An appraisal of organizational response to fiscally constraining regulation: the case of hospitals and DRGs

Results from analysis of 227,771 discharge abstracts from 68 short-term, acute-care hospitals and from interviews with a stratified random selection of 24 of the 68 chief executives of these hospitals demonstrate that institutions perceive implementation of DRGs as fiscally constraining, especially in light of other resource-constraining conditions (an increase in unemployment resulting in fewer people with hospitalization insurance, in addition to severe cuts in Medicaid rolls and budget). Hospitals responded to DRGs by decreasing the use of affected resources or services available to the hospitalized Medicare patient. In order to survive a more economically stringent marketplace, hospitals no longer protected the traditional core within the Medicare inpatient market. They opted instead to change practices and products at the unregulated margins of the DRG system.     

Performance models for unreliable flexible manufacturing systems

This paper deals with the analysis and application of queueing models for single and multi stage flexible manufacturing systems that are subject to resource failure. Exact results are derived for the single stage queueing system. Two approximations are presneted for the multi stage queueing system as a closed network. We validate the approximations by comparing their performance estimates against the exact global balance solution.     

Working Together to Improve Accessibility: Consortial E-Resource Accessibility and Advocacy

Abstract

In 2015, the Big Ten Academic Alliance (BTAA) Libraries formed the BTAA Library E-Resource Accessibility Group. This group, which consists of members from each Big Ten library and the BTAA Library Initiatives staff, was charged with creating boilerplate accessibility license language for vendor contracts, as well as collectively funding high level accessibility testing of e-resources and posting these publicly for all libraries and users. Since the creation of the group, about 50 databases have been tested and accessibility license language has been created that can be used and adapted by anyone. In 2019, the group welcomed another consortia, the Association of Southeastern Research Libraries (ASERL), to be partners in this work, renaming themselves the Library Accessibility Alliance. This paper examines the mission, accomplishments, and new partnership in more depth while also discussing the need for focused efforts to help ensure accessible e-resources.     

The obesity pay gap: gender,body size,and wage inequalities—a longitudinal study of Chinese adults, 1991–2011

Sociocultural values promoting Western body-type ideals have proliferated over the past 20 years. An important question is whether the same obesity wage penalties seen in the United States, such as wage reductions for obese individuals, are emerging in China as ideals of beauty change to reflect Western ones. We hypothesize that Westernisation will exacerbate the impact of body size on wages for years to come, particularly for urban non-manual workers whose workplaces call for extensive interpersonal relations with employers, colleagues, and customers. This study examines the economic outcomes for individuals aged 18–55, focusing on 6600 female and 8488 male participants in the longitudinal 1991–2011 China Health and Nutrition Survey. Linear fixed-effects regression models estimate the net effect of body mass index (BMI) on wages, as well as the marginal effect of BMI on wages, by survey year. All analyses control for demographic backgrounds and household fixed effects, and are stratified by gender. The results show that normal-weight women with non-manual jobs in 2011 made 2.79–2.95 times more than they had in 1991, while overweight women made 2.66–2.76 times more, and obese women made only 2.57–2.63 times more. The results also indicate that women with non-manual jobs have been subject to wage disparities since 2000. Specifically, the wage disparity for heavier women living in urban areas with non-manual jobs increased significantly after 2000, while current male obesity rates may have been propelled by social acceptance of larger body sizes among men, particularly for manual workers living in rural areas.     

NEW TRENDS IN THE DOCTOR-PATIENT RELATIONSHIP: IMPACTS OF MANAGED CARE ON THE GROWTH OF A CONSUMER PROTECTIONS MODEL

Managed care is prompting a large revision not only in the ways doctors are employed and paid but also in the essence of the relationship between doctors and patients. In medical sociology, a discipline with a long-standing focus on scrutinizing the role of both the physician and the patient, there has already been discussion of a shift from the doctor as more all knowing to a less dominant position vis-a-vis both the patient and delivery of care. Patients are aware of shifts that place physicians in an environment characterized by new roles and responsibilities, such as acting as a gatekeeper. Limitations on health care coverage and the rethinking of roles have led to a depiction of the patient as the consumer of care and the managed care plan's becoming the commercial enterprise from which a service is obtained. The model of the patient as consumer of medically related goods and services appears to be growing, as does a model of the physician as one who contracts for a specified range of services for specific patients. In this article, trends in and problems with contemporary managed care are raised. Calls for patients' rights legislation may be among the health trends of the new millennium.     

Men and women together: the impact of birth control technology on male-female relationships

The authors argue that "birth control technologies have fundamentally altered the nature of male-female relationships.... New sequences of love, intimacy, sex, and marriage in male-female relationships emerged. The expanded number of choices for individuals has simultaneously created new freedom and opportunity, as well as uncertainty and confusion in male-female relationships. New norms for cross-sex interactions and the new post-birth control morality are still evolving." The geographic focus is on developed countries.     

我为电影狂

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Benedict Cumberbatch:天才最性感

泰戈尔在某部小说中说,女性手中的花环,要么挂在禽兽的恶汉脖子上,要么献给强同虚构人手般空想。因为女性在心底深处,渴望被肉欲的车轮碾碎,又或者在思想的烈火中融化--这种言辞似乎过于极端,好像女人都像受虐狂--不过,女人确实热爱幻想田人的强大,或肉体,或精神.