Publications

Abstract Accountable care organizations (ACOs) have proliferated under the Affordable Care Act (ACA). If ACOs are to improve health care quality and lower costs, quality measures will be increasingly important in determining if provider consolidations associated with the development of ACOs are achieving their intended purpose. This article assesses quality measurement across public and private sectors. We reviewed available quality measures for a subset of programs in six organizations and assessed the number and domain of measures (structure, process, outcomes, and patient experience). Two-thirds of all quality measures were categorized as process measures. Outcome measures made up nearly 20 percent of measures. Patient experience and structure measures made up approximately 8 percent and 7 percent, respectively. We propose further improvements to quality measurement initiatives. For example, programs that reward providers should consider reward size and distribution within the organization. Quality improvement initiatives should consider what encourages provider buy-in and participation and the effects on populations with disproportionate health care needs. As the focus of quality initiatives may change from year to year, measures should be periodically revisited to ensure continued improvement and sustainability. Finally, we suggest quality measures that regulators could use prior to ACO formation or in the year or two following formation.

Calibration of the geological time scale is achieved by independent radioisotopic and astronomical dating, but these techniques yield discrepancies of ∼1.0% or more, limiting our ability to reconstruct Earth history. To overcome this fundamental setback, we compared astronomical and 40 Ar/ 39 Ar ages of tephras in marine deposits in Morocco to calibrate the age of Fish Canyon sanidine, the most widely used standard in 40 Ar/ 39 Ar geochronology. This calibration results in a more precise older age of 28.201 ± 0.046 million years ago (Ma) and reduces the 40 Ar/ 39 Ar method9s absolute uncertainty from ∼2.5 to 0.25%. In addition, this calibration provides tight constraints for the astronomical tuning of pre-Neogene successions, resulting in a mutually consistent age of ∼65.95 Ma for the Cretaceous/Tertiary boundary.

to their backbone is one of the key strategies to achieve better performances [1].One of the simplest approaches in this regard is to employ functionalised ligands (linkers) in the final coordination network [2].Since the functional groups often decrease the linkers' symmetry without affecting the framework connectivity, they usually occupy alternative positions with similar energy minima and thus occupancy values.Importantly, the assumption of their random distribution should be considered a misguided approximation as it excludes any relevant interaction between adjacent groups or with the framework itself.In this context we present the case studies of ZIF-90 [3] and NO 2 -MIL-53(Al) [4], whose linker disorder revealed to be strongly correlated or even crystallographic order upon symmetry breaking.Total scattering single crystal XRD analysis afforded corrected structural models showing important differences from the random disorder-based ones with consequences on relevant features such as pores opening, presence of dipole moments and availability of metal sites.These findings highlight the importance of local order of framework components in functionalised MOFs and the possible risks of trusting random disorder models.

Methods and apparatus are provided for developing a complete set of all admissible Type I and Type II fixture designs for a workpiece. The fixture processor generates the set of all admissible designs based on geometric access constraints and expected applied forces on the workpiece. For instance, the fixture processor may generate a set of admissible fixture designs for first, second and third locators placed in an array of holes on a fixture plate and a translating clamp attached to the fixture plate for contacting the workpiece. In another instance, a fixture vise is used in which first, second, third and fourth locators are used and first and second fixture jaws are tightened to secure the workpiece. The fixture process also ranks the set of admissible fixture designs according to a predetermined quality metric so that the optimal fixture design for the desired purpose may be identified from the set of all admissible fixture designs.

Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 100 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a “Full Text” option. The original article is trackable via the “References” option.

Abstract Recent studies suggest spectroscopic differences explain a fraction of the variation in Type Ia supernova (SN Ia) luminosities after light-curve/color standardization. In this work, (i) we empirically characterize the variations of standardized SN Ia luminosities, and (ii) we use a spectroscopically inferred parameter, SIP, to improve the precision of SNe Ia along the distance ladder and the determination of the Hubble constant ( H 0 ). First, we show that the Pantheon+ covariance model modestly overestimates the uncertainty of standardized magnitudes by ∼ 7%, in the parameter space used by the SH0ES Team to measure H 0 ; accounting for this alone yields H 0 = 73.01 ± 0.92 km s -1 Mpc -1 . Furthermore, accounting for spectroscopic similarity between SNe Ia on the distance ladder reduces their relative scatter to ∼ 0.12 mag per object (compared to ∼ 0.14 mag previously). Combining these two findings in the model of SN covariance, we find an overall 14% reduction (to ± 0.85 km s -1 Mpc -1 ) of the uncertainty in the Hubble constant and a modest increase in its value. Including a budget for systematic uncertainties itemized by Riess et al. (2022a), we report an updated local Hubble constant with ∼ 1.2% uncertainty, H 0 = 73.29 ± 0.90 km s -1 Mpc -1 . We conclude that spectroscopic differences among photometrically standardized SNe Ia do not explain the “Hubble tension”. Rather, accounting for such differences increases its significance, as the discrepancy against ΛCDM calibrated by the Planck 2018 measurement rises to 5.7σ.

High throughput serving of large language models (LLMs) requires batching sufficiently many requests at a time. However, existing systems struggle because the key-value cache (KV cache) memory for each request is huge and grows and shrinks dynamically. When managed inefficiently, this memory can be significantly wasted by fragmentation and redundant duplication, limiting the batch size. To address this problem, we propose PagedAttention, an attention algorithm inspired by the classical virtual memory and paging techniques in operating systems. On top of it, we build vLLM, an LLM serving system that achieves (1) near-zero waste in KV cache memory and (2) flexible sharing of KV cache within and across requests to further reduce memory usage. Our evaluations show that vLLM improves the throughput of popular LLMs by 2--4× with the same level of latency compared to the state-of-the-art systems, such as FasterTransformer and Orca. The improvement is more pronounced with longer sequences, larger models, and more complex decoding algorithms. vLLM's source code is publicly available at https://github.com/vllm-project/vllm.

Poor bone quality contributes to bone fragility in diabetes, aging, and osteogenesis imperfecta. However, the mechanisms controlling bone quality are not well understood, contributing to the current lack of strategies to diagnose or treat bone quality deficits. Transforming growth factor beta (TGF-β) signaling is a crucial mechanism known to regulate the material quality of bone, but its cellular target in this regulation is unknown. Studies showing that osteocytes directly remodel their perilacunar/canalicular matrix led us to hypothesize that TGF-β controls bone quality through perilacunar/canalicular remodeling (PLR). Using inhibitors and mice with an osteocyte-intrinsic defect in TGF-β signaling (TβRIIocy−/−), we show that TGF-β regulates PLR in a cell-intrinsic manner to control bone quality. Altogether, this study emphasizes that osteocytes are key in executing the biological control of bone quality through PLR, thereby highlighting the fundamental role of osteocyte-mediated PLR in bone homeostasis and fragility.

We compare the accuracy of conventional semilocal density functional theory (DFT), the DFT+U method, and the Heyd-Scuseria-Ernzerhof (HSE06) hybrid functional for structural parameters, redox react ...