HEALTH MAINTENANCE ORGANIZATION ENVIRONMENT: AN EMPIRICAL STUDY OF THE RELATIONSHIP OF EXTERNAL CONTEXT AND PERFORMANCE

The research project is an extension of a series of administrative science and health care research projects evaluating the influence of external context, organizational strategy, and organizational structure upon organizational success or performance. The research will rely on the assumption that there is not one single best approach to the management of organizations (the contingency theory). As organizational effectiveness is dependent on an appropriate mix of factors, organizations may be equally effective based on differing combinations of factors. The external context of the organization is expected to influence internal organizational strategy and structure and in turn the internal measures affect performance (discriminant theory). The research considers the relationship of external context and organization performance.^ The unit of study for the research will be the health maintenance organization (HMO); an organization the accepts in exchange for a fixed, advance capitation payment, contractual responsibility to assure the delivery of a stated range of health sevices to a voluntary enrolled population. With the current Federal resurgence of interest in the Health Maintenance Organization (HMO) as a major component in the health care system, attention must be directed at maximizing development of HMOs from the limited resources available. Increased skills are needed in both Federal and private evaluation of HMO feasibility in order to prevent resource investment and in projects that will fail while concurrently identifying potentially successful projects that will not be considered using current standards.^ The research considers 192 factors measuring contextual milieu (social, educational, economic, legal, demographic, health and technological factors). Through intercorrelation and principle components data reduction techniques this was reduced to 12 variables. Two measures of HMO performance were identified, they are (1) HMO status (operational or defunct), and (2) a principle components factor score considering eight measures of performance. The relationship between HMO context and performance was analysed using correlation and stepwise multiple regression methods. In each case it has been concluded that the external contextual variables are not predictive of success or failure of study Health Maintenance Organizations. This suggests that performance of an HMO may rely on internal organizational factors. These findings have policy implications as contextual measures are used as a major determinant in HMO feasibility analysis, and as a factor in the allocation of limited Federal funds. ^

Are anatomic brain locations important in determining the clinical outcomes in acute ischemic stroke? --- An exploratory analysis of the NINDS Stroke Trial data

Background and purpose. Brain lesions in acute ischemic stroke measured by imaging tools provide important clinical information for diagnosis and final infarct volume has been considered as a potential surrogate marker for clinical outcomes. Strong correlations have been found between lesion volume and clinical outcomes in the NINDS t-PA Stroke Trial but little has been published about lesion location and clinical outcomes. Studies of the National Institute of Neurological Disorders and Stroke (NINDS) t-PA Stroke Trial data found the direction of the t-PA treatment effect on a decrease in CT lesion volume was consistent with the observed clinical effects at 3 months, but measure of t-PA treatment benefits using CT lesion volumes showed a diminished statistical significance, as compared to using clinical scales. ^ Methods. We used the global test to evaluate the hypothesis that lesion locations were strongly associated with clinical outcomes within each treatment group at 3 months after stroke. The anatomic locations of CT scans were used for analysis. We also assessed the effect of t-PA on lesion location using a global statistical test. ^ Results. In the t-PA group, patients with frontal lesions had larger infarct volumes and worse NIHSS score at 3 months after stroke. The clinical status of patients with frontal lesions in t-PA group was less likely to be affected by lesion volume, as compared to those who had no frontal lesions in at 3 months. For patients within the placebo group, both brain stem and internal capsule locations were significantly associated with a lower odd of having favorable outcomes at 3 months. Using a global test we could not detect a significant effect of t-PA treatment on lesion location although differences between two treatment groups in the proportion of lesion findings in each location were found. ^ Conclusions. Frontal, brain stem, and internal capsule locations were significantly related to clinical status at 3 months after stroke onset. We detect no significant t-PA effect on all 9 locations although proportion of lesion findings in differed among locations between the two treatment groups.^

Gotland Deep (Baltic Sea) independent age model based on Palaeomagnetic Secular Variation (PSV) and lead (Pb) deposition profiles

Dating of sediment cores from the Baltic Sea has proven to be difficult due to uncertainties surrounding the 14C reservoir age and a scarcity of macrofossils suitable for dating. Here we present the results of multiple dating methods carried out on cores in the Gotland Deep area of the Baltic Sea. Particular emphasis is placed on the Littorina stage (8 ka ago to the present) of the Baltic Sea and possible changes in the 14C reservoir age of our dated samples. Three geochronological methods are used. Firstly, palaeomagnetic secular variations (PSV) are reconstructed, whereby ages are transferred to PSV features through comparison with varved lake sediment based PSV records. Secondly, lead (Pb) content and stable isotope analysis are used to identify past peaks in anthropogenic atmospheric Pb pollution. Lastly, 14C determinations were carried out on benthic foraminifera (Elphidium spec.) samples from the brackish Littorina stage of the Baltic Sea. Determinations carried out on smaller samples (as low as 4 µg C) employed an experimental, state-of-the-art method involving the direct measurement of CO2 from samples by a gas ion source without the need for a graphitisation step - the first time this method has been performed on foraminifera in an applied study. The PSV chronology, based on the uppermost Littorina stage sediments, produced ten age constraints between 6.29 and 1.29 cal ka BP, and the Pb depositional analysis produced two age constraints associated with the Medieval pollution peak. Analysis of PSV data shows that adequate directional data can be derived from both the present Littorina saline phase muds and Baltic Ice Lake stage varved glacial sediments. Ferrimagnetic iron sulphides, most likely authigenic greigite (Fe3S4), present in the intermediate Ancylus Lake freshwater stage sediments acquire a gyroremanent magnetisation during static alternating field (AF) demagnetisation, preventing the identification of a primary natural remanent magnetisation for these sediments. An inferred marine reservoir age offset (deltaR) is calculated by comparing the foraminifera 14C determinations to a PSV & Pb age model. This deltaR is found to trend towards younger values upwards in the core, possibly due to a gradual change in hydrographic conditions brought about by a reduction in marine water exchange from the open sea due to continued isostatic rebound.

Water scarcity and climate change impact and vulnerability in irrigated agriculture in Mediterranean river basins

Actualmente, la escasez de agua constituye un importante problema en muchos lugares del mundo. El crecimiento de la población, la creciente necesidad de alimentos, el desarrollo socio-económico y el cambio climático ejercen una importante y cada vez mayor presión sobre los recursos hídricos, a la que muchos países van a tener que enfrentarse en los próximos anos. La región Mediterránea es una de las regiones del mundo de mayor escasez de recursos hídricos, y es además una de las zonas más vulnerables al cambio climático. La mayoría de estudios sobre cambio climático prevén mayores temperaturas y una disminución de las precipitaciones, y una creciente escasez de agua debida a la disminución de recursos disponibles y al aumento de las demandas de riego. En el contexto actual de desarrollo de políticas se demanda cada vez más una mayor consideración del cambio climático en el marco de las políticas sectoriales. Sin embargo, los estudios enfocados a un solo sector no reflejan las múltiples dimensiones del los efectos del cambio climático. Numerosos estudios científicos han demostrado que el cambio climático es un fenómeno de naturaleza multi-dimensional y cuyos efectos se transmiten a múltiples escalas. Por tanto, es necesaria la producción de estudios y herramientas de análisis capaces de reflejar todas estas dimensiones y que contribuyan a la elaboración de políticas robustas en un contexto de cambio climático. Esta investigación pretende aportar una visión global de la problemática de la escasez de agua y los impactos, la vulnerabilidad y la adaptación al cambio climático en el contexto de la región mediterránea. La investigación presenta un marco integrado de modelización que se va ampliando progresivamente en un proceso secuencial y multi-escalar en el que en cada etapa se incorpora una nueva dimensión. La investigación consta de cuatro etapas que se abordan a lo largo de cuatro capítulos. En primer lugar, se estudia la vulnerabilidad económica de las explotaciones de regadío del Medio Guadiana, en España. Para ello, se utiliza un modelo de programación matemática en combinación con un modelo econométrico. A continuación, en la segunda etapa, se utiliza un modelo hidro-económico que incluye un modelo de cultivo para analizar los procesos que tienen lugar a escala de cultivo, explotación y cuenca teniendo en cuenta distintas escalas geográficas y de toma de decisiones. Esta herramienta permite el análisis de escenarios de cambio climático y la evaluación de posibles medidas de adaptación. La tercera fase consiste en el análisis de las barreras que dificultan la aplicación de procesos de adaptación para lo cual se analizan las redes socio-institucionales en la cuenca. Finalmente, la cuarta etapa aporta una visión sobre la escasez de agua y el cambio climático a escala nacional y regional mediante el estudio de distintos escenarios de futuro plausibles y los posibles efectos de las políticas en la escasez de agua. Para este análisis se utiliza un modelo econométrico de datos de panel para la región mediterránea y un modelo hidro-económico que se aplica a los casos de estudio de España y Jordania. Los resultados del estudio ponen de relieve la importancia de considerar múltiples escalas y múltiples dimensiones en el estudio de la gestión de los recursos hídricos y la adaptación al cambio climático en los contextos mediterráneos de escasez de agua estudiados. Los resultados muestran que los impactos del cambio climático en la cuenca del Guadiana y en el conjunto de España pueden comprometer la sostenibilidad del regadío y de los ecosistemas. El análisis a escala de cuenca hidrográfica resalta la importancia de las interacciones entre los distintos usuarios del agua y en concreto entre distintas comunidades de regantes, así como la necesidad de fortalecer el papel de las instituciones y de fomentar la creación de una visión común en la cuenca para facilitar la aplicación de los procesos de adaptación. Asimismo, los resultados de este trabajo evidencian también la capacidad y el papel fundamental de las políticas para lograr un desarrollo sostenible y la adaptación al cambio climático es regiones de escasez de agua tales como la región mediterránea. Especialmente, este trabajo pone de manifiesto el potencial de la Directiva Marco del Agua de la Unión Europea para lograr una efectiva adaptación al cambio climático. Sin embargo, en Jordania, además de la adaptación al cambio climático, es preciso diseñar estrategias de desarrollo sostenible más ambiciosas que contribuyan a reducir el riesgo futuro de escasez de agua. ABSTRACT Water scarcity is becoming a major concern in many parts of the world. Population growth, increasing needs for food production, socio-economic development and climate change represent pressures on water resources that many countries around the world will have to deal in the coming years. The Mediterranean region is one of the most water scarce regions of the world and is considered a climate change hotspot. Most projections of climate change envisage an increase in temperatures and a decrease in precipitation and a resulting reduction in water resources availability as a consequence of both reduced water availability and increased irrigation demands. Current policy development processes require the integration of climate change concerns into sectoral policies. However, sector-oriented studies often fail to address all the dimensions of climate change implications. Climate change research in the last years has evidenced the need for more integrated studies and methodologies that are capable of addressing the multi-scale and multi-dimensional nature of climate change. This research attempts to provide a comprehensive view of water scarcity and climate change impacts, vulnerability and adaptation in Mediterranean contexts. It presents an integrated modelling framework that is progressively enlarged in a sequential multi-scale process in which a new dimension of climate change and water resources is addressed at every stage. It is comprised of four stages, each one explained in a different chapter. The first stage explores farm-level economic vulnerability in the Spanish Guadiana basin using a mathematical programming model in combination with an econometric model. Then, in a second stage, the use of a hydro-economic modelling framework that includes a crop growth model allows for the analysis of crop, farm and basin level processes taking into account different geographical and decision-making scales. This integrated tool is used for the analysis of climate change scenarios and for the assessment of potential adaptation options. The third stage includes the analysis of barriers to the effective implementation of adaptation processes based on socioinstitutional network analysis. Finally, a regional and country level perspective of water scarcity and climate change is provided focusing on different possible socio-economic development pathways and the effect of policies on future water scarcity. For this analysis, a panel-data econometric model and a hydro-economic model are applied for the analysis of the Mediterranean region and country level case studies in Spain and Jordan. The overall results of the study demonstrate the value of considering multiple scales and multiple dimensions in water management and climate change adaptation in the Mediterranean water scarce contexts analysed. Results show that climate change impacts in the Guadiana basin and in Spain may compromise the sustainability of irrigation systems and ecosystems. The analysis at the basin level highlights the prominent role of interactions between different water users and irrigation districts and the need to strengthen institutional capacity and common understanding in the basin to enhance the implementation of adaptation processes. The results of this research also illustrate the relevance of water policies in achieving sustainable development and climate change adaptation in water scarce areas such as the Mediterranean region. Specifically, the EU Water Framework Directive emerges as a powerful trigger for climate change adaptation. However, in Jordan, outreaching sustainable development strategies are required in addition to climate change adaptation to reduce future risk of water scarcity.

The theory of electrostatic probes in strong magnetic fields : Thesis submitted to the Faculty of The Graduate School of the University of Colorado for the Degree Doctor of Philosophy Department of Aerospace Engineering Science

A theory is developed of an electrostatic probe in a fully-ionized plasma in the presence of a strong magnetic field. The ratio of electron Larmor radius to probe transverse dimension is assumed to be small. Poisson's equation, together with kinetic equations for ions and electrons are considered. An asymptotic perturbation method of multiple scales is used by considering the characteristic lengths appearing in the problem. The leading behavior of the solution is found. The results obtained appear to apply to weaker fields also, agreeing with the solutions known in the limit of no magnetic field. The range of potentials for wich results are presented is limited. The basic effects produced by the field are a depletion of the plasma near the probe and a non-monotonic potential surrounding the probe. The ion saturation current is not changed but changes appear in both the floating potential Vf and the slope of the current-voltage diagram at Vf. The transition region extends beyond the space potential Vs,at wich point the current is largely reduced. The diagram does not have an exponential form in this region as commonly assumed. There exists saturation in electron collection. The extent to which the plasma is disturbed is determined. A cylindrical probe has no solution because of a logarithmic singularity at infinity. Extensions of the theory are considered.

Asymptotic Solution for the Two Body Problem with Radial Perturbing Acceleration

In this article, an approximate analytical solution for the two body problem perturbed by a radial, low acceleration is obtained, using a regularized formulation of the orbital motion and the method of multiple scales. The results reveal that the physics of the problem evolve in two fundamental scales of the true anomaly. The first one drives the oscillations of the orbital parameters along each orbit. The second one is responsible of the long-term variations in the amplitude and mean values of these oscillations. A good agreement is found with high precision numerical solutions.

Aplicação de técnicas inteligentes com análise no domínio do tempo para reconhecimento de defeitos em motores de indução trifásicos

Os motores de indução trifásicos são os principais elementos de conversão de energia elétrica em mecânica motriz aplicados em vários setores produtivos. Identificar um defeito no motor em operação pode fornecer, antes que ele falhe, maior segurança no processo de tomada de decisão sobre a manutenção da máquina, redução de custos e aumento de disponibilidade. Nesta tese são apresentas inicialmente uma revisão bibliográfica e a metodologia geral para a reprodução dos defeitos nos motores e a aplicação da técnica de discretização dos sinais de correntes e tensões no domínio do tempo. É também desenvolvido um estudo comparativo entre métodos de classificação de padrões para a identificação de defeitos nestas máquinas, tais como: Naive Bayes, k-Nearest Neighbor, Support Vector Machine (Sequential Minimal Optimization), Rede Neural Artificial (Perceptron Multicamadas), Repeated Incremental Pruning to Produce Error Reduction e C4.5 Decision Tree. Também aplicou-se o conceito de Sistemas Multiagentes (SMA) para suportar a utilização de múltiplos métodos concorrentes de forma distribuída para reconhecimento de padrões de defeitos em rolamentos defeituosos, quebras nas barras da gaiola de esquilo do rotor e curto-circuito entre as bobinas do enrolamento do estator de motores de indução trifásicos. Complementarmente, algumas estratégias para a definição da severidade dos defeitos supracitados em motores foram exploradas, fazendo inclusive uma averiguação da influência do desequilíbrio de tensão na alimentação da máquina para a determinação destas anomalias. Os dados experimentais foram adquiridos por meio de uma bancada experimental em laboratório com motores de potência de 1 e 2 cv acionados diretamente na rede elétrica, operando em várias condições de desequilíbrio das tensões e variações da carga mecânica aplicada ao eixo do motor.

Integration3

Thesis (Master's)--University of Washington, 2016-06

Being, Belonging, and Connecting: Filipino Youths' Narratives of Place(s) and Wellbeing in Hawai'i

Thesis (Ph. D.)--University of Washington, 2016-04

Encounter success of free-ranging marine predator movements across a dynamic prey landscape

Movements of wide-ranging top predators can now be studied effectively using satellite and archival telemetry. However, the motivations underlying movements remain difficult to determine because trajectories are seldom related to key biological gradients, such as changing prey distributions. Here, we use a dynamic prey landscape of zooplankton biomass in the north-east Atlantic Ocean to examine active habitat selection in the plankton-feeding basking shark Cetorhinus maximus. The relative success of shark searches across this landscape was examined by comparing prey biomass encountered by sharks with encounters by random-walk simulations of ‘model’ sharks. Movements of transmitter-tagged sharks monitored for 964 days (16754km estimated minimum distance) were concentrated on the European continental shelf in areas characterized by high seasonal productivity and complex prey distributions. We show movements by adult and sub-adult sharks yielded consistently higher prey encounter rates than 90% of random-walk simulations. Behavioural patterns were consistent with basking sharks using search tactics structured across multiple scales to exploit the richest prey areas available in preferred habitats. Simple behavioural rules based on learned responses to previously encountered prey distributions may explain the high performances. This study highlights how dynamic prey landscapes enable active habitat selection in large predators to be investigated from a trophic perspective, an approach that may inform conservation by identifying critical habitat of vulnerable species.

Unplanned land clearing of Colombian rainforests: Spreading like disease?

Deforestation often occurs as temporal waves and in localized fronts termed 'deforestation hotspots' driven by economic pulses and population pressure. Of particular concern for conservation planning are 'biodiversity hotspots' where high concentrations of endemic species undergo rapid loss and fragmentation of habitat. We investigate the deforestation process in Caqueta, a biodiversity hotspot and major colonization front of the Colombian Amazon using multi-temporal satellite imagery of the periods 1989-1996-1999-2002. The probabilities of deforestation and regeneration were modeled against soil fertility, accessibility and neighborhood terms, using logistic regression analysis. Deforestation and regeneration patterns and rates were highly variable across the colonization front. The regional average annual deforestation rate was 2.6%, but varied locally between -1.8% (regeneration) and 5.3%, with maximum rates in landscapes with 40-60% forest cover and highest edge densities, showing an analogous pattern to the spread of disease. Soil fertility and forest and secondary vegetation neighbors showed positive and significant relationships with the probability of deforestation. For forest regeneration, soil fertility had a significant negative effect while the other parameters were marginally significant. The logistic regression models across all periods showed a high level of discrimination power for both deforestation and forest regeneration, with ROC values > 0.80. We document the effect of policies and institutional changes on the land clearing process, such as the failed peace process between government and guerillas in 1999-2002, which redirected the spread of deforestation and increased forest regeneration. The implications for conservation in biologically rich areas, such as Caqueta are discussed. (c) 2005 Elsevier B.V All rights reserved.

Measuring the degree of spatial correlation between histological features in thin sections of brain tissue

Histological features visible in thin sections of brain tissue, such as neuronal perikarya, blood vessels, or pathological lesions may exhibit a degree of spatial association or correlation. In neurodegenerative disorders such as AD, Pick's disease, and CJD, information on whether different types of pathological lesion are spatially correlated may be useful in elucidating disease pathogenesis. In the present article the statistical methods available for studying spatial association in histological sections are reviewed. These include tests of interspecific association between two or more histological features using χ2 contingency tables, measurement of 'complete' and 'absolute' association, and more complex methods that use grids of contiguous samples. In addition, the use of correlation matrices and stepwise multiple regression methods are described. The advantages and limitations of each method are reviewed and possible future developments discussed.

Measuring the degree of spatial correlation between pathological lesions in Alzheimer's disease

The pathological lesions characteristic of Alzheimer's disease (AD), viz., senile plaques (SP) and neurofibrillary tangles (NFT) may not be randomly distributed with reference to each other but exhibit a degree of sptial association or correlation, information on the degree of association between SP and NFT or between the lesions and normal histological features, such as neuronal perikarya and blood vessels, may be valuable in elucidating the pathogenesis of AD. This article reviews the statistical methods available for studying the degree of spatial association in histological sections of AD tissue. These include tests of interspecific association between two or more histological features using chi-square contingency tables, measurement of 'complete' and 'absolute' association, and more complex methods that use grids of contiguous samples. In addition, analyses of association using correlation matrices and stepwise multiple regression methods are described. The advantages and limitations of each method are reviewed and possible future developments discussed.

Redefining neuromarketing as an integrated science of influence

Multiple transformative forces target marketing, many of which derive from new technologies that allow us to sample thinking in real time (i.e., brain imaging), or to look at large aggregations of decisions (i.e., big data). There has been an inclination to refer to the intersection of these technologies with the general topic of marketing as “neuromarketing”. There has not been a serious effort to frame neuromarketing, which is the goal of this paper. Neuromarketing can be compared to neuroeconomics, wherein neuroeconomics is generally focused on how individuals make “choices”, and represent distributions of choices. Neuromarketing, in contrast, focuses on how a distribution of choices can be shifted or “influenced”, which can occur at multiple “scales” of behavior (e.g., individual, group, or market/society). Given influence can affect choice through many cognitive modalities, and not just that of valuation of choice options, a science of influence also implies a need to develop a model of cognitive function integrating attention, memory, and reward/aversion function. The paper concludes with a brief description of three domains of neuromarketing application for studying influence, and their caveats.