Physician Financial Incentives and Cesarean Section Delivery

The 'induced demand' model states that in the face of negative income shocks physicians may exploit their agency relationship with patients by providing excessive care in order to maintain their incomes. We test this model by exploiting an exogenous change in the financial environment facing obstetrician/gynecologists during the 1970s: declining fertility in the U.S. We argue that the 13.5% fall in fertility over the 1970-1982 period increased the income pressure on ob/gyns, and led them to substitute from normal childbirth towards a more highly reimbursed alternative, cesarean delivery. Using a nationally representative micro-data set for this period, we show that there is a strong correlation between within state declines in fertility and within state increases in cesarean utilization. This correlation is robust to consideration of a variety of alternative hypotheses, and appears to be symmetric with respect to periods of fertility decline and fertility increase.

The wavelength dependence of polarization. iii- the lunar surface final report

Photoelectric photometry, luminescence, and polarimetry of lunar surface - selenograph

Intercity rail-passenger car ride quality test program

The Federal Railroad Administration's research and development program relating to intercity rail-passenger ride quality focuses on developing ride quality design criteria and specifications. The FRA ride quality test program and some of the techniques being used to analyze and evaluate the design criteria of the program are discussed

Hydrogen masers with cavity frequency switching servos

The stability of the free-running hydrogen maser is limited by pulling of the unperturbed hydrogen transition frequency due to instability of the cavity resonance frequency. While automatic spin-exchange tuning is in principle the more basic and accurate method, the required beam intensity switching and the long servo time constant result in reduced stability for measuring intervals up to 10(exp 6) seconds. More importantly, the spin-exchange tuning method requires a second stable frequency source as a reference, ideally a second hydrogen maser, to get the best results. The cavity frequency switching servo, on the other hand, has very little effect on the maser short term stability, and is fast enough to correct for cavity drift while maintaining the cavity at the spin-exchange tuned offset required to minimize instability due to beam intensity fluctuations. Not only does the cavity frequency switching servo not require a second stable frequency source, but the frequency reference is the atomic hydrogen radiated beam signal, so that no extra RF connections need be made to the cavity, and externally generated signals that would perturb the hydrogen atom need not be transmitted through the cavity. The operation of the cavity frequency switching stabilization method is discussed and the transient response of the servo and certain other aspects of the technique that have potential for achieving improved basic accuracy are illustrated

A device-dependent interface for interactive image display

The structure of the device independent Display Management Subsystem (DMS) and the interface routines that are available to the applications programmer for use in developing a set of portable image display utility programs are described

Rural Kansas Family Physician Satisfaction with Caring for Spanish-Speaking Only Patients

Introduction. Patient satisfaction with the care they receive can beinfluenced negatively by a language barrier between the physician andpatient. However, there is a paucity of information regarding the consequencesof a language barrier on physician satisfaction, althoughthis barrier has the potential to decrease physician wellness. Thisstudy sought to determine if a language barrier is a source of professionaldissatisfaction in family medicine physicians in rural Kansas. Methods. In a cross-sectional study, members of the Kansas Academyof Family Physicians who practiced in the rural Kansas countieswith the highest percentage of Hispanic residents were surveyed. Aquestionnaire was developed to determine the demographics of thephysician, details regarding his or her practice, and percentage of Hispanicand Spanish-speaking only (SSO) patients in their practice.Physicians also were queried as to their level of Spanish-speakingability, availability of certified interpreters, and their satisfaction withcaring for their SSO patients. Results. Fifty-two physicians were identified and sent questionnairesby mail. Eighteen questionnaires were completed and returned, resultingin a 34% response rate. Respondents remained anonymous. In thepractices surveyed, 61% of practice settings had a Hispanic-patientpopulation greater than 25%. Only one of the eighteen respondentshad greater than 25% of SSO patients in his or her practice. A certifiedinterpreter was used less than 25% of the time in over 75% ofthe clinical encounters with SSO patients. Seventy-five percent ofphysicians reported no difficulty establishing trust and rapport withtheir SSO patients. Eighty-nine percent of respondents rated theirrelationship with SSO patients as good to excellent, and 83% weresatisfied with the care they were able to provide this group. Seventyeightpercent of respondents reported that their ability to care forSSO patients decreased or had no effect on their professional satisfaction.Seventy-eight percent of physicians also rated their overallprofessional satisfaction in regards to their physician/patient relationshipas good to excellent. However, language barriers affectedphysician-patient relationships, physician satisfaction with care, andprofessional satisfaction. Conclusion. Language barrier affected physician’s relationships withSSO patients, led to decreased physician satisfaction with the carethey provided and to decreased professional satisfaction.KS J Med 2017;10(4):79-83

Value-based analysis of routine pathologic septal and inferior turbinate specimens.

This article was presented at the 2012 AAO-HNSF Annual Meeting & OTO EXPO; September 9-12, 2012; Washington, DC. Objective To determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery and evaluate the necessity for histologic processing of nasal septal cartilage, bone, and inferior turbinate specimens. Study Design Case series with chart review. Setting Tertiary care academic medical center. Subjects and Methods A retrospective review of surgical pathology reports on adult patients undergoing sinonasal surgery during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, or directed septal biopsies were excluded from review. Results A total of 1194 pathology reports were reviewed from 1172 individual patients. This included histopathologic evaluation of 1194 septal cartilage and bone specimens and 714 inferior turbinate specimens. None of the patients had unanticipated histopathologic findings that were clinically significant. Conclusion Many surgeons obtain histopathologic diagnoses on all tissue removed from a patient. Based on our institutional case series, histopathology of the septum and inferior turbinates in routine sinonasal cases may not be necessary. A value-based approach to processing grossly unremarkable septal and turbinate tissue by waiving histologic processing and subsequent microscopic evaluation could provide significant cost savings

Female Blow Flies As Vertebrate Resource Indicators

Rapid vertebrate diversity evaluation is invaluable for monitoring changing ecosystems worldwide. Wild blow flies naturally recover DNA and chemical signatures from animal carcasses and feces. We demonstrate the power of blow flies as biodiversity monitors through sampling of flies in three environments with varying human influences: Indianapolis, IN and two national parks (the Great Smoky Mountains and Yellowstone). Dissected fly guts underwent vertebrate DNA sequencing (12S and 16S rRNA genes) and fecal metabolite screening. Integrated Nested Laplace Approximation (INLA) was used to determine the most important abiotic factor influencing fly-derived vertebrate richness. In 720 min total sampling time, 28 vertebrate species were identified, with 42% of flies containing vertebrate resources: 23% DNA, 5% feces, and 14% contained both. The species of blow fly used was not important for vertebrate DNA recovery, however the use of female flies versus male flies directly influenced DNA detection. Temperature was statistically relevant across environments in maximizing vertebrate detection (mean = 0.098, sd = 0.048). This method will empower ecologists to test vertebrate community ecology theories previously out of reach due practical challenges associated with traditional sampling

Output Contracts and the Unreasonably Disproportionate Clause of 2-306

Open quantity contracts evolved due to the commercial advantages inherent in such contracts. However, the level of permissible quantity variation within an open quantity contract has been frequently litigated. In Atlantic Track and Turnout v. Perini, the First Circuit resolved a dispute concerning variation within such a contract. This Note examines the traditional analysis used by the court in resolving this dispute and suggests an alternative method of analysis