Supply-side risk adjustment and outlier payment policy

In most health care systems where a prospective payment system is implemented, an outlier payment is used to cover the hospitals' unusually high costs. When the hospital chooses its cost reduction effort before observing a patient's severity, we show that the best outlier payment is based on the realized cost when the hospital exerts the first best level of effort, for any level of severity. [Authors]

GNU/Linux - Desenvolupaments intel·ligents : migració de sistemes Windows a Linux

L'empresa Desenvolupaments Intel·ligents es dedica a la creació del software financer i borsari. Tot el sistema informàtic esta basat en màquines amb plataformes Microsoft Windows. S'ha decidit implementar un nou sistema informàtic basat en GNU/Linux. Aquest és l'objecte d'aquest treball. El nou sistema informàtic basat en GNU/Linux ha de incloure tots els equips clients (que seran els ordinadors nous) i els servidors (es reaprofitaran els ordinadors antics) cobrint tots els serveis que abans donava el servidors antics mitjançant aquest sistema operatiu i software lliure.

Rather than words: Philip Larkin's 'High Windows'

Discussion of possible origins and analogues, including Milton, Herbert and Mallarmé, of the image in Larkin's famous poem.

An image quality comparison of standard and dual-side read CR systems for pediatric radiology.

An objective analysis of image quality parameters was performed for a computed radiography (CR) system using both standard single-side and prototype dual-side read plates. The pre-sampled modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) for the systems were determined at three different beam qualities representative of pediatric chest radiography, at an entrance detector air kerma of 5 microGy. The NPS and DQE measurements were realized under clinically relevant x-ray spectra for pediatric radiology, including x-ray scatter radiations. Compared to the standard single-side read system, the MTF for the dual-side read system is reduced, but this is offset by a significant decrease in image noise, resulting in a marked increase in DQE (+40%) in the low spatial frequency range. Thus, for the same image quality, the new technology permits the CR system to be used at a reduced dose level.

Animal model to compare the effects of suture technique on cross-sectional compliance on end-to-side anastomoses.

OBJECTIVE: An animal model has been developed to compare the effects of suture technique on the luminal dimensions and compliance of end-to-side vascular anastomoses. METHODS: Carotid and internal mammalian arteries (IMAs) were exposed in three pigs (90 kg). IMAs were sectioned distally to perform end-to-side anastomoses on carotid arteries. One anastomosis was performed with 7/0 polypropylene running suture. The other was performed with the automated suture delivery device (Perclose/Abbott Labs Inc.) that makes a 7/0 polypropylene interrupted suture. Four piezoelectric crystals were sutured on toe, heel and both lateral sides of each anastomosis to measure anastomotic axes. Anastomotic cross-sectional area (CSAA) was calculated with: CSAA = pi x mM/4 where m and M are the minor and major axes of the elliptical anastomosis. Cross-sectional anastomotic compliance (CSAC) was calculated as CSAC=Delta CSAA/Delta P where Delta P is the mean pulse pressure and Delta CSAA is the mean CSAA during cardiac cycle. RESULTS: We collected a total of 1200000 pressure-length data per animal. For running suture we had a mean systolic CSAA of 26.94+/-0.4 mm(2) and a mean CSAA in diastole of 26.30+/-0.5 mm(2) (mean Delta CSAA was 0.64 mm(2)). CSAC for running suture was 4.5 x 10(-6)m(2)/kPa. For interrupted suture we had a mean CSAA in systole of 21.98+/-0.2 mm(2) and a mean CSAA in diastole of 17.38+/-0.3 mm(2) (mean Delta CSAA was 4.6+/-0.1 mm(2)). CSAC for interrupted suture was 11 x 10(-6) m(2)/kPa. CONCLUSIONS: This model, even with some limitations, can be a reliable source of information improving the outcome of vascular anastomoses. The study demonstrates that suture technique has a substantial effect on cross-sectional anastomotic compliance of end-to-side anastomoses. Interrupted suture may maximise the anastomotic lumen and provides a considerably higher CSAC than continuous suture, that reduces flow turbulence, shear stress and intimal hyperplasia. The Heartflo anastomosis device is a reliable instrument that facilitates performance of interrupted suture anastomoses.

Migración Windows-GNU/Linux

El documento trata sobre la migración de un colegio de un entorno Windows a un entorno GNU/Linux con Ubuntu.

Sweerts sur Georges Lévy, 750 cmc [course motocycliste Paris-Reims-Paris, side-car, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54748

Boutet sur Rover, side-car 500 cmc [course motocycliste Paris-Reims-Paris, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54749

[Concurrent de la course motocycliste Paris-Reims-Paris, conduisant un side-car Rover, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54751

6.7.19, Paris-Reims-Paris, Catelle Georges (25) sur Lévy et Le Pen (26) sur Lévy à l'arrivée [en side-cars] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54768

Catellas/Georges Leroy, 750 cm3 [le side-car n° 25 au départ de la course Paris-Reims-Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54754

Lecomte sur Rover, 500 cmc [course motocycliste Paris-Reims-Paris, side-car, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54746

In vivo assessment of antiretroviral therapy-associated side effects

Antiretroviral therapy has been associated with side effects, either from the drug itself or in conjunction with the effects of human immunodeficiency virus infection. Here, we evaluated the side effects of the protease inhibitor (PI) indinavir in hamsters consuming a normal or high-fat diet. Indinavir treatment increased the hamster death rate and resulted in an increase in triglyceride, cholesterol and glucose serum levels and a reduction in anti-oxLDL auto-antibodies. The treatment led to histopathological alterations of the kidney and the heart. These results suggest that hamsters are an interesting model for the study of the side effects of antiretroviral drugs, such as PIs.

[Paul] Péan, sur Peugeot [course Paris-Reims-Paris, moto 6 HP avec side-car, 6 juillet 1919] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54734

Pasola sur A.J. S. [le side-car n° 31 au départ de la course Paris-Reims-Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 54756