The role of data in health care disparities in medicaid managed care

BACKGROUND: The Affordable Care Act includes provisions to standardize the collection of data on health care quality that can be used to measure disparities. We conducted a qualitative study among leaders of Medicaid managed care plans, that currently have access to standardized quality data stratified by race and ethnicity, to learn how they use it to address disparities. METHODS: We conducted semi-structured interviews with 21 health plan leaders across 9 Medicaid managed care plans in California. We used purposive sampling to maximize heterogeneity in geography and plan type (e.g., non-profit, commercial). We performed a thematic analysis based on iterative coding by two investigators. RESULTS: We found 4 major themes. Improving overall quality was tightly linked to a focus on standardized metrics that are integral to meeting regulatory or financial incentives. However, reducing disparities was not driven by standardized data, but by a mix of factors. Data were frequently only examined by race and ethnicity when overall performance was low. Disparities were attributed to either individual choices or cultural and linguistic factors, with plans focusing interventions on recently immigrated groups. CONCLUSIONS: While plans' efforts to address overall quality were often informed by standardized data, actions to reduce disparities were not, at least partly because there were few regulatory or financial incentives driving meaningful use of data on disparities. Standardized data, as envisaged by the Affordable Care Act, could become more useful for addressing disparities if they are combined with policies and regulations that promote health care equity

Fourth workshop on Experiments and Detectors for a Relativistic Heavy Ion Collider

We present a description of an experiment which can be used to search for effects of strong electromagnetic fields on the production of e(sup +) e(sup -) pairs in the elastic scattering of two heavy ions at the Relativistic Heavy Ion Collider (RHIC). A very brief discussion of other possible studies of electromagnetic phenomena at RHIC is also presented

The ring imaging Cherenkov detector for the BRAHMS experiment at RHIC

A ring imaging Cherenkov counter, to be read out by four 100-channel PMTs, is a key element of the BRAHMS experiment. We report here the most recent results obtained tested at the BNL AGS using several radiator gases, including the heavy fluorocarbon C4F10. Ring radii were measured for different particles (pions, muons, and electrons) for momenta ranging from 2 to 12 GeV/c employing pure C4F10 as radiator.Comment: 3 pages 3 figure

Preconscious control of stereotype activation through chronic egalitarian goals

This research shows stereotype activation is controlled by chronic egalitarian goals. In the first 2 studies it was found that the stereotype of women is equally available to individuals with and without chronic goals, and the discriminant validity of the concept of egalitarian goals was established. In the next 2 experiments, differences in stereotype activation as a function of this individual difference were found. In Study 3, participants read attributes following stereotypical primes. Facilitated response times to stereotypical attributes were found for nonchronics but not for chronics. This lack of facilitation occurred at stimulus onset asynchronies (SOAs) where effortful correction processes could not operate, demonstrating preconscious control of stereotype activation due to chronic goals. In Study 4, inhibition of the stereotype was found at an SOA where effortful processes of stereotype suppression could not operate. The data reveal that goals are activated and used preconsciously to prevent stereotype activation, demonstrating both the controllability of stereotype activation and the implicit role of goals in cognitive control. The current research addresses an important question for understanding both the nature of stereotyping and the nature of cognitive control: Can one's commitment to a goal lead to control over th

Passive States for Essential Observers

The aim of this note is to present a unified approach to the results given in \cite{bb99} and \cite{bs04} which also covers examples of models not presented in these two papers (e.g. $d$-dimensional Minkowski space-time for $d\geq 3$). Assuming that a state is passive for an observer travelling along certain (essential) worldlines, we show that this state is invariant under the isometry group, is a KMS-state for the observer at a temperature uniquely determined by the structure constants of the Lie algebra involved and fulfills (a variant of) the Reeh-Schlieder property. Also the modular objects associated to such a state and the observable algebra of an observer are computed and a version of weak locality is examined.Comment: 27 page

Estimating the Empirical Lorenz Curve and Gini Coefficient in the Presence of Error

The Lorenz curve is a graphical tool that is widely used to characterize the concentration of a measure in a population, such as wealth. It is frequently the case that the measure of interest used to rank experimental units when estimating the empirical Lorenz curve, and the corresponding Gini coefficient, is subject to random error. This error can result in an incorrect ranking of experimental units which inevitably leads to a curve that exaggerates the degree of concentration (variation) in the population. We explore this bias and discuss several widely available statistical methods that have the potential to reduce or remove the bias in the empirical Lorenz curve. The properties of these methods are examined and compared in a simulation study. This work is motivated by a health outcomes application which seeks to assess the concentration of black patient visits among primary care physicians. The methods are illustrated on data from this study

Diffusion tensor and volumetric magnetic resonance imaging using an MR-compatible hand-induced robotic device suggests training-induced neuroplasticity in patients with chronic stroke

Stroke is the third leading cause of mortality and a frequent cause of long-term adult impairment. Improved strategies to enhance motor function in individuals with chronic disability from stroke are thus required. Post-stroke therapy may improve rehabilitation and reduce long-term disability; however, objective methods for evaluating the specific impact of rehabilitation are rare. Brain imaging studies on patients with chronic stroke have shown evidence for reorganization of areas showing functional plasticity after a stroke. In this study, we hypothesized that brain mapping using a novel magnetic resonance (MR)-compatible hand device in conjunction with state-of-the-art magnetic resonance imaging (MRI) can serve as a novel biomarker for brain plasticity induced by rehabilitative motor training in patients with chronic stroke. This hypothesis is based on the premises that robotic devices, by stimulating brain plasticity, can assist in restoring movement compromised by stroke-induced pathological changes in the brain and that these changes can then be monitored by advanced MRI. We serially examined 15 healthy controls and 4 patients with chronic stroke. We employed a combination of diffusion tensor imaging (DTI) and volumetric MRI using a 3-tesla (3T) MRI system using a 12-channel Siemens Tim coil and a novel MR-compatible hand-induced robotic device. DTI data revealed that the number of fibers and the average tract length significantly increased after 8 weeks of hand training by 110% and 64%, respectively (p<0.001). New corticospinal tract (CST) fibers projecting progressively closer to the motor cortex appeared during training. Volumetric data analysis showed a statistically significant increase in the cortical thickness of the ventral postcentral gyrus areas of patients after training relative to pre-training cortical thickness (p<0.001). We suggest that rehabilitation is possible for a longer period of time after stroke than previously thought, showing that structural plasticity is possible even after 6 months due to retained neuroplasticity. Our study is an example of personalized medicine using advanced neuroimaging methods in conjunction with robotics in the molecular medicine era

Atom gratings produced by large angle atom beam splitters

An asymptotic theory of atom scattering by large amplitude periodic potentials is developed in the Raman-Nath approximation. The atom grating profile arising after scattering is evaluated in the Fresnel zone for triangular, sinusoidal, magneto-optical, and bichromatic field potentials. It is shown that, owing to the scattering in these potentials, two \QTR{em}{groups} of momentum states are produced rather than two distinct momentum components. The corresponding spatial density profile is calculated and found to differ significantly from a pure sinusoid.Comment: 16 pages, 7 figure

Quantum Monte Carlo calculation of Compton profiles of solid lithium

Recent high resolution Compton scattering experiments in lithium have shown significant discrepancies with conventional band theoretical results. We present a pseudopotential quantum Monte Carlo study of electron-electron and electron-ion correlation effects on the momentum distribution of lithium. We compute the correlation correction to the valence Compton profiles obtained within Kohn-Sham density functional theory in the local density approximation and determine that electronic correlation does not account for the discrepancy with the experimental results. Our calculations lead do different conclusions than recent GW studies and indicate that other effects (thermal disorder, core-valence separation etc.) must be invoked to explain the discrepancy with experiments.Comment: submitted to Phys. Rev.

A Constrained Path Monte Carlo Method for Fermion Ground States

We describe and discuss a recently proposed quantum Monte Carlo algorithm to compute the ground-state properties of various systems of interacting fermions. In this method, the ground state is projected from an initial wave function by a branching random walk in an over-complete basis of Slater determinants. By constraining the determinants according to a trial wave function $|\psi_T\rangle$, we remove the exponential decay of signal-to-noise ratio characteristic of the sign problem. The method is variational and is exact if $|\psi_T\rangle$ is exact. We illustrate the method by describing in detail its implementation for the two-dimensional one-band Hubbard model. We show results for lattice sizes up to $16\times 16$ and for various electron fillings and interaction strengths. Besides highly accurate estimates of the ground-state energy, we find that the method also yields reliable estimates of other ground-state observables, such as superconducting pairing correlation functions. We conclude by discussing possible extensions of the algorithm.Comment: 29 pages, RevTex, 3 figures included; submitted to Phys. Rev.