scholarly journals Physician Agency and Competition: Evidence from a Major Change to Medicare Chemotherapy Reimbursement Policy

2013 ◽  
Author(s):  
Mireille Jacobson ◽  
Tom Chang ◽  
Joseph Newhouse ◽  
Craig Earle
Keyword(s):  
Major Change ◽  
Reimbursement Policy ◽  
Physician Agency

Major Change Choice and Choice Self-Efficacy Measures

2010 ◽  
Author(s):  
Jason J. Dahling ◽  
Mindi N. Thompson
Keyword(s):  
Self Efficacy ◽  
Major Change ◽  
Efficacy Measures

SIEĆ PARAFIALNA W DIECEZJI EŁCKIEJ

2017 ◽  
Vol 14 (2) ◽  
pp. 67-88
Author(s):  
Ryszard Skawiński
Keyword(s):  
Catholic Church ◽  
Major Change ◽  
The Past ◽  
Russian State ◽  
The Way

The Diocese of Ełk was established in 1992 as a major change in the structure of the Churchin Poland. It connects the land belonging in the past to various forms of the Polish state and theGerman state, as well as the Russian state. As a result of these conditions, the parishes of theRoman Catholic Church in this area have arisen in different circumstances and have distincttraditions. Parishes are currently experiencing similar problems. Within the Diocese of Ełk therewas an increase in the number of parishes and the process of unifying the way they functioned.

Outcome after complex neurosurgery: the caregiver's burden is forgotten

1999 ◽  
Vol 7 (1) ◽  
pp. E1 ◽  
Author(s):  
Dorothy A. Lang ◽  
Glenn Neil-Dwyer ◽  
John Garfield
Keyword(s):  
Quality Of Life ◽  
Hypoglossal Nerve ◽  
Major Change ◽  
Percutaneous Gastrostomy ◽  
Petroclival Meningioma ◽  
Sf 36 ◽  
Skull Base Approach ◽  
Permanent Neurological Deficit ◽  
The Impact

Object The goals of this study were twofold: 1) to determine outcome, including quality of life, in patients who have undergone surgery for petroclival meningioma in which a standard skull base approach was used; and 2) to assess the impact of the patients' surgical treatment on their caregivers. Methods Seventeen patients (13 women and four men ranging in age from 29 to 63 years) who underwent a transpetrosal approach for a petroclival meningioma during a 5-year period were prospectively included in this study. Pre- and postoperative data including adverse events were noted. The patients were assessed at 3, 6, and 12 months postoperatively, and annually thereafter, and they completed a postoperative SF-36 questionnaire. In addition, each patient's caregiver was interviewed to determine the effect of the patient's illness on the caregiver's life and responsibilities. Twenty-two operations were performed. A new permanent neurological deficit developed in five patients and in eight a temporary deficit or exacerbation of existing deficits occurred. Two patients underwent surgery to create a facial-hypoglossal nerve communication; five required a temporary percutaneous gastrostomy and/or tracheostomy; three required a shunt; and one underwent successful squint surgery. At 1 year postoperatively 13 patients had made a good or moderate recovery, three were severely disabled, and one had died--outcomes in keeping with other studies. By contrast, responses to the SF-36 questionnaire showed that, in all eight of its categories, between 43% and 75% of surviving patients were functioning below accepted norms. Fifty-six percent of caregivers experienced a major change in lifestyle and 38% experienced a major change with respect to their work. Conclusions After transpetrosal excision of a petroclival meningioma, the quality of life for the patient is worse than that indicated in surgeons' reported results. The impact on the patient's caregiver is profound--a burden perhaps not fully appreciated by the surgeon.

Monitoring Effects of Catchment Management Practices on Phosphorus Loads into the Eutrophic Peel-Harvey Estuary, Western Australia

1986 ◽  
Vol 18 (4-5) ◽  
pp. 53-61 ◽  
Author(s):  
P. B. Birch ◽  
G. G. Forbes ◽  
N. J. Schofield
Keyword(s):  
Management Practices ◽  
Major Change ◽  
High Flow ◽  
Catchment Management ◽  
Flow Rates ◽  
Early Results ◽  
Phosphorus Loads ◽  
Time Of Year ◽  
High Runoff

Early results from monitoring runoff suggest that the programme to reduce application of superphosphate to farmlands in surrounding catchments has been successful in reducing input of phosphorus to the eutrophic Peel-Harvey estuary. In the estuary this phosphorus fertilizes algae which grow in abundance and accumulate and pollute once clean beaches. The success of the programme has been judged from application of an empirical statistical model, which was derived from 6 years of data from the Harvey Estuary catchment prior to a major change in fertilizer practices in 1984. The model relates concentration of phosphorus with rate of flow and time of year. High phosphorus concentrations were associated with high flow rates and with flows early in the high runoff season (May-July). The model predicted that the distribution of flows in 1984 should have resulted in a flow-weighted concentration of phosphorus near the long-term average; the observed concentration was 25% below the long-term average. This means that the amount of phosphorus discharged into the Harvey Estuary could have been about 2 5% less than expected from the volume of runoff which occurred. However several more years of data are required to confirm this trend.

Functional characterization and structural modelling of peptidoglycan degrading β-N-acetyl-glucosaminidase from a dental isolate of Serratia marcescens

2020 ◽  
Vol 23 ◽  
Author(s):  
Aditi Rathee ◽  
Anil Panwar ◽  
Seema Kumari ◽  
Sanjay Chhibber ◽  
Ashok Kumar
Keyword(s):  
Functional Characterization ◽  
Major Change ◽  
Crystal Form ◽  
Bound State ◽  
Dynamics Simulation ◽  
Gram Positive ◽  
Structural Cell ◽  
Stability Structure ◽  
Arginine Residues ◽  
The Stability

Introduction:: Enzymatic degradation of peptidoglycan, a structural cell wall component of Gram-positive bacteria, has attracted considerable attention being a specific target for many known antibiotics. Methods:: Peptidoglycan hydrolases are involved in bacterial lysis through peptidoglycan degradation. β-N-acetylglucosaminidase, a peptidoglycan hydrolase, acts on O-glycosidic bonds formed by N-acetylglucosamine and N-acetyl muramic acid residues of peptidoglycan. Aim of present study was to study the action of β-N-acetylglucosaminidase, on methicillin- resistant Staphylococcus aureus (MRSA) and other Gram-negative bacteria. Results:: We investigated its dynamic behaviour using molecular dynamics simulation and observed that serine and alanine residues are involved in catalytic reaction in addition to aspartic acid, histidine, lysine and arginine residues. When simulated in its bound state, the RMSD values were found lesser than crystal form in the time stamp of 1000 picoseconds revealing its stability. Structure remained stably folded over 1000 picoseconds without undergoing any major change further confirming the stability of complex. Conclusion:: It can be concluded that enzymes belonging to this category can serve as a tool in eradicating Gram-positive pathogens and associated infections.

EMERGING TRENDS IN BANKING SECTOR - ITS CHALLENGES AND OPPORTUNITIES

2018 ◽  
Vol 6 (26) ◽  
Author(s):  
Karigoleshwar .
Keyword(s):  
Banking Sector ◽  
Banking Industry ◽  
Banking System ◽  
Major Change ◽  
Commercial Banking ◽  
Foreign Banks ◽  
Emerging Trends ◽  
Reserve Bank ◽  
Challenges And Opportunities ◽  
Multiple Regions

In financial sector the banking industry is the largest player, has also been undergoing a major change. Today the banking industry is stronger and capable of withstanding the pressures of competition. Today, we are having a fairly well developed banking system with different classes of banks – public sector banks, foreign banks, private sector banks – both old and new generation, regional rural banks and co-operative banks with the Reserve Bank of India as the fountain Head of the system. In the banking field, there has been an unprecedented growth and diversification of banking industry has been so stupendous that it has no parallel in the annals of banking anywhere in the world. The banking industry has experienced a series of significant transformations in the last few decades. Among the most important of them is the change in the type of organizations that dominate the landscape. Since the eighties, banks have increased the scope and scale of their activities and several banks have become very large institutions with a presence in multiple regions of the country.' The paper examines the new trends in commercial banking. The present era the cashless transactions, E-cheques, mobile wallets. The paper attempts to present the emerging trends and its challenges that recently emerged in the banking sector with special emphasis on digitization. It will be useful to the academicians, banking and insurance personnel, students and researchers. Common readers also know the latest innovations in banking sector

Do People Trust in Robot-Assisted Surgery? Evidence from Europe (Preprint)

2020 ◽  
Author(s):  
Joan Torrent-Sellens ◽  
Ana Jiménez-Zarco ◽  
Francesc Saigí-Rubió
Keyword(s):  
Technology Acceptance ◽  
Surgical Intervention ◽  
Negative Relationship ◽  
Predictor Variable ◽  
Major Change ◽  
Ease Of Use ◽  
The European Union ◽  
Robot Assisted ◽  
Surgical Interventions ◽  
Robot Assisted Surgery

BACKGROUND Increasingly intelligent and autonomous robots are destined to have a huge impact on our society. Their adoption, however, represents a major change to the healthcare sector’s traditional practices, which, in turn, poses certain challenges. To what extent is it possible to foresee a near-future scenario in which minor routine surgery is directed by robots? And what are the patients’ or general public’s perceptions of having surgical procedures performed on them by robots, be it totally or partially? A patient’s trust in robots and AI may facilitate the spread and use of such technologies. OBJECTIVE The goal of our study was to establish the factors that influence how people feel about having a medical operation performed on them by a robot. METHODS We used data from a 2017 Flash Eurobarometer (number 460) of European Commission with 27,901 citizens aged 15 years and over in the 28 countries of the European Union. The research designs and tests a technology acceptance model (TAM). Logistic regression (odds ratios, OR) to model the predictors of trust in robot-assisted surgery was calculated through motivational factors, robots using experience and sociodemographic independent variables. RESULTS The negative relationship between most of the predictors of ease of use, expected benefits and attitude towards robots, and confidence in robot-assisted surgery was contrasted. The only non-sociodemographic predictor variable that has a positive relationship with trust in robots participating in a surgical intervention is previous experience in the use of robots. In this context, we analyze the confidence predictors for three different levels of robot use experience (zero use, average use, and high use). The results obtained indicate that, as the experience of using robots increases, the predictive coefficients related to information, attitude and perception of robots become more negative. Research results also determined that variables of a sociodemographic nature played an important predictive role. It was confirmed that the effect of experience on trust in robots for surgical interventions was greater among men, people between 40 and 54 years old, and those with higher educational levels. CONCLUSIONS Despite the considerable benefits for the patient that the use of robots can bring in a surgical intervention, the results obtained show that trust in robots goes beyond rational decision-making. By contrasting the reasons that generate trust and mistrust in robots, especially by highlighting the experience of use as a key element, the research makes a new contribution to the state of the art and draws practical implications of the use of robots for health policy and practice.

"Nécessité d'une orientation esthétique": Techniques of Development in the Music of Boulez

2019 ◽  
Vol 6 (1) ◽  
pp. 87-129
Author(s):  
Catherine Losada
Keyword(s):  
Significant Influence ◽  
Major Change ◽  
Compositional Process ◽  
Base Materials ◽  
Compositional Approach ◽  
The Creation ◽  
Open Work ◽  
Additional Level ◽  
New Perspective ◽  
The 1960S

The latter part of the 1950s saw a major change in Boulez's compositional approach: Instead of creating extensive pre-compositional sketches, he increasingly reused previously composed materials as the basis for new works. The shifting aesthetics that characterized this period had a significant influence on Boulez. His works from the late 1950s explore the ideas of mobility embedded in the open work. Balancing the concept of mobility with the ideals of control that form the basis of his compositional ideology led to an economy of means and an associated emphasis on the concept of development in his compositional process. Both facilitated the creation of new works from a more limited array of base materials.<br/> Tracing the concept of development in a sample of Boulez's sketches and works from the late 1950s through the 1960s, this essay presents a preliminary typology of recurring pitch and temporal developmental techniques. By taking a bird's-eye view, I add an additional level of interpretation, emphasizing their formal function, association with aspects of middleground structure and studying their implications in terms of perception. In this way, I present a new perspective on the association between these techniques and the practice of derivation from a limited amount of material that characterizes these works.

scholarly journals E.U. and China Trends in Trade in Challenging Times

2021 ◽  
Vol 14 (2) ◽  
pp. 71
Author(s):  
Irena Jindřichovská ◽  
Erginbay Uğurlu
Keyword(s):  
World Economy ◽  
Electronic Devices ◽  
Major Change ◽  
Chinese Economy ◽  
High Demand ◽  
Monthly Data ◽  
Medical Supplies ◽  
Chinese Export ◽  
Abrupt Rise ◽  
The Eu

The sudden and abrupt rise of COVID-19 became a challenge for the world economy. In this paper, we investigate the changes in a trend of mutual trade between the EU-15 countries and China during the demanding times of the COVID-19 crisis. We use monthly data for Chinese exports to the E.U. (2018:01–2020:05) and imports from the E.U. (2018:01–2020:07) relying on the data from the open-source TradeMap developed by the International Trade Centre UNCTAD/WTO (ITC). Overall, there is an obvious decline of 13–32 percent in worldwide trade as predicted by the WTO. This affected China as the main trading partner of electronic devices and medical supplies. The trade between the E.U. and China has decreased, but the major change in demand brought an alteration in commodities structures and the reorientation of Chinese export production. In the first five months of 2020, we witnessed the strong engagement of the Chinese economy in the production of goods newly in high demand—mainly articles strongly related to healthcare and medical equipment. Thus, we have observed that the Chinese were very flexible in changing the structure of their exports triggered by the COVID-19 crisis. This flexibility is worth further exploration, especially because the COVID-19 crisis is still not over and new data and changing results can be expected.

Change in Service Provision Networks: The Case of Animal Welfare Services

2021 ◽  
pp. 0160323X2110092
Author(s):  
Laura A. Reese ◽  
Xiaomeng Li
Keyword(s):  
Service Provision ◽  
Survey Design ◽  
Participant Observation ◽  
Local Level ◽  
Major Change ◽  
Network Evolution ◽  
Political Factors ◽  
Before And After ◽  
Organizational Ties ◽  
The Impact

This research focuses on change within informal service provision networks, specifically examining the impact that changes within a key organization can have on the larger network. Employing a before and after survey design with a treatment at the midpoint and participant observation, it asks: What is the impact of a major change within one organization on the larger external network? What is the nature of the organizational ties? and, How do political factors exogenous to the network impact the network evolution process? The findings suggest that internal change within a focal actor can have ripple effects throughout the network increasing density. Public service provision at the local level can be enhanced through an increase in partnerships between the public and nonprofit sectors. However, network evolution can be limited by the larger political environment and lack of a coordinating role on the part of local government.

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