Organizing the U.S. Health Care Delivery System for High Performance

Analyzes the fragmentation of the healthcare delivery system and makes policy recommendations -- including payment reform, regulatory changes, and infrastructure -- for creating mechanisms to coordinate care across providers and settings

Product and other fine structure in polynomial resolutions of mapping spaces

Let Map_T(K,X) denote the mapping space of continuous based functions between two based spaces K and X. If K is a fixed finite complex, Greg Arone has recently given an explicit model for the Goodwillie tower of the functor sending a space X to the suspension spectrum \Sigma^\infty Map_T(K,X). Applying a generalized homology theory h_* to this tower yields a spectral sequence, and this will converge strongly to h_*(Map_T(K,X)) under suitable conditions, e.g. if h_* is connective and X is at least dim K connected. Even when the convergence is more problematic, it appears the spectral sequence can still shed considerable light on h_*(Map_T(K,X)). Similar comments hold when a cohomology theory is applied. In this paper we study how various important natural constructions on mapping spaces induce extra structure on the towers. This leads to useful interesting additional structure in the associated spectral sequences. For example, the diagonal on Map_T(K,X) induces a `diagonal' on the associated tower. After applying any cohomology theory with products h^*, the resulting spectral sequence is then a spectral sequence of differential graded algebras. The product on the E_\infty -term corresponds to the cup product in h^*(Map_T(K,X)) in the usual way, and the product on the E_1-term is described in terms of group theoretic transfers. We use explicit equivariant S-duality maps to show that, when K is the sphere S^n, our constructions at the fiber level have descriptions in terms of the Boardman-Vogt little n-cubes spaces. We are then able to identify, in a computationally useful way, the Goodwillie tower of the functor from spectra to spectra sending a spectrum X to \Sigma ^\infty \Omega ^\infty X.Comment: Published by Algebraic and Geometric Topology at http://www.maths.warwick.ac.uk/agt/AGTVol2/agt-2-28.abs.htm

Is sharing the solution? : exploring the opportunities and challenges of privately rented shared accommodation for single people in housing need

Reduced availability of, and access to, affordable accommodation coupled with housing benefit reductions, particularly for single people under the age of 35, make it inevitable that more people will require shared accommodation as a financially viable solution to their housing needs. However, there is a reluctance to enter into sharing, particularly with 'strangers', and many members of vulnerable groups face challenges such as living with others, gaining access to the private rented sector, and sustaining tenancies. In response to these challenges, the Sharing Solutions Programme, run by Crisis and funded by the Department for Communities and Local Government (DCLG), recently piloted, developed and promoted new models for establishing successful sharing arrangements for single people in housing need. This paper draws on findings from an evaluation of that programme, alongside the literature on shared accommodation, to identify a number of potential barriers to making shared accommodation work, and ways in which these may be overcome. A range of factors are identified as pivotal in the success of sharing in the private rented sector, including changing perceptions of sharing, managing shared properties and supporting tenants. While the paper concludes that sharing can be a viable option for some, it simultaneously recognises the significant resources required to make it successful for tenants

Deletion of AIF1 but not of YCA1/MCA1 protects Saccharomyces cerevisiae and Candida albicans cells from caspofungin-induced programmed cell death

Caspofungin was the first member of a new class of antifungals called echinocandins to be approved by a drug regulatory authority. Like the other echinocandins, caspofungin blocks the synthesis of β(1,3)-D-glucan of the fungal cell wall by inhibiting the enzyme, β(1,3)-D-glucan synthase. Loss of β(1,3)-D-glucan leads to osmotic instability and cell death. However, the precise mechanism of cell death associated with the cytotoxicity of caspofungin was unclear. We now provide evidence that Saccharomyces cerevisiae cells cultured in media containing caspofungin manifest the classical hallmarks of programmed cell death (PCD) in yeast, including the generation of reactive oxygen species (ROS), the fragmentation of mitochondria, and the production of DNA strand breaks. Our data also suggests that deleting AIF1 but not YCA1/MCA1 protects S. cerevisiae and Candida albicans from caspofungin-induced cell death. This is not only the first time that AIF1 has been specifically tied to cell death in Candida but also the first time that caspofungin resistance has been linked to the cell death machinery in yeast

Naturopathic Physician Attitudes and Practices for Vaccination and Primary Care in the State of Vermont

Introduction: Recent increase in measles cases has sparked vaccination controversy. Naturopathic physicians (NDs) have been recognized as primary care providers by VT since 2012. It is not well understood how NDs address vaccination with patients. Our goal was to determine how Vermont NDs address vaccines and preventative care with their patients.https://scholarworks.uvm.edu/comphp_gallery/1234/thumbnail.jp

Compliance-Innovation: Supporting Regional Growth

Strategic growth can be delivered through Innovative Compliance a process through which conformity with requirements - compliance - drives improvements in quality, productivity and competitiveness. In this process GRC is an engine for growth by facilitating commercialisation of knowledge and business sustainability. The integration of Governance, Risk & Compliance (GRC) with Innovation activities and business strategy is what we mean by strategic growth. Maintaining attention and focus on growth is a challenge for business in the face of increasing demands on Boards and Directors to address not only considerably more but increasingly complex types of risks. At the same time, capacity to adapt and reconfigure resources in response to market challenges, regulatory reform and complex stakeholder influences and expectations is necessary to achieve the strategic growth businesses need. Innovation can be driven by a company?s GRC orientation in the context of its corporate GRC memory as well as its business strategy supported appropriately with technology. We term this orientation Innovative Compliance. One vital element for Innovative Compliance is access to timely regulatory-compliance data structured in line with a business?s product, market and geography focus: decision makers need actionable information. Modern IT makes this increasingly possible which is particularly welcome since much of the regulation aimed at business is not provided in a format or through channels or in a timely fashion to meet businesses? information needs. A further necessity for Innovative Compliance is the ability of business to assimilate and transform regulatory and compliance data so that it can be exploited for commercial ends. This depends on an organisation?s Absorptive Capacity. In specifically GRC terms Absorptive Capacity gets at the ability to nail the various intersections of three fast moving business targets i.e. (i) new regulations (ii) product evolution (new & improved) and (iii) intra-organisational strategic imperatives. IT must simultaneously support all three aspects. Knowledge integration is the basis of modern competitive advantage and the strategic growth orientation of the business is the governing force for such integration. Modern Compliance Knowledge Management Systems can support this imperative. To operationalize Innovative Compliance executives must bring together teams of knowledge workers who are differentiated by their knowledge bases and support them to integrate the knowledge across the bases. The nature and extent of integration must resonate with the business reality of growth-oriented GRC functional experts, whatever their title, domain or expertise. In the absence of such integration ? GRC, Innovation, IT and Strategy ? productive growth opportunities are being missed

Exploring the Nuances of 'Wickedness' in Information Systems Development

Information Systems Development (ISD) practice is an inherently challenging undertaking, as exemplified by the high rate of ISD project failures. The scale of the challenge is often heightened in distributed environments where ISD practitioners can face considerable complexity, uncertainty, and contention. The concept of -˜wickedness’ epitomizes such challenges. However, ISD literature has yet to fully explore the nuances of wickedness found in ISD practices within distributed environments. To address this gap, we use a theoretical framework to analyze case study findings from an interdisciplinary connected health project. In particular, we break open the social aspects of wickedness and explore their impact on shared understanding and shared commitment in ISD projects. The paper highlights the implications that these nuances have for group decision-making in distributed ISD project teams