The effect of the shift from HMO to PPO plans on the prevalence of hospital bad debt in the insured population: A case study in two Houston-area hospitals

In spite of the dramatic increase and general concern with U.S. hospital bad debt expense (AMNews, January 12, 2004; Philadelphia Business Journal, April 30, 2004; WSJ, July 23, 2004), there appears to be little available analysis of the precise sources and causes of its growth. This is particularly true in terms of the potential contribution of insured patients to bad debt expense in light of the recent shift in managed care from health maintenance organization (HMO) plans to preferred provider organization (PPO) plans (Kaiser Annual Survey Report, 2003). This study examines and attempts to explain the recent dramatic growth in bad debt expense by focusing on and analyzing data from two Houston-area hospital providers within one healthcare system. In contrast to prior studies in which self-pay was found to be the primary source of hospital bad debt expense (Saywell, R. M., et al., 1989; Zollinger, T. W., 1991; Weissman, Joel S., et al., 1999), this study hypothesizes that the growing hospital bad debt expense is mainly due to the shifting trend away from HMOs to PPOs as a conscious decision by employers to share costs with employees. Compared to HMO plans, the structure of PPOs includes higher co-pays, coinsurance, and deductibles for the patient-pay portion of medical bills, creating the potential for an increase in bad debt for hospital providers (from a case study). This bad debt expense has a greater impact in the community hospital than in the Texas Medical Center hospital. ^

Relative phase shift and oscillation observations at moorings in the Filchner Depression area

Properties of the dense ice shelf water plume emerging from the Filchner Depression in the southwestern Weddell Sea are described, using available current meter records and CTD stations. A mean hydrography, based on more than 300 CTD stations gathered over 25 yr points to a cold, relatively thin and vertically well-defined plume east of the two ridges cross-cutting the continental slope about 60 km from the Filchner sill, whereas the dense bottom layer is warmer, more stratified and much thicker west of these ridges. The data partly confirm the three major pathways suggested earlier and agree with recent theories on topographic steering by submarine ridges. A surprisingly high mesoscale variability in the overflow region is documented and discussed. The variability is to a large extent due to three distinct oscillations (with periods of about 35 h, 3 and 6 d) seen in both temperature and velocity records on the slope. The oscillations are episodic, barotropic and have a horizontal scale of ~20-40 km across the slope. They are partly geographically separated, with the longer period being stronger on the lower part of the slope and the shorter on the upper part of the slope. Energy levels are lower west of the ridges, and in the Filchner Depression. The observations are discussed in relation to existing theories on eddies, commonly generated in plumes, and continental shelf waves.

Compound specific stable isotopes, BIT, pollen and spores of Miocene to Pliocene sediments of ODP Hole 175-1085A

Pollen and stable carbon (d13C) and hydrogen (dD) isotope ratios of terrestrial plant wax from the South Atlantic sediment core, ODP Site 1085, is used to reconstruct Miocene to Pliocene changes of vegetation and rainfall regime of western southern Africa. Our results reveal changes in the relative amount of precipitation and indicate a shift of the main moisture source from the Atlantic to the Indian Ocean during the onset of a major aridification 8 Ma ago. We emphasise the importance of declining precipitation during the expansion of C4 and CAM (mainly succulent) vegetation in South Africa. We suggest that the C4 plant expansion resulted from an increased equator-pole temperature gradient caused by the initiation of strong Atlantic Meridional Overturning Circulation following the shoaling of the Central American Seaway during the Late Miocene.

El cambio de paradigma de las Políticas de Protección Social en Chile durante los gobiernos de la Concertación (1990-2010)

El presente artículo aborda la política de protección social en Chile como una política pública, inaugurada por los gobiernos posrégimen militar, que busca cambiar el paradigma, desde la tradicional visión asistencialista coyuntural por parte del Estado, a una perspectiva que persigue reducir las vulnerabilidades de manera sustentable y con una fuerte participación social en la elaboración de las políticas basado en tres pilares: equidad, integración y cohesión social.

Cenomanian/Turonian sea surface temperatures of the equatorial Atlantic reconstructed from geochemical data

Oceanic anoxic event 2 (OAE-2) occurring during the Cenomanian/Turonian (C/T) transition is evident from a globally recognized positive stable carbon isotopic excursion and is thought to represent one of the most extreme carbon cycle perturbations of the last 100 Myr. However, the impact of this major perturbation on and interaction with global climate remains unclear. Here we report new high-resolution records of sea surface temperature (SST) based on TEX86 and d 18O of excellently preserved planktic foraminifera and stable organic carbon isotopes across the C/T transition from black shales located offshore Suriname/French Guiana (Demerara Rise, Ocean Drilling Program Leg 207 Site 1260) and offshore Senegal (Cape Verde Basin, Deep Sea Drilling Project Leg 41 Site 367). At Site 1260, where both SST proxy records can be determined, a good match between conservative SST estimates from TEX86 and d 18O is observed. We find that late Cenomanian SSTs in the equatorial Atlantic Ocean (33°C) were substantially warmer than today (27°-29°C) and that the onset of OAE-2 coincided with a rapid shift to an even warmer (35°-36°C) regime. Within the early stages of the OAE a marked (4°C) cooling to temperatures lower than pre-OAE conditions is observed. However, well before the termination of OAE-2 the warm regime was reestablished and persisted into the Turonian. Our findings corroborate the view that the C/T transition represents the onset of the interval of peak Cretaceous warmth. More importantly, they are consistent with the hypotheses that mid-Cretaceous warmth can be attributed to high levels of atmospheric carbon dioxide (CO2) and that major OAEs were capable of triggering global cooling through the negative feedback effect of organic carbon-burial-led CO2 sequestration. Evidently, however, the factors that gave rise to the observed shift to a warmer climate regime at the onset of OAE-2 were sufficiently powerful that they were only briefly counterbalanced by the high rates of carbon burial attained during even the most extreme interval of organic carbon burial in the last 100 Myr.

Reefs shift from net accretion to net erosion along a natural environmental gradient

Coral reefs persist in an accretion-erosion balance and ocean acidification resulting from anthropogenic CO2 emissions threatens to shift this balance in favor of net reef erosion. Corals and calcifying algae, largely responsible for reef accretion, are vulnerable to environmental changes associated with ocean acidification, but the direct effects of lower pH on reef erosion has received less attention, particularly in the context of known drivers of bioerosion and natural variability. This study examines the balance between reef accretion and erosion along a well-characterized natural environmental gradient in Kane'ohe Bay, Hawai'i using experimental blocks of coral skeleton. Comparing before and after micro-computed tomography (µCT) scans to quantify net accretion and erosion, we show that, at the small spatial scale of this study (tens of meters), pH was a better predictor of the accretion-erosion balance than environmental drivers suggested by prior studies, including resource availability, temperature, distance from shore, or depth. In addition, this study highlights the fine-scale variation of pH in coastal systems and the importance of microhabitat variation for reef accretion and erosion processes. We demonstrate significant changes in both the mean and variance of pH on the order of meters, providing a local perspective on global increases in pCO2. Our findings suggest that increases in reef erosion, combined with expected decreases in calcification, will accelerate the shift of coral reefs to an erosion-dominated system in a high-CO2 world. This shift will make reefs increasingly susceptible to storm damage and sea-level rise, threatening the maintenance of the ecosystem services that coral reefs provide.

OS Planos Municipais de Educaçao no Tocantins : Arqueologia dos processos de construçao e perspectivas de regime de colaboraçao e da gestao democrática

O trabalho apresenta resultados de pesquisa acerca das políticas de educaçao no Brasil, do princípio regime de colaboraçao e da gestao da educaçao, apresentando, neste momento, aspectos da trajetória sociopolítica da elaboraçao ou adequaçao dos Planos Municipais de Educaçao (PMEs), deflagrada em 2013 pelo MEC/SASE, com as possibilidades de efetivaçao do regime de colaboraçao e da gestao democrática. Sua abordagem é qualitativa, de caráter teórico-empírico e exploratório, abarcando a documentaçao relativa aos PMEs dos Municípios. No Tocantins, até o início do ano de 2014, um georreferenciamento demonstra que dos 139 Municípios, apenas seis elaboraram seus PMEs. Neste contexto, predomina a visao de administraçao municipal restrita às suas instituiçoes escolares e ao tempo de sua gestao, sem relaçao ou articulaçao com metas nacionais comuns com vistas à materializaçao do Sistema Nacional de Educaçao. Deste processo, destaca-se o significativo movimento sociopolítico em torno do planejamento da educaçao no século XXI, enfrentado o desafio de definir o objetivo comum da educaçao brasileira. Entretanto, há ideias que merecem ser investigadas, como a sua concepçao de gestao e planejamento e as formas de colaboraçao estabelecidas

PLN : The paradigm shift in teacher and learner autonomy

This presentation explains a dozen tools and paradigm shifts that teachers should apply in transformative ways to working with their students, how Web 2.0, tagging, and RSS are crucial to this process, and how teachers can develop their own personal learning networks to practice continuous lifelong learning and 'teacher autonomy' before applying these concepts to students.

PLN : The paradigm shift in teacher and learner autonomy

This presentation explains a dozen tools and paradigm shifts that teachers should apply in transformative ways to working with their students, how Web 2.0, tagging, and RSS are crucial to this process, and how teachers can develop their own personal learning networks to practice continuous lifelong learning and 'teacher autonomy' before applying these concepts to students.

OS Planos Municipais de Educaçao no Tocantins : Arqueologia dos processos de construçao e perspectivas de regime de colaboraçao e da gestao democrática

O trabalho apresenta resultados de pesquisa acerca das políticas de educaçao no Brasil, do princípio regime de colaboraçao e da gestao da educaçao, apresentando, neste momento, aspectos da trajetória sociopolítica da elaboraçao ou adequaçao dos Planos Municipais de Educaçao (PMEs), deflagrada em 2013 pelo MEC/SASE, com as possibilidades de efetivaçao do regime de colaboraçao e da gestao democrática. Sua abordagem é qualitativa, de caráter teórico-empírico e exploratório, abarcando a documentaçao relativa aos PMEs dos Municípios. No Tocantins, até o início do ano de 2014, um georreferenciamento demonstra que dos 139 Municípios, apenas seis elaboraram seus PMEs. Neste contexto, predomina a visao de administraçao municipal restrita às suas instituiçoes escolares e ao tempo de sua gestao, sem relaçao ou articulaçao com metas nacionais comuns com vistas à materializaçao do Sistema Nacional de Educaçao. Deste processo, destaca-se o significativo movimento sociopolítico em torno do planejamento da educaçao no século XXI, enfrentado o desafio de definir o objetivo comum da educaçao brasileira. Entretanto, há ideias que merecem ser investigadas, como a sua concepçao de gestao e planejamento e as formas de colaboraçao estabelecidas

The shift of paradigm in the organizations like foundation of the style of ethical leadership

La presente investigación tiene por objeto analizar el cambio de paradigma en las organizaciones como fundamento del liderazgo ético desde una realidad postmoderna a fin de detectar la necesidad de un liderazgo ético en las organizaciones donde los líderes sean formadores de valores a través del modelaje directivo; es un estilo de liderazgo en el que la visión ética, sistémica e integradora son unas de las principales aptitudes que el líder ético ha de poner en la práctica. Se han desarrollado teorías de liderazgo centradas no tanto en los rasgos o comportamientos de los líderes, sino en la relación entre líder y sus seguidores

Eolian accumulation rates of ODP Leg 121 holes

The late Cenozoic history of eolian sedimentation in the eastern Indian Ocean was developed from samples recovered during drilling of Sites 752, 754, and 756. Temporal changes in the mass accumulation rate of eolian material reflect major climatic shifts in the southern African source region. A significant drop in dust mass flux values occurs near the end of the lower Oligocene. Younger sediments are characterized by a gradual reduction in dust accumulation rates until the middle Miocene after which values remain consistently low throughout the late Cenozoic, although a slight increase in eolian accumulation rate occurs near 2.5 Ma. This pattern of dust mass flux appears related to the supply of dust-sized particles in the source region and represents a shift in the climatic regime of southern Africa to increasingly more arid conditions throughout the late Cenozoic.