the iTRAQ approach. The most reactive sites were Cys358, Cys421, and Cys424, the three iron-sulfur cluster-coordinating cysteines, Cys99, the closest non-ligated cysteine to the cluster, and Cys565, which is located in the cleft leading to the active site. Interestingly, both enzyme activity assay and iTRAQ relative abundance plots appeared to be trending toward horizontal asymptotes, rather than completion. PMID:23518448

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

PubMed

Jona, J B; Nagaveni, N

2014-01-15

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

A Taxonomy of Accountable Care Organizations for Policy and Practice

PubMed Central

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

2014-01-01

Objective To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance. Data Sources/Study Setting Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs. Study Design Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data. Principal Findings We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital–physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities. Conclusions ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations. PMID:25251146

A taxonomy of accountable care organizations for policy and practice.

PubMed

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

2014-12-01

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

Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality.

PubMed

Huber, Thomas P; Shortell, Stephen M; Rodriguez, Hector P

2017-08-01

Examine the extent to which physician organization participation in an accountable care organization (ACO) and electronic health record (EHR) functionality are associated with greater adoption of care transition management (CTM) processes. A total of 1,398 physician organizations from the third National Study of Physician Organization survey (NSPO3), a nationally representative sample of medical practices in the United States (January 2012-May 2013). We used data from the third National Study of Physician Organization survey (NSPO3) to assess medical practice characteristics, including CTM processes, ACO participation, EHR functionality, practice type, organization size, ownership, public reporting, and pay-for-performance participation. Multivariate linear regression models estimated the extent to which ACO participation and EHR functionality were associated with greater CTM capabilities, controlling for practice size, ownership, public reporting, and pay-for-performance participation. Approximately half (52.4 percent) of medical practices had a formal program for managing care transitions in place. In adjusted analyses, ACO participation (p < .001) and EHR functionality (p < .001) were independently associated with greater use of CTM processes among medical practices. The growth of ACOs and similar provider risk-bearing arrangements across the country may improve the management of care transitions by physician organizations. © Health Research and Educational Trust.

VizieR Online Data Catalog: SG1120-1202 members HST imaging & 24um fluxes (Monroe+, 2017)

NASA Astrophysics Data System (ADS)

Monroe, J. T.; Tran, K.-V. H.; Gonzalez, A. H.

2017-09-01

We employ HST imaging of an ~8'x12' mosaic across three filters: F390W (WFC3/UVIS), F606W (ACS/WFC), and F814W (ACS/WFC) for a total of 44 pointings (combined primary and parallels) during cycles 14 (GO 10499) and 19 (GO 12470). We use the Spitzer MIPS 24um fluxes from Saintonge+ (2008ApJ...685L.113S) and Tran+ (2009ApJ...705..809T). The 24um observations were retrieved from the Spitzer archive. For details on spectroscopy from multi-band ground-based observations using Magellan (in 2006), MMT, and VLT/VIMOS (in 2003), we refer the reader to Tran+ (2009ApJ...705..809T). (1 data file).

VizieR Online Data Catalog: 12um ISOCAM survey of the ESO-Sculptor field (Seymour+, 2007)

NASA Astrophysics Data System (ADS)

Seymour, N.; Rocca-Volmerange, B.; de Lapparent, V.

2007-11-01

We present a detailed reduction of a mid-infrared 12um (LW10 filter) ISOCAM open time observation performed on the ESO-Sculptor Survey field (Arnouts et al., 1997A&AS..124..163A). A complete catalogue of 142 sources (120 galaxies and 22 stars), detected with high significance (equivalent to 5{sigma}), is presented above an integrated flux density of 0.31mJy. Star/galaxy separation is performed by a detailed study of colour-colour diagrams. The catalogue is complete to 1mJy and, below this flux density, the incompleteness is corrected using two independent methods. The first method uses stars and the second uses optical counterparts of the ISOCAM galaxies; these methods yield consistent results. We also apply an empirical flux density calibration using stars in the field. For each star, the 12um flux density is derived by fitting optical colours from a multi-band {chi}2 to stellar templates (BaSel-2.0) and using empirical optical-IR colour-colour relations. This article is a companion analysis to our 2007 paper (Rocca-Volmerange et al. 2007A&A...475..801R) where the 12um faint galaxy counts are presented and analysed per galaxy type with the evolutionary code PEGASE.3. (1 data file).

75 FR 57039 - Medicare Program; Workshop Regarding Accountable Care Organizations, and Implications Regarding...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

... panel discussions and a listening session on certain legal issues related to Accountable Care Organizations (ACOs). Physicians, physician associations, hospitals, health systems, consumers, and all others...-mail to [email protected] or sent via regular mail to: Attn: ACO Legal Issues, Mail Stop C5-15...

Consistent Evaluation of ACOS-GOSAT, BESD-SCIAMACHY, CarbonTracker, and MACC Through Comparisons to TCCON

NASA Technical Reports Server (NTRS)

Kulawik, Susan; Wunch, Debra; O’Dell, Christopher; Frankenberg, Christian; Reuter, Maximilian; Chevallier, Frederic; Oda, Tomohiro; Sherlock, Vanessa; Buchwitz, Michael; Osterman, Greg;

The Athenæum Club, the Royal Society and the reform of dentistry in nineteenth-century Britain: A research report

PubMed Central

Bishop, Malcolm G. H.

2017-01-01

In 1978 M. J. Peterson examined the role played by the Royal College of Surgeons (RCS) in nineteenth-century dental reform, noting the establishment of its Licence in Dental Surgery (LDS) in 1859. In a paper published in Notes and Records in 2010, the present author described the influential role played by Fellows of the Royal Society during the nineteenth-century campaign for dental reform led by Sir John Tomes. Key players in this campaign, including the dentists Samuel Cartwright, Thomas Bell and James Salter, were, as well as being Fellows of the Royal Society, members of the Athenæum Club. The present research report indicates the roles played by those members of the Athenæum Club who were also Fellows of the Royal Society in the scientific and professional reform of nineteenth-century dentistry. Although it does not attempt to document meetings at the Club, it suggests the potential for a symbiotic effect between the Royal Society and the Athenæum. Where the previous paper proposed an active scientific role for the Royal Society in reforming dentistry, this paper presents the Athenæum as a significant extension of the sphere of influence into the cultural realm for those who did enjoy membership of both organizations.

Accountable Care Organizations and Antitrust Enforcement: Promoting Competition and Innovation.

PubMed

Feinstein, Deborah L; Kuhlmann, Patrick; Mucchetti, Peter J

2015-08-01

The antitrust laws stand to protect consumers of health care services from conduct that would raise prices, lower quality, and decrease innovation by lessening competition. Importantly, though, vigorous antitrust enforcement does not impede accountable care organizations (ACOs) and similar collaborations that advance these same goals of better and more efficient care; in fact, by fostering competitive markets, the antitrust laws encourage such initiatives. This article summarizes the legal framework that the federal antitrust agencies - the Federal Trade Commission and the Antitrust Division of the US Department of Justice - use to analyze ACOs and other collaborations among health care providers. It outlines the guidance provided by the federal antitrust agencies concerning when ACOs and other provider collaborations likely would harm competition and consumers. In addition, it reviews common antitrust issues that can arise with ACOs and provides examples of enforcement actions that have prevented health care providers from taking or continuing anticompetitive actions. Copyright © 2015 by Duke University Press.

A strategic tension for hospitals moving upstream: Cede control but maintain accountability.

PubMed

Taylor, Lauren A; Berchuck, Caroline M; Barnett, Katherine Gergen

2018-07-01

Health systems are focusing attention on the role that social determinants of health (SDOH) can and should play in health care delivery. This is especially true among accountable care organizations (ACOs) and Medicaid ACOs in particular. In crafting SDOH strategies, senior leadership teams may face an organizational tension in aiming to cede control over dollars, data and patient experience to community-based organizations (CBOs) while also maintaining financial accountability for health outcomes. We review the history of neighborhood health centers (NHCs) in order to foreshadow the types of critiques ACOs are likely to face in working with CBOs. We conclude by suggesting a several strategies by which ACOs may be lessen accountability concerns, including raising the issue with regulators, using low-risk dollars to fund joint-work, working through an intermediary, providing technical assistance and viewing the relationship as a partnership rather than contract. Copyright © 2018 Elsevier Inc. All rights reserved.

ASSOCIATION BETWEEN PAYMENT REFORM AND PROVIDER CONSOLIDATION

PubMed Central

Neprash, Hannah T.; Chernew, Michael E.; McWilliams, J. Michael

2017-01-01

Provider consolidation has been associated with higher health care prices and spending. Prevailing wisdom assumes that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing from a number of data sources from 2008 onward, we examined the relationship between Medicare’s Accountable Care Organization (ACO) programs and provider consolidation. According to multiple measures, consolidation was underway in 2008–2010, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and specialty-oriented physician group size increased after the ACA, we found minimal evidence associating consolidation with ACO penetration at a market level or with ACO participation by physicians within markets. We conclude that payment reform has been associated with little acceleration in consolidation apart from trends already underway, but with some evidence of potential defensive consolidation in response to new payment models. PMID:28167725

Ethical Practice Under Accountable Care

PubMed Central

Bhandary, Asha; Rizzo, Matthew

2017-01-01

Accountable Care Organizations (ACOs) are a key mechanism of the Patient Protection and Affordable Care Act (PPACA). ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice (no novel conflicts with non-maleficence were identified). Conflicts include a bias against transient populations, a motive to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well. PMID:26002491

New Hampshire Nurse Practitioners Take the Lead in Forming an Accountable Care Organization.

PubMed

Wright, Wendy L

In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program. Hospitalization rates for NP-managed patients are among the lowest in the state. Cost of care for NP-managed patients is $66.85 less per member per month than the participating physician-managed patients. Data from this ACO provide evidence that NPs provide cost-effective, quality health care and are integral to the formation and sustainability of any ACO.

VizieR Online Data Catalog: 70um-1.2mm and N2H+ maps of IRDC18454 (W43) (Beuther+,

NASA Astrophysics Data System (ADS)

Beuther, H.; Tackenberg, J.; Linz, H.; Henning, T.; Krause, O.; Ragan, S.; Nielbock, M.; Launhardt, R.; Schmiedeke, A.; Schuller, F.; Carlhoff, P.; Nguyen-Luong, Q.; Sakai, T.

2011-11-01

The cloud complex with a size of ~6'x6' was observed with PACS on Herschel on 2010 March 9. Maps at 250, 350, and 500um were obtained with SPIRE 2010) on 2010 March 11. We observed IRDC18454-1 with the Plateau de Bure Interferometer during five nights in October and November 2009 at 93GHz in the C and D configurations. The N2H+ data has been observed using the BEARS receiver at the NRO 45m telescope in Nobeyama, Japan. The different velocity components have been observed one in April 2010 with an average system temperature of Tsys=206K, the second in June, at slightly lower Tsys. The MIPS 24um data (from MIPSGAL) as well as the IRAC 8um observations (from GLIMPSE) are taken from the Spitzer archive. The 1.2mm continuum data were first presented in Beuther et al. (2002, Cat. J/ApJ/566/945) and the APEX 870um data are part of the ATLASGAL survey of the Galactic plane (Schuller et al., 2009A&A...504..415S). (2 data files).

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

PubMed

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

2016-09-01

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

Evolution and Persistence of 5-um Hot Spots at the Galileo Probe entry Latitude

NASA Technical Reports Server (NTRS)

Fisher, B. M.

1997-01-01

We present a study on the longtudinal locations, morphology and evolution of the 5-um hot spots at 6.5 deg. N latitude (planetocentric), from an extensive IRTF-NSFCAM data set spanning more that 3 years, which includes the date of the Galileo Probe entry.

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR § 512.230 - Beneficiary inclusion criteria.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Scope of Episodes... in the Next Generation ACO model; (2) An ACO in a track of the Comprehensive ESRD Care Model... a member of a physician group practice that initiates BPCI Model 2 episodes at the EPM participant...

Attractors in Sequence Space: Agent-Based Exploration of MHC I Binding Peptides.

PubMed

Jäger, Natalie; Wisniewska, Joanna M; Hiss, Jan A; Freier, Anja; Losch, Florian O; Walden, Peter; Wrede, Paul; Schneider, Gisbert

2010-01-12

Ant Colony Optimization (ACO) is a meta-heuristic that utilizes a computational analogue of ant trail pheromones to solve combinatorial optimization problems. The size of the ant colony and the representation of the ants' pheromone trails is unique referring to the given optimization problem. In the present study, we employed ACO to generate novel peptides that stabilize MHC I protein on the plasma membrane of a murine lymphoma cell line. A jury of feedforward neural network classifiers served as fitness function for peptide design by ACO. Bioactive murine MHC I H-2K(b) stabilizing as well as nonstabilizing octapeptides were designed, synthesized and tested. These peptides reveal residue motifs that are relevant for MHC I receptor binding. We demonstrate how the performance of the implemented ACO algorithm depends on the colony size and the size of the search space. The actual peptide design process by ACO constitutes a search path in sequence space that can be visualized as trajectories on a self-organizing map (SOM). By projecting the sequence space on a SOM we visualize the convergence of the different solutions that emerge during the optimization process in sequence space. The SOM representation reveals attractors in sequence space for MHC I binding peptides. The combination of ACO and SOM enables systematic peptide optimization. This technique allows for the rational design of various types of bioactive peptides with minimal experimental effort. Here, we demonstrate its successful application to the design of MHC-I binding and nonbinding peptides which exhibit substantial bioactivity in a cell-based assay. Copyright © 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Pharmacologic activation of peroxisome proliferator-activating receptor-α accelerates hepatic fatty acid oxidation in neonatal pigs

PubMed Central

Shim, Kwanseob; Jacobi, Sheila; Odle, Jack; Lin, Xi

2018-01-01

Up-regulation of peroxisome proliferator-activating receptor-α (PPARα) and increasing fatty acid oxidation are important for reducing pre-weaning mortality of pigs. We examined the time-dependent regulatory effects of PPARα activation via oral postnatal clofibrate administration (75 mg/(kg-BW·d) for up to 7 days) on mitochondrial and peroxisomal fatty acid oxidation in pigs, a species with limited hepatic fatty acid oxidative capacity due to low ketogenesis. Hepatic oxidation was increased by 44-147% (depending on fatty acid chain-length) and was attained after only 4 days of clofibrate treatment. Acyl-CoA oxidase (ACO) and carnitine palmitoyltransferase I (CPTI) activities accelerated in parallel. The increase in CPTI activity was accompanied by a rapid reduction in the sensitivity of CPTI to malonyl-CoA inhibition. The mRNA abundance of CPTI and ACO, as well as peroxisomal keto-acyl-CoA thiolase (KetoACoA) and mitochondrial malonyl-CoA decarboxylase (MCD), also were augmented greatly. However, the increase in ACO activity and MCD expression were different from CPTI, and significant interactions were observed between postnatal age and clofibrate administration. Furthermore, the expression of acetyl-CoA carboxylase β (ACCβ) decreased with postnatal age and clofibrate had no effect on its expression. Collectively these results demonstrate that the expression of PPARα target genes and the increase in fatty acid oxidation induced by clofibrate are time- and age-dependent in the liver of neonatal pigs. Although the induction patterns of CPTI, MCD, ACO, KetoACoA, and ACCβ are different during the early postnatal period, 4 days of exposure to clofibrate were sufficient to robustly accelerate fatty acid oxidation.

Effects of neutral and anionic substituents on the carbonyl stretching bands of substituted methylbenzoates

NASA Astrophysics Data System (ADS)

Vassileva, P. J.; Binev, I. G.; Juchnovski, I. N.

Effects of neutral and anionic substitutents on frequencies (ν CO) and integrated intensities ( ACO) of the carbonyl stretching bands of substituted methylbenzoates (solvent dimethyl sulphoxide) have been studied in relation to Hammett's equation: satisfactory correlations have been found between ν CO and σ + constants, as well as by using the dual-parameter equations to Yukawa, Tsuno and Taft; ACO have been found to increase in cases of strong electron-releasing substituents. It has been found that constants of anionic substituents, determined on the basis of nitrile i.r. frequencies and intensities, reflect satisfactorily the effects of these substituents on ν CO and ACO of methylbenzoates.

New Methods for the Detection and Interception of Frequency-Hopped Waveforms

DTIC Science & Technology

1990-11-01

that £[p2 Q2 /O] = uF + 2 + o(cos 0 + 6 sin9)2 + 4n(acos0+/3sin)(7ycos0+6sinO)+o r(acos0+sinO)2 I + ( acosO +/3sinO) 2(Tcos9+ 6sin O)2 (3.134) i which...Jcins I lopk ins lI mvtrsi! t3 A pplied Physics Laborator Before1 NII After Figure 4.4: Deconvolut ion Applivod to Oi-fFci i r 100 The Johns 11opkins...Arlington, VA 20360 Library 2 Naval Postgraduate School Monterey, CA 92940 Library 2 Naval Research Laborator . Washington, DC 20375 Library 2 J. W

The short form of the recombinant CAL-A-type lipase UM03410 from the smut fungus Ustilago maydis exhibits an inherent trans-fatty acid selectivity.

PubMed

Brundiek, Henrike; Saß, Stefan; Evitt, Andrew; Kourist, Robert; Bornscheuer, Uwe T

2012-04-01

The Ustilago maydis lipase UM03410 belongs to the mostly unexplored Candida antarctica lipase (CAL-A) subfamily. The two lipases with [corrected] the highest identity are a lipase from Sporisorium reilianum and the prototypic CAL-A. In contrast to the other CAL-A-type lipases, this hypothetical U. maydis lipase is annotated to possess a prolonged N-terminus of unknown function. Here, we show for the first time the recombinant expression of two versions of lipase UM03410: the full-length form (lipUMf) and an Nterminally truncated form (lipUMs). For comparison to the prototype, the expression of recombinant CAL-A in E. coli was investigated. Although both forms of lipase UM03410 could be expressed functionally in E. coli, the N-terminally truncated form (lipUMs) demonstrated significantly higher activities towards p-nitrophenyl esters. The functional expression of the N-terminally truncated lipase was further optimized by the appropriate choice of the E. coli strain, lowering the cultivation temperature to 20 °C and enrichment of the cultivation medium with glucose. Primary characteristics of the recombinant lipase are its pH optimum in the range of 6.5-7.0 and its temperature optimum at 55 °C. As is typical for lipases, lipUM03410 shows preference for long chain fatty acid esters with myristic acid ester (C14:0 ester) being the most preferred one.More importantly, lipUMs exhibits an inherent preference for C18:1Δ9 trans and C18:1Δ11 trans-fatty acid esters similar to CAL-A. Therefore, the short form of this U. maydis lipase is the only other currently known lipase with a distinct trans-fatty acid selectivity.

The March to Accountable Care Organizations--How Will Rural Fare?

ERIC Educational Resources Information Center

MacKinney, A. Clinton; Mueller, Keith J.; McBride, Timothy D.

2011-01-01

Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA)…

Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

PubMed

Conway, Sarah J; Himmelrich, Sarah; Feeser, Scott A; Flynn, John A; Kravet, Steven J; Bailey, Jennifer; Hebert, Lindsay C; Donovan, Susan H; Kachur, Sarah G; Brown, Patricia M C; Baumgartner, William A; Berkowitz, Scott A

2018-02-02

Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.

Surgery scheduling optimization considering real life constraints and comprehensive operation cost of operating room.

PubMed

Xiang, Wei; Li, Chong

2015-01-01

Operating Room (OR) is the core sector in hospital expenditure, the operation management of which involves a complete three-stage surgery flow, multiple resources, prioritization of the various surgeries, and several real-life OR constraints. As such reasonable surgery scheduling is crucial to OR management. To optimize OR management and reduce operation cost, a short-term surgery scheduling problem is proposed and defined based on the survey of the OR operation in a typical hospital in China. The comprehensive operation cost is clearly defined considering both under-utilization and overutilization. A nested Ant Colony Optimization (nested-ACO) incorporated with several real-life OR constraints is proposed to solve such a combinatorial optimization problem. The 10-day manual surgery schedules from a hospital in China are compared with the optimized schedules solved by the nested-ACO. Comparison results show the advantage using the nested-ACO in several measurements: OR-related time, nurse-related time, variation in resources' working time, and the end time. The nested-ACO considering real-life operation constraints such as the difference between first and following case, surgeries priority, and fixed nurses in pre/post-operative stage is proposed to solve the surgery scheduling optimization problem. The results clearly show the benefit of using the nested-ACO in enhancing the OR management efficiency and minimizing the comprehensive overall operation cost.

Improved Modeling of Intelligent Tutoring Systems Using Ant Colony Optimization

ERIC Educational Resources Information Center

Rastegarmoghadam, Mahin; Ziarati, Koorush

2017-01-01

Swarm intelligence approaches, such as ant colony optimization (ACO), are used in adaptive e-learning systems and provide an effective method for finding optimal learning paths based on self-organization. The aim of this paper is to develop an improved modeling of adaptive tutoring systems using ACO. In this model, the learning object is…

Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models.

PubMed

Neprash, Hannah T; Chernew, Michael E; McWilliams, J Michael

2017-02-01

Provider consolidation has been associated with higher health care prices and spending. The prevailing wisdom is that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing on data from a number of sources from 2008 onward, we examined the relationship between Medicare's accountable care organization (ACO) programs and provider consolidation. We found that consolidation was under way in the period 2008-10, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and the size of specialty-oriented physician groups increased after the ACA was passed, we found minimal evidence that consolidation was associated with ACO penetration at the market level or with physicians' participation in ACOs within markets. We conclude that payment reform has been associated with little acceleration in consolidation in addition to trends already under way, but there is evidence of potential defensive consolidation in response to new payment models. Project HOPE—The People-to-People Health Foundation, Inc.

Research on global path planning based on ant colony optimization for AUV

NASA Astrophysics Data System (ADS)

Wang, Hong-Jian; Xiong, Wei

2009-03-01

Path planning is an important issue for autonomous underwater vehicles (AUVs) traversing an unknown environment such as a sea floor, a jungle, or the outer celestial planets. For this paper, global path planning using large-scale chart data was studied, and the principles of ant colony optimization (ACO) were applied. This paper introduced the idea of a visibility graph based on the grid workspace model. It also brought a series of pheromone updating rules for the ACO planning algorithm. The operational steps of the ACO algorithm are proposed as a model for a global path planning method for AUV. To mimic the process of smoothing a planned path, a cutting operator and an insertion-point operator were designed. Simulation results demonstrated that the ACO algorithm is suitable for global path planning. The system has many advantages, including that the operating path of the AUV can be quickly optimized, and it is shorter, safer, and smoother. The prototype system successfully demonstrated the feasibility of the concept, proving it can be applied to surveys of unstructured unmanned environments.

Regulatory neutrality is essential to establishing a level playing field for accountable care organizations.

PubMed

Bacher, Gary E; Chernew, Michael E; Kessler, Daniel P; Weiner, Stephen M

2013-08-01

Accountable care organizations (ACOs) are among the most widely discussed models for encouraging movement away from fee-for-service payment arrangements. Although ACOs have the potential to slow health spending growth and improve quality of care, regulating them poses special challenges. Regulations, particularly those that affect both ACOs and Medicare Advantage plans, could inadvertently favor or disfavor certain kinds of providers or payers. Such favoritism could drive efficient organizations from the market and thus increase costs or reduce quality of and access to care. To avoid this type of outcome, we propose a general principle: Regulation of ACOs should strive to preserve a level playing field among different kinds of organizations seeking the same cost, quality, and access objectives. This is known as regulatory neutrality. We describe the implications of regulatory neutrality in four key areas: antitrust, financial solvency regulation, Medicare governance requirements, and Medicare payment models. We also discuss issues relating to short-term versus long-term perspectives--to promote the goal of regulatory neutrality and allow the most efficient organizations to prevail in the marketplace.

An academic health center sees both challenges and enabling forces as it creates an accountable care organization.

PubMed

Tallia, Alfred F; Howard, Jenna

2012-11-01

Health care reform presents academic health centers with an opportunity to test new systems of care, such as accountable care organizations (ACOs), that are intended to improve patients' health and well-being, mitigate the anticipated shortage in primary care providers, and bend the cost curve. In its ongoing efforts to develop an ACO, the Robert Wood Johnson Medical School, an academic health center, has found helpful a rapidly evolving competitive environment and insurers willing to experiment with new models of care. But the center has also encountered six types of barriers: conceptual, financial, cultural, regulatory, organizational, and historical. How this academic health center has faced these barriers offers valuable lessons to other health systems engaged in creating ACOs.

Accountable care organizations: financial advantages of larger hospital organizations.

PubMed

Camargo, Rodrigo; Camargo, Thaisa; Deslich, Stacie; Paul, David P; Coustasse, Alberto

2014-01-01

Accountable care organizations (ACOs) are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of this study suggest that ACOs based in a larger hospital organization are more likely to meet Centers for Medicare and Medicaid Services criteria for formation because of financial and structural assets of those entities.

Tips for medical practice success in the upcoming accountable care era.

PubMed

Bobbitt, Julian D

2012-01-01

Due to the unsustainable cost of healthcare, the movement to accountable care will be inevitable. This author predicts that recent Medicare Accountable Care Organization (ACO) regulations will energize ACO development. There are specific practical strategies every medical practice leader should know in order to navigate this new healthcare environment successfully. There is a window of opportunity, which will not stay open long, to control a medical practice's destiny in molding a fair, sustainable, and successful ACO. Not being prepared and defaulting to the status quo through passivity is also a choice that promises more work for less compensation for medical practices. The choice is clear, and the blueprint for success is available.

48 CFR 42.602 - Assignment and location.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Assignment and location. (a) A CACO may be assigned only when (1) the contractor has at least two locations with resident ACO's or (2) the need for a CACO is approved by the agency head or designee (for this... devoted to a single contractor). One of the resident ACO's may be designated to perform the CACO functions...

48 CFR 42.602 - Assignment and location.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Assignment and location. (a) A CACO may be assigned only when (1) the contractor has at least two locations with resident ACO's or (2) the need for a CACO is approved by the agency head or designee (for this... devoted to a single contractor). One of the resident ACO's may be designated to perform the CACO functions...

Item Selection for the Development of Short Forms of Scales Using an Ant Colony Optimization Algorithm

ERIC Educational Resources Information Center

Leite, Walter L.; Huang, I-Chan; Marcoulides, George A.

2008-01-01

This article presents the use of an ant colony optimization (ACO) algorithm for the development of short forms of scales. An example 22-item short form is developed for the Diabetes-39 scale, a quality-of-life scale for diabetes patients, using a sample of 265 diabetes patients. A simulation study comparing the performance of the ACO algorithm and…

Characterisation of ethylene pathway components in non-climacteric capsicum.

PubMed

Aizat, Wan M; Able, Jason A; Stangoulis, James C R; Able, Amanda J

2013-11-28

Climacteric fruit exhibit high ethylene and respiration levels during ripening but these levels are limited in non-climacteric fruit. Even though capsicum is in the same family as the well-characterised climacteric tomato (Solanaceae), it is non-climacteric and does not ripen normally in response to ethylene or if harvested when mature green. However, ripening progresses normally in capsicum fruit when they are harvested during or after what is called the 'Breaker stage'. Whether ethylene, and components of the ethylene pathway such as 1-aminocyclopropane 1-carboxylate (ACC) oxidase (ACO), ACC synthase (ACS) and the ethylene receptor (ETR), contribute to non-climacteric ripening in capsicum has not been studied in detail. To elucidate the behaviour of ethylene pathway components in capsicum during ripening, further analysis is therefore needed. The effects of ethylene or inhibitors of ethylene perception, such as 1-methylcyclopropene, on capsicum fruit ripening and the ethylene pathway components may also shed some light on the role of ethylene in non-climacteric ripening. The expression of several isoforms of ACO, ACS and ETR were limited during capsicum ripening except one ACO isoform (CaACO4). ACS activity and ACC content were also low in capsicum despite the increase in ACO activity during the onset of ripening. Ethylene did not stimulate capsicum ripening but 1-methylcyclopropene treatment delayed the ripening of Breaker-harvested fruit. Some of the ACO, ACS and ETR isoforms were also differentially expressed upon treatment with ethylene or 1-methylcyclopropene. ACS activity may be the rate limiting step in the ethylene pathway of capsicum which restricts ACC content. The differential expression of several ethylene pathway components during ripening and upon ethylene or 1-methylclopropene treatment suggests that the ethylene pathway may be regulated differently in non-climacteric capsicum compared to the climacteric tomato. Ethylene independent pathways may

Characterisation of ethylene pathway components in non-climacteric capsicum

PubMed Central

2013-01-01

Background Climacteric fruit exhibit high ethylene and respiration levels during ripening but these levels are limited in non-climacteric fruit. Even though capsicum is in the same family as the well-characterised climacteric tomato (Solanaceae), it is non-climacteric and does not ripen normally in response to ethylene or if harvested when mature green. However, ripening progresses normally in capsicum fruit when they are harvested during or after what is called the ‘Breaker stage’. Whether ethylene, and components of the ethylene pathway such as 1-aminocyclopropane 1-carboxylate (ACC) oxidase (ACO), ACC synthase (ACS) and the ethylene receptor (ETR), contribute to non-climacteric ripening in capsicum has not been studied in detail. To elucidate the behaviour of ethylene pathway components in capsicum during ripening, further analysis is therefore needed. The effects of ethylene or inhibitors of ethylene perception, such as 1-methylcyclopropene, on capsicum fruit ripening and the ethylene pathway components may also shed some light on the role of ethylene in non-climacteric ripening. Results The expression of several isoforms of ACO, ACS and ETR were limited during capsicum ripening except one ACO isoform (CaACO4). ACS activity and ACC content were also low in capsicum despite the increase in ACO activity during the onset of ripening. Ethylene did not stimulate capsicum ripening but 1-methylcyclopropene treatment delayed the ripening of Breaker-harvested fruit. Some of the ACO, ACS and ETR isoforms were also differentially expressed upon treatment with ethylene or 1-methylcyclopropene. Conclusions ACS activity may be the rate limiting step in the ethylene pathway of capsicum which restricts ACC content. The differential expression of several ethylene pathway components during ripening and upon ethylene or 1-methylclopropene treatment suggests that the ethylene pathway may be regulated differently in non-climacteric capsicum compared to the climacteric tomato

Assessment of gene order computing methods for Alzheimer's disease

PubMed Central

2013-01-01

Background Computational genomics of Alzheimer disease (AD), the most common form of senile dementia, is a nascent field in AD research. The field includes AD gene clustering by computing gene order which generates higher quality gene clustering patterns than most other clustering methods. However, there are few available gene order computing methods such as Genetic Algorithm (GA) and Ant Colony Optimization (ACO). Further, their performance in gene order computation using AD microarray data is not known. We thus set forth to evaluate the performances of current gene order computing methods with different distance formulas, and to identify additional features associated with gene order computation. Methods Using different distance formulas- Pearson distance and Euclidean distance, the squared Euclidean distance, and other conditions, gene orders were calculated by ACO and GA (including standard GA and improved GA) methods, respectively. The qualities of the gene orders were compared, and new features from the calculated gene orders were identified. Results Compared to the GA methods tested in this study, ACO fits the AD microarray data the best when calculating gene order. In addition, the following features were revealed: different distance formulas generated a different quality of gene order, and the commonly used Pearson distance was not the best distance formula when used with both GA and ACO methods for AD microarray data. Conclusion Compared with Pearson distance and Euclidean distance, the squared Euclidean distance generated the best quality gene order computed by GA and ACO methods. PMID:23369541

Impact of anatomical variations of the circle of Willis on the incidence of aneurysms and their recurrence rate following endovascular treatment.

PubMed

Songsaeng, D; Geibprasert, S; Willinsky, R; Tymianski, M; TerBrugge, K G; Krings, T

2010-11-01

To analyse the impact of anatomical variations of the parent arteries on the incidence and recurrence rate following coil embolization of aneurysms of the anterior (AcoA), posterior communicating artery (PcoA) and basilar artery (BA) tip. Two hundred and two (96 AcoA, 67 PcoA, and 29 BA) aneurysms in 200 patients were treated with coil embolization between January 2000 and April 2008. Parent artery variations at each location were classified as: AcoA: A1 aplasia versus hypoplasia versus symmetrical size; PcoA: foetal origin versus medium versus small size, BA: cranial versus caudal versus asymmetrical fusion. The incidence of aneurysms and difference between recurrence rates for each group were recorded on follow-up. AcoA, PcoA, and BA aneurysms were more often associated with embryonically earlier vessel wall dispositions (A1 aplasia, foetal PcoA, asymmetrical fusion). Two of these variations were also associated with aneurysm recurrence following coil embolization: asymmetrical A1 segment (p=0.01), and asymmetrical BA tip (p=0.02). AcoA, PcoA, and BA tip aneurysms tend to occur more often in anatomically variant parent artery dispositions, some of which are related to aneurysm recurrence following coil embolization. This may relate to a more fragile vessel disposition as it is not fully matured or to altered haemodynamics secondary to the anatomical variations. Copyright © 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

CedA is a novel Escherichia coli protein that activates the cell division inhibited by chromosomal DNA over-replication.

PubMed

Katayama, T; Takata, M; Sekimizu, K

1997-11-01

We isolated and characterized a new gene related to the control of cell division regulation in Escherichia coli. At 30 degrees C, the dnaAcos mutant causes over-replication of the chromosome, and colony formation is inhibited. We found that, at this temperature, the dnaAcos cells form filaments; therefore, septum formation is inhibited. This inhibition was independent of SfiA, an inhibitor of the septum-forming protein, FtsZ. To identify factors involved in this pathway of inhibition, we isolated seven multicopy suppressors for the cold-sensitive phenotype of the dnaAcos mutant. One of these proved to be a previously unknown gene, which we named cedA. This gene encoded a 12 kDa protein and resided at 38.9min on the E. coli genome map. A multicopy supply of the cedA gene to the dnaAcos cells did not repress over-replication of the chromosome but did stimulate cell division of the host, the result being growth of cells with an abnormally elevated chromosomal copy number. Therefore, the expression level of the cedA gene seems to be important for inhibiting cell division of the dnaAcos mutant at 30 degrees C. We propose that over-replication of the chromosome activates a pathway for inhibiting cell division and that the cedA gene modulates this division control. In the dnaA+ background, cedA also seems to affect cell division.

Synthesis and characterization of para-pyridine linked NHC palladium complexes and their studies for the Heck-Mizoroki coupling reaction.

PubMed

Liu, Ya-Ming; Lin, Yi-Chun; Chen, Wen-Ching; Cheng, Jen-Hao; Chen, Yi-Lin; Yap, Glenn P A; Sun, Shih-Sheng; Ong, Tiow-Gan

2012-06-28

This paper describes the synthesis of 1-(pyridine-4-ylmethyl) NHC and their Pd(II) and Ag(I) complexes, which are fully characterized. Interestingly, we have also synthesized a Pd complex 3a-CO(3) using a more direct treatment of K(2)CO(3) with PdCl(2). 3a-CO(3) represents the first reported solid structure of a Pd η(2)-carbonato complex stabilized by an NHC framework. 3a-CO(3) can be easily converted to a PdCl(2) derivative by treating it with chloroform. We have found these palladium complexes mediate the Heck-Mizoroki coupling with a low catalyst loading. Furthermore, we also expand such catalytic manifold toward constructing fused polyaromatic substrates, a highly useful class of compounds in optoelectronic chemistry.

Wissenschaft, die unsere Kultur verändert. Tiefenschichten des Streits um die Evolutionstheorie

NASA Astrophysics Data System (ADS)

Patzelt, Werner J.

Die Evolutionstheorie ist eine der erfolgreichsten wissenschaftlichen Theorien. Sie erlaubt es, unsere Herkunft zu verstehen und riskante Merkmale gerade der menschlichen Spezies zu begreifen. Zugleich ist die Evolutionstheorie eine der umstrittensten Theorien. Das liegt nicht an ihrer empirischen Tragfähigkeit, sondern an ihrem Gegenstand. Sie handelt nämlich nicht nur - wie Hunderte andere wissenschaftliche Theorien - von der "Welt da draußen“, sondern vor allem auch von uns selbst und von unserem Platz in dieser Welt. Den einen gilt sie obendrein als Überwinderin religiösen Aberglaubens, den anderen als neuer Zugang zu Gott und seinem Wirken in der Welt. Ferner sehen die einen in der Evolution eine unbezweifelbare Tatsache gleich der Schwerkraft oder dem Holocaust, die anderen aber eine - noch oder dauerhaft - unbewiesene Hypothese oder gar eine falsche Schöpfungslehre. Und während die meisten Streitfragen solcher Art nach wechselseitig akzeptierten Regeln ‚normaler Wissenschaft‘ geklärt werden, wird bei der Frage nach dem Woher unserer Spezies und Kultur die intellektuelle Zuständigkeit von Wissenschaft mitunter überhaupt bezweifelt. Anscheinend geht es schon um recht tiefe Schichten unserer Kultur und nicht nur der wissenschaftlichen, wenn - wie seit 150 Jahren - um die Evolutionstheorie gestritten wird. Wie sehen diese Schichten aus?

The resolution sensitivity of the Asian summer monsoon and its inter-model comparison between MRI-AGCM and MetUM

NASA Astrophysics Data System (ADS)

Ogata, Tomomichi; Johnson, Stephanie J.; Schiemann, Reinhard; Demory, Marie-Estelle; Mizuta, Ryo; Yoshida, Kohei; Osamu Arakawa

2017-11-01

In this study, we compare the resolution sensitivity of the Asian Summer Monsoon (ASM) in two Atmospheric General Circulation Models (AGCMs): the MRI-AGCM and the MetUM. We analyze the MetUM at three different resolutions, N96 (approximately 200-km mesh on the equator), N216 (90-km mesh) and N512 (40-km mesh), and the MRI-AGCM at TL95 (approximately 180-km mesh on the equator), TL319 (60-km mesh), and TL959 (20-km mesh). The MRI-AGCM and the MetUM both show decreasing precipitation over the western Pacific with increasing resolution, but their precipitation responses differ over the Indian Ocean. In MRI-AGCM, a large precipitation increase appears off the equator (5-20°N). In MetUM, this off-equatorial precipitation increase is less significant and precipitation decreases over the equator. Moisture budget analysis demonstrates that a changing in moisture flux convergence at higher resolution is related to the precipitation response. Orographic effects, intra-seasonal variability and the representation of the meridional thermal gradient are explored as possible causes of the resolution sensitivity. Both high-resolution AGCMs (TL959 and N512) can represent steep topography, which anchors the rainfall pattern over south Asia and the Maritime Continent. In MRI-AGCM, representation of low pressure systems in TL959 also contributes to the rainfall pattern. Furthermore, the seasonal evolution of the meridional thermal gradient appears to be more accurate at higher resolution, particularly in the MRI-AGCM. These findings emphasize that the impact of resolution is only robust across the two AGCMs for some features of the ASM, and highlights the importance of multi-model studies of GCM resolution sensitivity.

CrpP Is a Novel Ciprofloxacin-Modifying Enzyme Encoded by the Pseudomonas aeruginosa pUM505 Plasmid.

PubMed

Chávez-Jacobo, Víctor M; Hernández-Ramírez, Karen C; Romo-Rodríguez, Pamela; Pérez-Gallardo, Rocío Viridiana; Campos-García, Jesús; Gutiérrez-Corona, J Félix; García-Merinos, Juan Pablo; Meza-Carmen, Víctor; Silva-Sánchez, Jesús; Ramírez-Díaz, Martha I

2018-06-01

The pUM505 plasmid, isolated from a clinical Pseudomonas aeruginosa isolate, confers resistance to ciprofloxacin (CIP) when transferred into the standard P. aeruginosa strain PAO1. CIP is an antibiotic of the quinolone family that is used to treat P. aeruginosa infections. In silico analysis, performed to identify CIP resistance genes, revealed that the 65-amino-acid product encoded by the orf131 gene in pUM505 displays 40% amino acid identity to the Mycobacterium smegmatis aminoglycoside phosphotransferase (an enzyme that phosphorylates and inactivates aminoglycoside antibiotics). We cloned orf131 (renamed crpP , for c iprofloxacin r esistance p rotein, p lasmid encoded) into the pUCP20 shuttle vector. The resulting recombinant plasmid, pUC- crpP , conferred resistance to CIP on Escherichia coli strain J53-3, suggesting that this gene encodes a protein involved in CIP resistance. Using coupled enzymatic analysis, we determined that the activity of CrpP on CIP is ATP dependent, while little activity against norfloxacin was detected, suggesting that CIP may undergo phosphorylation. Using a recombinant His-tagged CrpP protein and liquid chromatography-tandem mass spectrometry, we also showed that CIP was phosphorylated prior to its degradation. Thus, our findings demonstrate that CrpP, encoded on the pUM505 plasmid, represents a new mechanism of CIP resistance in P. aeruginosa , which involves phosphorylation of the antibiotic. Copyright © 2018 American Society for Microbiology.

An ant colony optimization based algorithm for identifying gene regulatory elements.

PubMed

Liu, Wei; Chen, Hanwu; Chen, Ling

2013-08-01

It is one of the most important tasks in bioinformatics to identify the regulatory elements in gene sequences. Most of the existing algorithms for identifying regulatory elements are inclined to converge into a local optimum, and have high time complexity. Ant Colony Optimization (ACO) is a meta-heuristic method based on swarm intelligence and is derived from a model inspired by the collective foraging behavior of real ants. Taking advantage of the ACO in traits such as self-organization and robustness, this paper designs and implements an ACO based algorithm named ACRI (ant-colony-regulatory-identification) for identifying all possible binding sites of transcription factor from the upstream of co-expressed genes. To accelerate the ants' searching process, a strategy of local optimization is presented to adjust the ants' start positions on the searched sequences. By exploiting the powerful optimization ability of ACO, the algorithm ACRI can not only improve precision of the results, but also achieve a very high speed. Experimental results on real world datasets show that ACRI can outperform other traditional algorithms in the respects of speed and quality of solutions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Improving the Interpretability of Classification Rules Discovered by an Ant Colony Algorithm: Extended Results.

PubMed

Otero, Fernando E B; Freitas, Alex A

2016-01-01

Most ant colony optimization (ACO) algorithms for inducing classification rules use a ACO-based procedure to create a rule in a one-at-a-time fashion. An improved search strategy has been proposed in the cAnt-Miner[Formula: see text] algorithm, where an ACO-based procedure is used to create a complete list of rules (ordered rules), i.e., the ACO search is guided by the quality of a list of rules instead of an individual rule. In this paper we propose an extension of the cAnt-Miner[Formula: see text] algorithm to discover a set of rules (unordered rules). The main motivations for this work are to improve the interpretation of individual rules by discovering a set of rules and to evaluate the impact on the predictive accuracy of the algorithm. We also propose a new measure to evaluate the interpretability of the discovered rules to mitigate the fact that the commonly used model size measure ignores how the rules are used to make a class prediction. Comparisons with state-of-the-art rule induction algorithms, support vector machines, and the cAnt-Miner[Formula: see text] producing ordered rules are also presented.

Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room.

PubMed

Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

2014-10-28

direcionada como complemento diagnóstico ao exame físico em um serviço terciário de emergências clínicas. Métodos: Foram incluídos cem pacientes adultos sem doenças cardíacas ou pulmonares conhecidas que procuraram atendimento de urgência com queixas cardiológicas. Foram excluídos pacientes com alterações isquêmicas no eletrocardiograma ou febre. A ecocardiografia direcionada foi realizada logo após a avaliação inicial do paciente na sala de emergência, com aparelho ultraportátil GE Vscan, avaliando subjetivamente: dimensões das cavidades, função sistólica ventricular, fluxos intracardíacos pelo mapeamento de fluxo em cores, pericárdio e aorta. Resultados: A idade média dos pacientes foi 61 ± 17 anos. O quadro clínico inicial foi dor torácica (52 pacientes), dispneia (32 pacientes), arritmia/avaliação da função ventricular (dez pacientes), hipotensão/tontura (cinco pacientes) e edema periférico (um paciente). Em 28 pacientes a ecocardiografia direcionada confirmou a hipótese diagnóstica inicial: 19 pacientes com insuficiência cardíaca, cinco com síndrome coronariana aguda, dois com tromboembolismo pulmonar e dois com tamponamento cardíaco. Em 17 pacientes, a ecocardiografia direcionada alterou o diagnóstico, afastando a hipótese clínica inicial em dez casos com suspeita de insuficiência cardíaca, dois com suspeita de tromboembolismo pulmonar, dois com hipotensão a esclarecer, e em cada um dos três restantes com suspeitas de síndrome coronariana aguda, tamponamento cardíaco e dissecção de aorta. Conclusão: A ecocardiografia direcionada ultraportátil em serviço de emergências clínicas pode definir rapidamente o diagnóstico e, com isso, é possível iniciar mais precocemente o tratamento adequado.

Chronic Obstructive Pulmonary Disease and Heart Failure Self-Management Kits for Outpatient Transitions of Care.

PubMed

Boylan, Paul; Joseph, Tina; Hale, Genevieve; Moreau, Cynthia; Seamon, Matthew; Jones, Renee

2018-03-01

To develop heart failure (HF) and chronic obstructive pulmonary disease (COPD) self-management kits in an accountable care organization (ACO) to facilitate patients' self-care and prevent hospital readmissions. Pharmacists practice in an outpatient-based ACO. They participate in interprofessional office visits with providers and independently manage maintenance pharmacotherapies. Pharmacists collaborate with an interprofessional team within the ACO including physicians, nurses, case managers, and paramedics. Two commonly encountered diseases are chronic COPD and HF. Reducing preventable readmissions for these conditions are important quality benchmarks and cost-saving strategies. Pharmacists were responsible for developing HF and COPD self-management kits containing patient education materials and prescriptions to facilitate self-care. Prior to kit development, pharmacists performed a literature review to determine the presence of previously published findings on these topics. The interprofessional team continually evaluates the successes and limitations of this initiative. Pharmacists developed training and instructions for ACO allied health professionals in an effort to incorporate the self-management kits in clinical practice. The initial literature search revealed no studies describing the intervention of interest. Innovative programs designed to help reduce preventable readmissions are lacking in primary care. Implementation of the self-management kits was accepted by interprofessional ACO leadership and is currently being integrated into allied health workflow. Patients at risk for having an exacerbation of COPD or HF should receive self-management strategies. Prompt therapy prior to exacerbations reduces hospital admissions and readmissions, speeds recovery, and slows disease progression. Pharmacist-facilitated implementation of self-management kits may be developed by interprofessional health care teams.

Meta-heuristic ant colony optimization technique to forecast the amount of summer monsoon rainfall: skill comparison with Markov chain model

NASA Astrophysics Data System (ADS)

Chaudhuri, Sutapa; Goswami, Sayantika; Das, Debanjana; Middey, Anirban

2014-05-01

Forecasting summer monsoon rainfall with precision becomes crucial for the farmers to plan for harvesting in a country like India where the national economy is mostly based on regional agriculture. The forecast of monsoon rainfall based on artificial neural network is a well-researched problem. In the present study, the meta-heuristic ant colony optimization (ACO) technique is implemented to forecast the amount of summer monsoon rainfall for the next day over Kolkata (22.6°N, 88.4°E), India. The ACO technique belongs to swarm intelligence and simulates the decision-making processes of ant colony similar to other adaptive learning techniques. ACO technique takes inspiration from the foraging behaviour of some ant species. The ants deposit pheromone on the ground in order to mark a favourable path that should be followed by other members of the colony. A range of rainfall amount replicating the pheromone concentration is evaluated during the summer monsoon season. The maximum amount of rainfall during summer monsoon season (June—September) is observed to be within the range of 7.5-35 mm during the period from 1998 to 2007, which is in the range 4 category set by the India Meteorological Department (IMD). The result reveals that the accuracy in forecasting the amount of rainfall for the next day during the summer monsoon season using ACO technique is 95 % where as the forecast accuracy is 83 % with Markov chain model (MCM). The forecast through ACO and MCM are compared with other existing models and validated with IMD observations from 2008 to 2012.

Ant colony optimisation-direct cover: a hybrid ant colony direct cover technique for multi-level synthesis of multiple-valued logic functions

NASA Astrophysics Data System (ADS)

Abd-El-Barr, Mostafa

2010-12-01

The use of non-binary (multiple-valued) logic in the synthesis of digital systems can lead to savings in chip area. Advances in very large scale integration (VLSI) technology have enabled the successful implementation of multiple-valued logic (MVL) circuits. A number of heuristic algorithms for the synthesis of (near) minimal sum-of products (two-level) realisation of MVL functions have been reported in the literature. The direct cover (DC) technique is one such algorithm. The ant colony optimisation (ACO) algorithm is a meta-heuristic that uses constructive greediness to explore a large solution space in finding (near) optimal solutions. The ACO algorithm mimics the ant's behaviour in the real world in using the shortest path to reach food sources. We have previously introduced an ACO-based heuristic for the synthesis of two-level MVL functions. In this article, we introduce the ACO-DC hybrid technique for the synthesis of multi-level MVL functions. The basic idea is to use an ant to decompose a given MVL function into a number of levels and then synthesise each sub-function using a DC-based technique. The results obtained using the proposed approach are compared to those obtained using existing techniques reported in the literature. A benchmark set consisting of 50,000 randomly generated 2-variable 4-valued functions is used in the comparison. The results obtained using the proposed ACO-DC technique are shown to produce efficient realisation in terms of the average number of gates (as a measure of chip area) needed for the synthesis of a given MVL function.

Presence of sarcopenia in asthma-COPD overlap syndrome may be a risk factor for decreased bone-mineral density, unlike asthma: Korean National Health and Nutrition Examination Survey (KNHANES) IV and V (2008-2011).

PubMed

Lee, Dong-Won; Jin, Hyun-Jung; Shin, Kyeong-Cheol; Chung, Jin-Hong; Lee, Hyoung-Woo; Lee, Kwan-Ho

2017-01-01

Sarcopenia and decreased bone-mineral density (BMD) are common in elderly people, and are major comorbidities of obstructive airway disease (OAD). However, the relationship between sarcopenia and BMD in each OAD phenotype, especially asthma-COPD overlap syndrome (ACOS), is not yet clear. We aimed to evaluate differences in BMD according to the presence of sarcopenia in each OAD phenotype. Among the research subjects in KNHANES IV and V (2008-2011), 5,562 were ≥50 years old and underwent qualified spirometry and dual-energy X-ray absorptiometry. A total of 947 subjects were included in the study: 89 had asthma, 748 COPD, and 110 ACOS. In the COPD and ACOS phenotypes, T-scores were lower in the sarcopenia group than the nonsarcopenia group. Prevalence rates of osteopenia and osteoporosis were higher in the sarcopenia group than the nonsarcopenia group. ( P <0.001 and P =0.017, respectively). The sarcopenia group had higher risks of developing osteopenia, osteoporosis, and low BMD than the nonsarcopenia group in the ACOS phenotype (OR 6.620, 95% CI 1.129-38.828 [ P =0.036], OR 9.611, 95% CI 1.133-81.544 [ P =0.038], and OR 6.935, 95% CI 1.194-40.272 [ P =0.031], respectively). However, in the asthma phenotype, the sarcopenia group showed no increased risk compared with the nonsarcopenia group. In the ACOS phenotype, individuals with sarcopenia had a higher prevalence rate and higher risks of osteopenia and osteoporosis than those without sarcopenia among all OAD phenotypes.

Labile dissolved organic carbon supply limits hyporheic denitrification

NASA Astrophysics Data System (ADS)

Zarnetske, Jay P.; Haggerty, Roy; Wondzell, Steven M.; Baker, Michelle A.

2011-12-01

We used an in situ steady state 15N-labeled nitrate (15NO3-) and acetate (AcO-) well-to-wells injection experiment to determine how the availability of labile dissolved organic carbon (DOC) as AcO-influences microbial denitrification in the hyporheic zone of an upland (third-order) agricultural stream. The experimental wells receiving conservative (Cl- and Br) and reactive (15NO3-) solute tracers had hyporheic median residence times of 7.0 to 13.1 h, nominal flowpath lengths of 0.7 to 3.7 m, and hypoxic conditions (<1.5 mg O2 L-1). All receiving wells demonstrated 15N2 production during ambient conditions, indicating that the hyporheic zone was an environment with active denitrification. The subsequent addition of AcO- stimulated more denitrification as evidenced by significant δ15N2 increases by factors of 2.7 to 26.1 in receiving wells and significant decreases of NO3- and DO in the two wells most hydrologically connected to the injection. The rate of nitrate removal in the hyporheic zone increased from 218 kg ha-1 yr-1 to 521 kg ha-1 yr-1 under elevated AcO- conditions. In all receiving wells, increases of bromide and 15N2 occurred without concurrent increases in AcO-, indicating that 100% of AcO- was retained or lost in the hyporheic zone. These results support the hypothesis that denitrification in anaerobic portions of the hyporheic zone is limited by labile DOC supply.

Holistic Contract Administration in Army Forces Abroad

DTIC Science & Technology

2016-10-01

Defense (DoD) civil- ian personnel—i.e., 1910 Quality Assurance Specialist, 1102 Contract Specialist, and 1103 Industrial Property Management Specialist... 1103 -series civilian property ad- ministrators throughout ACC, the battalion experienced diffi- culties hiring for these positions during its deployment...tasks. Counting on 1103 support, ACOs received minimal property training prior to deploy- ment. This proved to be a major setback as ACOs struggled

Asthma Is a Risk Factor for Respiratory Exacerbations Without Increased Rate of Lung Function Decline: Five-Year Follow-up in Adult Smokers From the COPDGene Study.

PubMed

Hayden, Lystra P; Hardin, Megan E; Qiu, Weiliang; Lynch, David A; Strand, Matthew J; van Beek, Edwin J; Crapo, James D; Silverman, Edwin K; Hersh, Craig P

2018-02-01

Previous investigations in adult smokers from the COPDGene Study have shown that early-life respiratory disease is associated with reduced lung function, COPD, and airway thickening. Using 5-year follow-up data, we assessed disease progression in subjects who had experienced early-life respiratory disease. We hypothesized that there are alternative pathways to reaching reduced FEV 1 and that subjects who had childhood pneumonia, childhood asthma, or asthma-COPD overlap (ACO) would have less lung function decline than subjects without these conditions. Subjects returning for 5-year follow-up were assessed. Childhood pneumonia was defined by self-reported pneumonia at < 16 years. Childhood asthma was defined as self-reported asthma diagnosed by a health professional at < 16 years. ACO was defined as subjects with COPD who self-reported asthma diagnosed by a health-professional at ≤ 40 years. Smokers with and those without these early-life respiratory diseases were compared on measures of disease progression. Follow-up data from 4,915 subjects were examined, including 407 subjects who had childhood pneumonia, 323 subjects who had childhood asthma, and 242 subjects with ACO. History of childhood asthma or ACO was associated with an increased exacerbation frequency (childhood asthma, P < .001; ACO, P = .006) and odds of severe exacerbations (childhood asthma, OR, 1.41; ACO, OR, 1.42). History of childhood pneumonia was associated with increased exacerbations in subjects with COPD (absolute difference [β], 0.17; P = .04). None of these early-life respiratory diseases were associated with an increased rate of lung function decline or progression on CT scans. Subjects who had early-life asthma are at increased risk of developing COPD and of having more active disease with more frequent and severe respiratory exacerbations without an increased rate of lung function decline over a 5-year period. ClinicalTrials.gov; No. NCT00608764; https

Differences in the effects of Asian dust on pulmonary function between adult patients with asthma and those with asthma–chronic obstructive pulmonary disease overlap syndrome

PubMed Central

Watanabe, Masanari; Noma, Hisashi; Kurai, Jun; Sano, Hiroyuki; Ueda, Yasuto; Mikami, Masaaki; Yamamoto, Hiroyuki; Tokuyasu, Hirokazu; Kato, Kazuhiro; Konishi, Tatsuya; Tatsukawa, Toshiyuki; Shimizu, Eiji; Kitano, Hiroya

2016-01-01

Background Asian dust (AD) exposure exacerbates pulmonary dysfunction in patients with asthma. Asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS), characterized by coexisting symptoms of asthma and chronic obstructive pulmonary disease, is considered a separate disease entity. Previously, we investigated the effects of AD on pulmonary function in adult patients with asthma. Here, we present the findings of our further research on the differences in the effects of AD exposure on pulmonary function between patients with asthma alone and those with ACOS. Methods Between March and May 2012, we conducted a panel study wherein we monitored daily peak expiratory flow (PEF) values in 231 adult patients with asthma. These patients were divided into 190 patients with asthma alone and 41 patients with ACOS in this study. Daily AD particle levels were measured using light detection and ranging systems. Two heavy AD days (April 23 and 24) were determined according to the Japan Meteorological Agency definition. A linear mixed model was used to estimate the association between PEF and AD exposure. Results Increments in the interquartile range of AD particles (0.018 km−1) led to PEF changes of −0.50 L/min (95% confidence interval, −0.98 to −0.02) in patients with asthma alone and −0.11 L/min (−0.11 to 0.85) in patients with ACOS. The PEF changes after exposure to heavy AD were −2.21 L/min (−4.28 to −0.15) in patients with asthma alone and −2.76 L/min (−6.86 to 1.35) in patients with ACOS. In patients with asthma alone, the highest decrease in PEF values was observed on the heavy AD day, with a subsequent gradual increase over time. Conclusion Our results suggest that the effects of AD exposure on pulmonary function differ between patients with asthma alone and ACOS, with the former exhibiting a greater likelihood of decreased pulmonary function after AD exposure. PMID:26869784

Integration Strategies of Pharmacists in Primary Care-Based Accountable Care Organizations: A Report from the Accountable Care Organization Research Network, Services, and Education.

PubMed

Joseph, Tina; Hale, Genevieve M; Eltaki, Sara M; Prados, Yesenia; Jones, Renee; Seamon, Matthew J; Moreau, Cynthia; Gernant, Stephanie A

2017-05-01

The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal. As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care. Pharmacist-provided care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional care settings, their role has often been overlooked in the primary care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice faculty dedicated to using innovative approaches to patient care, while providing unique learning experiences for pharmacy students by partnering with ACOs in the South Florida region. Five opportunities are presented for pharmacists to improve medication use specifically in primary care-based ACOs: medication therapy management, annual wellness visits, chronic disease state management, chronic care management, and transitions of care. Several challenges and barriers that prevent the full integration of pharmacists into primary care-based ACOs include lack of awareness of pharmacist roles in primary care; complex laws and regulations surrounding clinical protocols, such as collaborative practice agreements; provider status that allows compensation for pharmacist services; and limited access to medical records. By understanding and maximizing the role of pharmacists, several opportunities exist to better manage the medication-use process in value-based care settings. As more organizations realize

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries.

PubMed

Colla, Carrie H; Lewis, Valerie A; Kao, Lee-Sien; O'Malley, A James; Chang, Chiang-Hua; Fisher, Elliott S

2016-08-01

Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. Total spending decreased by $34 (95% CI, -$52 to -$15) per

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

PubMed Central

Colla, Carrie H.; Lewis, Valerie A.; Kao, Lee-Sien; O’Malley, A. James; Chang, Chiang-Hua; Fisher, Elliott S.

2016-01-01

IMPORTANCE Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. OBJECTIVE To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. EXPOSURES Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. MAIN OUTCOMES AND MEASURES Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive

Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

PubMed

McLellan, Robert K; Sherman, Bruce; Loeppke, Ronald R; McKenzie, Judith; Mueller, Kathryn L; Yarborough, Charles M; Grundy, Paul; Allen, Harris; Larson, Paul W

2012-04-01

In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering

Um enfoque antropológico para o ensino de astronomia no nível médio

NASA Astrophysics Data System (ADS)

Costa, G. B.; Jafelice, L. C.

2003-08-01

Há uma enorme carência de materiais didático-pedagógicos em astronomia para professores do ensino médio, sobretudo materiais que explorem também aspectos humanísticos. A origem do Universo é um bom exemplo desta constatação central. Embora tal origem teve explicações culturais diversas, os professores não têm informações sobre isso e muito menos material que trabalhe diferentes visões de mundo e treinamento que os capacite a abordá-las devidamente. Conseqüentemente o ensino de astronomia costuma ser tecnicista e dissociado do aspecto humano que alimenta o grande interesse e curiosidade que esses temas despertam. Aqui apresentamos propostas visando contribuir para reverter esse quadro e trabalhamos distintas visões de Universo: espontâneas, autóctones e científicas. Desenvolvemos práticas, materiais instrucionais e textos para viabilizar a adoção de um enfoque antropológico para o ensino de astronomia no nível médio, no qual as culturas humanística e científica sejam integradas de uma maneira contextualizada e eficaz para aquele ensino. Estas propostas foram aplicadas em um curso de treinamento para professores da rede pública de diferentes disciplinas. A receptividade dos professores à abordagem proposta e os resultados alcançados foram muito estimulantes. Destes, destacamos: produção de roteiros de atividades; desenvolvimento de práticas didático-pedagógicas específicas (e.g., encenação de mitos; dança primordial guarani; "criação" de constelações e interpretações pluriculturais; etc.); e sugestões concretas para a efetiva realização de um ensino interdisciplinar contextualizado, onde questões cosmogônicas servem de mote para iniciar tal ensino. Discutimos estes resultados e como o enfoque adotado pode instrumentalizar os professores para leituras de mundo que incluem naturalmente aspectos culturais, sociais e históricos associados aos temas estudados. (PPGECNM/UFRN; PRONEX/FINEP; NUPA/USP; Temáticos/FAPESP)

The U. S. Geological Survey, Digital Spectral Library: Version 1 (0.2 to 3.0um)

USGS Publications Warehouse

Clark, Roger N.; Swayze, Gregg A.; Gallagher, Andrea J.; King, Trude V.V.; Calvin, Wendy M.

1993-01-01

We have developed a digital reflectance spectral library, with management and spectral analysis software. The library includes 498 spectra of 444 samples (some samples include a series of grain sizes) measured from approximately 0.2 to 3.0 um . The spectral resolution (Full Width Half Maximum) of the reflectance data is <= 4 nm in the visible (0.2-0.8 um) and <= 10 nm in the NIR (0.8-2.35 um). All spectra were corrected to absolute reflectance using an NIST Halon standard. Library management software lets users search on parameters (e.g. chemical formulae, chemical analyses, purity of samples, mineral groups, etc.) as well as spectral features. Minerals from borate, carbonate, chloride, element, halide, hydroxide, nitrate, oxide, phosphate, sulfate, sulfide, sulfosalt, and the silicate (cyclosilicate, inosilicate, nesosilicate, phyllosilicate, sorosilicate, and tectosilicate) classes are represented. X-Ray and chemical analyses are tabulated for many of the entries, and all samples have been evaluated for spectral purity. The library also contains end and intermediate members for the olivine, garnet, scapolite, montmorillonite, muscovite, jarosite, and alunite solid-solution series. We have included representative spectra of H2O ice, kerogen, ammonium-bearing minerals, rare-earth oxides, desert varnish coatings, kaolinite crystallinity series, kaolinite-smectite series, zeolite series, and an extensive evaporite series. Because of the importance of vegetation to climate-change studies we have include 17 spectra of tree leaves, bushes, and grasses. The library and software are available as a series of U.S.G.S. Open File reports. PC user software is available to convert the binary data to ascii files (a separate U.S.G.S. open file report). Additionally, a binary data files are on line at the U.S.G.S. in Denver for anonymous ftp to users on the Internet. The library search software enables a user to search on documentation parameters as well as spectral features. The

Weathering resistance of thin plasma polymer films on pre-coated steel =

NASA Astrophysics Data System (ADS)

Serra, Ricardo Gil Henriques

O trabalho apresentado teve origem no projecto de investigacao “Tailored Thin Plasma Polymers Films for Surface Engineering of Coil Coated Steel”, financiado pelo Programa Europeu ECSC Steel Research. Sistemas de aco galvanizado pre-pintado em banda a base de poliester e poliuretano foram submetidos a um processo de polimerizacao por plasma onde um filme fino foi depositado de modo a modificar as propriedades de superficie. Foram usados reactores de catodo oco, microondas e radio frequencia para a deposicao do polimero fino. Os sistemas preparados foram analisados de modo a verificar a influencia do processo de polimerizacao por plasma na alteracao das propriedades barreira dos sistemas pre-pintados em banda. Foi estudado o efeito dos diferentes passos do processo de polimerizacao por plasma, bem como o efeito de diferentes variaveis operatorias. A mistura precursora foi variada de modo a modificar as propriedades da superficie de modo a poder vir a obter maior hidrofobicidade, maior resistencia a marcas digitais, bem como maior facilidade de limpeza. Os testes foram conduzidos em solucao de NaCl 0,5 M. Para o trabalho foram usadas tecnicas de analise da morfologia da superficie como Microscopia de Forca Atomica e Microscopia Electronica de Varrimento. As propriedades electroquimicas dos sistemas foram estudadas por Espectroscopia de Impedancia Electroquimica. A estrutura dos filmes gerados no processo de polimerizacao por plasma foi caracterizada por Microscopia de Transmissao Electronica. A modificacao das propriedades opticas devido ao processo de polimerizacao por plasma foi tambem obtida.

VizieR Online Data Catalog: MIPS 24um nebulae (Gvaramadze+, 2010)

NASA Astrophysics Data System (ADS)

Gvaramadze, V. V.; Kniazev, A. Y.; Fabrika, S.

2011-03-01

Massive evolved stars lose a large fraction of their mass via copious stellar wind or instant outbursts. During certain evolutionary phases, they can be identified by the presence of their circumstellar nebulae. In this paper, we present the results of a search for compact nebulae (reminiscent of circumstellar nebulae around evolved massive stars) using archival 24um data obtained with the Multiband Imaging Photometer for Spitzer. We have discovered 115 nebulae, most of which bear a striking resemblance to the circumstellar nebulae associated with luminous blue variables (LBVs) and late WN-type (WNL) Wolf-Rayet (WR) stars in the Milky Way and the Large Magellanic Cloud (LMC). (1 data file).

"Um, I Can Tell You're Lying": Linguistic Markers of Deception versus Truth-Telling in Speech

ERIC Educational Resources Information Center

Arciuli, Joanne; Mallard, David; Villar, Gina

2010-01-01

Lying is a deliberate attempt to transmit messages that mislead others. Analysis of language behaviors holds great promise as an objective method of detecting deception. The current study reports on the frequency of use and acoustic nature of "um" and "like" during laboratory-elicited lying versus truth-telling. Results obtained using a…

Gender and asthma-chronic obstructive pulmonary disease overlap syndrome.

PubMed

Wheaton, Anne G; Pleasants, Roy A; Croft, Janet B; Ohar, Jill A; Heidari, Khosrow; Mannino, David M; Liu, Yong; Strange, Charlie

2016-09-01

To assess relationships between obstructive lung diseases, respiratory symptoms, and comorbidities by gender. Data from 12 594 adult respondents to the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were used. Five categories of chronic obstructive airway disease (OAD) were defined: former asthma only, current asthma only, chronic obstructive pulmonary disease (COPD) only, asthma-COPD overlap syndrome (ACOS), and none. Associations of these categories with respiratory symptoms (frequent productive cough, shortness of breath, and impaired physical activities due to breathing problems), overall health, and comorbidities were assessed using multivariable logistic regression for men and women. Overall, 16.2% of men and 18.7% of women reported a physician diagnosis of COPD and/or asthma. Former asthma only was higher among men than women (4.9% vs. 3.2%, t-test p = 0.008). Current asthma only was more prevalent among women than men (7.2% vs. 4.7%, p < 0.001), as was ACOS (4.0% vs. 2.2%, p < 0.001). Having COPD only did not differ between women (4.3%) and men (4.4%). Adults with ACOS were most likely to report the 3 respiratory symptoms. COPD only and ACOS were associated with higher likelihoods of poor health and most comorbidities for men and women. Current asthma only was also associated with these outcomes among women, but not among men. In this large population-based sample, women were more likely than men to report ACOS and current asthma, but not COPD alone. Gender differences were evident between the OAD groups in sociodemographic characteristics, respiratory symptoms, and comorbidities, as well as overall health.

Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes.

PubMed

Kaewpoowat, Quanhathai; Salazar, Lucrecia; Aguilera, Elizabeth; Wootton, Susan H; Hasbun, Rodrigo

2016-06-01

To describe the clinical manifestations, cerebrospinal fluid (CSF) characteristics, imaging studies and prognostic factors of adverse clinical outcomes (ACO) among adults with herpes simplex virus (HSV) or varicella zoster virus (VZV) CNS infections. Retrospective review of adult patients with positive HSV or VZV polymerase chain reaction on CSF from an observational study of meningitis or encephalitis in Houston, TX (2004-2014), and New Orleans, LA (1999-2008). Ninety-eight adults patients were identified; 25 had encephalitis [20 (20.4 %) HSV, 5 (5.1 %) VZV], and 73 had meningitis [60 (61.1 %) HSV and 13 (13.3 %) VZV]. HSV and VZV had similar presentations except for nausea (P < 0.01) and rash (P < 0.001). The CSF profile did not differ between HSV and VZV infection. Abnormal neuroimaging findings were found in 11.6 % (10/86) brain CTs and 21.3 % (16/75) brain MRIs. The EEG was abnormal in 57.9 % (11/19). Sixteen patients (16.3 %) had an ACO (10 HSV encephalitis, 3 VZV encephalitis and 3 VZV meningitis). Intravenous acyclovir administered within 48 h was protective against an ACO [OR 0.19 (0.04-0.80), P = 0.02). However, on logistic regression only Charlson comorbidity score >1 and an encephalitis presentation were independently associated with an ACO. The treatment for HSV meningitis was variable, and all patients had a good clinical outcome. Alpha herpes CNS infections due to HSV and VZV infections have similar clinical and laboratory manifestations. ACO was observed more frequently in those patients with comorbidities and an encephalitis presentation.

Changing Paradigms in the Endovascular Management of Ruptured Anterior Communicating Artery Aneurysms.

PubMed

Moon, Karam; Park, Min S; Albuquerque, Felipe C; Levitt, Michael R; Mulholland, Celene B; McDougall, Cameron G

2017-10-01

Approximately 17% of ruptured anterior communicating artery (ACoA) aneurysms were deemed unsuitable for coil embolization during the Barrow Ruptured Aneurysm Trial (BRAT), most commonly due to unfavorable dome-to-neck ratio or small size. To compare patients treated by coil embolization for ruptured ACoA aneurysms during the trial to those treated after the trial to determine whether advances in endovascular techniques have allowed for effective treatment of these lesions. All cases of ruptured ACoA aneurysms treated by endovascular modalities during BRAT (2003-2007) and post-BRAT (2007-2012) were reviewed for patient and aneurysm characteristics, treatment types, and clinical and angiographic outcomes at 3-yr or last follow-up. The BRAT ACoA cohort included 39 patients treated with coiling (excluding those crossed over to clipping). The post-BRAT cohort included 93 patients who were significantly older (mean age, 59.5 vs 52.8 yr, P = .005) than the BRAT cohort; there were no significant cohort differences in sex, Hunt and Hess grade, or mean aneurysm size. The use of balloon remodeling was significantly higher in the post-BRAT cohort (31.2% [29/93] vs 5.1% [2/39], P = .001), as was the proportion of wide-necked aneurysms treated (66.7% [62/93] vs 30.8% [12/39], P < .001). There was no significant difference in clinical outcome or retreatment rate between the 2 cohorts (P = .90 and P = .48, respectively). ACoA lesions thought unamenable to endovascular therapy in an earlier randomized trial are now successfully coiled with increased use of adjunctive techniques, without sacrificing patient outcome or treatment durability. Copyright © 2016 by the Congress of Neurological Surgeons.

Athena Community Office

NASA Astrophysics Data System (ADS)

Martínez-Núnez, S.; Barcons, X.; Barret, D.; Bozzo, E.; Carrera, F. J.; Ceballos, M. T.; Gómez, S.; Monterde, M. P.; Rau, A.

2017-03-01

The Athena Community Office (ACO) has been established by ESA's Athena Science Study Team (ASST) in order to obtain support in performing its tasks assigned by ESA, and most specially in the ASST role as "focal point for the interests of the broad scientific community". The ACO is led by the Instituto de Física de Cantabria (CSIC-UC), and its activities are funded by CSIC and UC. Further ACO contributors are the University of Geneva, MPE and IRAP. In this poster, we present ACO to the Spanish Astronomical Community, informing about its main responsibilities, which are: assist the ASST in organising and collecting support from the Athena Working Groups and Topical Panels; organise and maintain the documentation generated by the Athena Working Groups and Topical Panels; manage the Working Group and Topical Panel membership lists; assist the ASST in promoting Athena science capabilities in the research world, through conferences and workshops; keep a record of all papers and presentations related to Athena; support the production of ASST documents; produce and distribute regularly an Athena Newsletter, informing the community about all mission and science developments; create and maintain the Athena Community web portal; maintain an active communication activity; promote, organise and support Athena science-related public outreach, in coordination with ESA and other agencies involved when appropriate; and, design, produce materials and provide pointers to available materials produced by other parties. In summary, ACO is meant to become a focal point to facilitate the scientific exchange between the Athena activities and the scientific community at large, and to disseminate the Athena science objectives to the general public.

Sex differences in aneurysm morphologies and clinical outcomes in ruptured anterior communicating artery aneurysms: a retrospective study

PubMed Central

Lin, Boli; Chen, Weijian; Ruan, Lei; Chen, Yongchun; Zhong, Ming; Zhuge, Qichuan; Fan, Liang Hao; Zhao, Bing; Yang, Yunjun

2016-01-01

Objectives Ruptured anterior communicating artery (ACoA) aneurysms occur more frequently in men. The purpose of the study was to investigate sex difference in aneurysm morphologies and clinical outcomes in patients with ruptured ACoA aneurysms. Setting A tertiary referral hospital. Participants A total of 574 consecutive patients with ACoA aneurysms were admitted to our hospital from December 2007 to February 2015. In all, 474 patients (257 men and 217 women) with ruptured ACoA aneurysms were included in the study. Main outcome measures Aneurysm morphologies were measured using computed tomographic angiography and clinical outcomes were measured with Glasgow coma score at discharge. Results The aneurysm sizes (p=0.001), aneurysm heights (p=0.011), size ratios (p<0.001), flow angles (p=0.047) and vessel angles (p=0.046) were larger in the male patients than in the females. The female patients more often had larger vessel sizes (p=0.002). Multivariate logistic analysis revealed that significant differences in aneurysm morphologies between men and women were aneurysm size (OR 1.1, 95% CI 1.0 to 1.3; p=0.036), aneurysm height (OR 0.8, 95% CI 0. to 0.9; p=0.006) and size ratio (OR 1.4, 95% CI 0.5 to 1.7; p=0.001). There were no statistically significant differences in the outcomes between men and women (OR 1.0, 95% CI 0.6 to 1.7, p=0.857). Conclusions The men were independently associated with larger aneurysm sizes, greater aneurysm heights and larger size ratios. Sex was not a risk factor for poor outcome in patients with ruptured ACoA aneurysms. PMID:27084272

Routing and spectrum assignment based on ant colony optimization of minimum consecutiveness loss in elastic optical networks

NASA Astrophysics Data System (ADS)

Wang, Fu; Liu, Bo; Zhang, Lijia; Xin, Xiangjun; Tian, Qinghua; Zhang, Qi; Rao, Lan; Tian, Feng; Luo, Biao; Liu, Yingjun; Tang, Bao

2016-10-01

Elastic Optical Networks are considered to be a promising technology for future high-speed network. In this paper, we propose a RSA algorithm based on the ant colony optimization of minimum consecutiveness loss (ACO-MCL). Based on the effect of the spectrum consecutiveness loss on the pheromone in the ant colony optimization, the path and spectrum of the minimal impact on the network are selected for the service request. When an ant arrives at the destination node from the source node along a path, we assume that this path is selected for the request. We calculate the consecutiveness loss of candidate-neighbor link pairs along this path after the routing and spectrum assignment. Then, the networks update the pheromone according to the value of the consecutiveness loss. We save the path with the smallest value. After multiple iterations of the ant colony optimization, the final selection of the path is assigned for the request. The algorithms are simulated in different networks. The results show that ACO-MCL algorithm performs better in blocking probability and spectrum efficiency than other algorithms. Moreover, the ACO-MCL algorithm can effectively decrease spectrum fragmentation and enhance available spectrum consecutiveness. Compared with other algorithms, the ACO-MCL algorithm can reduce the blocking rate by at least 5.9% in heavy load.

Accountable Care Organizations: roles and opportunities for hospitals.

PubMed

Schoenbaum, Stephen C

2011-08-01

Federal health reform has established Medicare Accountable Care Organizations (ACOs) as a new program, and some states and private payers have been independently developing ACO pilot projects. The objective is to hold provider groups accountable for the quality and cost of care to a population. The financial models for providers generally build off of shared savings between the payers and providers or some type of global payment that includes the possibility of partial or full capitation. For ACOs to achieve the same outcomes with lower costs or, better yet, improved outcomes with the same or lower costs, the delivery system will need to become more oriented toward primary care and care coordination than is currently the case. Providers of clinical services, in order to be more effective, efficient, and coordinated, will need to be supported by a variety of shared services, such as off-hours care, easy access to specialties, and information exchanges. These services can be organized by an ACO as a medical neighborhood or community. Hospitals, because they have a management structure, history of developing programs and services, and accessibility 24/7/365, are logical leaders of this enhancement of health care delivery for populations and other providers.

Geochemistry of hot springs in the Ie Seu’um hydrothermal areas at Aceh Besar district, Indonesia

NASA Astrophysics Data System (ADS)

Idroes, R.; Yusuf, M.; Alatas, M.; Subhan; Lala, A.; Saiful; Suhendra, R.; Idroes, G. M.; Marwan

2018-03-01

Indonesia geothermal resources are the largest in the world, about 40 percent of the total geothermal resources worldwide with a potential energy of 28,617 MW. Geothermal energy is one of the renewable energy in the world that can be developed sustainably. This kind of energy is not only environmentally friendly but also highly prospective compared to fossil energy. One of the potential geothermal energy in Indonesia is Seulawah Agam geothermal field with some manifestation areas. The fluid type of Ie Seu’um manifestation was chloride (Cl-) obtained from the ternary diagram Cl--SO4 2--HCO3 -, using UV-Vis spectrophotometry, argentometry and acidimetry method. The reservoir range temperature was 188,7 ± 9,3°C calculated using geothermometer Na-K-Ca, Na-K Fournier and Na-K Giggenbach by applying Atomic Absorption Spectroscopy method. This data processing was carried out using liquid chemistry plotting spreadsheet version 3 powell geoscience Ltd.3 September 2012 by Powell & Cumming. The potential in the geothermal manifestation of Ie Seu’um was estimated about 50-100 MW (medium enthalpy).

Finite grade pheromone ant colony optimization for image segmentation

NASA Astrophysics Data System (ADS)

Yuanjing, F.; Li, Y.; Liangjun, K.

2008-06-01

By combining the decision process of ant colony optimization (ACO) with the multistage decision process of image segmentation based on active contour model (ACM), an algorithm called finite grade ACO (FACO) for image segmentation is proposed. This algorithm classifies pheromone into finite grades and updating of the pheromone is achieved by changing the grades and the updated quantity of pheromone is independent from the objective function. The algorithm that provides a new approach to obtain precise contour is proved to converge to the global optimal solutions linearly by means of finite Markov chains. The segmentation experiments with ultrasound heart image show the effectiveness of the algorithm. Comparing the results for segmentation of left ventricle images shows that the ACO for image segmentation is more effective than the GA approach and the new pheromone updating strategy appears good time performance in optimization process.

The Role of Social Work Leadership: Mount Sinai Care, the Accountable Care Organization, and Population Health Management.

PubMed

Xenakis, Nancy

2015-10-01

In July 2012, The Mount Sinai Medical Center was selected by the Centers for Medicare and Medicaid to join the first cohort of Accountable Care Organizations (ACOs) in this country under its Medicare Shared Savings Program. A critical component of an ACO is care coordination of patients, which is a complex concept, intertwined with other concepts related to quality, delivery and organization of health care. This article provides an overview of the development, structure and functionality of Mount Sinai Care, the ACO of The Mount Sinai Health System, and how it was the beginning of its work in population health management. It describes the important role of social work leadership in the development and operation of its care coordination model. The model's successes and challenges and recommendations for future development of care coordination and population health management are outlined.

Um estudo espectrofotométrico da variável cataclísmica V3885 Sgr

NASA Astrophysics Data System (ADS)

Ribeiro, F. M. A.; Diaz, M. P.

2003-08-01

Variáveis Cataclísmicas são sistemas binários cerrados compostos de uma anã vermelha que transfere matéria para uma anã branca, em sistemas não magnéticos ocorre a formação de um disco de acresção em torno da anã branca. V3885 Sgr é uma variável cataclísmica classificada como sendo do tipo nova-like. É apresentado um estudo espectrofotométrico de V3885 Sgr de alta resolução temporal feito na região do visível. A região observada é centrada em Ha e abrange também a linha de HeI 6678. O primeiro resultado obtido neste estudo é a determinação do período orbital a partir de medidas da velocidade radial da linha de Ha como sendo 0,20716071(22) dias, resolvendo inconsistências quanto a esse valor na literatura e definindo uma efeméride a longo prazo para o sistema. Com este período e as medidas de velocidade radial do perfil de linha de Ha foi construído um diagrama de massas, através do qual restringimos as massas das componentes estelares do sistema e limitamos a inclinação orbital do sistema. Foram construídos diagramas de Greenstein para as linhas de Ha e HeI, onde os espectros médios em cada intervalo de fase são representados lado a lado em escala de cinza, indicando a existência de uma emissão intensa proveniente da parte posterior do disco. A partir da tomografia Doppler obtivemos perfis de emissividade radial para o disco tanto para a linha de Ha como para HeI. Os resultados obtidos são comparados com os de outros sistemas estudados com a mesma técnica. Serão apresentados também resultados da tomografia de flickering para o sistema.

A short-term operating room surgery scheduling problem integrating multiple nurses roster constraints.

PubMed

Xiang, Wei; Yin, Jiao; Lim, Gino

2015-02-01

Operating room (OR) surgery scheduling determines the individual surgery's operation start time and assigns the required resources to each surgery over a schedule period, considering several constraints related to a complete surgery flow and the multiple resources involved. This task plays a decisive role in providing timely treatments for the patients while balancing hospital resource utilization. The originality of the present study is to integrate the surgery scheduling problem with real-life nurse roster constraints such as their role, specialty, qualification and availability. This article proposes a mathematical model and an ant colony optimization (ACO) approach to efficiently solve such surgery scheduling problems. A modified ACO algorithm with a two-level ant graph model is developed to solve such combinatorial optimization problems because of its computational complexity. The outer ant graph represents surgeries, while the inner graph is a dynamic resource graph. Three types of pheromones, i.e. sequence-related, surgery-related, and resource-related pheromone, fitting for a two-level model are defined. The iteration-best and feasible update strategy and local pheromone update rules are adopted to emphasize the information related to the good solution in makespan, and the balanced utilization of resources as well. The performance of the proposed ACO algorithm is then evaluated using the test cases from (1) the published literature data with complete nurse roster constraints, and 2) the real data collected from a hospital in China. The scheduling results using the proposed ACO approach are compared with the test case from both the literature and the real life hospital scheduling. Comparison results with the literature shows that the proposed ACO approach has (1) an 1.5-h reduction in end time; (2) a reduction in variation of resources' working time, i.e. 25% for ORs, 50% for nurses in shift 1 and 86% for nurses in shift 2; (3) an 0.25h reduction in

Physical properties of asteroids in comet-like orbits in the infrared asteroidal survey catalogs

NASA Astrophysics Data System (ADS)

Kim, Y.; Ishiguro, M.; Usui, F.

2014-07-01

Dormant comet and Infrared Asteroidal Survey Catalogs. Comet nucleus is a solid body consisting of dark refractory material and ice. Cometary volatiles sublimate from subsurface layer by solar heating, leaving behind large dust grains on the surface. Eventually, the appearance could turn into asteroidal rather than cometary. It is, therefore, expected that there would be ''dormant comets'' in the list of known asteroids. Over past decade, several ground-based studies have been performed to dig out such dormant comets. One common approach is applying a combination of optical and dynamical properties learned from active comet nucleus to the list of known asteroids. Typical comet nucleus has (i) Tisserand parameter with respect to Jupiter, T_{J}<3, (ii) low geometric albedo, p_{v}<0.1 and (iii) reddish or neutral spectra, similar to P, D, C-type asteroids. Following past ground-based surveys, infrared space missions gave us an opportunity to work on further study of dormant comets. To the present, three infrared asteroidal catalogs taken with IRAS[1], AKARI[2] and WISE[3] are available, providing information of sizes and albedos which are useful to study the physical properties of dormant comets as well as asteroids. Usui et al. (2014) merged three infrared asteroidal catalogs with valid sizes and albedos into single catalog, what they called I-A-W[4]. We applied a huge dataset of asteroids in I-A-W to investigate the physical properties of asteroids in comet-like orbits (ACOs, whose orbits satisfy Q>4.5 au and T_{J}<3). Here we present a study of ACOs in infrared asteroidal catalogs taken with AKARI, IRAS and WISE. In this presentation, we aim to introduce albedo and size properties of ACOs in infrared asteroidal survey catalogs, in combination with orbital and spectral properties from literature. Results and Implications. We summarize our finding and implication as followings: - are 123 ACOs (Q>4.5 au and T_J<3) in I-A-W catalog after rejection of objects with large

Impact of chronic cough on quality of life.

PubMed

French, C L; Irwin, R S; Curley, F J; Krikorian, C J

Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. To determine whether chronic cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of chronic cough with specific therapy improved these adverse effects. The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a chronic, persistently troublesome cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for cough, ACOS and SIP instruments were readministered. The ages, sex, duration, and spectra and frequencies of the causes of cough were similar to multiple other studies. At baseline, patients reported a mean +/- SD of 8.6 +/- 4.8 types of adverse occurrences related to cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (P<.02). After cough disappeared with treatment, ACOS complaints decreased to a mean +/- SD of 1.9 +/- 3.2 (P<.0001) as did total (mean +/- SD, 4.8 +/- 4.5 to 1.8 +/- 2.2) (P= .004), psychosocial (mean +/- SD, 4.2 +/- 6.8 to 0.8 +/- 2.3) (P = .004), and physical (mean +/- SD, 2.2 +/- 2.9 to 0.9 +/- 1.8) (P = .05) SIP scores. Multiple linear regression analysis showed that 54% of variability of the psychosocial SIP score was explained by 4 ACOS items while none of the physical score was explained. Chronic cough was associated with deterioration in patients' quality of life

Optic disc detection using ant colony optimization

NASA Astrophysics Data System (ADS)

Dias, Marcy A.; Monteiro, Fernando C.

2012-09-01

The retinal fundus images are used in the treatment and diagnosis of several eye diseases, such as diabetic retinopathy and glaucoma. This paper proposes a new method to detect the optic disc (OD) automatically, due to the fact that the knowledge of the OD location is essential to the automatic analysis of retinal images. Ant Colony Optimization (ACO) is an optimization algorithm inspired by the foraging behaviour of some ant species that has been applied in image processing for edge detection. Recently, the ACO was used in fundus images to detect edges, and therefore, to segment the OD and other anatomical retinal structures. We present an algorithm for the detection of OD in the retina which takes advantage of the Gabor wavelet transform, entropy and ACO algorithm. Forty images of the retina from DRIVE database were used to evaluate the performance of our method.

The changing roles of registered nurses in Pioneer Accountable Care Organizations.

PubMed

Pittman, Patricia; Forrest, Emily

2015-01-01

This study focuses on whether and how Pioneer Accountable Care Organization (ACO) leaders believe the deployment of the registered nurse workforce is changing in response to the shared savings incentives. Semistructured phone interviews with leaders from 18 of the original 32 Pioneer ACOs were conducted. Narrative analysis suggests that all of the organizations are developing new and enhanced roles for registered nurses across the continuum of care. Overall, eight types of changes were reported: enhancement of roles, substitution, delegation, increased numbers of nurses, relocation of services, transfer of nurses from one setting to another, the use of liaison nurses across settings, and partnerships between nurses coordinating care in primary and acute care settings. This exploratory study suggests that Pioneer ACO leaders believe that payment models are affecting the deployment of the health workforce and that these changes are, in turn, driving outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Optic neuropathy after anterior communicating artery aneurysm clipping: 3 cases and techniques to address a correctable pitfall.

PubMed

Linzey, Joseph R; Chen, Kevin S; Savastano, Luis; Thompson, B Gregory; Pandey, Aditya S

2018-06-01

Brain shifts following microsurgical clip ligation of anterior communicating artery (ACoA) aneurysms can lead to mechanical compression of the optic nerve by the clip. Recognition of this condition and early repositioning of clips can lead to reversal of vision loss. The authors identified 3 patients with an afferent pupillary defect following microsurgical clipping of ACoA aneurysms. Different treatment options were used for each patient. All patients underwent reexploration, and the aneurysm clips were repositioned to prevent clip-related compression of the optic nerve. Near-complete restoration of vision was achieved at the last clinic follow-up visit in all 3 patients. Clip ligation of ACoA aneurysms has the potential to cause clip-related compression of the optic nerve. Postoperative visual examination is of utmost importance, and if any changes are discovered, reexploration should be considered as repositioning of the clips may lead to resolution of visual deterioration.

National findings regarding health IT use and participation in health care delivery reform programs among office-based physicians.

PubMed

Heisey-Grove, Dawn; Patel, Vaishali

2017-01-01

Our objective was to characterize physicians' participation in delivery and payment reform programs over time and describe how participants in these programs were using health information technology (IT) to coordinate care, engage patients, manage patient populations, and improve quality. A nationally representative cohort of physicians was surveyed in 2012 (unweighted N = 2567) and 2013 (unweighted N = 2399). Regression analyses used those survey responses to identify associations between health IT use and participation in and attrition from patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and pay-for-performance programs (P4Ps). In 2013, 45% of physicians participated in PCMHs, ACOs, or P4Ps. While participation in each program increased (P < .05) between 2012 and 2013, program attrition ranged from 31-40%. Health IT use was associated with greater program participation (RR = 1.07-1.16). PCMH, ACO, and P4P participants were more likely than nonparticipants to perform quality improvement and patient engagement activities electronically (RR = 1.09-1.14); only ACO participants were more likely to share information electronically (RR = 1.07-1.09). Participation in delivery and payment reform programs increased between 2012 and 2013. Participating physicians were more likely to use health IT. There was significant attrition from and switching between PCMHs, ACOs, and P4Ps. This work provides the basis for understanding physician participation in and attrition from delivery and payment reform programs, as well as how health IT was used to support those programs. Understanding health IT use by program participants may help to identify factors enabling a smooth transition to alternative payment models. Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the United States.

Delivery system characteristics and their association with quality and costs of care: implications for accountable care organizations.

PubMed

Chukmaitov, Askar; Harless, David W; Bazzoli, Gloria J; Carretta, Henry J; Siangphoe, Umaporn

2015-01-01

Implementation of accountable care organizations (ACOs) is currently underway, but there is limited empirical evidence on the merits of the ACO model. The aim was to study the associations between delivery system characteristics and ACO competencies, including centralization strategies to manage organizations, hospital integration with physicians and outpatient facilities, health information technology, infrastructure to monitor community health and report quality, and risk-adjusted 30-day all-cause mortality and case-mixed-adjusted inpatient costs for the Medicare population. Panel data (2006-2009) were assembled from Florida and multiple sources: inpatient hospital discharge, vital statistics, the American Hospital Association, the Healthcare Information and Management Systems Society, and other databases. We applied a panel study design, controlling for hospital and market characteristics. Hospitals that were in centralized health systems or became more centralized over the study period had significantly larger reductions in mortality compared with hospitals that remained freestanding. Surprisingly, tightly integrated hospital-physician arrangements were associated with increased mortality; as such, hospitals may wish to proceed cautiously when developing specific types of alignment with local physician organizations. We observed no statistically significant differences in the growth rate of costs across hospitals in any of the health systems studied relative to freestanding hospitals. Although we observed quality improvement in some organizational types, these outcome improvements were not coupled with the additional desired objective of lower cost growth. This implies that additional changes not present during our study period, potentially changes in provider payment approaches, are essential for achieving the ACO objectives of higher quality of care at lower costs. Provider organizations implementing ACOs should consider centralizing service delivery as a

Plasma Inflammatory Cytokine IL-4, IL-8, IL-10, and TNF-α Levels Correlate with Pulmonary Function in Patients with Asthma-Chronic Obstructive Pulmonary Disease (COPD) Overlap Syndrome.

PubMed

Huang, Ai-Xia; Lu, Li-Wen; Liu, Wen-Juan; Huang, Mao

2016-08-09

BACKGROUND The aim of this study was to investigate the plasma inflammatory cytokine levels and their correlations with pulmonary function in patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). MATERIAL AND METHODS Between January 2013 and December 2014, a total of 96 patients with asthma, acute exacerbation of chronic obstructive pulmonary disease (AECOPD), or ACOS were enrolled, and 35 healthy people were included as a control group. Fasting plasma interleukin (IL)-4, IL-8, IL-10, and tumor necrosis factor alpha (TNF-α) levels were detected using enzyme-linked immunosorbent assay (ELISA). Correlations between the plasma inflammatory cytokine levels and forced expiratory volume in 1 second (FEV1), FEV1/predicted value ratio (FEV1%pred), and FEV1/forced vital capacity (FVC) were analyzed. RESULTS IL-4 and IL-8 levels showed statistically significant differences among the 3 groups of patients (both P<0.001); IL-4 level was significantly lower, while IL-8 level was significantly higher in the AECOPD group and ACOS group than those in the asthma group (all P<0.05). IL-10 level and TNF-α level were significantly different among the 3 patient groups (both P<0.001). IL-10 level was significantly different between each of the 2 groups (all P<0.001). TNF-α level in the asthma group was higher than in the AECOPD group and ACOS group (both P<0.001). IL-4 and IL-10 were positively and IL-8 and TNF-α were negatively related with FEV1, FEV1%pred, and FEV1/FVC. CONCLUSIONS Plasma levels of inflammatory cytokines IL-4, IL-8, IL-10, and TNF-α are related with severity of airway diseases and could be potential markers for the evaluation of asthma, COPD, and ACOS.

Ethylene biosynthesis and perception during ripening of loquat fruit (Eriobotrya japonica Lindl.).

PubMed

Alos, E; Martinez-Fuentes, A; Reig, C; Mesejo, C; Rodrigo, M J; Agustí, M; Zacarías, L

2017-03-01

In order to gain insights into the controversial ripening behavior of loquat fruits, in the present study we have analyzed the expression of three genes related to ethylene biosynthesis (ACS1, ACO1 and ACO2), two ethylene receptors (ERS1a and ERS1b), one signal transduction component (CTR1) and one transcription factor (EIL1) in peel and pulp of loquat fruit during natural ripening and also in fruits treated with ethylene (10μLL -1 ) and 1-MCP (10μLL -1 ), an ethylene action inhibitor. In fruits attached to or detached from the tree, a slight increase in ethylene production was detected at the yellow stage, but the respiration rate declined progressively during ripening. Accumulation of transcripts of ethylene biosynthetic genes did not correlate with changes in ethylene production, since the maximum accumulation of ACS1 and ACO1 mRNA was detected in fully coloured fruits. Expression of ethylene receptor and signaling genes followed a different pattern in peel and pulp tissues. After fruit detachment and incubation at 20°C for up to 6days, ACS1 mRNA slightly increased, ACO1 experienced a substantial increment and ACO2 declined. In the peel, these changes were advanced by exogenous ethylene and partially inhibited by 1-MCP. In the pulp, 1-MCP repressed most of the changes in the expression of biosynthetic genes, while ethylene had almost no effects. Expression of ethylene perception and signaling genes was barely affected by ethylene or 1-MCP. Collectively, a differential transcriptional regulation of ethylene biosynthetic genes operates in peel and pulp, and support the notion of non-climacteric ripening in loquat fruits. Ethylene action, however, appears to be required to sustain or maintain the expression of specific genes. Copyright © 2016. Published by Elsevier GmbH.

Genetic Variation in Iron Metabolism Is Associated with Neuropathic Pain and Pain Severity in HIV-Infected Patients on Antiretroviral Therapy

PubMed Central

Kallianpur, Asha R.; Jia, Peilin; Ellis, Ronald J.; Zhao, Zhongming; Bloss, Cinnamon; Wen, Wanqing; Marra, Christina M.; Hulgan, Todd; Simpson, David M.; Morgello, Susan; McArthur, Justin C.; Clifford, David B.; Collier, Ann C.; Gelman, Benjamin B.; McCutchan, J. Allen; Franklin, Donald; Samuels, David C.; Rosario, Debralee; Holzinger, Emily; Murdock, Deborah G.; Letendre, Scott; Grant, Igor

2014-01-01

HIV sensory neuropathy and distal neuropathic pain (DNP) are common, disabling complications associated with combination antiretroviral therapy (cART). We previously associated iron-regulatory genetic polymorphisms with a reduced risk of HIV sensory neuropathy during more neurotoxic types of cART. We here evaluated the impact of polymorphisms in 19 iron-regulatory genes on DNP in 560 HIV-infected subjects from a prospective, observational study, who underwent neurological examinations to ascertain peripheral neuropathy and structured interviews to ascertain DNP. Genotype-DNP associations were explored by logistic regression and permutation-based analytical methods. Among 559 evaluable subjects, 331 (59%) developed HIV-SN, and 168 (30%) reported DNP. Fifteen polymorphisms in 8 genes (p<0.05) and 5 variants in 4 genes (p<0.01) were nominally associated with DNP: polymorphisms in TF, TFRC, BMP6, ACO1, SLC11A2, and FXN conferred reduced risk (adjusted odds ratios [ORs] ranging from 0.2 to 0.7, all p<0.05); other variants in TF, CP, ACO1, BMP6, and B2M conferred increased risk (ORs ranging from 1.3 to 3.1, all p<0.05). Risks associated with some variants were statistically significant either in black or white subgroups but were consistent in direction. ACO1 rs2026739 remained significantly associated with DNP in whites (permutation p<0.0001) after correction for multiple tests. Several of the same iron-regulatory-gene polymorphisms, including ACO1 rs2026739, were also associated with severity of DNP (all p<0.05). Common polymorphisms in iron-management genes are associated with DNP and with DNP severity in HIV-infected persons receiving cART. Consistent risk estimates across population subgroups and persistence of the ACO1 rs2026739 association after adjustment for multiple testing suggest that genetic variation in iron-regulation and transport modulates susceptibility to DNP. PMID:25144566

Um satélite brasileiro para observação do diâmetro solar

NASA Astrophysics Data System (ADS)

Emilio, M.; Leister, N. V.; Benevides Soares, P.; Teixeira, R.; Kuhn, J.

2003-08-01

Propomos uma missão espacial para medir a forma e o diâmetro solar com o objetivo de ajudar a determinar o potencial gravitacional do Sol e a sua rotação com precisão, testar modelos teóricos de variação de energia e pela primeira vez medir os modos g de oscilação. As observações serão obtidas através do instrumento denominado APT (Astrometric and Photometric Telescope) descrito por Kuhn(1983). A sensibilidade do instrumento é de 0,2 mas em 27 dias para as observações do diâmetro solar feitas a cada minuto. Esta é uma missão de três anos de duração e pode complementar as medidas que serão feitas pelo satélite PICARD (a ser lançado em 2007). Outros parâmetros físicos podem ser obtidos com as mesmas imagens o que certamente interessará à comunidade de física solar. Um primeiro contato foi realizado com a agência espacial brasileira que pretende lançar um satélite científico a cada dois anos.

UmUTracker: A versatile MATLAB program for automated particle tracking of 2D light microscopy or 3D digital holography data

NASA Astrophysics Data System (ADS)

Zhang, Hanqing; Stangner, Tim; Wiklund, Krister; Rodriguez, Alvaro; Andersson, Magnus

2017-10-01

We present a versatile and fast MATLAB program (UmUTracker) that automatically detects and tracks particles by analyzing video sequences acquired by either light microscopy or digital in-line holographic microscopy. Our program detects the 2D lateral positions of particles with an algorithm based on the isosceles triangle transform, and reconstructs their 3D axial positions by a fast implementation of the Rayleigh-Sommerfeld model using a radial intensity profile. To validate the accuracy and performance of our program, we first track the 2D position of polystyrene particles using bright field and digital holographic microscopy. Second, we determine the 3D particle position by analyzing synthetic and experimentally acquired holograms. Finally, to highlight the full program features, we profile the microfluidic flow in a 100 μm high flow chamber. This result agrees with computational fluid dynamic simulations. On a regular desktop computer UmUTracker can detect, analyze, and track multiple particles at 5 frames per second for a template size of 201 ×201 in a 1024 × 1024 image. To enhance usability and to make it easy to implement new functions we used object-oriented programming. UmUTracker is suitable for studies related to: particle dynamics, cell localization, colloids and microfluidic flow measurement. Program Files doi : http://dx.doi.org/10.17632/fkprs4s6xp.1 Licensing provisions : Creative Commons by 4.0 (CC by 4.0) Programming language : MATLAB Nature of problem: 3D multi-particle tracking is a common technique in physics, chemistry and biology. However, in terms of accuracy, reliable particle tracking is a challenging task since results depend on sample illumination, particle overlap, motion blur and noise from recording sensors. Additionally, the computational performance is also an issue if, for example, a computationally expensive process is executed, such as axial particle position reconstruction from digital holographic microscopy data. Versatile

"Uh," "Um," and Autism: Filler Disfluencies as Pragmatic Markers in Adolescents with Optimal Outcomes from Autism Spectrum Disorder

ERIC Educational Resources Information Center

Irvine, Christina A.; Eigsti, Inge-Marie; Fein, Deborah A.

2016-01-01

Filler disfluencies--"uh" and "um"--are thought to serve distinct discourse functions. We examined fillers in spontaneous speech by youth with autism spectrum disorder (ASD), who struggle with pragmatic language, and by youth with ASD who have achieved an "optimal outcome" (OO), as well as in peers with typical…

Complementary DNA cloning of the pear 1-aminocyclopropane-1-carboxylic acid oxidase gene and agrobacterium-mediated anti-sense genetic transformation.

PubMed

Qi, Jing; Dong, Zhen; Zhang, Yu-Xing

2015-12-01

The aim of the present study was to genetically modify plantlets of the Chinese yali pear to reduce their expression of ripening-associated 1-aminocyclopropane-1-carboxylic acid oxidase (ACO) and therefore increase the shelf-life of the fruit. Primers were designed with selectivity for the conserved regions of published ACO gene sequences, and yali complementary DNA (cDNA) cloning was performed by reverse transcription quantitative polymerase chain reaction (PCR). The obtained cDNA fragment contained 831 base pairs, encoding 276 amino acid residues, and shared no less than 94% nucleotide sequence identity with other published ACO genes. The cDNA fragment was inversely inserted into a pBI121 expression vector, between the cauliflower mosaic virus 35S promoter and the nopaline synthase terminator, in order to construct the anti‑sense expression vector of the ACO gene; it was transfected into cultured yali plants using Agrobacterium LBA4404. Four independent transgenic lines of pear plantlets were obtained and validated by PCR analysis. A Southern blot assay revealed that there were three transgenic lines containing a single copy of exogenous gene and one line with double copies. The present study provided germplasm resources for the cultivation of novel storage varieties of pears, therefore providing a reference for further applications of anti‑sense RNA technology in the genetic improvement of pears and other fruit.

The modification of hybrid method of ant colony optimization, particle swarm optimization and 3-OPT algorithm in traveling salesman problem

NASA Astrophysics Data System (ADS)

Hertono, G. F.; Ubadah; Handari, B. D.

2018-03-01

The traveling salesman problem (TSP) is a famous problem in finding the shortest tour to visit every vertex exactly once, except the first vertex, given a set of vertices. This paper discusses three modification methods to solve TSP by combining Ant Colony Optimization (ACO), Particle Swarm Optimization (PSO) and 3-Opt Algorithm. The ACO is used to find the solution of TSP, in which the PSO is implemented to find the best value of parameters α and β that are used in ACO.In order to reduce the total of tour length from the feasible solution obtained by ACO, then the 3-Opt will be used. In the first modification, the 3-Opt is used to reduce the total tour length from the feasible solutions obtained at each iteration, meanwhile, as the second modification, 3-Opt is used to reduce the total tour length from the entire solution obtained at every iteration. In the third modification, 3-Opt is used to reduce the total tour length from different solutions obtained at each iteration. Results are tested using 6 benchmark problems taken from TSPLIB by calculating the relative error to the best known solution as well as the running time. Among those modifications, only the second and third modification give satisfactory results except the second one needs more execution time compare to the third modifications.

Memristive effects in oxygenated amorphous carbon nanodevices

NASA Astrophysics Data System (ADS)

Bachmann, T. A.; Koelmans, W. W.; Jonnalagadda, V. P.; Le Gallo, M.; Santini, C. A.; Sebastian, A.; Eleftheriou, E.; Craciun, M. F.; Wright, C. D.

2018-01-01

Computing with resistive-switching (memristive) memory devices has shown much recent progress and offers an attractive route to circumvent the von-Neumann bottleneck, i.e. the separation of processing and memory, which limits the performance of conventional computer architectures. Due to their good scalability and nanosecond switching speeds, carbon-based resistive-switching memory devices could play an important role in this respect. However, devices based on elemental carbon, such as tetrahedral amorphous carbon or ta-C, typically suffer from a low cycling endurance. A material that has proven to be capable of combining the advantages of elemental carbon-based memories with simple fabrication methods and good endurance performance for binary memory applications is oxygenated amorphous carbon, or a-CO x . Here, we examine the memristive capabilities of nanoscale a-CO x devices, in particular their ability to provide the multilevel and accumulation properties that underpin computing type applications. We show the successful operation of nanoscale a-CO x memory cells for both the storage of multilevel states (here 3-level) and for the provision of an arithmetic accumulator. We implement a base-16, or hexadecimal, accumulator and show how such a device can carry out hexadecimal arithmetic and simultaneously store the computed result in the self-same a-CO x cell, all using fast (sub-10 ns) and low-energy (sub-pJ) input pulses.

Mutant DnaAs of Escherichia coli that are refractory to negative control

PubMed Central

Chodavarapu, Sundari; Felczak, Magdalena M.; Simmons, Lyle A.; Murillo, Alec; Kaguni, Jon M.

2013-01-01

DnaA is the initiator of DNA replication in bacteria. A mutant DnaA named DnaAcos is unusual because it is refractory to negative regulation. We developed a genetic method to isolate other mutant DnaAs that circumvent regulation to extend our understanding of mechanisms that control replication initiation. Like DnaAcos, one mutant bearing a tyrosine substitution for histidine 202 (H202Y) withstands the regulation exerted by datA, hda and dnaN (β clamp), and both DnaAcos and H202Y resist inhibition by the Hda-β clamp complex in vitro. Other mutant DnaAs carrying G79D, E244K, V303M or E445K substitutions are either only partially sensitive or refractory to inhibition by the Hda-β clamp complex in vitro but are responsive to hda expression in vivo. All mutant DnaAs remain able to interact directly with Hda. Of interest, both DnaAcos and DnaAE244K bind more avidly to Hda. These mutants, by sequestrating Hda, may limit its availability to regulate other DnaA molecules, which remain active to induce extra rounds of DNA replication. Other evidence suggests that a mutant bearing a V292M substitution hyperinitiates by escaping the effect of an unknown regulatory factor. Together, our results provide new insight into the mechanisms that regulate replication initiation in Escherichia coli. PMID:23990329

Mutant DnaAs of Escherichia coli that are refractory to negative control.

PubMed

Chodavarapu, Sundari; Felczak, Magdalena M; Simmons, Lyle A; Murillo, Alec; Kaguni, Jon M

2013-12-01

DnaA is the initiator of DNA replication in bacteria. A mutant DnaA named DnaAcos is unusual because it is refractory to negative regulation. We developed a genetic method to isolate other mutant DnaAs that circumvent regulation to extend our understanding of mechanisms that control replication initiation. Like DnaAcos, one mutant bearing a tyrosine substitution for histidine 202 (H202Y) withstands the regulation exerted by datA, hda and dnaN (β clamp), and both DnaAcos and H202Y resist inhibition by the Hda-β clamp complex in vitro. Other mutant DnaAs carrying G79D, E244K, V303M or E445K substitutions are either only partially sensitive or refractory to inhibition by the Hda-β clamp complex in vitro but are responsive to hda expression in vivo. All mutant DnaAs remain able to interact directly with Hda. Of interest, both DnaAcos and DnaAE244K bind more avidly to Hda. These mutants, by sequestrating Hda, may limit its availability to regulate other DnaA molecules, which remain active to induce extra rounds of DNA replication. Other evidence suggests that a mutant bearing a V292M substitution hyperinitiates by escaping the effect of an unknown regulatory factor. Together, our results provide new insight into the mechanisms that regulate replication initiation in Escherichia coli.

Ethylene-dependent aerenchyma formation in adventitious roots is regulated differently in rice and maize.

PubMed

Yamauchi, Takaki; Tanaka, Akihiro; Mori, Hitoshi; Takamure, Itsuro; Kato, Kiyoaki; Nakazono, Mikio

2016-10-01

In roots of gramineous plants, lysigenous aerenchyma is created by the death and lysis of cortical cells. Rice (Oryza sativa) constitutively forms aerenchyma under aerobic conditions, and its formation is further induced under oxygen-deficient conditions. However, maize (Zea mays) develops aerenchyma only under oxygen-deficient conditions. Ethylene is involved in lysigenous aerenchyma formation. Here, we investigated how ethylene-dependent aerenchyma formation is differently regulated between rice and maize. For this purpose, in rice, we used the reduced culm number1 (rcn1) mutant, in which ethylene biosynthesis is suppressed. Ethylene is converted from 1-aminocyclopropane-1-carboxylic acid (ACC) by the action of ACC oxidase (ACO). We found that OsACO5 was highly expressed in the wild type, but not in rcn1, under aerobic conditions, suggesting that OsACO5 contributes to aerenchyma formation in aerated rice roots. By contrast, the ACO genes in maize roots were weakly expressed under aerobic conditions, and thus ACC treatment did not effectively induce ethylene production or aerenchyma formation, unlike in rice. Aerenchyma formation in rice roots after the initiation of oxygen-deficient conditions was faster and greater than that in maize. These results suggest that the difference in aerenchyma formation in rice and maize is due to their different mechanisms for regulating ethylene biosynthesis. © 2016 John Wiley & Sons Ltd.

Low-Power Differential SRAM design for SOC Based on the 25-um Technology

NASA Astrophysics Data System (ADS)

Godugunuri, Sivaprasad; Dara, Naveen; Sambasiva Nayak, R.; Nayeemuddin, Md; Singh, Yadu, Dr.; Veda, R. N. S. Sunil

2017-08-01

In recent, the SOC styles area unit the vast complicated styles in VLSI these SOC styles having important low-power operations problems, to comprehend this we tend to enforced low-power SRAM. However these SRAM Architectures critically affects the entire power of SOC and competitive space. To beat the higher than disadvantages, during this paper, a low-power differential SRAM design is planned. The differential SRAM design stores multiple bits within the same cell, operates at minimum in operation low-tension and space per bit. The differential SRAM design designed supported the 25-um technology using Tanner-EDA Tool.

Role of perceptual and organizational factors in amnesics' recall of the Rey-Osterrieth complex figure: a comparison of three amnesic groups.

PubMed

Kixmiller, J S; Verfaellie, M M; Mather, M M; Cermak, L S

2000-04-01

To examine the contribution of visual-perceptual and visual-organizational factors to visual memory in amnesia, Korsakoff, medial temporal, and anterior communicating artery (ACoA) aneurysm amnesics' copy, organization, and recall performance on the Rey-Osterrieth Complex Figure was assessed. Korsakoff patients were matched to medial temporal patients in terms of severity of amnesia, while the ACoA group, which was less severely amnesic, was matched to the Korsakoff patients on performance on executive tasks. Results indicated that while both the ACoA and Korsakoff groups had poorer copy accuracy and organization than controls, only the Korsakoff patients' copy accuracy was worse than the other two amnesic groups. While the Korsakoff patient's visuoperceptual deficits could partially explain this group's poor performance at immediate recall, the Korsakoff group's comparatively worse performance at delayed recall could not be accounted for by poor copy accuracy, reduced visual organization, or even the combined influence of these two factors.

Improved Ant Algorithms for Software Testing Cases Generation

PubMed Central

Yang, Shunkun; Xu, Jiaqi

2014-01-01

Existing ant colony optimization (ACO) for software testing cases generation is a very popular domain in software testing engineering. However, the traditional ACO has flaws, as early search pheromone is relatively scarce, search efficiency is low, search model is too simple, positive feedback mechanism is easy to porduce the phenomenon of stagnation and precocity. This paper introduces improved ACO for software testing cases generation: improved local pheromone update strategy for ant colony optimization, improved pheromone volatilization coefficient for ant colony optimization (IPVACO), and improved the global path pheromone update strategy for ant colony optimization (IGPACO). At last, we put forward a comprehensive improved ant colony optimization (ACIACO), which is based on all the above three methods. The proposed technique will be compared with random algorithm (RND) and genetic algorithm (GA) in terms of both efficiency and coverage. The results indicate that the improved method can effectively improve the search efficiency, restrain precocity, promote case coverage, and reduce the number of iterations. PMID:24883391

A novel global Harmony Search method based on Ant Colony Optimisation algorithm

NASA Astrophysics Data System (ADS)

Fouad, Allouani; Boukhetala, Djamel; Boudjema, Fares; Zenger, Kai; Gao, Xiao-Zhi

2016-03-01

The Global-best Harmony Search (GHS) is a stochastic optimisation algorithm recently developed, which hybridises the Harmony Search (HS) method with the concept of swarm intelligence in the particle swarm optimisation (PSO) to enhance its performance. In this article, a new optimisation algorithm called GHSACO is developed by incorporating the GHS with the Ant Colony Optimisation algorithm (ACO). Our method introduces a novel improvisation process, which is different from that of the GHS in the following aspects. (i) A modified harmony memory (HM) representation and conception. (ii) The use of a global random switching mechanism to monitor the choice between the ACO and GHS. (iii) An additional memory consideration selection rule using the ACO random proportional transition rule with a pheromone trail update mechanism. The proposed GHSACO algorithm has been applied to various benchmark functions and constrained optimisation problems. Simulation results demonstrate that it can find significantly better solutions when compared with the original HS and some of its variants.

Feasibility Study to Adapt the Microflown Vector Sensor for Underwater Use

DTIC Science & Technology

2012-12-01

properties were of less importance for this experiment. A calibrated ACO Pacific pressure microphone in combination with an ACO pacific 1/2” preamplifier ... preamplifier was used for amplification and filtering. Pre-amplification was set to 10x and a 1 kHz High pass and 100 kHz Low pass filter was used to reduce...Kjær Turntable system type 9640 Stanford RS preamplifier model SR560 Pre-amplification: 10x High pass filter: 1 kHz Low pass filter: 100 kHz

Validation of the A&D UM-201 device for office blood pressure measurement according to the European Society of Hypertension International Protocol Revision 2010.

PubMed

Fania, Claudio; Albertini, Federica; Palatini, Paolo

2017-08-01

The aim of this study was to determine the accuracy of the A&D UM-201 device coupled to several cuffs for different arm sizes for office blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension. Evaluation was carried out in 33 individuals. The mean age of the individuals was 59.3±13.2 years, systolic BP was 145.4±20.6 mmHg (range: 109-186 mmHg), diastolic BP was 87.3±18.0 mmHg (range: 50-124 mmHg), and arm circumference was 30.4±4.2 cm (range: 23-39 cm). The protocol requirements were followed precisely. The UM-201 monitor passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated systolic BP by 3.0±2.1 mmHg and diastolic BP by 2.6±2.0 mmHg. These data show that the A&D UM-201 device coupled to several cuffs for different ranges of arm circumference fulfilled the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

[Polarization of neutrophils from patients with asthma, chronic obstructive pulmonary disease and asthma-chronic obstructive pulmonary disease overlap syndrome].

PubMed

Deng, Fan; Dong, Hangming; Zou, Mengchen; Zhao, Haijin; Cai, Chunqing; Cai, Shaoxi

2014-12-30

To explore the polarization of migration dynamics of neutrophils isolated from patients with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS) compared with healthy smoking and non-smoking controls. Recruited volunteers were classified as healthy controls, healthy smokers, asthma, COPD and ACOS at Nanfang Hospital from April 2013 to June 2014 according to the Global Strategy for the Diagnosis, Management and Prevention of COPD 2011, Global Strategy for Asthma Management and Prevention 2011 and Consensus on Overlap Phenotype COPD-asthma in COPD 2012. Neutrophils were freshly isolated from whole blood with density gradient technique. The proportion of polarized cells with gradient concentration of formyl-Met-Leu-Phe (fMLP) in Zigmond chamber and vital component of Store Operated Calcium Entry (SOCE) (stromal interaction molecule (STIM) 1, 2 and Orai1) in neutrophils was detected by Western blot. Asthma, COPD and ACOS neutrophils demonstrated a higher spontaneous polarization rate versus healthy controls and healthy smokers ((25.05 ± 4.06)%, (16.20 ± 4.46)%, (29.43 ± 5.53)% vs (7.27 ± 0.99)%, (7.06 ± 3.12)%, all P < 0.01), asthma and ACOS neutrophils showed a higher directed polarization rate ((14.62 ± 2.26)%, (8.00 ± 1.75)%, all P < 0.05), but COPD had a relatively lower rate of directional polarization rate than healthy controls and healthy smokers ((2.45 ± 0.54)% vs (5.12 ± 1.28)%, (5.24 ± 1.34)%, all P < 0.01). The vital component of SOCE in neutrophils from asthma, COPD and ACOS were all up-regulated versus healthy controls and healthy smokers (STIM1: 1.63 ± 0.14, 0.88 ± 0.41, 1.29 ± 0.22 vs 0.26 ± 0.14, 0.38 ± 0.12; STIM2: 0.52 ± 0.19, 0.22 ± 0.13, 0.24 ± 0.10 vs 0.05 ± 0.03, 0.10 ± 0.06; Orai1: 0.56 ± 0.04, 0.39 ± 0.05, 0.48 ± 0.05 vs 0.13 ± 0.04, 0.13 ± 0.03) (all P < 0.01). Asthma, COPD and ACOS neutrophils are intrinsically different than counterparts from healthy control subjects and

Multiple Regression Redshift Calibration for Clusters of Galaxies

NASA Astrophysics Data System (ADS)

Kalinkov, M.; Kuneva, I.; Valtchanov, I.

A new procedure for calibration of distances to ACO (Abell et al.1989) clusters of galaxies has been developed. In the previous version of the Reference Catalog of ACO Clusters of Galaxies (Kalinkov & Kuneva 1992) an attempt has been made to compare various calibration schemes. For the Version 93 we have made some refinements. Many improvements from the early days of the photometric calibration have been made --- from Rowan-Robinson (1972), Corwin (1974), Kalinkov & Kuneva (1975), Mills Hoskins (1977) to more complicated --- Leir & van den Bergh (1977), Postman et al.(1985), Kalinkov Kuneva (1985, 1986, 1990), Scaramella et al.(1991), Zucca et al. (1993). It was shown that it is impossible to use the same calibration relation for northern (A) and southern (ACO) clusters of galaxies. Therefore the calibration have to be made separately for both catalogs. Moreover it is better if one could find relations for the 274 A-clusters, studied by the authors of ACO. We use the luminosity distance for H0=100km/s/Mpc and q0 = 0.5 and we have 1200 clusters with measured redshifts. The first step is to fit log(z) on m10 (magnitude of the tenth rank galaxy) for A-clusters and on m1, m3 and m10 for ACO clusters. The second step is to take into account the K-correction and the Scott effect (Postman et al.1985) with iterative process. To avoid the initial errors of the redshift estimates in A- and ACO catalogs we adopt Hubble's law for the apparent radial distribution of galaxies in clusters. This enable us to calculate a new cluster richness from preliminary redshift estimate. This is the third step. Further continues the study of the correlation matrix between log(z) and prospective predictors --- new richness groups, BM, RS and A types, radio and X-ray fluxes, apparent separations between the first three brightest galaxies, mean population (gal/sq.deg), Multiple linear as well as nonlinear regression estimators are found. Many clusters that deviate by more than 2.5 sigmas are

Spliceosomal protein U1A is involved in alternative splicing and salt stress tolerance in Arabidopsis thaliana

PubMed Central

Gu, Jinbao; Xia, Zhiqiang; Luo, Yuehua; Jiang, Xingyu; Qian, Bilian; Xie, He; Zhu, Jian-Kang; Xiong, Liming; Zhu, Jianhua; Wang, Zhen-Yu

2018-01-01

Abstract Soil salinity is a significant threat to sustainable agricultural production worldwide. Plants must adjust their developmental and physiological processes to cope with salt stress. Although the capacity for adaptation ultimately depends on the genome, the exceptional versatility in gene regulation provided by the spliceosome-mediated alternative splicing (AS) is essential in these adaptive processes. However, the functions of the spliceosome in plant stress responses are poorly understood. Here, we report the in-depth characterization of a U1 spliceosomal protein, AtU1A, in controlling AS of pre-mRNAs under salt stress and salt stress tolerance in Arabidopsis thaliana. The atu1a mutant was hypersensitive to salt stress and accumulated more reactive oxygen species (ROS) than the wild-type under salt stress. RNA-seq analysis revealed that AtU1A regulates AS of many genes, presumably through modulating recognition of 5′ splice sites. We showed that AtU1A is associated with the pre-mRNA of the ROS detoxification-related gene ACO1 and is necessary for the regulation of ACO1 AS. ACO1 is important for salt tolerance because ectopic expression of ACO1 in the atu1a mutant can partially rescue its salt hypersensitive phenotype. Our findings highlight the critical role of AtU1A as a regulator of pre-mRNA processing and salt tolerance in plants. PMID:29228330

Subcallosal artery stroke: infarction of the fornix and the genu of the corpus callosum. The importance of the anterior communicating artery complex. Case series and review of the literature.

PubMed

Meila, Dan; Saliou, Guillaume; Krings, Timo

2015-01-01

Despite the variable anatomy of the anterior communicating artery (AcoA) complex, three main perforating branches can be typically identified the largest of which being the subcallosal artery (ScA). We present a case series of infarction in the vascular territory of the ScA to highlight the anatomy, the clinical symptomatology, and the presumed pathophysiology as it pertains to endovascular and surgical management of vascular pathology in this region. In this retrospective multicenter case series study of patients who were diagnosed with symptomatic ScA stroke, we analyzed all available clinical records, MRI, and angiographic details. Additionally, a review of the literature is provided. We identified five different cases of ScA stroke, leading to a subsequent infarction of the fornix and the genu of the corpus callosum. The presumed pathophysiology in non-iatrogenic cases is microangiopathy, rather than embolic events; iatrogenic SCA occlusion can present after both surgical and endovascular treatment of AcoA aneurysms that may occur with or without occlusion of the AcoA. Stroke in the vascular territory of the ScA leads to a characteristic imaging and clinical pattern. Ischemia involves the anterior columns of the fornix and the genu of the corpus callosum, and patients present with a Korsakoff's syndrome including disturbances of short-term memory and cognitive changes. We conclude that despite its small size, the ScA is an important artery to watch out for during surgical or endovascular treatment of AcoA aneurysms.

Application of Design of Experiments and Surrogate Modeling within the NASA Advanced Concepts Office, Earth-to-Orbit Design Process

NASA Technical Reports Server (NTRS)

Zwack, Mathew R.; Dees, Patrick D.; Holt, James B.

2016-01-01

Decisions made during early conceptual design have a large impact upon the expected life-cycle cost (LCC) of a new program. It is widely accepted that up to 80% of such cost is committed during these early design phases. Therefore, to help minimize LCC, decisions made during conceptual design must be based upon as much information as possible. To aid in the decision making for new launch vehicle programs, the Advanced Concepts Office (ACO) at NASA Marshall Space Flight Center (MSFC) provides rapid turnaround pre-phase A and phase A concept definition studies. The ACO team utilizes a proven set of tools to provide customers with a full vehicle mass breakdown to tertiary subsystems, preliminary structural sizing based upon worst-case flight loads, and trajectory optimization to quantify integrated vehicle performance for a given mission. Although the team provides rapid turnaround for single vehicle concepts, the scope of the trade space can be limited due to analyst availability and the manpower requirements for manual execution of the analysis tools. In order to enable exploration of a broader design space, the ACO team has implemented an advanced design methods (ADM) based approach. This approach applies the concepts of design of experiments (DOE) and surrogate modeling to more exhaustively explore the trade space and provide the customer with additional design information to inform decision making. This paper will first discuss the automation of the ACO tool set, which represents a majority of the development effort. In order to fit a surrogate model within tolerable error bounds a number of DOE cases are needed. This number will scale with the number of variable parameters desired and the complexity of the system's response to those variables. For all but the smallest design spaces, the number of cases required cannot be produced within an acceptable timeframe using a manual process. Therefore, automation of the tools was a key enabler for the successful

Application of Design of Experiments and Surrogate Modeling within the NASA Advanced Concepts Office, Earth-to-Orbit Design Process

NASA Technical Reports Server (NTRS)

Zwack, Mathew R.; Dees, Patrick D.; Holt, James B.

2016-01-01

Decisions made during early conceptual design have a large impact upon the expected life-cycle cost (LCC) of a new program. It is widely accepted that up to 80% of such cost is committed during these early design phases.1 Therefore, to help minimize LCC, decisions made during conceptual design must be based upon as much information as possible. To aid in the decision making for new launch vehicle programs, the Advanced Concepts Office (ACO) at NASA Marshall Space Flight Center (MSFC) provides rapid turnaround pre-phase A and phase A concept definition studies. The ACO team utilizes a proven set of tools to provide customers with a full vehicle mass breakdown to tertiary subsystems, preliminary structural sizing based upon worst-case flight loads, and trajectory optimization to quantify integrated vehicle performance for a given mission.2 Although the team provides rapid turnaround for single vehicle concepts, the scope of the trade space can be limited due to analyst availability and the manpower requirements for manual execution of the analysis tools. In order to enable exploration of a broader design space, the ACO team has implemented an Advanced Design Methods (ADM) based approach. This approach applies the concepts of Design of Experiments (DOE) and surrogate modeling to more exhaustively explore the trade space and provide the customer with additional design information to inform decision making. This paper will first discuss the automation of the ACO tool set, which represents a majority of the development e ort. In order to t a surrogate model within tolerable error bounds a number of DOE cases are needed. This number will scale with the number of variable parameters desired and the complexity of the system's response to those variables. For all but the smallest design spaces, the number of cases required cannot be produced within an acceptable timeframe using a manual process. Therefore, automation of the tools was a key enabler for the successful

76 FR 71517 - Takes of Marine Mammals During Specified Activities; Blasting Operations by the U.S. Army Corps...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-18

...NMFS has received an application from the U.S. Army Corps of Engineers (ACOE) for an Incidental Harassment Authorization (IHA) to take small numbers of marine mammals, by harassment, incidental to blasting operations in the Port of Miami in Miami, Florida. NMFS has reviewed the application, including all supporting documents, and determined that it is adequate and complete. Pursuant to the Marine Mammal Protection Act (MMPA), NMFS is requesting comments on its proposal to issue an IHA to ACOE to incidentally harass, by Level B harassment only, marine mammals during the specified activity.

Cadmium-induced ethylene production and responses in Arabidopsis thaliana rely on ACS2 and ACS6 gene expression

PubMed Central

2014-01-01

Background Anthropogenic activities cause metal pollution worldwide. Plants can absorb and accumulate these metals through their root system, inducing stress as a result of excess metal concentrations inside the plant. Ethylene is a regulator of multiple plant processes, and is affected by many biotic and abiotic stresses. Increased ethylene levels have been observed after exposure to excess metals but it remains unclear how the increased ethylene levels are achieved at the molecular level. In this study, the effects of cadmium (Cd) exposure on the production of ethylene and its precursor 1-aminocyclopropane-1-carboxylic acid (ACC), and on the expression of the ACC Synthase (ACS) and ACC Oxidase (ACO) multigene families were investigated in Arabidopsis thaliana. Results Increased ethylene release after Cd exposure was directly measurable in a system using rockwool-cultivated plants; enhanced levels of the ethylene precursor ACC together with higher mRNA levels of ethylene responsive genes: ACO2, ETR2 and ERF1 also indicated increased ethylene production in hydroponic culture. Regarding underlying mechanisms, it was found that the transcript levels of ACO2 and ACO4, the most abundantly expressed members of the ACO multigene family, were increased upon Cd exposure. ACC synthesis is the rate-limiting step in ethylene biosynthesis, and transcript levels of both ACS2 and ACS6 showed the highest increase and became the most abundant isoforms after Cd exposure, suggesting their importance in the Cd-induced increase of ethylene production. Conclusions Cadmium induced the biosynthesis of ACC and ethylene in Arabidopsis thaliana plants mainly via the increased expression of ACS2 and ACS6. This was confirmed in the acs2-1acs6-1 double knockout mutants, which showed a decreased ethylene production, positively affecting leaf biomass and resulting in a delayed induction of ethylene responsive gene expressions without significant differences in Cd contents between wild-type and

Proton beam therapy and accountable care: the challenges ahead.

PubMed

Elnahal, Shereef M; Kerstiens, John; Helsper, Richard S; Zietman, Anthony L; Johnstone, Peter A S

2013-03-15

Proton beam therapy (PBT) centers have drawn increasing public scrutiny for their high cost. The behavior of such facilities is likely to change under the Affordable Care Act. We modeled how accountable care reform may affect the financial standing of PBT centers and their incentives to treat complex patient cases. We used operational data and publicly listed Medicare rates to model the relationship between financial metrics for PBT center performance and case mix (defined as the percentage of complex cases, such as pediatric central nervous system tumors). Financial metrics included total daily revenues and debt coverage (daily revenues - daily debt payments). Fee-for-service (FFS) and accountable care (ACO) reimbursement scenarios were modeled. Sensitivity analyses were performed around the room time required to treat noncomplex cases: simple (30 minutes), prostate (24 minutes), and short prostate (15 minutes). Sensitivity analyses were also performed for total machine operating time (14, 16, and 18 h/d). Reimbursement under ACOs could reduce daily revenues in PBT centers by up to 32%. The incremental revenue gained by replacing 1 complex case with noncomplex cases was lowest for simple cases and highest for short prostate cases. ACO rates reduced this incremental incentive by 53.2% for simple cases and 41.7% for short prostate cases. To cover daily debt payments after ACO rates were imposed, 26% fewer complex patients were allowable at varying capital costs and interest rates. Only facilities with total machine operating times of 18 hours per day would cover debt payments in all scenarios. Debt-financed PBT centers will face steep challenges to remain financially viable after ACO implementation. Paradoxically, reduced reimbursement for noncomplex cases will require PBT centers to treat more such cases over cases for which PBT has demonstrated superior outcomes. Relative losses will be highest for those facilities focused primarily on treating noncomplex cases

Induction of SA-signaling pathway and ethylene biosynthesis in Trichoderma harzianum-treated tomato plants after infection of the root-knot nematode Meloidogyne incognita.

PubMed

Leonetti, Paola; Zonno, Maria Chiara; Molinari, Sergio; Altomare, Claudio

2017-04-01

Salicylic acid-signaling pathway and ethylene biosynthesis were induced in tomato treated with Trichoderma harzianum when infected by root-knot nematodes and limited the infection by activation of SAR and ethylene production. Soil pre-treatment with Trichoderma harzianum (Th) strains ITEM 908 (T908) and T908-5 decreased susceptibility of tomato to Meloidogyne incognita, as assessed by restriction in nematode reproduction and development. The effect of T. harzianum treatments on plant defense was detected by monitoring the expression of the genes PR-1/PR-5 and JERF3/ACO, markers of the SA- and JA/ET-dependent signaling pathways, respectively. The compatible nematode-plant interaction in absence of fungi caused a marked suppression of PR-1, PR-5, and ACO gene expressions, either locally or systemically, whilst expression of JERF3 gene resulted unaffected. Conversely, when plants were pre-treated with Th-strains, over-expression of PR-1, PR-5, and ACO genes was observed in roots 5 days after nematode inoculation. JERF3 gene expression did not change in Th-colonized plants challenged with nematodes. In the absence of nematodes, Trichoderma-root interaction was characterized by the inhibition of both SA-dependent signaling pathway and ET biosynthesis, and, in the case of PR-1 and ACO genes, this inhibition was systemic. JERF3 gene expression was systemically restricted only at the very early stages of plant-fungi interaction. Data presented indicate that Th-colonization primed roots for Systemic Acquired Resistance (SAR) against root-knot nematodes and reacted to nematode infection more efficiently than untreated plants. Such a response probably involves also activation of ET production, through an augmented transcription of the ACO gene, which encodes for the enzyme catalyzing the last step of ET biosynthesis. JA signaling and Induced Systemic Resistance (ISR) do not seem to be involved in the biocontrol action of the tested Th-strains against RKNs.

Proton Beam Therapy and Accountable Care: The Challenges Ahead

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

Elnahal, Shereef M., E-mail: selnahal@partners.org; Kerstiens, John; Helsper, Richard S.

2013-03-15

Purpose: Proton beam therapy (PBT) centers have drawn increasing public scrutiny for their high cost. The behavior of such facilities is likely to change under the Affordable Care Act. We modeled how accountable care reform may affect the financial standing of PBT centers and their incentives to treat complex patient cases. Methods and Materials: We used operational data and publicly listed Medicare rates to model the relationship between financial metrics for PBT center performance and case mix (defined as the percentage of complex cases, such as pediatric central nervous system tumors). Financial metrics included total daily revenues and debt coveragemore » (daily revenues − daily debt payments). Fee-for-service (FFS) and accountable care (ACO) reimbursement scenarios were modeled. Sensitivity analyses were performed around the room time required to treat noncomplex cases: simple (30 minutes), prostate (24 minutes), and short prostate (15 minutes). Sensitivity analyses were also performed for total machine operating time (14, 16, and 18 h/d). Results: Reimbursement under ACOs could reduce daily revenues in PBT centers by up to 32%. The incremental revenue gained by replacing 1 complex case with noncomplex cases was lowest for simple cases and highest for short prostate cases. ACO rates reduced this incremental incentive by 53.2% for simple cases and 41.7% for short prostate cases. To cover daily debt payments after ACO rates were imposed, 26% fewer complex patients were allowable at varying capital costs and interest rates. Only facilities with total machine operating times of 18 hours per day would cover debt payments in all scenarios. Conclusions: Debt-financed PBT centers will face steep challenges to remain financially viable after ACO implementation. Paradoxically, reduced reimbursement for noncomplex cases will require PBT centers to treat more such cases over cases for which PBT has demonstrated superior outcomes. Relative losses will be highest for

Gene expression analyses in tomato near isogenic lines provide evidence for ethylene and abscisic acid biosynthesis fine-tuning during arbuscular mycorrhiza development.

PubMed

Fracetto, Giselle Gomes Monteiro; Peres, Lázaro Eustáquio Pereira; Lambais, Marcio Rodrigues

2017-07-01

Plant responses to the environment and microorganisms, including arbuscular mycorrhizal fungi, involve complex hormonal interactions. It is known that abscisic acid (ABA) and ethylene may be involved in the regulation of arbuscular mycorrhiza (AM) and that part of the detrimental effects of ABA deficiency in plants is due to ethylene overproduction. In this study, we aimed to determine whether the low susceptibility to mycorrhizal colonization in ABA-deficient mutants is due to high levels of ethylene and whether AM development is associated with changes in the steady-state levels of transcripts of genes involved in the biosynthesis of ethylene and ABA. For that, tomato (Solanum lycopersicum) ethylene overproducer epinastic (epi) mutant and the ABA-deficient notabilis (not) and sitiens (sit) mutants, in the same Micro-Tom (MT) genetic background, were inoculated with Rhizophagus clarus, and treated with the ethylene biosynthesis inhibitor aminoethoxyvinylglycine (AVG). The development of AM, as well as the steady-state levels of transcripts involved in ethylene (LeACS2, LeACO1 and LeACO4) and ABA (LeNCED) biosynthesis, was determined. The intraradical colonization in epi, not and sit mutants was significantly reduced compared to MT. The epi mutant completely restored the mycorrhizal colonization to the levels of MT with the application of 10 µM of AVG, probably due to the inhibition of the ACC synthase gene expression. The steady-state levels of LeACS2 and LeACO4 transcripts were induced in mycorrhizal roots of MT, whereas the steady-state levels of LeACO1 and LeACO4 transcripts were significantly induced in sit, and the steady-state levels of LeNCED transcripts were significantly induced in all genotypes and in mycorrhizal roots of epi mutants treated with AVG. The reduced mycorrhizal colonization in sit mutants seems not to be limited by ethylene production via ACC oxidase regulation. Both ethylene overproduction and ABA deficiency impaired AM fungal

Technology Alignment and Portfolio Prioritization (TAPP): Advanced Methods in Strategic Analysis, Technology Forecasting and Long Term Planning for Human Exploration and Operations, Advanced Exploration Systems and Advanced Concepts

NASA Technical Reports Server (NTRS)

Funaro, Gregory V.; Alexander, Reginald A.

2015-01-01

The Advanced Concepts Office (ACO) at NASA, Marshall Space Flight Center is expanding its current technology assessment methodologies. ACO is developing a framework called TAPP that uses a variety of methods, such as association mining and rule learning from data mining, structure development using a Technological Innovation System (TIS), and social network modeling to measure structural relationships. The role of ACO is to 1) produce a broad spectrum of ideas and alternatives for a variety of NASA's missions, 2) determine mission architecture feasibility and appropriateness to NASA's strategic plans, and 3) define a project in enough detail to establish an initial baseline capable of meeting mission objectives ACO's role supports the decision­-making process associated with the maturation of concepts for traveling through, living in, and understanding space. ACO performs concept studies and technology assessments to determine the degree of alignment between mission objectives and new technologies. The first step in technology assessment is to identify the current technology maturity in terms of a technology readiness level (TRL). The second step is to determine the difficulty associated with advancing a technology from one state to the next state. NASA has used TRLs since 1970 and ACO formalized them in 1995. The DoD, ESA, Oil & Gas, and DoE have adopted TRLs as a means to assess technology maturity. However, "with the emergence of more complex systems and system of systems, it has been increasingly recognized that TRL assessments have limitations, especially when considering [the] integration of complex systems." When performing the second step in a technology assessment, NASA requires that an Advancement Degree of Difficulty (AD2) method be utilized. NASA has used and developed or used a variety of methods to perform this step: Expert Opinion or Delphi Approach, Value Engineering or Value Stream, Analytical Hierarchy Process (AHP), Technique for the Order of

An Automated Cloud Observation System (ACOS).

DTIC Science & Technology

1980-12-17

IQ 4. TITLE (and SubliIII.J 5- TYPE OF REPORT & PERIOD COVERED AN.JUTOXMATrD A LOUD OBSERVATION Scientific . Interim. SYSTEM (ALLIS) 6 PERFORMING ORG...p oci -dIi IV ( ( )S). . hhe 6 lists the percentage of agreement realizied by -:~ tc thc fiftt en metthods (I’ p touping ceilomieter t’ ata (see Ta

Accountable care organizations and the allergist: challenges and opportunities.

PubMed

Ein, Daniel; Foggs, Michael B

2014-01-01

For decades, health care policy experts have wrestled with ways to solve problems of access, cost, and quality in US health care. The current consensus is that the solution to all three lies in changing financial incentives for providers and delivering care through integrated systems. The currently favored vehicle for this, both in the public and private sectors, is through Accountable Care Organizations (ACOs). Medicare has several models and has fostered rapid growth in the number of operative ACOs. At least an equal number of private ACOs are in operation. Whether or not these organizations will fulfill their promise is unknown but there is reason for cautious optimism. Allergists can and should be part of the process of this transformation in our health care system. They can be integral to helping these organizations save money by reducing hospitalizations and improving the quality of allergy and asthma care in the populations served. In order to accomplish this, allergists must become more involved in their medical communities and hospitals. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

A comparison of different activated carbon performances on catalytic ozonation of a model azo reactive dye.

PubMed

Gül, S; Eren, O; Kır, S; Onal, Y

2012-01-01

The objective of this study is to compare the performances of catalytic ozonation processes of two activated carbons prepared from olive stone (ACOS) and apricot stone (ACAS) with commercial ones (granular activated carbon-GAC and powder activated carbon-PAC) in degradation of reactive azo dye (Reactive Red 195). The optimum conditions (solution pH and amount of catalyst) were investigated by using absorbencies at 532, 220 and 280 nm wavelengths. Pore properties of the activated carbon (AC) such as BET surface area, pore volume, pore size distribution, and pore diameter were characterized by N(2) adsorption. The highest BET surface area carbon (1,275 m(2)/g) was obtained from ACOS with a particle size of 2.29 nm. After 2 min of catalytic ozonation, decolorization performances of ACOS and ACAS (90.4 and 91.3%, respectively) were better than that of GAC and PAC (84.6 and 81.2%, respectively). Experimental results showed that production of porous ACs with high surface area from olive and apricot stones is feasible in Turkey.

The effect of accountable care organizations on oncology practice.

PubMed

Shulman, Lawrence N

2014-01-01

Cancer care accounts for a significant portion of the rise in health care costs, and therefore, as national efforts escalate to control cost, cancer care will be a focus of concern. Cost increases in cancer care are related to many factors, including increasing cancer incidence in an aging population, the introduction of new high-cost therapeutics, and the high cost of end-of-life care. Accountable care organizations (ACOs) have been one of the major efforts directed at controlling health care costs. How cancer care will fit into the rubric of ACOs is not entirely clear but will certainly evolve over the coming years. The oncology profession has the opportunity to play a role in this evolution or could leave the evolution to others driving the process, such as the Centers for Medicare and Medicaid Services (CMS), private payers, and ACOs. Ideally all parties will work together to provide a construct for high-value, high-quality care for patients with cancer while contributing to cost control in overall health care.

Dynamic routing and spectrum assignment based on multilayer virtual topology and ant colony optimization in elastic software-defined optical networks

NASA Astrophysics Data System (ADS)

Wang, Fu; Liu, Bo; Zhang, Lijia; Zhang, Qi; Tian, Qinghua; Tian, Feng; Rao, Lan; Xin, Xiangjun

2017-07-01

Elastic software-defined optical networks greatly improve the flexibility of the optical switching network while it has brought challenges to the routing and spectrum assignment (RSA). A multilayer virtual topology model is proposed to solve RSA problems. Two RSA algorithms based on the virtual topology are proposed, which are the ant colony optimization (ACO) algorithm of minimum consecutiveness loss and the ACO algorithm of maximum spectrum consecutiveness. Due to the computing power of the control layer in the software-defined network, the routing algorithm avoids the frequent link-state information between routers. Based on the effect of the spectrum consecutiveness loss on the pheromone in the ACO, the path and spectrum of the minimal impact on the network are selected for the service request. The proposed algorithms have been compared with other algorithms. The results show that the proposed algorithms can reduce the blocking rate by at least 5% and perform better in spectrum efficiency. Moreover, the proposed algorithms can effectively decrease spectrum fragmentation and enhance available spectrum consecutiveness.

VizieR Online Data Catalog: Herschel SPIRE/FTS 194-671um survey of GOALS LIRGs (Lu+, 2017)

NASA Astrophysics Data System (ADS)

Lu, N.; Zhao, Y.; Diaz-Santos, T.; Xu, C. K.; Gao, Y.; Armus, L.; Isaak, K. G.; Mazzarella, J. M.; van der Werf, P. P.; Appleton, P. N.; Charmandaris, V.; Evans, A. S.; Howell, J.; Iwasawa, K.; Leech, J.; Lord, S.; Petric, A. O.; Privon, G. C.; Sanders, D. B.; Schulz, B.; Surace, J. A.

2017-06-01

In this paper we presented a Herschel SPIRE/FTS 194-671um spectroscopic survey of 121 galaxies belonging to a complete, flux-limited sample of 123 luminous infrared galaxies (LIRGs) down to a total IR flux of 6.5x10-13W/m2, selected from the Great Observatories All-Sky LIRG Survey (GOALS; Armus+ 2009PASP..121..559A). All 123 observed targets are listed in Table 1. (3 data files).

Town and Gown Differences Among the 100 Largest Medical Groups in the United States.

PubMed

Welch, W Pete; Bindman, Andrew B

2016-07-01

The authors undertook a study to determine whether large academic and community-based medical groups differ in terms of their financial stake in Medicare Advantage or Medicare Accountable Care Organizations (ACOs) and whether their participation in these alternative payment models is related to their size, specialty mix, and Medicare physician market share in their local area. The authors used the 2013 Medicare Data on Provider Practice and Specialty database and a national database of ACOs to conduct a cross-sectional descriptive study of the 100 largest medical groups in the United States. Medical groups were categorized as academic or community based on matches of their name with a list of U.S. medical schools or the results of a series of Internet search procedures. Sixty-eight of the 100 largest groups were academic, and 32 were community based. On average, community-based groups had more than twice the percentage of primary care physicians as academic groups (mean, 38.4%; 95% CI, 34.7%-42.0%; vs. 18.3%; 95% CI, 17.0%-19.6%). Community groups were significantly (P < .001) more likely than academic groups to have a financial stake in a Medicare ACO or Medicare Advantage plan, but this difference was no longer significant when the percentage of primary care physicians in the group was added to the model. The specialty mix within academic medical groups may hinder their ability to transform themselves into organizations that can manage the financial responsibilities of caring for a patient population through a Medicare ACO or Medicare Advantage.

Academic Medical Centers Forming Accountable Care Organizations and Partnering With Community Providers: The Experience of the Johns Hopkins Medicine Alliance for Patients.

PubMed

Berkowitz, Scott A; Ishii, Lisa; Schulz, John; Poffenroth, Matt

2016-03-01

Academic medical centers (AMCs)--which include teaching hospital(s) and additional care delivery entities--that form accountable care organizations (ACOs) must decide whether to partner with other provider entities, such as community practices. Indeed, 67% (33/49) of AMC ACOs through the Medicare Shared Savings Program through 2014 are believed to include an outside community practice. There are opportunities for both the AMC and the community partners in pursuing such relationships, including possible alignment around shared goals and adding ACO beneficiaries. To create the Johns Hopkins Medicine Alliance for Patients (JMAP), in January 2014, Johns Hopkins Medicine chose to partner with two community primary care groups and one cardiology practice to support clinical integration while adding approximately 60 providers and 5,000 Medicare beneficiaries. The principal initial interventions within JMAP included care coordination for high-risk beneficiaries and later, in 2014, generating dashboards of ACO quality measures to facilitate quality improvement and early efforts at incorporating clinical pathways and Choosing Wisely recommendations. Additional interventions began in 2015.The principal initial challenges JMAP faced were data integration, generation of quality measure reports among disparate electronic medical records, receiving and then analyzing claims data, and seeking to achieve provider engagement; all these affected timely deployment of the early interventions. JMAP also created three regional advisory councils as a forum promoting engagement of local leadership. Network strategies among AMCs, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.

Assessing anaerobic co-digestion of pig manure with agroindustrial wastes: the link between environmental impacts and operational parameters.

PubMed

Rodriguez-Verde, Ivan; Regueiro, Leticia; Carballa, Marta; Hospido, Almudena; Lema, Juan M

2014-11-01

Anaerobic co-digestion (AcoD) is established as a techno-economic profitable process by incrementing biogas yield (increased cost-efficiency) and improving the nutrient balance (better quality digestate) in comparison to mono-digestion of livestock wastes. However, few data are available on the environmental consequences of AcoD and most of them are mainly related to the use of energy crops as co-substrates. This work analysed the environmental impact of the AcoD of pig manure (PM) with several agroindustrial wastes (molasses, fish, biodiesel and vinasses residues) using life cycle assessment (LCA) methodology. For comparative purposes, mono digestion of PM has also been evaluated. Four out of six selected categories (acidification, eutrophication, global warming and photochemical oxidation potentials) showed environmental impacts in all the scenarios assessed, whereas the other two (abiotic depletion and ozone layer depletion potentials) showed environmental credits, remarking the benefit of replacing fossil fuels by biogas. This was also confirmed by the sensitivity analysis applied to the PM quality (i.e. organic matter content) and the avoided energy source demonstrating the importance of the energy recovery step. The influence of the type of co-substrate could not be discerned; however, a link between the environmental performance and the hydraulic retention time, the organic loading rate and the nutrient content in the digestate could be established. Therefore, LCA results were successfully correlated to process variables involved in AcoD, going a step further in the combination of techno-economic and environmental feasibilities. Copyright © 2014 Elsevier B.V. All rights reserved.

Characterization of differential ripening pattern in association with ethylene biosynthesis in the fruits of five naturally occurring banana cultivars and detection of a GCC-box-specific DNA-binding protein.

PubMed

Choudhury, Swarup Roy; Roy, Sujit; Saha, Progya Paramita; Singh, Sanjay Kumar; Sengupta, Dibyendu N

2008-07-01

MA-ACS1 and MA-ACO1 are the two major ripening genes in banana and play crucial role in the regulation of ethylene production during ripening. Here, we report a comparative ripening pattern in five different naturally occurring banana cultivars namely Cavendish (AAA), Rasthali (AAB), Kanthali (AB), Poovan (AAB) and Monthan (ABB), which have distinct genome composition. We found a distinct variation in the climacteric ethylene production and in-vivo ACC oxidase activity level during the ripening stages in the five cultivars. We identified the cDNAs for MA-ACS1 and MA-ACO1 from the five cultivars and studied the transcript accumulation patterns of the two genes, which correlated well with the differential timing in the expression of these two genes during ripening. The GCC-box is one of the ethylene-responsive elements (EREs) found in the promoters of many ethylene-inducible genes. We have identified a GCC-box motif (putative ERE) in the promoters of MA-ACS1 and MA-ACO1 in banana cultivars. DNA-protein interaction studies revealed the presence of a GCC-box-specific DNA-binding activity in the fruit nuclear extract and such DNA-binding activity was enhanced following ethylene treatment. South-Western blotting revealed a 25-kDa nuclear protein that binds specifically to GCC-box DNA in the climacteric banana fruit. Together, these results indicate the probable involvement of the GCC-box motif as the cis-acting ERE in the regulation of MA-ACS1 and MA-ACO1 during ripening in banana fruits via binding of specific ERE-binding protein.

Health care delivery system reform: accountable care organizations.

PubMed

Dove, James T; Weaver, W Douglas; Lewin, Jack

2009-09-08

Health care reform is moving forward at a frantic pace. There have been 3 documents released from the Senate Finance Committee and proposed legislation from the Senate HELP Committee and the House of Representatives Tri-Committee on Health Reform. The push for legislative action has not been sidetracked by the economic conditions. Integrated health care delivery is the current favored approach to aligning resource use and cost. Accountable care organizations (ACOs), a concept included in health care reform legislation before both the House and Senate, propose to translate the efficiencies and lessons learned from large integrated systems and apply them to nonintegrated practices. The ACO design could be real or virtual integration of local delivery providers. This new structure is complicated, and clinicians, patients, and payers should have input regarding the design and function of it. Because most of health care is delivered in the ambulatory setting, it remains to be determined whether the ACOs are best developed in parallel among physician practices and hospitals or as partnerships between hospitals and physicians. Many are concerned that hospital-led ACOs will force physician employment by hospitals with possible unintended negative consequences for physicians, hospitals, and patients. Patients, physicians, other providers, and payers are in a better position to guide the redesign of the health care delivery system than government agencies, policy organizations, or elected officials, no matter how well intended. We strongly believe-and ACC has proclaimed-that change in health care delivery must be accomplished with patients and physicians at the table.

Antioxidant nutrients in plasma of Japanese patients with chronic obstructive pulmonary disease, asthma-COPD overlap syndrome and bronchial asthma.

PubMed

Kodama, Yuzo; Kishimoto, Yuki; Muramatsu, Yoko; Tatebe, Junko; Yamamoto, Yu; Hirota, Nao; Itoigawa, Yukinari; Atsuta, Ryo; Koike, Kengo; Sato, Tadashi; Aizawa, Koich; Takahashi, Kazuhisa; Morita, Toshisuke; Homma, Sakae; Seyama, Kuniaki; Ishigami, Akihito

2017-11-01

Few studies to date have investigated the antioxidant nutrients such as vitamin C (ascorbic acid), vitamin E (α-tocopherol), retinol and carotenoids in plasma from patients with pulmonary disease in Japan. To clarify the role of antioxidant nutrients such as vitamin C, vitamin E, retinol and various carotenoids in plasma of Japanese patients with chronic obstructive lung diseases (COPD), asthma-COPD overlap syndrome (ACOS) and/or bronchial asthma (BA), we compared to healthy elderly controls. Ascorbic acid (AA), carotenoids (lutein, zeaxanthin, β-cryptoxanthin, α-carotene, β-carotene and lycopene), retinol and α-tocopherol levels in plasma were determined by using a high performance liquid chromatography. Reduced glutathione (GSH), oxidised glutathione (GSSG) in whole blood and urinary 8-OHdG were also determined. Plasma AA level of COPD subjects was significantly lower than that of healthy elderly people. Conversely, ACOS and BA subjects showed no significant difference from healthy elderly people. Moreover, plasma lycopene and total carotenoid levels and GSH content in blood were significantly lower in COPD subjects than these in healthy elderly people. However, other redox markers such as GSSG, GSH/GSSG ratio and urinary 8-OHdG found no significant differences between COPD, ACOS and BA compared to healthy elderly people. These results suggested that COPD of Japanese patients may develop partly because of oxidative stress derived from a shortage of antioxidant nutrients, especially of AA and lycopene, as well as GSH while this may not be the case in both ACOS and BA. © 2016 John Wiley & Sons Ltd.

Specializing in accountability: strategies to prepare a subspecialty workforce for care delivery redesign.

PubMed

Nambudiri, Vinod E; Sober, Arthur J; Kimball, Alexa B

2013-12-01

Accountable care organizations (ACOs) emphasize cost-effectiveness, rewarding health care systems that provide the highest-quality care delivered by the most cost-efficient providers. Transitioning to an ACO model introduces distinct challenges for specialist physicians within academic health centers. As skin diseases constitute a large number of visits to primary care providers and specialists and place a significant financial burden on the health care system, the authors sought to identify specialist-driven strategies for cost-effective, patient-centered care delivery in dermatology. As part of the Massachusetts General Hospital's transition to an ACO, the Department of Dermatology in 2012 employed a team-based strategy to identify measures aimed at curbing the rate of rise in per-patient medical expense. Their approach may represent a methodological framework that translates to other specialist workforces. The authors identified four action areas: (1) rational, cost-conscious prescribing within therapeutic classes; (2) enhanced management of urgent access and follow-up appointment scheduling; (3) procedure standardization; and (4) interpractitioner variability assessment. They describe the practices implemented in these action areas, which include a mix of changes in both clinical decision making and operational practice and are aimed at improving overall quality and value of care delivery. They also offer recommendations for other specialty departments Involving specialist physicians in care delivery redesign efforts provides unique insights to enhance quality, cost-effectiveness, and efficiency of care delivery. With increasing emphasis on ACO models, further specialist-driven strategies for ensuring patient-centered delivery warrant development alongside other delivery reform efforts.

Ant colony algorithm for clustering in portfolio optimization

NASA Astrophysics Data System (ADS)

Subekti, R.; Sari, E. R.; Kusumawati, R.

2018-03-01

This research aims to describe portfolio optimization using clustering methods with ant colony approach. Two stock portfolios of LQ45 Indonesia is proposed based on the cluster results obtained from ant colony optimization (ACO). The first portfolio consists of assets with ant colony displacement opportunities beyond the defined probability limits of the researcher, where the weight of each asset is determined by mean-variance method. The second portfolio consists of two assets with the assumption that each asset is a cluster formed from ACO. The first portfolio has a better performance compared to the second portfolio seen from the Sharpe index.

Expression patterns of ethylene biosynthesis genes from bananas during fruit ripening and in relationship with finger drop

PubMed Central

Hubert, Olivier; Mbéguié-A-Mbéguié, Didier

2012-01-01

Background and aims Banana finger drop is defined as dislodgement of individual fruits from the hand at the pedicel rupture area. For some banana varieties, this is a major feature of the ripening process, in addition to ethylene production and sugar metabolism. The few studies devoted to assessing the physiological and molecular basis of this process revealed (i) the similarity between this process and softening, (ii) the early onset of related molecular events, between the first and fourth day after ripening induction, and (iii) the putative involvement of ethylene as a regulatory factor. This study was conducted with the aim of identifying, through a candidate gene approach, a quality-related marker that could be used as a tool in breeding programmes. Here we examined the relationship between ripening ethylene biosynthesis (EB) and finger drop in order to gain further insight into the upstream regulatory steps of the banana finger drop process and to identify putative related candidate genes. Methods Postharvest ripening of green banana fruit was induced by acetylene treatment and fruit taken at 1–4 days after ripening induction, and total RNA extracted from the median area [control zone (CZ)] and the pedicel rupture area [drop zone (DZ)] of peel tissue. Then the expression patterns of EB genes (MaACO1, MaACO2, MaACS1, MaACS2, MaACS3 and MaACS4) were comparatively examined in CZ and DZ via real-time quantitative polymerase chain reaction. Principal results Differential expression of EB gene was observed in CZ and DZ during the postharvest period examined in this study. MaACO1, MaACS2 and MaACS1 were more highly induced in DZ than in the control, while a slight induction of the MaACS4 gene was observed. No marked differences between the two zones were observed for the MaACO2 gene. Conclusions The finger drop process enhanced EB gene expression including developmental- and ripening-induced genes (MaACO1), specific ripening-induced genes (MaACS1) and wound

Detecting metal-poor gas accretion in the star-forming dwarf galaxies UM 461 and Mrk 600

NASA Astrophysics Data System (ADS)

Lagos, P.; Scott, T. C.; Nigoche-Netro, A.; Demarco, R.; Humphrey, A.; Papaderos, P.

2018-06-01

Using VIsible MultiObject Spectrograph (VIMOS)-integral field unit (IFU) observations, we study the interstellar medium (ISM) of two star-forming dwarf galaxies, UM 461 and Mrk 600. Our aim was to search for the existence of metallicity inhomogeneities that might arise from infall of nearly pristine gas feeding ongoing localized star formation. The IFU data allowed us to study the impact of external gas accretion on the chemical evolution as well as the ionized gas kinematics and morphologies of these galaxies. Both systems show signs of morphological distortions, including cometary-like morphologies. We analysed the spatial variation of 12 + log(O/H) abundances within both galaxies using the direct method (Te), the widely applied HII-CHI-mistry code, as well as by employing different standard calibrations. For UM 461, our results show that the ISM is fairly well mixed, at large scales; however, we find an off-centre and low-metallicity region with 12 + log(O/H) < 7.6 in the SW part of the brightest H II region, using the direct method. This result is consistent with the recent infall of a metal-poor H I cloud into the region now exhibiting the lowest metallicity, which also displays localized perturbed neutral and ionized gas kinematics. Mrk 600 in contrast, appears to be chemically homogeneous on both large and small scales. The intrinsic differences in the spatially resolved properties of the ISM in our analysed galaxies are consistent with these systems being at different evolutionary stages.

Generation of narrow energy spread ion beams via collisionless shock waves using ultra-intense 1 um wavelength laser systems

NASA Astrophysics Data System (ADS)

Albert, Felicie; Pak, A.; Kerr, S.; Lemos, N.; Link, A.; Patel, P.; Pollock, B. B.; Haberberger, D.; Froula, D.; Gauthier, M.; Glenzer, S. H.; Longman, A.; Manzoor, L.; Fedosejevs, R.; Tochitsky, S.; Joshi, C.; Fiuza, F.

2017-10-01

In this work, we report on electrostatic collisionless shock wave acceleration experiments that produced proton beams with peak energies between 10-17.5 MeV, with narrow energy spreads between Δ E / E of 10-20%, and with a total number of protons in these peaks of 1e7-1e8. These beams of ions were created by driving an electrostatic collisionless shock wave in a tailored near critical density plasma target using the ultra-intense ps duration Titan laser that operates at a wavelength of 1 um. The near critical density target was produced through the ablation of an initially 0.5 um thick Mylar foil with a separate low intensity laser. A narrow energy spread distribution of carbon / oxygen ions with a similar velocity to the accelerated proton distribution, consistent with the reflection and acceleration of ions from an electrostatic field, was also observed. This work was supported by Lawrence Livermore National Laboratory's Laboratory Directed Research and Development program under project 15-LW-095, and the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA2734.

High-speed 1.3 -1.55 um InGaAs/InP PIN photodetector for microwave photonics

NASA Astrophysics Data System (ADS)

Kozyreva, O. A.; Solov'ev, Y. V.; Polukhin, I. S.; Mikhailov, A. K.; Mikhailovskiy, G. A.; Odnoblyudov, M. A.; Gareev, E. Z.; Kolodeznyi, E. S.; Novikov, I. I.; Karachinsky, L. Ya; Egorov, A. Yu; Bougrov, V. E.

2017-11-01

We have fabricated the 1.3-1.55 um PIN photodetector based on InGaAs/InP heterostructure. Measurement results of optical and electrical characteristics of PIN photodetector chip were the following: photoconductivity at 1550 nm was 0.65 A/W and internal capacitance was 0.025 pF. Microwave model of photodetector was developed and verified by measurements of scattering matrix. The implementation of broadband (up to 20 GHz) hybrid integrated matching and biasing circuit for high-speed photodetector is presented.

Uma Visão do Universo Segundo um Grupo de Alunos do Ensino Médio de São Paulo

NASA Astrophysics Data System (ADS)

Elias, D. S.; Araújo, M.; Amaral, L. H.; Voelzke, M. R.; Araújo, M.

2005-08-01

A astronomia, embora seja uma ciência popular, com inúmeras descobertas de interesse público, ainda é apresentada desconsiderando-se os aspectos históricos e científicos relacionados ao seu desenvolvimento, sendo geralmente veiculada nos meios de comunicação de maneira pouco esclarecedora e não raro com imprecisões. Neste trabalho analisou-se a concepção de um grupo de estudantes de Ensino Médio sobre conceitos de astronomia, visando identificar sua visão de mundo a respeito do Universo, envolvendo idéias sobre espaço e tempo. Para issso, foi aplicado um questionário em três escolas da grande São Paulo em um espaço amostral de 270 alunos. Constatou-se que, embora o ensino de astronomia esteja previsto nos PCNEM, os resultados obtidos na pesquisa mostram que há grande deficiência no conhecimento dos temas investigados. Nesse sentido, verificou-se que apenas 20% dos alunos eram capazes de relacionar a sucessão das semanas com as fases da lua, enquanto 28% associaram as estações do ano à inclinação do eixo de rotação da Terra. Por outro lado, somente 23% dos alunos tinham noções das distâncias entre os objetos celestes próximos da Terra e 56% conseguiram relacionar o Big Bang com a origem do Universo. Finalmente, constatou-se que 37% reconheciam o ano-luz como uma unidade de distância e 60% reconheciam o Sol como sendo uma estrela. Apesar de 60% dos alunos indicarem que a escola é a principal fonte para aquisição dos conhecimentos de astronomia, conclui-se que seus conceitos nessa área ainda são inadequados, havendo necessidade de ampliação e aprimoramento da abordagem desses conteúdos nos ambientes escolares.

Elucidation of rice rhizosphere metagenome in relation to methane and nitrogen metabolism under elevated carbon dioxide and temperature using whole genome metagenomic approach.

PubMed

Bhattacharyya, P; Roy, K S; Das, M; Ray, S; Balachandar, D; Karthikeyan, S; Nayak, A K; Mohapatra, T

2016-01-15

Carbon (C) and nitrogen (N) mineralization is one of the key processes of biogeochemical cycling in terrestrial ecosystem in general and rice ecology in particular. Rice rhizosphere is a rich niche of microbial diversity influenced by change in atmospheric temperature and concentration of carbon dioxide (CO2). Structural changes in microbial communities in rhizosphere influence the nutrient cycling. In the present study, the bacterial diversity and population dynamics were studied under ambient CO2 (a-CO2) and elevated CO2+temperature (e-CO2T) in lowland rice rhizosphere using whole genome metagenomic approach. The whole genome metagenomic sequence data of lowland rice exhibited the dominance of bacterial communities including Proteobacteria, Firmicutes, Acidobacteria, Actinobacteria and Planctomycetes. Interestingly, four genera related to methane production namely, Methanobacterium, Methanosphaera, Methanothermus and Methanothermococcus were absent in a-CO2 but noticed under e-CO2T. The acetoclastic pathway was found as the predominant pathway for methanogenesis, whereas, the serine pathway was found as the principal metabolic pathway for CH4 oxidation in lowland rice. The abundances of reads of enzymes in the acetoclastic methanogenesis pathway and serine pathways of methanotrophy were much higher in e-CO2T (328 and 182, respectively) as compared with a-CO2 (118 and 98, respectively). Rice rhizosphere showed higher structural diversities and functional activities in relation to N metabolism involving nitrogen fixation, assimilatory and dissimilatory nitrate reduction and denitrification under e-CO2T than that of a-CO2. Among the three pathways of N metabolism, dissimilarity pathways were predominant in lowland rice rhizosphere and more so under e-CO2T. Consequently, under e-CO2T, CH4 emission, microbial biomass nitrogen (MBN) and dehydrogenase activities were 45%, 20% and 35% higher than a-CO2, respectively. Holistically, a high bacterial diversity and

Cerebral vasomotor reactivity: steady-state versus transient changes in carbon dioxide tension.

PubMed

Brothers, R Matthew; Lucas, Rebekah A I; Zhu, Yong-Sheng; Crandall, Craig G; Zhang, Rong

2014-11-01

Cerebral vasomotor reactivity (CVMR) to changes in arterial carbon dioxide tension (P aCO 2) is assessed during steady-state or transient changes in P aCO 2. This study tested the following two hypotheses: (i) that CVMR during steady-state changes differs from that during transient changes in P aCO 2; and (ii) that CVMR during rebreathing-induced hypercapnia would be blunted when preceded by a period of hyperventilation. For each hypothesis, end-tidal carbon dioxide tension (P ET , CO 2) middle cerebral artery blood velocity (CBFV), cerebrovascular conductance index (CVCI; CBFV/mean arterial pressure) and CVMR (slope of the linear regression between changes in CBFV and CVCI versus P ET , CO 2) were assessed in eight individuals. To address the first hypothesis, measurements were made during the following two conditions (randomized): (i) steady-state increases in P ET , CO 2 of 5 and 10 Torr above baseline; and (ii) rebreathing-induced transient breath-by-breath increases in P ET , CO 2. The linear regression for CBFV versus P ET , CO 2 (P = 0.65) and CVCI versus P ET , CO 2 (P = 0.44) was similar between methods; however, individual variability in CBFV or CVCI responses existed among subjects. To address the second hypothesis, the same measurements were made during the following two conditions (randomized): (i) immediately following a brief period of hypocapnia induced by hyperventilation for 1 min followed by rebreathing; and (ii) during rebreathing only. The slope of the linear regression for CBFV versus P ET , CO 2 (P < 0.01) and CVCI versus P ET , CO 2 (P < 0.01) was reduced during hyperventilation plus rebreathing relative to rebreathing only. These results indicate that cerebral vasomotor reactivity to changes in P aCO 2 is similar regardless of the employed methodology to induce changes in P aCO 2 and that hyperventilation-induced hypocapnia attenuates the cerebral vasodilatory responses during a subsequent period of rebreathing

Urban Growth Modeling Using Cellular Automata with Multi-Temporal Remote Sensing Images Calibrated by the Artificial Bee Colony Optimization Algorithm.

PubMed

Naghibi, Fereydoun; Delavar, Mahmoud Reza; Pijanowski, Bryan

2016-12-14

Cellular Automata (CA) is one of the most common techniques used to simulate the urbanization process. CA-based urban models use transition rules to deliver spatial patterns of urban growth and urban dynamics over time. Determining the optimum transition rules of the CA is a critical step because of the heterogeneity and nonlinearities existing among urban growth driving forces. Recently, new CA models integrated with optimization methods based on swarm intelligence algorithms were proposed to overcome this drawback. The Artificial Bee Colony (ABC) algorithm is an advanced meta-heuristic swarm intelligence-based algorithm. Here, we propose a novel CA-based urban change model that uses the ABC algorithm to extract optimum transition rules. We applied the proposed ABC-CA model to simulate future urban growth in Urmia (Iran) with multi-temporal Landsat images from 1997, 2006 and 2015. Validation of the simulation results was made through statistical methods such as overall accuracy, the figure of merit and total operating characteristics (TOC). Additionally, we calibrated the CA model by ant colony optimization (ACO) to assess the performance of our proposed model versus similar swarm intelligence algorithm methods. We showed that the overall accuracy and the figure of merit of the ABC-CA model are 90.1% and 51.7%, which are 2.9% and 8.8% higher than those of the ACO-CA model, respectively. Moreover, the allocation disagreement of the simulation results for the ABC-CA model is 9.9%, which is 2.9% less than that of the ACO-CA model. Finally, the ABC-CA model also outperforms the ACO-CA model with fewer quantity and allocation errors and slightly more hits.

Urban Growth Modeling Using Cellular Automata with Multi-Temporal Remote Sensing Images Calibrated by the Artificial Bee Colony Optimization Algorithm

PubMed Central

Naghibi, Fereydoun; Delavar, Mahmoud Reza; Pijanowski, Bryan

2016-01-01

Cellular Automata (CA) is one of the most common techniques used to simulate the urbanization process. CA-based urban models use transition rules to deliver spatial patterns of urban growth and urban dynamics over time. Determining the optimum transition rules of the CA is a critical step because of the heterogeneity and nonlinearities existing among urban growth driving forces. Recently, new CA models integrated with optimization methods based on swarm intelligence algorithms were proposed to overcome this drawback. The Artificial Bee Colony (ABC) algorithm is an advanced meta-heuristic swarm intelligence-based algorithm. Here, we propose a novel CA-based urban change model that uses the ABC algorithm to extract optimum transition rules. We applied the proposed ABC-CA model to simulate future urban growth in Urmia (Iran) with multi-temporal Landsat images from 1997, 2006 and 2015. Validation of the simulation results was made through statistical methods such as overall accuracy, the figure of merit and total operating characteristics (TOC). Additionally, we calibrated the CA model by ant colony optimization (ACO) to assess the performance of our proposed model versus similar swarm intelligence algorithm methods. We showed that the overall accuracy and the figure of merit of the ABC-CA model are 90.1% and 51.7%, which are 2.9% and 8.8% higher than those of the ACO-CA model, respectively. Moreover, the allocation disagreement of the simulation results for the ABC-CA model is 9.9%, which is 2.9% less than that of the ACO-CA model. Finally, the ABC-CA model also outperforms the ACO-CA model with fewer quantity and allocation errors and slightly more hits. PMID:27983633

Risk factors and consequences of unexpected trapping for ruptured anterior communicating artery aneurysms

PubMed Central

Fukuda, Hitoshi; Iwasaki, Koichi; Murao, Kenichi; Yamagata, Sen; Lo, Benjamin W.Y.; Macdonald, R. Loch

2014-01-01

Background: While clipping cerebral aneurysms at the neck is optimal, in some cases this is not possible and other strategies are necessary. The purpose of this study was to describe the incidence, risk factors, and outcomes for inability to clip reconstruct ruptured anterior communicating artery (ACoA) aneurysms. Methods: Of the 70 cases of ruptured ACoA aneurysms between January 2006 and December 2013, our institutional experience revealed four cases of small ACoA aneurysms that had been considered clippable prior to operation but required trapping. When a unilateral A2 segment of anterior cerebral artery (ACA) was compromised by trapping, revascularization was performed by bypass surgery. Clinical presentation, angiographic characteristics, operative approach, intraoperative findings, and treatment outcomes were assessed. Results: Very small aneurysm under 3 mm was a risk factor for unexpected trapping. The reason for unexpected trapping was laceration of the aneurysmal neck in two cases, and lack of clippaple component due to disintegration of entire aneurysmal wall at the time of rupture in the others. Aneurysms with bilateral A1 were treated with sole trapping through pterional approach in two cases. The other two cases had hypoplastic unilateral A1 segment of ACA and were treated with combination of aneurysm trapping and revascularization of A2 segment of ACA through interhemispheric approach. No patients had new cerebral infarctions of cortical ACA territory from surgery. Cognitive dysfunction was observed in three cases, but all patients became independent at 12-month follow up. Conclusions: Unexpected trapping was performed when ruptured ACoA aneurysms were unclippable. Trapping with or without bypass can result in reasonable outcomes, with acceptable risk of cognitive dysfunction. PMID:25101201

Applying Organizational Learning Research to Accountable Care Organizations.

PubMed

Nembhard, Ingrid M; Tucker, Anita L

2016-12-01

To accomplish the goal of improving quality of care while simultaneously reducing cost, Accountable Care Organizations (ACOs) need to find new and better ways of providing health care to populations of patients. This requires implementing best practices and improving collaboration across the multiple entities involved in care delivery, including patients. In this article, we discuss seven lessons from the organizational learning literature that can help ACOs overcome the inherent challenges of learning how to work together in radically new ways. The lessons involve setting expectations, creating a supportive culture, and structuring the improvement efforts. For example, with regard to setting expectations, framing the changes as learning experiences rather than as implementation projects encourages the teams to utilize helpful activities, such as dry runs and pilot tests. It is also important to create an organizational culture where employees feel safe pointing out improvement opportunities and experimenting with new ways of working. With regard to structure, stable, cross-functional teams provide a powerful building block for effective improvement efforts. The article concludes by outlining opportunities for future research on organizational learning in ACOs. © The Author(s) 2016.

An Ant Colony Optimization Based Feature Selection for Web Page Classification

PubMed Central

2014-01-01

The increased popularity of the web has caused the inclusion of huge amount of information to the web, and as a result of this explosive information growth, automated web page classification systems are needed to improve search engines' performance. Web pages have a large number of features such as HTML/XML tags, URLs, hyperlinks, and text contents that should be considered during an automated classification process. The aim of this study is to reduce the number of features to be used to improve runtime and accuracy of the classification of web pages. In this study, we used an ant colony optimization (ACO) algorithm to select the best features, and then we applied the well-known C4.5, naive Bayes, and k nearest neighbor classifiers to assign class labels to web pages. We used the WebKB and Conference datasets in our experiments, and we showed that using the ACO for feature selection improves both accuracy and runtime performance of classification. We also showed that the proposed ACO based algorithm can select better features with respect to the well-known information gain and chi square feature selection methods. PMID:25136678

An ant colony optimization based feature selection for web page classification.

PubMed

Saraç, Esra; Özel, Selma Ayşe

2014-01-01

The increased popularity of the web has caused the inclusion of huge amount of information to the web, and as a result of this explosive information growth, automated web page classification systems are needed to improve search engines' performance. Web pages have a large number of features such as HTML/XML tags, URLs, hyperlinks, and text contents that should be considered during an automated classification process. The aim of this study is to reduce the number of features to be used to improve runtime and accuracy of the classification of web pages. In this study, we used an ant colony optimization (ACO) algorithm to select the best features, and then we applied the well-known C4.5, naive Bayes, and k nearest neighbor classifiers to assign class labels to web pages. We used the WebKB and Conference datasets in our experiments, and we showed that using the ACO for feature selection improves both accuracy and runtime performance of classification. We also showed that the proposed ACO based algorithm can select better features with respect to the well-known information gain and chi square feature selection methods.

Image Edge Tracking via Ant Colony Optimization

NASA Astrophysics Data System (ADS)

Li, Ruowei; Wu, Hongkun; Liu, Shilong; Rahman, M. A.; Liu, Sanchi; Kwok, Ngai Ming

2018-04-01

A good edge plot should use continuous thin lines to describe the complete contour of the captured object. However, the detection of weak edges is a challenging task because of the associated low pixel intensities. Ant Colony Optimization (ACO) has been employed by many researchers to address this problem. The algorithm is a meta-heuristic method developed by mimicking the natural behaviour of ants. It uses iterative searches to find the optimal solution that cannot be found via traditional optimization approaches. In this work, ACO is employed to track and repair broken edges obtained via conventional Sobel edge detector to produced a result with more connected edges.

Achieving Population Health in Accountable Care Organizations

PubMed Central

Walker, Deborah Klein

2013-01-01

Although “population health” is one of the Institute for Healthcare Improvement’s Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as “panel” management seems to be the default definition, we called for a broader “community health” definition that could improve relationships between clinical delivery and public health systems and health outcomes for communities. We discussed this broader definition and offered recommendations for linking ACOs with the public health system toward improving health for patients and their communities. PMID:23678910

Rupture of a non-traumatic anterior communicating artery aneurysm: Does location of aneurysm associate with functional independence following post-acute in-patient neurorehabilitation?

PubMed

Stabel, Henriette Holm; Pedersen, Asger Roer; Johnsen, Søren Paaske; Nielsen, Jørgen Feldbæk

2017-12-01

Patients with non-traumatic rupture of an aneurysm located at the anterior communicating artery (ACoA) often experience cognitive disabilities. It is unknown whether location of aneurysm also affects the possibility for improvement in functional independence compared to patients with an aneurysmal subarachnoid hemorrhage (a-SAH) located elsewhere. The aim was to explore the association between location of aneurysm (ACoA versus other) and level of functional independence, measured by Functional Independence Measure (FIM), at discharge from rehabilitation. Additionally, age and FIM at admission were explored. Historical cohort study among 107 patients with a-SAH based on data from a clinical database and a population-based register. Data were analyzed using multivariable logistic regression. Patients with ACoA were admitted with poorer cognitive FIM (median 6 (IQR 5-14) compared to patients with aneurysms located elsewhere (median 12 (IQR 6-23) (p = 0.0129); no difference at discharge. No association between aneurysm location and functional independence was observed. Higher age was associated with poorer outcome in bowel management OR 0.54 (95% CI 0.31-0.92), bladder management OR 0.59 (95% CI 0.35-0.98), comprehension OR 0.53 (95% CI 0.30-0.94), and memory OR 0.48 (95% CI 0.25-0.93). Overall, FIM at admission was associated with functional independence at discharge with the exception of stair walking and bladder management which did not reach statistical significance. ACoA was not associated with poorer level of functional independence compared to patients with a-SAH located elsewhere. Higher age was associated with poorer outcome in continence, comprehension, and memory, whereas higher FIM was associated with better functional independence across items at discharge.

Negative urgency and ventromedial prefrontal cortex responses to alcohol cues: FMRI evidence of emotion-based impulsivity.

PubMed

Cyders, Melissa A; Dzemidzic, Mario; Eiler, William J; Coskunpinar, Ayca; Karyadi, Kenny; Kareken, David A

2014-02-01

Recent research has highlighted the role of emotion-based impulsivity (negative and positive urgency personality traits) for alcohol use and abuse, but has yet to examine how these personality traits interact with the brain's motivational systems. Using functional magnetic resonance imaging (fMRI), we tested whether urgency traits and mood induction affected medial prefrontal responses to alcohol odors (AcO). Twenty-seven social drinkers (mean age = 25.2, 14 males) had 6 fMRI scans while viewing negative, neutral, or positive mood images (3 mood conditions) during intermittent exposure to AcO and appetitive control (AppCo) aromas. Voxel-wise analyses (p < 0.001) confirmed [AcO > AppCo] activation throughout medial prefrontal cortex (mPFC) and ventromedial PFC (vmPFC) regions. Extracted from a priori mPFC and vmPFC regions and analyzed in Odor (AcO, AppCo) × Mood factorial models, AcO activation was greater than AppCo in left vmPFC (p < 0.001), left mPFC (p = 0.002), and right vmPFC (p = 0.01) regions. Mood did not interact significantly with activation, but the covariate of trait negative urgency accounted for significant variance in left vmPFC (p = 0.01) and right vmPFC (p = 0.01) [AcO > AppCo] activation. Negative urgency also mediated the relationship between vmPFC activation and both (i) subjective craving and (ii) problematic drinking. The trait of negative urgency is associated with neural responses to alcohol cues in the vmPFC, a region involved in reward value and emotion-guided decision-making. This suggests that negative urgency might alter subjective craving and brain regions involved in coding reward value. Copyright © 2013 by the Research Society on Alcoholism.

Real time expression of ACC oxidase and PR-protein genes mediated by Methylobacterium spp. in tomato plants challenged with Xanthomonas campestris pv. vesicatoria.

PubMed

Yim, W J; Kim, K Y; Lee, Y W; Sundaram, S P; Lee, Y; Sa, T M

2014-07-15

Biotic stress like pathogenic infection increases ethylene biosynthesis in plants and ethylene inhibitors are known to alleviate the severity of plant disease incidence. This study aimed to reduce the bacterial spot disease incidence in tomato plants caused by Xanthomonas campestris pv. vesicatoria (XCV) by modulating stress ethylene with 1-aminocyclopropane-1-carboxylate (ACC) deaminase activity of Methylobacterium strains. Under greenhouse condition, Methylobacterium strains inoculated and pathogen challenged tomato plants had low ethylene emission compared to pathogen infected ones. ACC accumulation and ACC oxidase (ACO) activity with ACO related gene expression increased in XCV infected tomato plants over Methylobacterium strains inoculated plants. Among the Methylobacterium spp., CBMB12 resulted lowest ACO related gene expression (1.46 Normalized Fold Expression), whereas CBMB20 had high gene expression (3.42 Normalized Fold Expression) in pathogen challenged tomato. But a significant increase in ACO gene expression (7.09 Normalized Fold Expression) was observed in the bacterial pathogen infected plants. In contrast, Methylobacterium strains enhanced β-1,3-glucanase and phenylalanine ammonia-lyase (PAL) enzyme activities in pathogen challenged tomato plants. The respective increase in β-1,3-glucanase related gene expressions due to CBMB12, CBMB15, and CBMB20 strains were 66.3, 25.5 and 10.4% higher over pathogen infected plants. Similarly, PAL gene expression was high with 0.67 and 0.30 Normalized Fold Expression, in pathogen challenged tomato plants inoculated with CBMB12 and CBMB15 strains. The results suggest that ethylene is a crucial factor in bacterial spot disease incidence and that methylobacteria with ACC deaminase activity can reduce the disease severity with ultimate pathogenesis-related protein increase in tomato. Copyright © 2014 Elsevier GmbH. All rights reserved.

A Critical Analysis of the Utility of Intraoperative Angiography.

PubMed

Ares, William J; Kenmuir, Cynthia L; Panczykowski, David M; Weiner, Gregory M; Jadhav, Ashu P; Jovin, Tudor G; Gross, Bradley A; Jankowitz, Brian T

2018-02-01

Intraoperative digital subtraction angiography (ioDSA) is touted as the gold standard imaging evaluation for aneurysm clip constructs. Candid evaluations of its limitations are sparse. A prospectively collected hospital billing database was queried to identify craniotomies for aneurysm clipping from January 2010 to December 2013. We evaluated the rate of occult residual and parent vessel stenosis determined on follow-up angiography for patients undergoing ioDSA and those not undergoing ioDSA. Comparisons were performed via Fisher exact test, with P < 0.05 considered statistically significant. From our database search, we found 187 patients who underwent ioDSA after aneurysm clipping and an additional 91 patients who did not. Results from ioDSA influenced operative management in 17% of cases. Sixty-four patients with 70 treated aneurysms undergoing ioDSA had postoperative angiography; 7 occult residuals were discovered, yielding a 10% false-negative rate, with 10% of aneurysms showing residual. Occult residuals at the middle cerebral artery bifurcation represented most discovered residuals (6/7). Thirty-two patients with 37 treated aneurysms did not undergo ioDSA and had angiographic follow-up; 24% of patients were found to have residual aneurysms (P = 0.08 compared with patients undergoing ioDSA). Residuals at the anterior communicating artery (ACoA) represented 56% of all residuals, whereas the ACoA represented only 18% of aneurysms clipped. The rate of residuals was significantly higher than that for patients with clipped ACoA aneurysms undergoing ioDSA (P = 0.008). ioDSA influenced management in nearly one fifth of cases. It can be particularly beneficial in detecting residuals for ACoA aneurysms; its benefit was less apparent for middle cerebral artery aneurysms. Copyright © 2017 Elsevier Inc. All rights reserved.

Heat stress differentially modifies ethylene biosynthesis and signaling in pea floral and fruit tissues.

PubMed

Savada, Raghavendra P; Ozga, Jocelyn A; Jayasinghege, Charitha P A; Waduthanthri, Kosala D; Reinecke, Dennis M

2017-10-01

Ethylene biosynthesis is regulated in reproductive tissues in response to heat stress in a manner to optimize resource allocation to pollinated fruits with developing seeds. High temperatures during reproductive development are particularly detrimental to crop fruit/seed production. Ethylene plays vital roles in plant development and abiotic stress responses; however, little is known about ethylene's role in reproductive tissues during development under heat stress. We assessed ethylene biosynthesis and signaling regulation within the reproductive and associated tissues of pea during the developmental phase that sets the stage for fruit-set and seed development under normal and heat-stress conditions. The transcript abundance profiles of PsACS [encode enzymes that convert S-adenosyl-L-methionine to 1-aminocyclopropane-1-carboxylic acid (ACC)] and PsACO (encode enzymes that convert ACC to ethylene), and ethylene evolution were developmentally, environmentally, and tissue-specifically regulated in the floral/fruit/pedicel tissues of pea. Higher transcript abundance of PsACS and PsACO in the ovaries, and PsACO in the pedicels was correlated with higher ethylene evolution and ovary senescence and pedicel abscission in fruits that were not pollinated under control temperature conditions. Under heat-stress conditions, up-regulation of ethylene biosynthesis gene expression in pre-pollinated ovaries was also associated with higher ethylene evolution and lower retention of these fruits. Following successful pollination and ovule fertilization, heat-stress modified PsACS and PsACO transcript profiles in a manner that suppressed ovary ethylene evolution. The normal ethylene burst in the stigma/style and petals following pollination was also suppressed by heat-stress. Transcript abundance profiles of ethylene receptor and signaling-related genes acted as qualitative markers of tissue ethylene signaling events. These data support the hypothesis that ethylene biosynthesis is

Sebacina vermifera Promotes the Growth and Fitness of Nicotiana attenuata by Inhibiting Ethylene Signaling1[W

PubMed Central

Barazani, Oz; von Dahl, Caroline C.; Baldwin, Ian T.

2007-01-01

Sebacina vermifera, a growth-promoting endophytic fungus, significantly increases Nicotiana attenuata's growth but impairs both its herbivore resistance and its accumulation of the costly, jasmonic acid (JA)-regulated defense protein, trypsin proteinase inhibitor (TPI). To determine if the fungi's growth-promoting effects can be attributed to lower TPI-related defense costs, we inoculated transformed N. attenuata plants silenced in their ability to synthesize JA, JA-isoleucine, and TPI by antisense (lipoxygenase 3 [as-lox3] and Thr deaminase [as-td]) and inverted repeat (ir-tpi) expression, and found that inoculation promoted plant growth as in untransformed wild-type plants. Moreover, herbivore-elicited increases in JA and JA-isoleucine concentrations did not differ between inoculated and uninoculated wild-type plants. However, inoculation significantly reduced the morphological effect of 1-aminocyclopropane-1-carboxylic acid on wild-type seedlings in a triple response assay, suggesting that ethylene signaling was impaired. Furthermore, S. vermifera failed to promote the growth of N. attenuata plants transformed to silence ethylene production (1-aminocyclopropane-1-carboxylic acid oxidase [ir-aco]). Inoculating wild-type plants with S. vermifera decreased the ethylene burst elicited by applying Manduca sexta oral secretions to mechanical wounds. Accordingly, oral secretion-elicited transcript levels of the ethylene synthesis genes NaACS3, NaACO1, and NaACO3 in inoculated plants were significantly lower compared to these levels in uninoculated wild-type plants. Inoculation accelerated germination in wild-type seeds; however, uninoculated wild-type seeds germinated as rapidly as inoculated seeds in the presence of the ethylene scrubber KMnO4. In contrast, neither inoculation nor KMnO4 exposure influenced the germination of ir-aco seeds. We conclude that S. vermifera increases plant growth by impairing ethylene production independently of JA signaling and TPI

Changes in the salinity tolerance of sweet pepper plants as affected by nitrogen form and high CO2 concentration.

PubMed

Piñero, María C; Pérez-Jiménez, Margarita; López-Marín, Josefa; Del Amor, Francisco M

2016-08-01

The assimilation and availability of nitrogen in its different forms can significantly affect the response of primary productivity under the current atmospheric alteration and soil degradation. An elevated CO2 concentration (e[CO2]) triggers changes in the efficiency and efficacy of photosynthetic processes, water use and product yield, the plant response to stress being altered with respect to ambient CO2 conditions (a[CO2]). Additionally, NH4(+) has been related to improved plant responses to stress, considering both energy efficiency in N-assimilation and the overcoming of the inhibition of photorespiration at e[CO2]. Therefore, the aim of this work was to determine the response of sweet pepper plants (Capsicum annuum L.) receiving an additional supply of NH4(+) (90/10 NO3(-)/NH4(+)) to salinity stress (60mM NaCl) under a[CO2] (400μmolmol(-1)) or e[CO2] (800μmolmol(-1)). Salt-stressed plants grown at e[CO2] showed DW accumulation similar to that of the non-stressed plants at a[CO2]. The supply of NH4(+) reduced growth at e[CO2] when salinity was imposed. Moreover, NH4(+) differentially affected the stomatal conductance and water use efficiency and the leaf Cl(-), K(+), and Na(+) concentrations, but the extent of the effects was influenced by the [CO2]. An antioxidant-related response was prompted by salinity, the total phenolics and proline concentrations being reduced by NH4(+) at e[CO2]. Our results show that the effect of NH4(+) on plant salinity tolerance should be globally re-evaluated as e[CO2] can significantly alter the response, when compared with previous studies at a[CO2]. Copyright © 2016 Elsevier GmbH. All rights reserved.

Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS).

PubMed

De Hert, Marc; Van Bos, Liesbet; Sweers, Kim; Wampers, Martien; De Lepeleire, Jan; Correll, Christophe U

2015-01-01

When psychiatric patients express a wish for euthanasia, this should first and foremost be interpreted as a cry for help. Due to their close day-to-day relationship, psychiatric nurses may play an important and central role in responding to such requests. However, little is known about nurses' attitudes towards euthanasia motivated by unbearable mental suffering. The aim of this study was to provide insight into the attitudes and actions taken by psychiatric nurses when confronted with a patient's euthanasia request based on unbearable mental suffering (UMS). A questionnaire was sent to 11 psychiatric hospitals in the Flemish part of Belgium. The overall response rate was 70% (N = 627). Psychiatric nurses were frequently confronted with a request for euthanasia, either directly (N = 329, 53%) or through a colleague (N = 427, 69%). A majority (N = 536, 84%) did not object to euthanasia in a psychiatrically ill population with UMS. Confounding factors were the psychiatric diagnosis and the type of ward where the nurses were working. Most participants acknowledged a lack of knowledge and skills to adequately address the euthanasia request (N = 434, 71%). Nearly unanimously (N = 618, 99%), study participants indicated that dealing with euthanasia requests and other end-of-life issues should be part of the formal training of nurses. The results highlight the need for ethically sound and comprehensive provision of care. Psychiatric nurses play an important role in dealing with the complex issue of requests for euthanasia. There is also a need for education, training and clear guidelines on the level of health care organizations.

Analysis of the stability of housekeeping gene expression in the left cardiac ventricle of rats submitted to chronic intermittent hypoxia.

PubMed

Julian, Guilherme Silva; Oliveira, Renato Watanabe de; Tufik, Sergio; Chagas, Jair Ribeiro

2016-01-01

Obstructive sleep apnea (OSA) has been associated with oxidative stress and various cardiovascular consequences, such as increased cardiovascular disease risk. Quantitative real-time PCR is frequently employed to assess changes in gene expression in experimental models. In this study, we analyzed the effects of chronic intermittent hypoxia (an experimental model of OSA) on housekeeping gene expression in the left cardiac ventricle of rats. Analyses via four different approaches-use of the geNorm, BestKeeper, and NormFinder algorithms; and 2-ΔCt (threshold cycle) data analysis-produced similar results: all genes were found to be suitable for use, glyceraldehyde-3-phosphate dehydrogenase and 18S being classified as the most and the least stable, respectively. The use of more than one housekeeping gene is strongly advised. RESUMO A apneia obstrutiva do sono (AOS) tem sido associada ao estresse oxidativo e a várias consequências cardiovasculares, tais como risco aumentado de doença cardiovascular. A PCR quantitativa em tempo real é frequentemente empregada para avaliar alterações na expressão gênica em modelos experimentais. Neste estudo, analisamos os efeitos da hipóxia intermitente crônica (um modelo experimental de AOS) na expressão de genes de referência no ventrículo cardíaco esquerdo de ratos. Análises a partir de quatro abordagens - uso dos algoritmos geNorm, BestKeeper e NormFinder e análise de dados 2-ΔCt (ciclo limiar) - produziram resultados semelhantes: todos os genes mostraram-se adequados para uso, sendo que gliceraldeído-3-fosfato desidrogenase e 18S foram classificados como o mais e o menos estável, respectivamente. A utilização de mais de um gene de referência é altamente recomendada.

Theoretical and experimental study of organic nano-material for acetate anion based on 1, 10-phenanthroline.

PubMed

Shang, Xuefang; Zhao, Yuan; Wei, Xiaofang; Feng, Yaqian; Li, Xin; Gao, Shuyan; Xu, Xiufang

2015-01-01

New phenanthroline derivatives (1, 2, 3, 4) containing phenol groups have been synthesized and optimized. The nano-material of compound 2 was also developed. Their binding properties were evaluated for various biological anions (F(-), Cl(-), Br(-), I(-), AcO(-) and H(2)PO(4)(-)) by theoretical investigation, UV-vis, fluorescence, (1)HNMR titration experiments and these compounds all showed strong binding ability for AcO(-) without the interference of other anions tested. The anion binding ability could be regularized by electron push-pull properties of the ortho- or para- substituent on benzene. Theoretical investigation analysis revealed the effect of intramolecular hydrogen bond existed between -OH and other atoms in the structure of these compounds.

Free recall memory performance after aneurysmal subarachnoid hemorrhage.

PubMed

Sheldon, Signy; Macdonald, R Loch; Schweizer, Tom A

2012-03-01

Memory deficits for survivors of aneurysmal subarachnoid hemorrhage (SAH) are common, however, the nature of these deficits is not well understood. In this study, 24 patients with SAH and matched control participants were asked to study six lists containing words from four different categories. For half the lists, the categories were presented together (organized lists). For the remaining lists, the related words were presented randomly to maximize the use of executive processes such as strategy and organization (unorganized lists). Across adjoining lists, there was overlap in the types of categories given, done to promote intrusions. Compared to control participants, SAH patients recalled a similar number of words for the organized lists, but significantly fewer words for the unorganized lists. SAH patients also reported more intrusions than their matched counterparts. Separating patients into anterior communicating artery ruptures (ACoA) and ruptures in other regions, there was a recall deficit only for the unorganized list for those with ACoA ruptures and deficits across both list types for other rupture locations. These results suggest that memory impairment following SAH is likely driven by impairment in the executive components of memory, particularly for those with ACoA ruptures. Such findings may help direct future cognitive-therapeutic programs.

Brain tissue segmentation in MR images based on a hybrid of MRF and social algorithms.

PubMed

Yousefi, Sahar; Azmi, Reza; Zahedi, Morteza

2012-05-01

Effective abnormality detection and diagnosis in Magnetic Resonance Images (MRIs) requires a robust segmentation strategy. Since manual segmentation is a time-consuming task which engages valuable human resources, automatic MRI segmentations received an enormous amount of attention. For this goal, various techniques have been applied. However, Markov Random Field (MRF) based algorithms have produced reasonable results in noisy images compared to other methods. MRF seeks a label field which minimizes an energy function. The traditional minimization method, simulated annealing (SA), uses Monte Carlo simulation to access the minimum solution with heavy computation burden. For this reason, MRFs are rarely used in real time processing environments. This paper proposed a novel method based on MRF and a hybrid of social algorithms that contain an ant colony optimization (ACO) and a Gossiping algorithm which can be used for segmenting single and multispectral MRIs in real time environments. Combining ACO with the Gossiping algorithm helps find the better path using neighborhood information. Therefore, this interaction causes the algorithm to converge to an optimum solution faster. Several experiments on phantom and real images were performed. Results indicate that the proposed algorithm outperforms the traditional MRF and hybrid of MRF-ACO in speed and accuracy. Copyright © 2012 Elsevier B.V. All rights reserved.

Using Ant Colony Optimization for Routing in VLSI Chips

NASA Astrophysics Data System (ADS)

Arora, Tamanna; Moses, Melanie

2009-04-01

Rapid advances in VLSI technology have increased the number of transistors that fit on a single chip to about two billion. A frequent problem in the design of such high performance and high density VLSI layouts is that of routing wires that connect such large numbers of components. Most wire-routing problems are computationally hard. The quality of any routing algorithm is judged by the extent to which it satisfies routing constraints and design objectives. Some of the broader design objectives include minimizing total routed wire length, and minimizing total capacitance induced in the chip, both of which serve to minimize power consumed by the chip. Ant Colony Optimization algorithms (ACO) provide a multi-agent framework for combinatorial optimization by combining memory, stochastic decision and strategies of collective and distributed learning by ant-like agents. This paper applies ACO to the NP-hard problem of finding optimal routes for interconnect routing on VLSI chips. The constraints on interconnect routing are used by ants as heuristics which guide their search process. We found that ACO algorithms were able to successfully incorporate multiple constraints and route interconnects on suite of benchmark chips. On an average, the algorithm routed with total wire length 5.5% less than other established routing algorithms.

NAC Transcription Factor SPEEDY HYPONASTIC GROWTH Regulates Flooding-Induced Leaf Movement in Arabidopsis[W

PubMed Central

Rauf, Mamoona; Arif, Muhammad; Fisahn, Joachim; Xue, Gang-Ping; Balazadeh, Salma; Mueller-Roeber, Bernd

2013-01-01

In rosette plants, root flooding (waterlogging) triggers rapid upward (hyponastic) leaf movement representing an important architectural stress response that critically determines plant performance in natural habitats. The directional growth is based on localized longitudinal cell expansion at the lower (abaxial) side of the leaf petiole and involves the volatile phytohormone ethylene (ET). We report the existence of a transcriptional core unit underlying directional petiole growth in Arabidopsis thaliana, governed by the NAC transcription factor SPEEDY HYPONASTIC GROWTH (SHYG). Overexpression of SHYG in transgenic Arabidopsis thaliana enhances waterlogging-triggered hyponastic leaf movement and cell expansion in abaxial cells of the basal petiole region, while both responses are largely diminished in shyg knockout mutants. Expression of several EXPANSIN and XYLOGLUCAN ENDOTRANSGLYCOSYLASE/HYDROLASE genes encoding cell wall–loosening proteins was enhanced in SHYG overexpressors but lowered in shyg. We identified ACC OXIDASE5 (ACO5), encoding a key enzyme of ET biosynthesis, as a direct transcriptional output gene of SHYG and found a significantly reduced leaf movement in response to root flooding in aco5 T-DNA insertion mutants. Expression of SHYG in shoot tissue is triggered by root flooding and treatment with ET, constituting an intrinsic ET-SHYG-ACO5 activator loop for rapid petiole cell expansion upon waterlogging. PMID:24363315

Functional analysis of CedA based on its structure: residues important in binding of DNA and RNA polymerase and in the cell division regulation

PubMed Central

Abe, Yoshito; Fujisaki, Naoki; Miyoshi, Takanori; Watanabe, Noriko; Katayama, Tsutomu; Ueda, Tadashi

2016-01-01

DnaAcos, a mutant of the initiator DnaA, causes overinitiation of chromosome replication in Escherichia coli, resulting in inhibition of cell division. CedA was found to be a multi-copy suppressor which represses the dnaAcos inhibition of cell division. However, functional mechanism of CedA remains elusive except for previously indicated possibilities in binding to DNA and RNA polymerase. In this study, we searched for the specific sites of CedA in binding of DNA and RNA polymerase and in repression of cell division inhibition. First, DNA sequence to which CedA preferentially binds was determined. Next, the several residues and β4 region in CedA C-terminal domain was suggested to specifically interact with the DNA. Moreover, we found that the flexible N-terminal region was required for tight binding to longer DNA as well as interaction with RNA polymerase. Based on these results, several cedA mutants were examined in ability for repressing dnaAcos cell division inhibition. We found that the N-terminal region was dispensable and that Glu32 in the C-terminal domain was required for the repression. These results suggest that CedA has multiple roles and residues with different functions are positioned in the two regions. PMID:26400504

NAC transcription factor speedy hyponastic growth regulates flooding-induced leaf movement in Arabidopsis.

PubMed

Rauf, Mamoona; Arif, Muhammad; Fisahn, Joachim; Xue, Gang-Ping; Balazadeh, Salma; Mueller-Roeber, Bernd

2013-12-01

In rosette plants, root flooding (waterlogging) triggers rapid upward (hyponastic) leaf movement representing an important architectural stress response that critically determines plant performance in natural habitats. The directional growth is based on localized longitudinal cell expansion at the lower (abaxial) side of the leaf petiole and involves the volatile phytohormone ethylene (ET). We report the existence of a transcriptional core unit underlying directional petiole growth in Arabidopsis thaliana, governed by the NAC transcription factor speedy hyponastic growth (SHYG). Overexpression of SHYG in transgenic Arabidopsis thaliana enhances waterlogging-triggered hyponastic leaf movement and cell expansion in abaxial cells of the basal petiole region, while both responses are largely diminished in shyg knockout mutants. Expression of several expansin and xyloglucan endotransglycosylase/hydrolase genes encoding cell wall-loosening proteins was enhanced in SHYG overexpressors but lowered in shyg. We identified ACC oxidase5 (ACO5), encoding a key enzyme of ET biosynthesis, as a direct transcriptional output gene of SHYG and found a significantly reduced leaf movement in response to root flooding in aco5 T-DNA insertion mutants. Expression of SHYG in shoot tissue is triggered by root flooding and treatment with ET, constituting an intrinsic ET-SHYG-ACO5 activator loop for rapid petiole cell expansion upon waterlogging.

Mission planning optimization of video satellite for ground multi-object staring imaging

NASA Astrophysics Data System (ADS)

Cui, Kaikai; Xiang, Junhua; Zhang, Yulin

2018-03-01

This study investigates the emergency scheduling problem of ground multi-object staring imaging for a single video satellite. In the proposed mission scenario, the ground objects require a specified duration of staring imaging by the video satellite. The planning horizon is not long, i.e., it is usually shorter than one orbit period. A binary decision variable and the imaging order are used as the design variables, and the total observation revenue combined with the influence of the total attitude maneuvering time is regarded as the optimization objective. Based on the constraints of the observation time windows, satellite attitude adjustment time, and satellite maneuverability, a constraint satisfaction mission planning model is established for ground object staring imaging by a single video satellite. Further, a modified ant colony optimization algorithm with tabu lists (Tabu-ACO) is designed to solve this problem. The proposed algorithm can fully exploit the intelligence and local search ability of ACO. Based on full consideration of the mission characteristics, the design of the tabu lists can reduce the search range of ACO and improve the algorithm efficiency significantly. The simulation results show that the proposed algorithm outperforms the conventional algorithm in terms of optimization performance, and it can obtain satisfactory scheduling results for the mission planning problem.

Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in the management of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction

PubMed Central

Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Beer-Furlan, André Luiz; Rotta, José Marcus

2016-01-01

Background: Internal carotid artery bifurcation (ICAb) aneurysms account for about 2–15% of all intracranial aneurysms. In giant and complex cases, treatment may be difficult and dangerous, once some aneurysms have wide neck and anterior cerebral artery (ACA) and middle cerebral artery (MCA) may arise from the aneurysm itself. Clip reconstruction may be difficult in such cases. Whenever possible, the occlusion of ACA transform the bifurcation in a single artery reconstruction (ICA to MCA), much easier than a bifurcation reconstruction. Methods: In patients with giant and complex ICAb aneurysms, we propose routine preoperative angiography with anatomical evaluation of anterior communicating artery (ACoA) patency during cervical common carotid compression with concomitant contralateral carotid artery injection. This allowed visualization of the expected reversal of flow in the A1 segment–ACoA complex. When test is positive, we can perform ipsilateral ACA (A1 segment) clip occlusion and flow modification of the ACA-ACoA complex transforming a three vessel (ICA, ACA, and MCA) reconstruction into a two vessel (ICA and MCA) reconstruction. Results: Two patients were treated, with 100% of occlusion and good outcome. Conclusions: Surgical treatment of giant and complex ICAb may be achieved with acceptable morbidity. PMID:27313968

Ant Colony Optimization Analysis on Overall Stability of High Arch Dam Basis of Field Monitoring

PubMed Central

Liu, Xiaoli; Chen, Hong-Xin; Kim, Jinxie

2014-01-01

A dam ant colony optimization (D-ACO) analysis of the overall stability of high arch dams on complicated foundations is presented in this paper. A modified ant colony optimization (ACO) model is proposed for obtaining dam concrete and rock mechanical parameters. A typical dam parameter feedback problem is proposed for nonlinear back-analysis numerical model based on field monitoring deformation and ACO. The basic principle of the proposed model is the establishment of the objective function of optimizing real concrete and rock mechanical parameter. The feedback analysis is then implemented with a modified ant colony algorithm. The algorithm performance is satisfactory, and the accuracy is verified. The m groups of feedback parameters, used to run a nonlinear FEM code, and the displacement and stress distribution are discussed. A feedback analysis of the deformation of the Lijiaxia arch dam and based on the modified ant colony optimization method is also conducted. By considering various material parameters obtained using different analysis methods, comparative analyses were conducted on dam displacements, stress distribution characteristics, and overall dam stability. The comparison results show that the proposal model can effectively solve for feedback multiple parameters of dam concrete and rock material and basically satisfy assessment requirements for geotechnical structural engineering discipline. PMID:25025089

Application of Design of Experiments and Surrogate Modeling within the NASA Advanced Concepts Office, Earth-to-Orbit Design Process

NASA Technical Reports Server (NTRS)

Zwack, Mathew R.; Dees, Patrick D.; Holt, James B.

2016-01-01

Decisions made during early conceptual design have a large impact upon the expected life-cycle cost (LCC) of a new program. It is widely accepted that up to 80% of such cost is committed during these early design phases [1]. Therefore, to help minimize LCC, decisions made during conceptual design must be based upon as much information as possible. To aid in the decision making for new launch vehicle programs, the Advanced Concepts Office (ACO) at NASA Marshall Space Flight Center (MSFC) provides rapid turnaround pre-phase A and phase A concept definition studies. The ACO team utilizes a proven set of tools to provide customers with a full vehicle mass breakdown to tertiary subsystems, preliminary structural sizing based upon worst-case flight loads, and trajectory optimization to quantify integrated vehicle performance for a given mission [2]. Although the team provides rapid turnaround for single vehicle concepts, the scope of the trade space can be limited due to analyst availability and the manpower requirements for manual execution of the analysis tools. In order to enable exploration of a broader design space, the ACO team has implemented an advanced design methods (ADM) based approach. This approach applies the concepts of design of experiments (DOE) and surrogate modeling to more exhaustively explore the trade space and provide the customer with additional design information to inform decision making. This paper will first discuss the automation of the ACO tool set, which represents a majority of the development effort. In order to fit a surrogate model within tolerable error bounds a number of DOE cases are needed. This number will scale with the number of variable parameters desired and the complexity of the system's response to those variables. For all but the smallest design spaces, the number of cases required cannot be produced within an acceptable timeframe using a manual process. Therefore, automation of the tools was a key enabler for the successful

77 FR 64755 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2; Corrections

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-23

... EHR PQRS, ACO, Group Clinical Process/ Blood Pressure. Contact Information: Reporting PQRS, UDS... of hypertension and whose blood pressure was adequately controlled ( www.asco.org ;. cancer who are...

[Integration of sex/gender into environmental health research. Results of the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET)].

PubMed

Bolte, Gabriele; David, Madlen; Dębiak, Małgorzata; Fiedel, Lotta; Hornberg, Claudia; Kolossa-Gehring, Marike; Kraus, Ute; Lätzsch, Rebecca; Paeck, Tatjana; Palm, Kerstin; Schneider, Alexandra

2018-06-01

The comprehensive consideration of sex/gender in health research is essential to increase relevance and validity of research results. Contrary to other areas of health research, there is no systematic summary of the current state of research on the significance of sex/gender in environmental health. Within the interdisciplinary research network Sex/Gender-Environment-Health (GeUmGe-NET) the current state of integration of sex/gender aspects or, respectively, gender theoretical concepts into research was systematically assessed within selected topics of the research areas environmental toxicology, environmental medicine, environmental epidemiology and public health research on environment and health. Knowledge gaps and research needs were identified in all research areas. Furthermore, the potential for methodological advancements by using gender theoretical concepts was depicted. A dialogue between biomedical research, public health research, and gender studies was started with the research network GeUmGe-NET. This dialogue has to be continued particularly regarding a common testing of methodological innovations in data collection and data analysis. Insights of this interdisciplinary research are relevant for practice areas such as environmental health protection, health promotion, environmental justice, and environmental health monitoring.

76 FR 38332 - Airworthiness Directives; The Boeing Company Model MD-11 and MD-11F Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... Engineer, Propulsion Branch, ANM-140L, FAA, Los Angeles Aircraft Certification Office, 3960 Paramount..., Aerospace Engineer, Propulsion Branch, ANM-140L, FAA, Los Angeles ACO, 3960 Paramount Boulevard, Lakewood...

Attitudes of Psychiatric Nurses about the Request for Euthanasia on the Basis of Unbearable Mental Suffering(UMS)

PubMed Central

Wampers, Martien; De Lepeleire, Jan; Correll, Christophe U.

2015-01-01

Introduction When psychiatric patients express a wish for euthanasia, this should first and foremost be interpreted as a cry for help. Due to their close day-to-day relationship, psychiatric nurses may play an important and central role in responding to such requests. However, little is known about nurses’ attitudes towards euthanasia motivated by unbearable mental suffering. Objectives The aim of this study was to provide insight into the attitudes and actions taken by psychiatric nurses when confronted with a patient’s euthanasia request based on unbearable mental suffering (UMS). Method A questionnaire was sent to 11 psychiatric hospitals in the Flemish part of Belgium. Results The overall response rate was 70% (N = 627). Psychiatric nurses were frequently confronted with a request for euthanasia, either directly (N = 329, 53%) or through a colleague (N = 427, 69%). A majority (N = 536, 84%) did not object to euthanasia in a psychiatrically ill population with UMS. Confounding factors were the psychiatric diagnosis and the type of ward where the nurses were working. Most participants acknowledged a lack of knowledge and skills to adequately address the euthanasia request (N = 434, 71%). Nearly unanimously (N = 618, 99%), study participants indicated that dealing with euthanasia requests and other end-of-life issues should be part of the formal training of nurses. Conclusion The results highlight the need for ethically sound and comprehensive provision of care. Psychiatric nurses play an important role in dealing with the complex issue of requests for euthanasia. There is also a need for education, training and clear guidelines on the level of health care organizations. PMID:26700007

Best practices: an electronic drug alert program to improve safety in an accountable care environment.

PubMed

Griesbach, Sara; Lustig, Adam; Malsin, Luanne; Carley, Blake; Westrich, Kimberly D; Dubois, Robert W

2015-04-01

The accountable care organization (ACO), one of the most promising and talked about new models of care, focuses on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO's ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic's Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events. Once the medication safety concern is identified, it is reviewed to evaluate whether an alert warrants sending prescribers a communication that identifies individual patients or a general communication to all physicians describing the safety concern. Instead of basing its decisions regarding clinician notification about drug alerts on subjective criteria, the Marshfield Clinic's DSAP uses an internally developed scoring system. The scoring system includes criteria developed from previous drug alerts, such as level of evidence, size of population affected, severity of adverse event identified or targeted, litigation risk, available alternatives, and potential for duration of medication use. Each of the 6 criteria is assigned a weight and is scored based upon the content and severity of the alert received.  In its first 12 months, the program targeted 6 medication safety concerns involving the following medications: topiramate, glyburide, simvastatin, citalopram, pioglitazone, and lovastatin. Baseline and follow-up prescribing data were gathered on the targeted medications. Follow-up review of prescribing data demonstrated that the DSAP provided quality up-to-date safety information that led to changes in drug therapy and to decreases in potential adverse drug events. In aggregate, nearly 10,000 total

Fluid evolution of Au-Cu zones in Um Balad area, North Eastern Desert of Egypt: Implications from mineral chemistry and fluid inclusions

NASA Astrophysics Data System (ADS)

Abd El Monsef, Mohamed; Salem, Ibrahim; Slobodník, Marek; Ragab, Ahmed

2018-07-01

Scanning electron microscope (SEM), Electron microprobe (EMPA) and fluid inclusion studies of the ore body, as well as geochemical analyses of country rocks were performed to determine the nature and characteristics of the mineralizing fluid responsible for Au-Cu deposits in Um Balad area, Northern Eastern Desert of Egypt. The Um Balad Au-Cu deposits are confined to well developed-quartz veins and veinlets cutting through the hosting country rocks. Petrographic and geochemical investigations of the hosting rocks distinguished between two main rock units; 1) metagabbro-diorite rocks with tholeiitic nature derived in island arc/continental margin tectonic regime, and 2) granodiorite rocks formed from calc-alkaline magma in continental margin regime. Wallrock alterations are represented by propylitic and argillic types. The mineralized quartz veins are striking in NE-SW direction and dipping between (35°-45°) in SE direction, other mineralized mafic dykes enriched with auriferous quartz veinlets are trending NE-SW and dipping 70°/SE. The main ore minerals are represented by gold, chalcopyrite, pyrite, sphalerite, malachite, covellite and goethite. While, geffroyite, cuprite, chrysocolla, pseudomalachite, britholite, wolframite, scheelite, hematite and rutile are detected as minor constituents. Fluid inclusions microthermometry and isochore calculations combined with chlorite geothermometry revealed that the Um Balad deposits were formed at temperature ranging from 305 °C to 325 °C and pressure between (100-500 bar). The mineralization had been developed in the shallow levels, beneath the water table at depth of 350-1760 m, rather than common mesothermal vein-type deposits in Egypt. Magmatic water have been suggested as the main source for the mineralized fluid. The transportation of the gold metal seems to be happen as bisulfide complexes in moderately acidic environment. The deposition was resulted from combination of changes in physico-chemical parameters

Picture perfect staffing in today's economy.

PubMed

Kolender, Ellen R

2009-01-01

This article describes the methods one Cancer Registry Department used to justify adequate staffing and obtain approval for an increase in full-time employees (FTEs). Each day it is getting more difficult to keep up with registry work while hospitals are compensating for loss of income by implementing changes that often impact staffing. Departments such as Cancer Registries, which are historically understaffed, must find ways to keep up with increasing workloads. If a hospital intends to maintain accreditation by the American College of Surgeons (ACoS) Commission on Cancer (CoC) and the treatment facility of choice for cancer patients, it is the opinion of this author that administrators must realize that adequate staff for the Cancer Registry Department is essential.

Selective Phosphonylation of 5'-Adenosine Monophosphate (5'-AMP) via Pyrophosphite [PPi(III)].

PubMed

Kaye, Karl; Bryant, David E; Marriott, Katie E R; Ohara, Shohei; Fishwick, Colin W G; Kee, Terence P

2016-11-01

We describe here experiments which demonstrate the selective phospho-transfer from a plausibly prebiotic condensed phosphorus (P) salt, pyrophosphite [H 2 P 2 O 5 2- ; PPi(III)], to the phosphate group of 5'-adenosine mono phosphate (5'-AMP). We show further that this P-transfer process is accelerated both by divalent metal ions (M 2+ ) and by organic co-factors such as acetate (AcO - ). In this specific case of P-transfer from PPi(III) to 5'-AMP, we show a synergistic enhancement of transfer in the combined presence of M 2+ & AcO - . Isotopic labelling studies demonstrate that hydrolysis of the phosphonylated 5'-AMP, [P(III)P(V)-5'-AMP], proceeds via nuceophilic attack of water at the Pi(III) terminus.

Asthma-COPD overlap syndrome-Coexistence of chronic obstructive pulmonary disease and asthma in elderly patients and parameters for their differentiation.

PubMed

Tochino, Yoshihiro; Asai, Kazuhisa; Shuto, Taichi; Hirata, Kazuto

2017-03-01

Japan is an aging society, and the number of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) is consequently increasing, with an estimated incidence of approximately 5 million. In 2014, asthma-COPD overlap syndrome (ACOS) was defined by a joint project of Global Initiative for Asthma (GINA) committee and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee. The main aims of this consensus-based document are to assist clinicians, especially those in primary care or nonpulmonary specialties. In this article, we discussed parameters to differentiate asthma and COPD in elderly patients and showed prevalence, clinical features and treatment of ACOS on the basis of the guidelines of GINA and GOLD. Furthermore, we showed also referral for specialized investigations.

Surgical site infection in patients submitted to heart transplantation.

PubMed

Rodrigues, Jussara Aparecida Souza do Nascimento; Ferretti-Rebustini, Renata Eloah de Lucena; Poveda, Vanessa de Brito

2016-08-29

to analyze the occurrence and predisposing factors for surgical site infection in patients submitted to heart transplantation, evaluating the relationship between cases of infections and the variables related to the patient and the surgical procedure. retrospective cohort study, with review of the medical records of patients older than 18 years submitted to heart transplantation. The correlation between variables was evaluated by using Fisher's exact test and Mann-Whitney-Wilcoxon test. the sample consisted of 86 patients, predominantly men, with severe systemic disease, submitted to extensive preoperative hospitalizations. Signs of surgical site infection were observed in 9.3% of transplanted patients, with five (62.5%) superficial incisional, two (25%) deep and one (12.5%) case of organ/space infection. There was no statistically significant association between the variables related to the patient and the surgery. there was no association between the studied variables and the cases of surgical site infection, possibly due to the small number of cases of infection observed in the sample investigated. analisar a ocorrência e os fatores predisponentes para infecção de sítio cirúrgico em pacientes submetidos a transplante cardíaco e verificar a relação entre os casos de infecção e as variáveis referentes ao paciente e ao procedimento cirúrgico. estudo de coorte retrospectivo, com exame dos prontuários médicos de pacientes maiores de 18 anos, submetidos a transplante cardíaco. A correlação entre variáveis foi realizada por meio dos testes exato de Fischer e de Mann-Whitney-Wilcoxon. a amostra foi constituída por 86 pacientes, predominantemente homens, com doença sistêmica grave, submetidos a internações pré-operatórias extensas. Apresentaram sinais de infecção do sítio cirúrgico 9,3% dos transplantados, sendo cinco (62,5%) incisionais superficiais, duas (25%) profundas e um (12,5%) caso de infecção de órgão/espaço. Não houve associa

Raman spectral feature selection using ant colony optimization for breast cancer diagnosis.

PubMed

Fallahzadeh, Omid; Dehghani-Bidgoli, Zohreh; Assarian, Mohammad

2018-06-04

Pathology as a common diagnostic test of cancer is an invasive, time-consuming, and partially subjective method. Therefore, optical techniques, especially Raman spectroscopy, have attracted the attention of cancer diagnosis researchers. However, as Raman spectra contain numerous peaks involved in molecular bounds of the sample, finding the best features related to cancerous changes can improve the accuracy of diagnosis in this method. The present research attempted to improve the power of Raman-based cancer diagnosis by finding the best Raman features using the ACO algorithm. In the present research, 49 spectra were measured from normal, benign, and cancerous breast tissue samples using a 785-nm micro-Raman system. After preprocessing for removal of noise and background fluorescence, the intensity of 12 important Raman bands of the biological samples was extracted as features of each spectrum. Then, the ACO algorithm was applied to find the optimum features for diagnosis. As the results demonstrated, by selecting five features, the classification accuracy of the normal, benign, and cancerous groups increased by 14% and reached 87.7%. ACO feature selection can improve the diagnostic accuracy of Raman-based diagnostic models. In the present study, features corresponding to ν(C-C) αhelix proline, valine (910-940), νs(C-C) skeletal lipids (1110-1130), and δ(CH2)/δ(CH3) proteins (1445-1460) were selected as the best features in cancer diagnosis.

Development of a diagnostic decision tree for obstructive pulmonary diseases based on real-life data

PubMed Central

in ’t Veen, Johannes C.C.M.; Dekhuijzen, P.N. Richard; van Heijst, Ellen; Kocks, Janwillem W.H.; Muilwijk-Kroes, Jacqueline B.; Chavannes, Niels H.; van der Molen, Thys

2016-01-01

The aim of this study was to develop and explore the diagnostic accuracy of a decision tree derived from a large real-life primary care population. Data from 9297 primary care patients (45% male, mean age 53±17 years) with suspicion of an obstructive pulmonary disease was derived from an asthma/chronic obstructive pulmonary disease (COPD) service where patients were assessed using spirometry, the Asthma Control Questionnaire, the Clinical COPD Questionnaire, history data and medication use. All patients were diagnosed through the Internet by a pulmonologist. The Chi-squared Automatic Interaction Detection method was used to build the decision tree. The tree was externally validated in another real-life primary care population (n=3215). Our tree correctly diagnosed 79% of the asthma patients, 85% of the COPD patients and 32% of the asthma–COPD overlap syndrome (ACOS) patients. External validation showed a comparable pattern (correct: asthma 78%, COPD 83%, ACOS 24%). Our decision tree is considered to be promising because it was based on real-life primary care patients with a specialist's diagnosis. In most patients the diagnosis could be correctly predicted. Predicting ACOS, however, remained a challenge. The total decision tree can be implemented in computer-assisted diagnostic systems for individual patients. A simplified version of this tree can be used in daily clinical practice as a desk tool. PMID:27730177

'Naked-eye' detection of biologically important anions in aqueous media by colorimetric receptor and its real life applications

NASA Astrophysics Data System (ADS)

Singh, Archana; Trivedi, Darshak R.

2017-05-01

A colorimetric receptor R 2-[(2-Hydroxy-naphthalen-1-ylmethylene)-hydrazonomethyl]-quinolin-8-ol has been designed and synthesized with good yield and characterized by the standard spectroscopic techniques such as FT-IR, UV-Visible, 1H NMR, 13C NMR and ESI-MS. The receptor R showed naked-eye detection and spectral change in the presence of F-, AcO- and H2PO4- over other anions. Interestingly, receptor R displaying high selective recognition towards F-, AcO- ion with a drastic color change from pale yellow to red in dry DMSO solvent and orange in mixed solvent DMSO/H2O (9:1, v/v). The behavior of receptor R towards F-, AcO- ion was investigated using UV-Vis and 1H NMR experiment. The detailed 1H NMR experiment result revealed that the receptor R is forming the hydrogen bonding between imine nitrogen and phenolic sbnd OH proton towards anions. The receptor R is able to detect sodium salts of flouride (NaF) and acetate (NaAcO) in aqueous medium and it exhibited dramatic color change from pale yellow to red. The receptor R demonstrated itself to be useful for real life application by detecting flouride and acetate ion in sea-water and commercially available product such as toothpaste, mouthwash and vinegar solution.

Functional analysis of CedA based on its structure: residues important in binding of DNA and RNA polymerase and in the cell division regulation.

PubMed

Abe, Yoshito; Fujisaki, Naoki; Miyoshi, Takanori; Watanabe, Noriko; Katayama, Tsutomu; Ueda, Tadashi

2016-02-01

DnaAcos, a mutant of the initiator DnaA, causes overinitiation of chromosome replication in Escherichia coli, resulting in inhibition of cell division. CedA was found to be a multi-copy suppressor which represses the dnaAcos inhibition of cell division. However, functional mechanism of CedA remains elusive except for previously indicated possibilities in binding to DNA and RNA polymerase. In this study, we searched for the specific sites of CedA in binding of DNA and RNA polymerase and in repression of cell division inhibition. First, DNA sequence to which CedA preferentially binds was determined. Next, the several residues and β4 region in CedA C-terminal domain was suggested to specifically interact with the DNA. Moreover, we found that the flexible N-terminal region was required for tight binding to longer DNA as well as interaction with RNA polymerase. Based on these results, several cedA mutants were examined in ability for repressing dnaAcos cell division inhibition. We found that the N-terminal region was dispensable and that Glu32 in the C-terminal domain was required for the repression. These results suggest that CedA has multiple roles and residues with different functions are positioned in the two regions. © The Authors 2015. Published by Oxford University Press on behalf of the Japanese Biochemical Society. All rights reserved.

Time domain reshuffling for OFDM based indoor visible light communication systems.

PubMed

You, Xiaodi; Chen, Jian; Yu, Changyuan; Zheng, Huanhuan

2017-05-15

For orthogonal frequency division multiplexing (OFDM) based indoor visible light communication (VLC) systems, partial non-ideal transmission conditions such as insufficient guard intervals and a dispersive channel can result in severe inter-symbol crosstalk (ISC). By deriving from the inverse Fourier transform, we present a novel time domain reshuffling (TDR) concept for both DC-biased optical (DCO-) and asymmetrically clipped optical (ACO-) OFDM VLC systems. By using only simple operations in the frequency domain, potential high peaks can be relocated within each OFDM symbol to alleviate ISC. To simplify the system, we also propose an effective unified design of the TDR schemes for both DCO- and ACO-OFDM. Based on Monte-Carlo simulations, we demonstrate the statistical distribution of the signal high peak values and the complementary cumulative distribution function of the peak-to-average power ratio under different cases for comparison. Simulation results indicate improved bit error rate (BER) performance by adopting TDR to counteract ISC deterioration. For example, for binary phase shift keying at a BER of 10 -3 , the signal to noise ratio gains are ~1.6 dB and ~6.6 dB for DCO- and ACO-OFDM, respectively, with ISC of 1/64. We also show a reliable transmission by adopting TDR for rectangle 8-quadrature amplitude modulation with ISC of < 1/64.

Banana ethylene response factors are involved in fruit ripening through their interactions with ethylene biosynthesis genes.

PubMed

Xiao, Yun-yi; Chen, Jian-ye; Kuang, Jiang-fei; Shan, Wei; Xie, Hui; Jiang, Yue-ming; Lu, Wang-jin

2013-05-01

The involvement of ethylene response factor (ERF) transcription factor (TF) in the transcriptional regulation of ethylene biosynthesis genes during fruit ripening remains largely unclear. In this study, 15 ERF genes, designated as MaERF1-MaERF15, were isolated and characterized from banana fruit. These MaERFs were classified into seven of the 12 known ERF families. Subcellular localization showed that MaERF proteins of five different subfamilies preferentially localized to the nucleus. The 15 MaERF genes displayed differential expression patterns and levels in peel and pulp of banana fruit, in association with four different ripening treatments caused by natural, ethylene-induced, 1-methylcyclopropene (1-MCP)-delayed, and combined 1-MCP and ethylene treatments. MaERF9 was upregulated while MaERF11 was downregulated in peel and pulp of banana fruit during ripening or after treatment with ethylene. Furthermore, yeast-one hybrid (Y1H) and transient expression assays showed that the potential repressor MaERF11 bound to MaACS1 and MaACO1 promoters to suppress their activities and that MaERF9 activated MaACO1 promoter activity. Interestingly, protein-protein interaction analysis revealed that MaERF9 and -11 physically interacted with MaACO1. Taken together, these results suggest that MaERFs are involved in banana fruit ripening via transcriptional regulation of or interaction with ethylene biosynthesis genes.

Banana ethylene response factors are involved in fruit ripening through their interactions with ethylene biosynthesis genes

PubMed Central

Xiao, Yun-yi; Chen, Jian-ye; Kuang, Jiang-fei; Shan, Wei; Xie, Hui; Jiang, Yue-ming; Lu, Wang-jin

2013-01-01

The involvement of ethylene response factor (ERF) transcription factor (TF) in the transcriptional regulation of ethylene biosynthesis genes during fruit ripening remains largely unclear. In this study, 15 ERF genes, designated as MaERF1–MaERF15, were isolated and characterized from banana fruit. These MaERFs were classified into seven of the 12 known ERF families. Subcellular localization showed that MaERF proteins of five different subfamilies preferentially localized to the nucleus. The 15 MaERF genes displayed differential expression patterns and levels in peel and pulp of banana fruit, in association with four different ripening treatments caused by natural, ethylene-induced, 1-methylcyclopropene (1-MCP)-delayed, and combined 1-MCP and ethylene treatments. MaERF9 was upregulated while MaERF11 was downregulated in peel and pulp of banana fruit during ripening or after treatment with ethylene. Furthermore, yeast-one hybrid (Y1H) and transient expression assays showed that the potential repressor MaERF11 bound to MaACS1 and MaACO1 promoters to suppress their activities and that MaERF9 activated MaACO1 promoter activity. Interestingly, protein–protein interaction analysis revealed that MaERF9 and -11 physically interacted with MaACO1. Taken together, these results suggest that MaERFs are involved in banana fruit ripening via transcriptional regulation of or interaction with ethylene biosynthesis genes. PMID:23599278

Asthma-chronic obstructive pulmonary disease overlap syndrome in Poland. Findings of an epidemiological study.

PubMed

Brzostek, Dorota; Kokot, Marek

2014-12-01

Recent years have seen an increased interest in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). In 2012, Takeda Polska conducted a non-interventional epidemiological study aimed at identifying the typical phenotype of ACOS patients receiving pulmonary care. The study enrolled a total of 12,103 of smoking patients above 45 years of age (mean age: 61.5 years; mean duration of smoking: 28.4 pack-years). A total of 68.6% of patients represented the frequent-exacerbation phenotype (mean number of exacerbations during 12 months: 2.11), and 56.4% of patients from the group comprising 12,103 participants were hospitalized at least once during their lifetime due to a respiratory system disease (mean number: 3.82 ±3.76). The most commonly found asthma symptoms included paroxysmal dyspnoea with wheezing, and good response to inhaled steroids. The most frequently identified COPD-associated symptoms were: long-lasting reduction in forced expiratory volume in 1 s (FEV1) (< 80% after administering a bronchodilator) and chronic productive cough. Eighty-five percent of patients were diagnosed with concomitant diseases, predominantly arterial hypertension (62.9%) and metabolic diseases (metabolic syndrome, obesity, type 2 diabetes - 46.4% in total). A clinically severe course of ACOS and the presence of concomitant diseases should be regarded as factors justifying an individual selection of inhalation therapy which specifically takes into account anti-inflammatory treatment and patient safety.

Um Projeto de Intervenção nos Espaços de Exposições do Planetário do Parque do Ibirapuera

NASA Astrophysics Data System (ADS)

Elias, D. S.; Amaral, L. H.; de Araújo, C. F., Jr.; Matsuura, O. T.; Voelzke, M. R.

2005-08-01

Cada vez mais a humanidade, em sua imensa maioria, está alheia às próprias conquistas. A insatisfação com esta realidade tem levado muitos pesquisadores, instituições, empresas e governos a procurar formas alternativas de acompanhar e transmitir todo este acervo científico cultural à sociedade, buscando a melhoria da qualidade da divulgação científica e contribuindo para o processo de cultura e alfabetização científica. Não há tempo nem espaço nos limitados planos curriculares do ensino médio e mesmo nos programas de ensino que propiciem a cultura científica e o acompanhamento do vertiginoso progresso científico e tecnológico atual. Neste sentido, a educação formal escolar precisa ser complementada ou acrescida de uma educação informal, extra-escolar, que possa oferecer à sociedade o que a escola não pode oferecer. A interação do público com museus, feiras de ciências, planetários, exposições científicas e/ou culturais é de grande importância para a aquisição e difusão de conhecimentos relacionados ao mundo científico. Reconhecidamente como um modelo de alfabetização científica esses ambientes promovem uma interação social capaz de propiciar de forma efetiva uma melhor relação ensino-aprendizagem com o público. Partindo desta realidade a Universidade Cruzeiro do Sul e a Escola Municipal de Astronomia (EMA) vêm desenvolvendo um projeto de intervenção no espaço em torno do Planetário do Parque do Ibirapuera com o objetivo de se implantar um ambiente de aprendizagem motivador e desafiador que promova a popularização de conteúdos relacionados à astronomia, astrofísica e cosmologia. Busca-se, também, a aproximação e interação do público com exposições que estão sendo implementadas no planetário. Considerando que se trata de um projeto de mestrado em fase inicial o objetivo do presente trabalho é apresentar a concepção básica e os critérios que estão sendo utilizados do ponto de vista pedag

Low prevalence of collateral cerebral circulation in the circle of Willis in patients with severe carotid artery stenosis and recent ischemic stroke.

PubMed

Badacz, Rafał; Przewłocki, Tadeusz; Karch, Izabela; Pieniążek, Piotr; Rosławiecka, Agnieszka; Mleczko, Szymon; Brzychczy, Andrzej; Trystuła, Mariusz; Żmudka, Krzysztof; Kabłak-Ziembicka, Anna

2015-01-01

The circle of Willis is thought to play a key role in development of collateral flow in patients with internal carotid artery stenosis (ICAS). To assess flow in the circle of Willis in patients with recent ischemic stroke (IS). The study included 371 patients, 102 symptomatic with severe ICAS and recent IS (within the last 3 months) (group I) and 269 asymptomatic with severe ICAS (group II). Flow in the middle (MCA), anterior (ACA) and posterior (PCA) cerebral arteries and pattern of the cross-flow through anterior (ACoA) and posterior (PCoA) communicating arteries were assessed with transcranial color-coded Doppler ultrasonography (TCCD). The ACoA or PCoA was less prevalent in group I than in group II (54% vs. 78%, p < 0.001 and 20% vs. 42%, p < 0.001, respectively), resulting in lower peak-systolic velocity (PSV) in the MCA in group I vs. group II (p = 0.015). Any collateral pathway was present in 67% of patients in group I, compared to 86% in group II (p < 0.001). Both PSV and end-diastolic (EDV) flow velocity in the ACA were lower in patients with recent IS, compared to asymptomatic subjects (71 ±24 cm/s vs. 86 ±34 cm/s, p < 0.001 and 32 ±12 cm/s vs. 37 ±17 cm/s, p = 0.038, respectively). Presence of ACoA or PCoA and higher PSV in the MCA and ACA were associated with significant risk reduction of IS (RR = 0.28 (95% CI = 0.16-0.49, p < 0.001), RR = 0.28 (95% CI = 0.15-0.52, p < 0.001), RR = 0.97 (95% CI = 0.96-0.99, p < 0.001), RR = 0.99 (95% CI = 0.98-0.99, p < 0.032), respectively). However, ROC curves failed to show reliable MCA or ACA PSV cut-offs for IS risk assessment. The ACoA and PCoA seem to play a key role in the evaluation of IS risk in subjects with severe ICAS.

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries

PubMed Central

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending

Quantitative computed tomography measurements of emphysema for diagnosing asthma-chronic obstructive pulmonary disease overlap syndrome

PubMed Central

Xie, Mengshuang; Wang, Wei; Dou, Shuang; Cui, Liwei; Xiao, Wei

2016-01-01

Background The diagnostic criteria of asthma–COPD overlap syndrome (ACOS) are controversial. Emphysema is characteristic of COPD and usually does not exist in typical asthma patients. Emphysema in patients with asthma suggests the coexistence of COPD. Quantitative computed tomography (CT) allows repeated evaluation of emphysema noninvasively. We investigated the value of quantitative CT measurements of emphysema in the diagnosis of ACOS. Methods This study included 404 participants; 151 asthma patients, 125 COPD patients, and 128 normal control subjects. All the participants underwent pulmonary function tests and a high-resolution CT scan. Emphysema measurements were taken with an Airway Inspector software. The asthma patients were divided into high and low emphysema index (EI) groups based on the percentage of low attenuation areas less than −950 Hounsfield units. The characteristics of asthma patients with high EI were compared with those having low EI or COPD. Results The normal value of percentage of low attenuation areas less than −950 Hounsfield units in Chinese aged >40 years was 2.79%±2.37%. COPD patients indicated more severe emphysema and more upper-zone-predominant distribution of emphysema than asthma patients or controls. Thirty-two (21.2%) of the 151 asthma patients had high EI. Compared with asthma patients with low EI, those with high EI were significantly older, more likely to be male, had more pack-years of smoking, had more upper-zone-predominant distribution of emphysema, and had greater airflow limitation. There were no significant differences in sex ratios, pack-years of smoking, airflow limitation, or emphysema distribution between asthma patients with high EI and COPD patients. A greater number of acute exacerbations were seen in asthma patients with high EI compared with those with low EI or COPD. Conclusion Asthma patients with high EI fulfill the features of ACOS, as described in the Global Initiative for Asthma and Global

Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction.

PubMed

Zhou, Jia-Min; Yao, Li-Qing; Xu, Jian-Min; Xu, Mei-Dong; Zhou, Ping-Hong; Chen, Wei-Feng; Shi, Qiang; Ren, Zhong; Chen, Tao; Zhong, Yun-Shi

2013-09-07

To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction (ACO). From April 2008 to April 2012, surgery-related parameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent (SEMS) placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics. The characteristics of patients among these groups were comparable. The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (3.3 ± 0.9 d vs 4.2 ± 1.5 d and 6.7 ± 1.1 d vs 9.5 ± 6.7 d, P = 0.016 and P = 0.005), and surgical time was significantly longer (152.1 ± 44.4 min vs 127.4 ± 38.4 min, P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval between stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all surgery-related parameters, complications, OS, and DFS in the control group were comparable. The stent-laparoscopy approach is a feasible, rapid, and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.

Free-air CO2 enrichment (FACE) reduces the inhibitory effect of soil nitrate on N2 fixation of Pisum sativum.

PubMed

Butterly, Clayton R; Armstrong, Roger; Chen, Deli; Tang, Caixian

2016-01-01

Additional carbohydrate supply resulting from enhanced photosynthesis under predicted future elevated CO2 is likely to increase symbiotic nitrogen (N) fixation in legumes. This study examined the interactive effects of atmospheric CO2 and nitrate (NO3(-)) concentration on the growth, nodulation and N fixation of field pea (Pisum sativum) in a semi-arid cropping system. Field pea was grown for 15 weeks in a Vertosol containing 5, 25, 50 or 90 mg NO3(-)-N kg(-1) under either ambient CO2 (aCO2; 390 ppm) or elevated CO2 (eCO2; 550 ppm) using free-air CO2 enrichment (SoilFACE). Under aCO2, field pea biomass was significantly lower at 5 mg NO3(-)-N kg(-1) than at 90 mg NO3(-)-N kg(-1) soil. However, increasing the soil N level significantly reduced nodulation of lateral roots but not the primary root, and nodules were significantly smaller, with 85% less nodule mass in the 90 NO3(-)-N kg(-1) than in the 5 mg NO3(-)-N kg(-1) treatment, highlighting the inhibitory effects of NO3(-). Field pea grown under eCO2 had greater biomass (approx. 30%) than those grown under aCO2, and was not affected by N level. Overall, the inhibitory effects of NO3(-) on nodulation and nodule mass appeared to be reduced under eCO2 compared with aCO2, although the effects of CO2 on root growth were not significant. Elevated CO2 alleviated the inhibitory effect of soil NO3(-) on nodulation and N2 fixation and is likely to lead to greater total N content of field pea growing under future elevated CO2 environments. © The Author 2015. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Randomized Trial of Displaying Paid Price Information on Imaging Study and Procedure Ordering Rates.

PubMed

Chien, Alyna T; Lehmann, Lisa Soleymani; Hatfield, Laura A; Koplan, Kate E; Petty, Carter R; Sinaiko, Anna D; Rosenthal, Meredith B; Sequist, Thomas D

2017-04-01

Prior studies have demonstrated how price transparency lowers the test-ordering rates of trainees in hospitals, and physician-targeted price transparency efforts have been viewed as a promising cost-controlling strategy. To examine the effect of displaying paid-price information on test-ordering rates for common imaging studies and procedures within an accountable care organization (ACO). Block randomized controlled trial for 1 year. A total of 1205 fully licensed clinicians (728 primary care, 477 specialists). Starting January 2014, clinicians in the Control arm received no price display; those in the intervention arms received Single or Paired Internal/External Median Prices in the test-ordering screen of their electronic health record. Internal prices were the amounts paid by insurers for the ACO's services; external paid prices were the amounts paid by insurers for the same services when delivered by unaffiliated providers. Ordering rates (orders per 100 face-to-face encounters with adult patients): overall, designated to be completed internally within the ACO, considered "inappropriate" (e.g., MRI for simple headache), and thought to be "appropriate" (e.g., screening colonoscopy). We found no significant difference in overall ordering rates across the Control, Single Median Price, or Paired Internal/External Median Prices study arms. For every 100 encounters, clinicians in the Control arm ordered 15.0 (SD 31.1) tests, those in the Single Median Price arm ordered 15.0 (SD 16.2) tests, and those in the Paired Prices arms ordered 15.7 (SD 20.5) tests (one-way ANOVA p-value 0.88). There was no difference in ordering rates for tests designated to be completed internally or considered to be inappropriate or appropriate. Displaying paid-price information did not alter how frequently primary care and specialist clinicians ordered imaging studies and procedures within an ACO. Those with a particular interest in removing waste from the health care system may want to

Innovative care models for high-cost Medicare beneficiaries: delivery system and payment reform to accelerate adoption.

PubMed

Davis, Karen; Buttorff, Christine; Leff, Bruce; Samus, Quincy M; Szanton, Sarah; Wolff, Jennifer L; Bandeali, Farhan

2015-05-01

About a third of Medicare beneficiaries are covered by Medicare Advantage (MA) plans or accountable care organizations (ACOs). As a result of assuming financial risk for Medicare services and/or being eligible for shared savings, these organizations have an incentive to adopt models of delivering care that contribute to better care, improved health outcomes, and lower cost. This paper identifies innovative care models across the care continuum for high-cost Medicare beneficiaries that MA plans and ACOs could adopt to improve care while potentially achieving savings. It suggests policy changes that would accelerate testing and spread of promising care delivery model innovations. Targeted review of the literature to identify care delivery models focused on high-cost or high-risk Medicare beneficiaries. This paper presents select delivery models for high-risk Medicare beneficiaries across the care continuum that show promise of yielding better care at lower cost that could be considered for adoption by MA plans and ACOs. Common to these models are elements of the Wagner Chronic Care Model, including practice redesign to incorporate a team approach to care, the inclusion of nonmedical personnel, efforts to promote patient engagement, supporting provider education on innovations,and information systems allowing feedback of information to providers. The goal of these models is to slow the progression to long-term care, reduce health risks, and minimize adverse health impacts, all while achieving savings.These models attempt to maintain the ability of high-risk individuals to live in the home or a community-based setting, thereby avoiding costly institutional care. Identifying and implementing promising care delivery models will become increasingly important in launching successful population health initiatives. MA plans and ACOs stand to benefit financially from adopting care delivery models for high-risk Medicare beneficiaries that reduce hospitalization. Spreading

Theoretical and Experimental: The Synthetic and Anion-Binding Properties of Tripodal Salicylaldehyde Derivatives.

PubMed

Xu, Zhong-Jie; Zhang, Li-Rong

2016-05-19

A series of colorimetric anion probes 1-6 containing OH and NO₂ groups were synthesized, and their recognition properties toward various anions were investigated by visual observation, ultraviolet-visible spectroscopy, fluorescence, ¹H nuclear magnetic resonance titration spectra and theoretical investigation. Nanomaterials of three compounds 2-4 were prepared successfully. Four compounds 3-6 that contain electron-withdrawing substituents showed a high binding ability for AcO(-). The host-guest complex formed through a 1:1 binding ratio, and color changes were detectable during the recognition process. Theoretical investigation analysis revealed that an intramolecular hydrogen bond existed in the structures of compounds and the roles of molecular frontier orbitals in molecular interplay. These studies suggested that this series of compounds could be used as colorimetric probes to detect of AcO(-).

Ant Colony Optimization for Markowitz Mean-Variance Portfolio Model

NASA Astrophysics Data System (ADS)

Deng, Guang-Feng; Lin, Woo-Tsong

This work presents Ant Colony Optimization (ACO), which was initially developed to be a meta-heuristic for combinatorial optimization, for solving the cardinality constraints Markowitz mean-variance portfolio model (nonlinear mixed quadratic programming problem). To our knowledge, an efficient algorithmic solution for this problem has not been proposed until now. Using heuristic algorithms in this case is imperative. Numerical solutions are obtained for five analyses of weekly price data for the following indices for the period March, 1992 to September, 1997: Hang Seng 31 in Hong Kong, DAX 100 in Germany, FTSE 100 in UK, S&P 100 in USA and Nikkei 225 in Japan. The test results indicate that the ACO is much more robust and effective than Particle swarm optimization (PSO), especially for low-risk investment portfolios.

Research notes : listening to bridges.

DOT National Transportation Integrated Search

2008-09-01

The Federal Highway Administration requires owners of structurally deficient bridges to repair, replace, restrict truck loads, or conduct analysis and testing to maintain a safe highway system. Past experiments on reinforced concrete beams showed aco...

48 CFR 32.503-5 - Administration of progress payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... considered desirable by the ACO to determine the validity of progress payments already made and expected to... resources to complete the contract; and (4) There is reason to doubt the adequacy and reliability of the...

Properties of metallic glasses containing actinide metals. I. Thermal properties of U--M glasses (M = V, Cr, Mn, Fe, Co, and Ni)

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

Giessen, B.C.; Elliott, R.O.

1978-01-01

The results of a preparative and calorimetric study forming part of a continuing investigation of the new actinide glasses are reported. Specifically, lower bounds for the composition limits of glass formation (G.F.) at moderate cooling rates have been obtained for the U-M (M = Mn, Fe, Co, Ni) systems and the thermal stabilities of glasses in these four systems as well as for a U-V glass and a U-Cr glass have been surveyed.

Ford/BASF/UM Activities in Support of the Hydrogen Storage Engineering Center of Excellence

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

Veenstra, Mike; Purewal, Justin; Xu, Chunchuan

Widespread adoption of hydrogen as a vehicular fuel depends critically on the development of low-cost, on-board hydrogen storage technologies capable of achieving high energy densities and fast kinetics for hydrogen uptake and release. As present-day technologies -- which rely on physical storage methods such as compressed hydrogen -- are incapable of attaining established Department of Energy (DOE) targets, development of materials-based approaches for storing hydrogen have garnered increasing attention. Material-based storage technologies have potential to store hydrogen beyond twice the density of liquid hydrogen. To hasten development of these ‘hydride’ materials, the DOE previously established three centers of excellence formore » materials storage R&D associated with the key classes of materials: metal hydrides, chemical hydrogen, and adsorbents. While these centers made progress in identifying new storage materials, the challenges associated with the engineering of the system around a candidate storage material are in need of further advancement. In 2009 the DOE established the Hydrogen Storage Engineering Center of Excellence with the objective of developing innovative engineering concepts for materials-based hydrogen storage systems. As a partner in the Hydrogen Storage Engineering Center of Excellence, the Ford-UM-BASF team conducted a multi-faceted research program that addresses key engineering challenges associated with the development of materials-based hydrogen storage systems. First, we developed a novel framework that allowed for a material-based hydrogen storage system to be modeled and operated within a virtual fuel cell vehicle. This effort resulted in the ability to assess dynamic operating parameters and interactions between the storage system and fuel cell power plant, including the evaluation of performance throughout various drive cycles. Second, we engaged in cost modeling of various incarnations of the storage systems. This analysis

32 CFR 37.570 - What must I do if a CAS-covered participant accounts differently for its own and the Federal...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Accounting Standard (CAS) 402. Noncompliance with CAS 402 is a potential issue only for a participant that... contractors with their ACOs (currently on the World Wide Web at http://alerts.dcmdw.dcma.mil/support, a site...

Project UM-HAUL: A self-unloading reusable lunar lander

NASA Technical Reports Server (NTRS)

1991-01-01

The establishment of a lunar base is technologically and financially challenging. Given the necessary resources and political support, it can be done. In addition to the geopolitical obstacles, however, there are logistical problems involved in establishing such bases that can only be overcome with the acquisition of a significant transportation and communications network in the Earth-Moon spatial region. Considering the significant number of payloads that will be required in this process, the mass-specific cost of launching these payloads, and the added risk and cost of human presence in space, it is clearly desirable to automate major parts of such an operation. One very costly and time-consuming factor in this picture is the delivery of payloads to the Moon. Foreseeable payloads would include atmospheric modules, inflatable habitat kits, energy and oxygen plant elements, ground vehicles, laboratory modules, crew supplies, etc. The duration of high-risk human presence on the Moon could be greatly reduced if all such payloads were delivered to the prospective base site in advance of crew arrival. In this view, the idea of a 'Self-Unloading Reusable Lunar Lander' (SURLL) arises naturally. The general scenario depicts the lander being brought to low lunar orbit (LLO) from Earth atop a generic Orbital Transfer Vehicle (OTV). From LLO, the lander shuttles payloads down to the lunar surface, where, by means of some resident, detachable unloading device, it deploys the payloads and returns to orbit. The general goal is for the system to perform with maximum payload capability, automation, and reliability, while also minimizing environmental hazards, servicing needs, and mission costs. Our response to this demand is UM-HAUL, or the UnManned Heavy pAyload Unloader and Lander. The complete study includes a system description, along with a preliminary cost analysis and a design status assessment.

Project UM-HAUL: A self-unloading reusable lunar lander

NASA Astrophysics Data System (ADS)

The establishment of a lunar base is technologically and financially challenging. Given the necessary resources and political support, it can be done. In addition to the geopolitical obstacles, however, there are logistical problems involved in establishing such bases that can only be overcome with the acquisition of a significant transportation and communications network in the Earth-Moon spatial region. Considering the significant number of payloads that will be required in this process, the mass-specific cost of launching these payloads, and the added risk and cost of human presence in space, it is clearly desirable to automate major parts of such an operation. One very costly and time-consuming factor in this picture is the delivery of payloads to the Moon. Foreseeable payloads would include atmospheric modules, inflatable habitat kits, energy and oxygen plant elements, ground vehicles, laboratory modules, crew supplies, etc. The duration of high-risk human presence on the Moon could be greatly reduced if all such payloads were delivered to the prospective base site in advance of crew arrival. In this view, the idea of a 'Self-Unloading Reusable Lunar Lander' (SURLL) arises naturally. The general scenario depicts the lander being brought to low lunar orbit (LLO) from Earth atop a generic Orbital Transfer Vehicle (OTV). From LLO, the lander shuttles payloads down to the lunar surface, where, by means of some resident, detachable unloading device, it deploys the payloads and returns to orbit. The general goal is for the system to perform with maximum payload capability, automation, and reliability, while also minimizing environmental hazards, servicing needs, and mission costs. Our response to this demand is UM-HAUL, or the UnManned Heavy pAyload Unloader and Lander. The complete study includes a system description, along with a preliminary cost analysis and a design status assessment.

Spattering activity at Halemáumáu in 2015 and the transition between Hawaiian and Strombolian eruptions

NASA Astrophysics Data System (ADS)

Mintz, B. G.; Houghton, B. F.; Orr, T. R.; Taddeucci, J.; Gaudin, D.; Kueppers, U.; Carey, R.; Scarlato, P.; Del Bello, E.

2016-12-01

Explosive activity in 2015 at the free surface of the Halemáumáu lava lake at Kīlauea showed features of both Hawaiian fountaining and Strombolian explosivity. Like low Hawaiian fountains, spattering events often persisted for tens of minutes or hours. However, like Strombolian explosions, the activity consisted of a series of bursting of discrete, meter-sized gas bubbles. Each bubble burst threw fluidal bombs, with meter to decimeter diameters, to elevations of meters to a few tens of meters above the collapsing bubble remnant. Initial velocities of the pyroclasts were lower than either Strombolian explosions or high Hawaiian fountains, typically only 7 to 14 meters/second on average.Although some events were triggered by short-lived rock falls that penetrated the crust of the lava lake, the resulting outgassing activity would become self-sustaining and persistent. Activity was at times, confined to a single point source, to several point sources, or along arcs extending tens of meters parallel to the lake margin.This activity represents another type of behavior exhibited by basaltic volcanoes and provides greater insight into the spectrum between Hawaiian fountaining and Strombolian explosivity. Consequently, this activity is highly instructive in terms of: (a) the diversity of degassing/outgassing possible at basaltic volcanoes and (b) the controls on mechanically coupled versus decoupled behavior of the exsolved bubbles. The 2015 Halemáumáu activity was often continuous over similar timescales to Hawaiian fountaining but was markedly less steady than high fountains. A significant portion of the gas phase was released as discrete bubble bursts, but with frequencies two or three orders of magnitude higher than at Stromboli, which permitted sustained but not steady events.

Coumarin-indole conjugate donor-acceptor system: Synthesis, photophysical properties, anion sensing ability, theoretical and biological activity studies of two coumarin-indole based push-pull dyes

NASA Astrophysics Data System (ADS)

Aksungur, Tuğçe; Aydıner, Burcu; Seferoğlu, Nurgül; Özkütük, Müjgan; Arslan, Leyla; Reis, Yasemin; Açık, Leyla; Seferoğlu, Zeynel

2017-11-01

Two coumarin-indole conjugate fluorescent dyes having donor-acceptor-donor (D-A-D) (CI-1 and CI-2) were synthesized, and characterized using IR, 1H/13C NMR and HRMS. The absorption and emission properties of the dyes were determined in different solvents. The anion sensitivity and selectivity of the dyes were studied with some anions (CN-, F-, AcO-, Cl-, Br-, I-, HSO4- and H2PO4-) in DMSO, and their interaction mechanisms were evaluated by spectrophotometric and 1H NMR titration techniques. In addition, the molecular and electronic structures of CI-1, as well as the molecular complexes of CI-1, formed with the anions (F- and AcO-), were obtained theoretically and confirmed by DFT and TD-DFT calculations. CI-1 behaves as a colorimetric chemosensor for selective and sensitive detection of CN- in DMSO/H2O (9:1) over other competing anions such as F- and AcO-. However, only CN- interacts with chromophore CI-2 via Michael addition and the main absorption maxima shifts hypsochromically with an observed distinctive color change from orange to yellow. For using as a optic dye, the thermal stability properties of the dyes was determined by TGA (Thermal Gravimetric Analysis). Antimicrobial, antifungal and DNA-ligand interaction studies of the dyes were also examined. The dyes cause conformational changes on DNA and selectively bind to nucleotides of A/A and G/G.

De novo giant A2 aneurysm following anterior communicating artery occlusion.

PubMed

Ibrahim, Tarik F; Hafez, Ahmad; Andrade-Barazarte, Hugo; Raj, Rahul; Niemela, Mika; Lehto, Hanna; Numminen, Jussi; Jarvelainen, Juha; Hernesniemi, Juha

2015-01-01

De novo intracranial aneurysms are reported to occur with varying incidence after intracranial aneurysm treatment. They are purported to be observed, however, with increased incidence after Hunterian ligation; particularly in cases of carotid artery occlusion for giant or complex aneurysms deemed unclippable. We report a case of right-sided de novo giant A2 aneurysm 6 years after an anterior communicating artery (ACoA) aneurysm clipping. We believe this de novo aneurysm developed in part due to patient-specific risk factors but also a significant change in cerebral hemodynamics. The ACoA became occluded after surgery that likely altered the cerebral hemodynamics and contributed to the de novo aneurysm. We believe this to be the first reported case of a giant de novo aneurysm in this location. Following parent vessel occlusion (mostly of the carotid artery), there are no reports of any de novo aneurysms in the pericallosal arteries let alone a giant one. The patient had a dominant right A1 and the sudden increase in A2 blood flow likely resulted in increased wall shear stress, particularly in the medial wall of the A2 where the aneurysm occurred 2 mm distal to the A1-2 junction. ACoA preservation is a key element of aneurysm surgery in this location. Suspected occlusion of this vessel may warrant closer radiographic follow-up in patients with other risk factors for aneurysm development.

Exogenously induced expression of ethylene biosynthesis, ethylene perception, phospholipase D, and Rboh-oxidase genes in broccoli seedlings

PubMed Central

Jakubowicz, Małgorzata; Gałgańska, Hanna; Nowak, Witold; Sadowski, Jan

2010-01-01

In higher plants, copper ions, hydrogen peroxide, and cycloheximide have been recognized as very effective inducers of the transcriptional activity of genes encoding the enzymes of the ethylene biosynthesis pathway. In this report, the transcriptional patterns of genes encoding the 1-aminocyclopropane-1-carboxylate synthases (ACSs), 1-aminocyclopropane-1-carboxylate oxidases (ACOs), ETR1, ETR2, and ERS1 ethylene receptors, phospholipase D (PLD)-α1, -α2, -γ1, and -δ, and respiratory burst oxidase homologue (Rboh)-NADPH oxidase-D and -F in response to these inducers in Brassica oleracea etiolated seedlings are shown. ACS1, ACO1, ETR2, PLD-γ1, and RbohD represent genes whose expression was considerably affected by all of the inducers used. The investigations were performed on the seedlings with (i) ethylene insensitivity and (ii) a reduced level of the PLD-derived phosphatidic acid (PA). The general conclusion is that the expression of ACS1, -3, -4, -5, -7, and -11, ACO1, ETR1, ERS1, and ETR2, PLD-γ 1, and RbohD and F genes is undoubtedly under the reciprocal cross-talk of the ethylene and PAPLD signalling routes; both signals affect it in concerted or opposite ways depending on the gene or the type of stimuli. The results of these studies on broccoli seedlings are in agreement with the hypothesis that PA may directly affect the ethylene signal transduction pathway via an inhibitory effect on CTR1 (constitutive triple response 1) activity. PMID:20581125

A comparison of OCO-2 XCO2 Observations to GOSAT and Models

NASA Astrophysics Data System (ADS)

O'Dell, C.; Eldering, A.; Crisp, D.; Gunson, M. R.; Fisher, B.; Mandrake, L.; McDuffie, J. L.; Baker, D. F.; Wennberg, P. O.

2016-12-01

With their high spatial resolution and dense sampling density, observations of atmospheric carbon dioxide (CO2) from space-based sensors such as the Orbiting Carbon Observatory-2 (OCO-2) have the potential to revolutionize our understanding of carbon sources and sinks. To achieve this goal, however, requires the observations to have sub-ppm systematic errors; the large data density of OCO-2 generally reduces the importance of random errors in the retrieval of of regional scale fluxes. In this work, the Atmospheric Carbon Observations from Space (ACOS) algorithm has been applied to both OCO-2 and GOSAT observations, which overlap for the period spanning Sept 2014 to present (2+ years). Previous activities utilizing TCCON and aircraft data have shown the ACOS/GOSAT B3.5 product to be quite accurate (1-2 ppm) over both land and ocean. In this work, we apply nearly identical versions of the ACOS retrieval algorithm to both OCO-2 and GOSAT to enable comparisons during the period of overlap, and to minimize algorithm-induced differences. GOSAT/OCO-2 comparisons are used to explore potential biases in the OCO-2 data, and to better understand the nature of the bias correction required for each product. Finally, each product is compared to an ensemble of models in order to evaluate their relative consistency, a critical activity before both can be used simultaneously in carbon flux inversions with confidence.

A swarm intelligence framework for reconstructing gene networks: searching for biologically plausible architectures.

PubMed

Kentzoglanakis, Kyriakos; Poole, Matthew

2012-01-01

In this paper, we investigate the problem of reverse engineering the topology of gene regulatory networks from temporal gene expression data. We adopt a computational intelligence approach comprising swarm intelligence techniques, namely particle swarm optimization (PSO) and ant colony optimization (ACO). In addition, the recurrent neural network (RNN) formalism is employed for modeling the dynamical behavior of gene regulatory systems. More specifically, ACO is used for searching the discrete space of network architectures and PSO for searching the corresponding continuous space of RNN model parameters. We propose a novel solution construction process in the context of ACO for generating biologically plausible candidate architectures. The objective is to concentrate the search effort into areas of the structure space that contain architectures which are feasible in terms of their topological resemblance to real-world networks. The proposed framework is initially applied to the reconstruction of a small artificial network that has previously been studied in the context of gene network reverse engineering. Subsequently, we consider an artificial data set with added noise for reconstructing a subnetwork of the genetic interaction network of S. cerevisiae (yeast). Finally, the framework is applied to a real-world data set for reverse engineering the SOS response system of the bacterium Escherichia coli. Results demonstrate the relative advantage of utilizing problem-specific knowledge regarding biologically plausible structural properties of gene networks over conducting a problem-agnostic search in the vast space of network architectures.

Minority Use of a National Cancer Institute-Designated Comprehensive Cancer Center and Non-specialty Hospitals in Two Florida Regions.

PubMed

Sultan, Dawood H; Gishe, Jemal; Hanciles, Angella; Comins, Meg M; Norris, Claire M

2015-09-01

To examine cancer treatment disparities at a National Cancer Institute-designated comprehensive cancer center (NCI-CCC) and non-specialty hospitals. Florida hospital discharge datasets were used. ICD9-CM codes were used to define patients with female reproductive organ cancers (FROC), male reproductive organ cancers (MROC), and OTHER cancer diagnoses. A total of 7462 NCI-CCC patients and 21,875 non-specialty hospital patients were included in the statistical analysis. Data analysis was conducted in SAS 9.2. Increases in age reduced the odds of receiving treatment at the NCI-CCC. Male patients were more likely than female patients to be treated at the NCI-CCC. Age-adjusted odds of African American and Hispanic out/inpatients being treated at the NCI-CCC were significantly lower than those of White out/inpatients. Only patients with workers' compensation, charity, or other insurance had higher odds of being treated at the NCI-CCC. The odds of minority patients receiving outpatient treatment at the NCI-CCC declined after 2005. The odds of receiving inpatient treatment at the NCI-CCC significantly increased after 2006. More targeted outreach by the NCI-CCC is required. However, we expect the creation of local Accountable Care Organizations (ACOs) to reduce the numbers of minority and older patients at the NCI-CCC. Coordinated quality care at ACOs implies a potential for retaining the patient market share held by non-specialty hospitals and a potential for increased demand for ACO care by minority and older patients.

Dissociating basal forebrain and medial temporal amnesic syndromes: insights from classical conditioning.

PubMed

Myer, Catherine E; Bryant, Deborah; DeLuca, John; Gluck, Mark A

2002-01-01

In humans, anterograde amnesia can result from damage to the medial temporal (MT) lobes (including hippocampus), as well as to other brain areas such as basal forebrain. Results from animal classical conditioning studies suggest that there may be qualitative differences in the memory impairment following MT vs. basal forebrain damage. Specifically, delay eyeblink conditioning is spared after MT damage in animals and humans, but impaired in animals with basal forebrain damage. Recently, we have likewise shown delay eyeblink conditioning impairment in humans with amnesia following anterior communicating artery (ACoA) aneurysm rupture, which damages the basal forebrain. Another associative learning task, a computer-based concurrent visual discrimination, also appears to be spared in MT amnesia while ACoA amnesics are slower to learn the discriminations. Conversely, animal and computational models suggest that, even though MT amnesics may learn quickly, they may learn qualitatively differently from controls, and these differences may result in impaired transfer when familiar information is presented in novel combinations. Our initial data suggests such a two-phase learning and transfer task may provide a double dissociation between MT amnesics (spared initial learning but impaired transfer) and ACoA amnesics (slow initial learning but spared transfer). Together, these emerging data suggest that there are subtle but dissociable differences in the amnesic syndrome following damage to the MT lobes vs. basal forebrain, and that these differences may be most visible in non-declarative tasks such as eyeblink classical conditioning and simple associative learning.

The Triple Aim and its implications on the management of chronic rhinosinusitis.

PubMed

Barry, Jonnae Y; McCrary, Hilary C; Kent, Sean; Saleh, Ahlam A; Chang, Eugene H; Chiu, Alexander G

2016-09-01

Accountable care organizations (ACO) and alternative payment models are a sign of the change in reimbursement from fee-for-service to value-based reimbursement. The focus of health care under ACOs is represented by the Triple Aim: to improve the experience of health care, improve the health of populations, and reduce the per capita costs. Individuals with chronic rhinosinusitis (CRS) are heavy consumers of health care services. Results of recent studies have indicated that there is the potential for improved outcomes and cost savings from early surgical intervention. Adhering to the principles of the Triple Aim may signal a paradigm shift in regard to timing of intervention for CRS in certain patients. A scoping review was performed to analyze the current literature related to management of CRS and the impact on cost, population health outcomes, and the patient's experience of health care. A growing body of literature indicates that, in appropriately selected patients, when compared with medical management, endoscopic sinus surgery has the potential to improve patient outcomes and reduce the long-term cost burden of CRS. With the advent of ACOs, a paradigm shift in the treatment of CRS is inevitable to better conform to the goals of the Triple Aim. Future treatment algorithms will need to account for the heterogeneity within CRS and seek to identify appropriate timing and interventions for patients on an individual basis if the value of health care is to be improved.

42 CFR 425.204 - Content of the application.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... implement these processes. (iii) Materials documenting the ACO's organization and management structure... structures, and job descriptions for senior administrative and clinical leaders including administrative and...

42 CFR 425.204 - Content of the application.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... implement these processes. (iii) Materials documenting the ACO's organization and management structure... structures, and job descriptions for senior administrative and clinical leaders including administrative and...

Nationwide differential global positioning system (NDGPS) : capabilities and potential.

DOT National Transportation Integrated Search

2009-06-01

NDGPS is a National PNT Utility: : -Operated/managed by Coast Guard as a Combined NDGPS (Maritime + DOT + ACOE sites) : -System Specifications : --Corrections broadcast at 285 and 325 kHz using Minimum shift Keying (MSK) modulation : --Real-time diff...

Solving Energy-Aware Real-Time Tasks Scheduling Problem with Shuffled Frog Leaping Algorithm on Heterogeneous Platforms

PubMed Central

Zhang, Weizhe; Bai, Enci; He, Hui; Cheng, Albert M.K.

2015-01-01

Reducing energy consumption is becoming very important in order to keep battery life and lower overall operational costs for heterogeneous real-time multiprocessor systems. In this paper, we first formulate this as a combinatorial optimization problem. Then, a successful meta-heuristic, called Shuffled Frog Leaping Algorithm (SFLA) is proposed to reduce the energy consumption. Precocity remission and local optimal avoidance techniques are proposed to avoid the precocity and improve the solution quality. Convergence acceleration significantly reduces the search time. Experimental results show that the SFLA-based energy-aware meta-heuristic uses 30% less energy than the Ant Colony Optimization (ACO) algorithm, and 60% less energy than the Genetic Algorithm (GA) algorithm. Remarkably, the running time of the SFLA-based meta-heuristic is 20 and 200 times less than ACO and GA, respectively, for finding the optimal solution. PMID:26110406

Early augmented language intervention for children with developmental delays: potential secondary motor outcomes.

PubMed

Whitmore, Ani S; Romski, Mary Ann; Sevcik, Rose A

2014-09-01

This exploratory study examined the potential secondary outcome of an early augmented language intervention that incorporates speech-generating devices (SGD) on motor skill use for children with developmental delays. The data presented are from a longitudinal study by Romski and colleagues. Toddlers in the augmented language interventions were either required (Augmented Communication-Output; AC-O) or not required (Augmented Communication-Input; AC-I) to use the SGD to produce an augmented word. Three standardized assessments and five event-based coding schemes measured the participants' language abilities and motor skills. Toddlers in the AC-O intervention used more developmentally appropriate motor movements and became more accurate when using the SGD to communicate than toddlers in the AC-I intervention. AAC strategies, interventionist/parent support, motor learning opportunities, and physical feedback may all contribute to this secondary benefit of AAC interventions that use devices.

A novel coumarin-pyrazole-triazine based fluorescence chemosensor for fluoride detection via deprotonation process: Experimental and theoretical studies

NASA Astrophysics Data System (ADS)

Yalçın, Ergin; Alkış, Meltem; Seferoğlu, Nurgül; Seferoğlu, Zeynel

2018-03-01

A novel fluorescence coumarin-pyrazole-triazine based chemosensor (CPT) bearing 5-hydroxypyrazole as a receptoric part was synthesized and characterized by using IR, 1H/13C NMR and HRMS for the purpose of recognition of anions in DMSO. The most stable tautomeric form of CPT was determined by experimental techniques and theoretical calculations. The selectivity and sensitivity of CPT towards anions (CN-, F-, Cl-, Br-, I-, AcO-, HSO4-, H2PO4- and ClO4-) were determined using spectrophotometric and 1H NMR titration techniques as the experimental approach, and the results were explained by employing theoretical calculations. It was found to be suitable for the selective detection of F- in the presence of CN- and AcO- as competing anions. In addition, CPT exhibits significant "light-up" effect after interaction with TFA in CH2Cl2.

Enhancing artificial bee colony algorithm with self-adaptive searching strategy and artificial immune network operators for global optimization.

PubMed

Chen, Tinggui; Xiao, Renbin

2014-01-01

Artificial bee colony (ABC) algorithm, inspired by the intelligent foraging behavior of honey bees, was proposed by Karaboga. It has been shown to be superior to some conventional intelligent algorithms such as genetic algorithm (GA), artificial colony optimization (ACO), and particle swarm optimization (PSO). However, the ABC still has some limitations. For example, ABC can easily get trapped in the local optimum when handing in functions that have a narrow curving valley, a high eccentric ellipse, or complex multimodal functions. As a result, we proposed an enhanced ABC algorithm called EABC by introducing self-adaptive searching strategy and artificial immune network operators to improve the exploitation and exploration. The simulation results tested on a suite of unimodal or multimodal benchmark functions illustrate that the EABC algorithm outperforms ACO, PSO, and the basic ABC in most of the experiments.

Enhancing Artificial Bee Colony Algorithm with Self-Adaptive Searching Strategy and Artificial Immune Network Operators for Global Optimization

PubMed Central

Chen, Tinggui; Xiao, Renbin

2014-01-01

Artificial bee colony (ABC) algorithm, inspired by the intelligent foraging behavior of honey bees, was proposed by Karaboga. It has been shown to be superior to some conventional intelligent algorithms such as genetic algorithm (GA), artificial colony optimization (ACO), and particle swarm optimization (PSO). However, the ABC still has some limitations. For example, ABC can easily get trapped in the local optimum when handing in functions that have a narrow curving valley, a high eccentric ellipse, or complex multimodal functions. As a result, we proposed an enhanced ABC algorithm called EABC by introducing self-adaptive searching strategy and artificial immune network operators to improve the exploitation and exploration. The simulation results tested on a suite of unimodal or multimodal benchmark functions illustrate that the EABC algorithm outperforms ACO, PSO, and the basic ABC in most of the experiments. PMID:24772023

FAA Air Traffic Activity: Fiscal Year 1989

DTIC Science & Technology

1990-11-01

TEXARKANA (TXK) N ITINERANT OPERATIONS ............................................................. 35464 6 10125 23032 2301 LOCAL O PERATIO NS...48465 W ACO MUNICIPAL ............ . . ..... TX N 338 62067 TEXARKANA ............... ........................... AR N 378 48059 MISSOULA... TEXARKANA ........................................................ AR N 363 35464 SPOKANE FELTS FIELD ..... ................... A M 324 42975 LAKE

Microbial association with the dynamics of particulate organic carbon in response to the amendment of elevated CO2-derived wheat residue into a Mollisol.

PubMed

Wang, Yanhong; Yu, Zhenhua; Li, Yansheng; Wang, Guanghua; Liu, Junjie; Liu, Judong; Liu, Xiaobing; Jin, Jian

2017-12-31

As the chemical quality of crop residue is likely to be affected by elevated CO 2 (eCO 2 ), residue amendments may influence soil organic carbon (SOC) sequestration. However, in Mollisols, the dynamics of the SOC fractions in response to amendment with wheat residue produced under eCO 2 and the corresponding microbial community composition remain unknown. Such investigation is essential to residue management, which affects the soil quality and productivity of future farming systems. To narrow this knowledge gap, 13 C-labeled shoot and root residue derived from ambient CO 2 (aCO 2 ) or eCO 2 were amended into Mollisols and incubated for 200days. The soil was sampled during the incubation period to determine the residue-C retained in the three SOC fractions, i.e., coarse intra-aggregate particulate organic C (coarse iPOC), fine iPOC and mineral-associated organic C (MOC). The soil bacterial community was assessed using a MiSeq sequencing instrument. The results showed that the increase in SOC concentrations attributable to the application of the wheat residue primarily occurred in the coarse iPOC fraction. Compared with the aCO 2 -derived shoot residue, the amendment of eCO 2 -derived shoot residue resulted in greater SOC concentrations, whereas no significant differences (P>0.05) were observed between the aCO 2 - and eCO 2 -derived roots. Principal coordinates analysis (PCoA) showed that the residue amendment significantly (P≤0.05) altered the bacterial community composition compared with the non-residue amendment. Additionally, the bacterial community in the aCO 2 -derived shoot treatment differed from those in the other residue treatments until day 200 of the incubation period. The eCO 2 -derived shoot treatment significantly increased (P≤0.05) the relative abundances of the genera Acidobacteriaceae_(Subgroup_1)_uncultured, Bryobacter, Candidatus_Solibacter, Gemmatimonas and Nitrosomonadaceae_uncultured, whereas the opposite trend was observed in Nonomuraea

Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization.

PubMed

Gleeson, Sean; Kelleher, Kelly; Gardner, William

2016-03-01

Pay for performance (P4P) is a mechanism by which purchasers of health care offer greater financial rewards to physicians for improving processes or outcomes of care. To our knowledge, P4P has not been studied within the context of a pediatric accountable care organization (ACO). To determine whether P4P promotes pediatric performance improvement in primary care physicians. This retrospective cohort study was conducted from January 1, 2010, to December 31, 2013. A differences-in-differences design was used to test whether P4P improved physician performance in an ACO serving Medicaid children. Data were obtained from 2966 physicians and 323,812 patients. Three groups of physicians were identified: (1) community physicians who received the P4P incentives, (2) nonincentivized community physicians, and (3) nonincentivized physicians employed at a hospital. Pay for performance. Healthcare Effectiveness Data Information Set measure rates for preventive care, chronic care, and acute care primary care services. We examined 21 quality measures, 14 of which were subject to P4P incentives. There were 203 incentivized physicians, 2590 nonincentivized physicians, and 173 nonincentivized hospital physicians. Among them, the incentivized community physicians had greater improvements in performance than the nonincentivized community physicians on 2 of 2 well visits (largest difference was for adolescent well care: odds ratio, 1.05; 99.88% CI, 1.02-1.08), 3 of 10 immunization-incentivized measures (largest difference was for inactivated polio vaccine: odds ratio, 1.14; 99.88% CI, 1.07-1.21), and 2 nonincentivized measures (largest difference was for rotavirus: odds ratio, 1.11; 99.88% CI, 1.04-1.18). The employed physician group at the hospital had greater improvements in performance than the incentivized community physicians on 8 of 14 incentivized measures and 1 of 7 nonincentivized measures (largest difference was for hepatitis A vaccine: odds ratio, 0.34; 99.88% CI, 0

Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms.

PubMed

Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M

2017-07-26

To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p < .001) and a 0.8 percentage-point increase in the probability of participating in Meaningful Use (SE, 0.1, p < .001), controlling for practice characteristics. Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data

Delivery system integration and health care spending and quality for Medicare beneficiaries.

PubMed

McWilliams, J Michael; Chernew, Michael E; Zaslavsky, Alan M; Hamed, Pasha; Landon, Bruce E

2013-08-12

The Medicare accountable care organization (ACO) programs rely on delivery system integration and health care provider risk sharing to lower spending while improving quality of care. To compare spending and quality between larger and smaller provider groups and examine how size-related differences vary by 2 factors considered central to ACO performance: group primary care orientation and financial risk sharing by health care providers. Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to health care provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We assessed the primary care orientation of larger groups' specialty mix and used health maintenance organization market penetration and data from the Community Tracking Study to measure the extent of financial risk accepted by different types of provider groups in different areas for managed care patients. We estimated linear regression models comparing spending and quality between larger and smaller health care provider groups, allowing size-related differences to vary by measures of group primary care orientation and risk sharing. Spending and quality measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference, +$849), higher 30-day readmission rates (+1.3 percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per

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

NASA Astrophysics Data System (ADS)

Osei, Richard

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

Characterization and Expression of Genes Involved in the Ethylene Biosynthesis and Signal Transduction during Ripening of Mulberry Fruit

PubMed Central

Liu, Changying; Zhao, Aichun; Zhu, Panpan; Li, Jun; Han, Leng; Wang, Xiling; Fan, Wei; Lü, Ruihua; Wang, Chuanhong; Li, Zhengang; Lu, Cheng; Yu, Maode

2015-01-01

Although ethylene is well known as an essential regulator of fruit development, little work has examined the role ethylene plays in the development and maturation of mulberry (Morus L.) fruit. To study the mechanism of ethylene action during fruit development in this species, we measured the ethylene production, fruit firmness, and soluble solids content (SSC) during fruit development and harvest. By comparing the results with those from other climacteric fruit, we concluded that Morus fruit are probably climacteric. Genes associated with the ethylene signal transduction pathway of Morus were characterized from M. notabilis Genome Database, including four ethylene receptor genes, a EIN2-like gene, a CTR1-like gene, four EIN3-like genes, and a RTE1-like gene. The expression patterns of these genes were analyzed in the fruit of M. atropurpurea cv. Jialing No.40. During fruit development, transcript levels of MaETR2, MaERS, MaEIN4, MaRTE, and MaCTR1 were lower at the early stages and higher after 26 days after full bloom (DAF), while MaETR1, MaEIL1, MaEIL2, and MaEIL3 remained constant. In ripening fruit, the transcripts of MaACO1 and MaACS3 increased, while MaACS1 and MaACO2 decreased after harvest. The transcripts of MaACO1, MaACO2, and MaACS3 were inhibited by ethylene, and 1-MCP (1–methylcyclopropene) upregulated MaACS3. The transcripts of the MaETR-like genes, MaRTE, and MaCTR1 were inhibited by ethylene and 1-MCP, suggesting that ethylene may accelerate the decline of MaETRs transcripts. No significant changes in the expression of MaEIN2, MaEIL1, and MaEIL3 were observed during ripening or in response to ethylene, while the expressions of MaEIL2 and MaEIL4 increased rapidly after 24 h after harvest (HAH) and were upregulated by ethylene. The present study provides insights into ethylene biosynthesis and signal transduction in Morus plants and lays a foundation for the further understanding of the mechanisms underlying Morus fruit development and ripening. PMID

The Relationship between the Expression of Ethylene-Related Genes and Papaya Fruit Ripening Disorder Caused by Chilling Injury

PubMed Central

Zou, Yuan; Zhang, Lin; Rao, Shen; Zhu, Xiaoyang; Ye, Lanlan; Chen, Weixin; Li, Xueping

2014-01-01

Papaya (Carica papaya L.) is sensitive to low temperature and easy to be subjected to chilling injury, which causes fruit ripening disorder. This study aimed to investigate the relationship between the expression of genes related to ethylene and fruit ripening disorder caused by chilling injury. Papaya fruits were firstly stored at 7°C and 12°C for 25 and 30 days, respectively, then treated with exogenous ethylene and followed by ripening at 25°C for 5 days. Chilling injury symptoms such as pulp water soaking were observed in fruit stored at 7°C on 20 days, whereas the coloration and softening were completely blocked after 25 days, Large differences in the changes in the expression levels of twenty two genes involved in ethylene were seen during 7°C-storage with chilling injury. Those genes with altered expression could be divided into three groups: the group of genes that were up-regulated, including ACS1/2/3, EIN2, EIN3s/EIL1, CTR1/2/3, and ERF1/3/4; the group of genes that were down-regulated, including ACO3, ETR1, CTR4, EBF2, and ERF2; and the group of genes that were un-regulated, including ACO1/2, ERS, and EBF1. The results also showed that pulp firmness had a significantly positive correlation with the expression of ACS2, ACO1, CTR1/4, EIN3a/b, and EBF1/2 in fruit without chilling injury. This positive correlation was changed to negative one in fruit after storage at 7°C for 25 days with chilling injury. The coloring index displayed significantly negative correlations with the expression levels of ACS2, ACO1/2, CTR4, EIN3a/b, ERF3 in fruit without chilling injury, but these correlations were changed into the positive ones in fruit after storage at 7°C for 25 days with chilling injury. All together, these results indicate that these genes may play important roles in the abnormal softening and coloration with chilling injury in papaya. PMID:25542021

Leaf water relations and net gas exchange responses of salinized Carrizo citrange seedlings during drought stress and recovery.

PubMed

Pérez-Pérez, J G; Syvertsen, J P; Botía, P; García-Sánchez, F

2007-08-01

Since salinity and drought stress can occur together, an assessment was made of their interacting effects on leaf water relations, osmotic adjustment and net gas exchange in seedlings of the relatively chloride-sensitive Carrizo citrange, Citrus sinensis x Poncirus trifoliata. Plants were fertilized with nutrient solution with or without additional 100 mm NaCl (salt and no-salt treatments). After 7 d, half of the plants were drought stressed by withholding irrigation water for 10 d. Thus, there were four treatments: salinized and non-salinized plants under drought-stress or well-watered conditions. After the drought period, plants from all stressed treatments were re-watered with nutrient solution without salt for 8 d to study recovery. Leaf water relations, gas exchange parameters, chlorophyll fluorescence, proline, quaternary ammonium compounds and leaf and root concentrations of Cl(-) and Na(+) were measured. Salinity increased leaf Cl(-) and Na(+) concentrations and decreased osmotic potential (Psi(pi)) such that leaf relative water content (RWC) was maintained during drought stress. However, in non-salinized drought-stressed plants, osmotic adjustment did not occur and RWC decreased. The salinity-induced osmotic adjustment was not related to any accumulation of proline, quaternary ammonium compounds or soluble sugars. Net CO(2) assimilation rate (A(CO2)) was reduced in leaves from all stressed treatments but the mechanisms were different. In non-salinized drought-stressed plants, lower A(CO2) was related to low RWC, whereas in salinized plants decreased A(CO2) was related to high levels of leaf Cl(-) and Na(+). A(CO2) recovered after irrigation in all the treatments except in previously salinized drought-stressed leaves which had lower RWC and less chlorophyll but maintained high levels of Cl(-), Na(+) and quaternary ammonium compounds after recovery. High leaf levels of Cl(-) and Na(+) after recovery apparently came from the roots. Plants preconditioned by

48 CFR 44.302 - Requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Requirements. 44.302 Section 44.302 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT SUBCONTRACTING POLICIES AND PROCEDURES Contractors' Purchasing Systems Reviews 44.302 Requirements. (a) The ACO...

48 CFR 44.302 - Requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Requirements. 44.302 Section 44.302 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT SUBCONTRACTING POLICIES AND PROCEDURES Contractors' Purchasing Systems Reviews 44.302 Requirements. (a) The ACO...

42 CFR 425.112 - Required processes and patient-centeredness criteria.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... (a) General. (1) An ACO must— (i) Promote evidence-based medicine and beneficiary engagement... to accomplish the following: (1) Promote evidence-based medicine. These processes must cover...) Communication of clinical knowledge/evidence-based medicine to beneficiaries in a way that is understandable to...

42 CFR 425.112 - Required processes and patient-centeredness criteria.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... (a) General. (1) An ACO must— (i) Promote evidence-based medicine and beneficiary engagement... to accomplish the following: (1) Promote evidence-based medicine. These processes must cover...) Communication of clinical knowledge/evidence-based medicine to beneficiaries in a way that is understandable to...

42 CFR 425.112 - Required processes and patient-centeredness criteria.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... (a) General. (1) An ACO must— (i) Promote evidence-based medicine and beneficiary engagement... to accomplish the following: (1) Promote evidence-based medicine. These processes must cover...) Communication of clinical knowledge/evidence-based medicine to beneficiaries in a way that is understandable to...

SEDIMENT TOXICITY AS AN INDICATOR OF CONTAMINANT STRESS IN EMAP-ESTUARIES

EPA Science Inventory

Toxicity of sediments is widely used in EPA, ACOE, and NOAA monitoring and regulatory programs as a complement to measuring of chemical concentrations as it provides an indication of the bioavailability of sediment contaminants. Sediment toxicity was included as an abiotic condit...

76 FR 77937 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-15

... Sutherland, Aerospace Engineer, Airframe Branch, ANM-120S, FAA, Seattle Aircraft Certification Office (ACO...: James.Sutherland@faa.gov . SUPPLEMENTARY INFORMATION: Comments Invited We invite you to send any written... Information (1) For more information about this AD, contact James Sutherland, Aerospace Engineer, Airframe...

32 CFR 536.19 - Disaster claims planning.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Disaster claims planning. 536.19 Section 536.19... AGAINST THE UNITED STATES The Army Claims System § 536.19 Disaster claims planning. All ACOs will prepare... requirements related to disaster claims planning. ...