CMS Innovation Center at 10 Years — Progress and Lessons Learned

The Swarm mission concept is innovative in its recognition that high-quality measurements of the geomagnetic field from LEO require accurate knowledge of Earth’s plasma environment, and furthermore that combined, precision measurements of fields, plasmas and neutral density from polar orbit provide a new window into ionosphere-thermosphere-magnetosphere (ITM) coupling and science. During the first decade of operations, event-based studies have led to new discoveries such as extreme plasma flows associated with the Birkeland current systems, the electrodynamic structure of multiple auroral arcs, the sub-auroral “STEVE” phenomenon, and the existence of standing Alfvén waves at equatorial latitudes. At the same time, the mission has accumulated an extensive database of measurements at high spatial resolution collected over a wide range of condition covering nearly a full solar cycle; these data have been used in longer-term statistical studies of plasma properties, high-latitude convection and ITM coupling via Poynting flux. As we enter the next decade of operations, the Swarm data are increasingly being used to inform empirical and physics-based models of the ionosphere; these in turn will comprise an important part of the long-term legacy of the Swarm mission. This talk will highlight scientific discoveries from the first decade of EFI operations, centred on observations of ion flows and associated electric fields from the EFI’s Thermal Ion Imagers, and made possible by a large and active community of collaborators. 

Accurate and reliable calibration of the Advanced LIGO detectors has enabled a plethora of gravitational-wave discoveries in the detectors' first decade of operation, starting with the ground-breaking discovery, GW150914. In the first decade of operation, the calibrated strain data from Advanced LIGO detectors has become available at a lower latency and with more reliability. In this paper, we discuss the relevant history of Advanced LIGO calibration and introduce new tools that have been developed to enable faster and more robust calibrated strain data products in the fourth observing run (O4). 
We discuss improvements to the robustness, reliability, and accuracy of the low-latency calibration pipeline as well as the development of a new tool for monitoring the LIGO detector calibration in real time.

The CMS Innovation Center: Delivering on the Promise of Payment and Delivery Reform

A Health Affairs Web First article released today describes the new rapid-cycle approach to program evaluation at the recently established Center for Medicare and Medicaid Innovation. The Affordable Care Act created the Innovation Center within the Centers for Medicare and Medicaid Services (CMS) to test payments and service delivery models, reduce costs in Medicare and Medicaid, and improve quality. As the Innovation Center moves ahead with innovative payment and service delivery models, the Rapid Cycle Evaluation Group at the center delivers frequent feedback to providers while evaluating the outcomes of each model tested. When a model is considered for testing, staff from the Rapid Cycle Evaluation Group and CMS' Office of the Actuary are immediately assigned to help create the model. The Office of the Actuary provides timely and impartial actuarial, economic, and statistical estimates--and monitors Innovation Center initiatives once testing has begun. This group's rigorous and speedy assessment and evaluation is driven by performance metrics and robust new methodologies. Researchers from the evaluation group have also been organized into "affinity groups" and use CMS data to answer critical policy questions that may shape future payment and service delivery models. The Innovation Center also plans to identify and promote population health metrics--measures of the functional status, healthy behavior, and health outcomes of a population--to promote disease prevention and achieve a more accountable, equitable, and coordinated health care system. All these efforts will contribute to the Innovation Center's success in carrying out its mission of improving the quality of care combined with the slowing spending growth.

The year 2012 marks a decade of observations undertaken by the U.S. Climate Reference Network (USCRN) under the auspices of NOAA's National Climatic Data Center and Atmospheric Turbulence and Diffusion Division. The network consists of 114 sites across the conterminous 48 states, with additional sites in Alaska and Hawaii. Stations are installed in open (where possible), rural sites very likely to have stable land-cover/use conditions for several decades to come. At each site a suite of meteorological parameters are monitored, including triple redundancy for the primary air temperature and precipitation variables and for soil moisture/temperature. Instrumentation is regularly calibrated to National Institute for Standards and Technology (NIST) standards and maintained by a staff of expert engineers. This attention to detail in USCRN is intended to ensure the creation of an unimpeachable record of changes in surface climate over the United States for decades to come. Data are made available without restriction for all public, private, and government use. This article describes the rationale for the USCRN, its implementation, and some of the highlights of the first decade of operations. One critical use of these observations is as an independent data source to verify the existing U.S. temperature record derived from networks corrected for nonhomogenous histories. Future directions for the network are also discussed, including the applicability of USCRN approaches for networks monitoring climate at scales from regional to global. Constructive feedback from end users will allow for continued improvement of USCRN in the future and ensure that it continues to meet stakeholder requirements for precise climate measurements.

The coastal ocean observing system in the Gulf of Maine was deployed in the summer of 2001. The system operated a real-time data buoy array that collected oceanographic and meteorological measurements in a 24/7 operation at as many as 11 locations in the Gulf of Maine (GoM). The data return of the GoM sensor array has averaged approximately 90% over its first decade of operation. In addition to the hourly operational data delivery to several online websites, the University of Maine provides an archive of data and model output that are significantly advancing the scientific understanding of the GoM as a physical and ecological system. Over the decade of operation, the data have revealed marked seasonal and interannual variability of the circulation and physical properties of the gulf. From the time of the initial deployments in the summer of 2001, the GoM buoy array has been an unusually comprehensive suite of oceanographic sensors including surface current meters, Doppler current profilers for subsurface currents, temperature, salinity, dissolved oxygen, chlorophyll and colored dissolved organic matter (CDOM) fluorometers, radiometers, multi wavelength absorption, and attenuation sensors at multiple depths. In addition, wave instruments and meteorological sensors were deployed on the buoys including air temperature, wind speed and direction, atmospheric pressure, and forward scattering visibility. In recent years the sampling scheme of the system has increased in resolution beyond hourly for several high-value data streams. The meteorological data are collected at ten-minute intervals, and water-column temperature and salinity are measured at three-minute intervals to provide records of internal wave activity. The higher frequency records are not provided in real-time. The full ten-minute meteorological data are updated hourly (or half-hourly during storm events), and the higher frequency temperature and salinity data are updated semi annually. Wave measurements have recently included wave directional spectra. The broad suite of sensors on the GoM Integrated Ocean Observing System (GoMIOOS) serve a wide variety of real-time oceanographic and marine meteorological data and data products to scientists, state and federal regulators, the National Weather Service, the US and Canadian Coast Guards, educators, regional natural-resource managers, the Gulf of Maine fishing and maritime industries, fishermen, boaters, and the general public. The success of the system has resulted inan energized and enthusiastic scientific and technical community involved in operational ocean observing activities, and a large user group which have come to depend on the real-time data streams the system provides. The first decade of data collected by the GoMIOOS has provided a wealth of scientific information, and lead to a new understating in of the oceanography of the GoM. In many cases the buoy array provided the first baseline information as well as the first comprehensive characterizations of marked seasonal and interannual variability of the circulation and physical properties of the Gulf. Between the fall of 2004 and spring of 2005 Doppler currents measured, for the first time, outflow of deep salty slope waters that suggested a regime shift in the transports through the Northeast Channel (NEC). Experiments from earlier decades consistently observed inflow of dense slope waters throughout all seasons. During the same period a salinity anomaly event lowered salinity throughout the GoM by roughly 2 psu by the winter of 2005. In following years, the previously unusual slope outflow and reduced salinity have often reoccurred. These modern measurements are oceanographic anomalies that suggest climate change may be causing significant physical transformations. Ocean sensors, ocean platform technologies, and modeling and visualization techniques are in a period of rapid technical development. If stable funding can be achieved, the capabilities of operational ocean observing systems will increase dramatically over the next decade. Autonomous vehicles could become the fast response survey fleet of the Integrated Ocean Observing System (IOOS®), as well as the workhorses for routine, sustained, marine survey functions that are currently prohibitively expensive using research vessels. Practical autonomous vehicles will likely expand beyond gliders and propeller-driven autonomous underwater vehicles (AUVs) to include autonomous surface vessels (ASVs). The combination of time-series measurements from profiling packages on buoy arrays with the repeated spatial surveys of the autonomous fleets will provide a new look at our coastal oceans that could transform coastal ocean science and management.

Integrated services for mothers with dual diagnoses and their children. Arkansas Center for Addictions Research, Education, and Services ( Arkansas CARES).

In this chapter, the author explores community activism in the health policy process through analysis of the nature of activism engaged in by the Consumers' Health Forum (CHF) of Australia, from its inception in 1987 through to 1996. He provides a definition of the key term 'health policy'. He then gives an overview of the 'unbalanced political market in health care', and defines 'policy activism' within this context. He then moves on to examine the nature of community activism in the health policy process which was facilitated by the Consumers' Health Forum in its first decade of operation. The CHF was established to strengthen the 'voice' of the consumer and community sector in health policy decision-making. The term 'health policy' includes also the election and other policies of political parties, that might or might not be translated into government action at a later stage.

The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the Affordable Care Act to promote research on the comparative effectiveness of treatment options. Advocates hoped this information would help reduce wasteful spending by identifying low-value treatments, but many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: overcoming the controversy of its birth and escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system. The growing attention among policymakers and researchers to provider prices (rather than utilization) as the driver of health care spending could be helpful to the political prospects of the evidence-based medicine project by making it appear to be less as rationing driven by costs and more as an effort to improve quality and uphold medical professionalism.

This chapter compares the dispute settlement of the World Trade Organization (WTO) and regional trade agreements (RTA). It outlines the operation of the WTO's Dispute Settlement Understanding and evaluates the results it has produced in its first decade of operation. It compares these results with the operation of RTA dispute settlement systems. This chapter concludes that RTA cannot supplant the WTO's role as a forum for trade negotiations because the existing regional agreements do not include enough major trading nations to enable deals to be struck on key global issues involving a broad range of nations with disparate interests.

FRANKWOOD E. WILLIAMS was convinced that the new science of human nature would not only provide treatment methods for severe and persistent forms of mental illness but also intervention strategies for their prevention. During his association with the National Committee for Mental Hygiene from 1916 to 1931 (the last 9 years of which he served as medical director), Williams stimulated, guided, and oversaw the implementation of a wide range of preventive methods. The National Committee was founded in 1909 by Clifford W. Beers, who had spent 3 years in mental hospitals, and Adolf Meyer, by then the foremost American psychiatrist. It aimed to increase the status of psychiatry, placing the discipline on a sound scientific footing by arranging funding for medical research and improving the care provided to individuals institutionalized in mental hospitals. At that time, there were no effective treatments for severe and persistent forms of mental illness. The Committee therefore embraced the ideal of prevention as the most effective measure to decrease the incidence of mental illness. Williams had studied medicine at the University of Michigan in Ann Arbor and specialized in psychiatry at one of the first hospitals established for the scientific study of mental illness in the United States. His teacher, Albert M. Barrett, adhered to a strictly somatic approach within psychiatry, as did E. E. Southard, director of the Boston Psychopathic Hospital, where Williams spent 2 years after the completion of his studies in 1913. Southard was also known for his interest in social issues such as alcoholism and criminality, issues that also became of interest to Williams. During the first decade of operation, the psychiatrists associated with the National Committee conducted a number of surveys that demonstrated the social significance of mental illness. Williams participated in a survey of prisons in the county of New York that showed that a significant percentage of individuals confined in them suffered from mental illness.1 Among recidivists, the number was even higher. To Williams, these findings indicated that judges and jail keepers were dealing with mental illness without any insight into its nature. These findings inspired the psychiatrists of the National Committee to develop clinics for the treatment of juvenile delinquents. With early intervention, it was thought, a life of crime could be prevented. In the 1920s, mental hygienists became interested in childhood as the period during which preventive measures could most effectively be implemented. In 1925, Williams traveled to Vienna to undergo psychoanalysis with Otto Rank, who at that time was one of Sigmund Freud’s closest disciples. According to Williams, Freud’s psychoanalysis indicated that virtually all problems later in life were caused by difficulties in early childhood. To prevent these problems, intervention strategies that targeted early childhood were needed. The National Committee oversaw the establishment of a dozen Child Guidance Clinics where parents confronted with troublesome children could ask for help. Williams actively promoted progressive education because he believed that only a complete transformation of the educational system could make it congruent with the demands of emotional development. He was also actively involved in the establishment of several college mental hygiene programs in the belief that college students, the future leaders of society, needed to be free of emotional problems.2 At the time Williams wrote “Finding a Way in Mental Hygiene,” he had already announced his resignation from the National Committee and had come to doubt the effectiveness of its programs. He recognized that to realize the sometimes utopian ideals of the mental hygiene movement, only the complete reorganization of American society along the lines of the science of human nature would do. He began to spend most of his time conducting psychoanalytic psychotherapy, which he had come to see as the only effective way to change human nature. In 1929, the stock market crashed, which was followed by a worldwide economic depression. For most mental hygienists, the consequences of the Depression were disconcerting and at times even alarming. Because of widespread economic insecurity, the incidences of depression, anxiety, and suicide were at an all-time high. To counter this, they argued that structural instead of individualized measures were urgently needed. In 1931, Williams visited the Soviet Union and was astounded by what he witnessed in the carefully maintained villages designed for visitors from the West, where a life of plenitude, happiness, and mental health was enjoyed by all. Williams returned as a convert to the Soviet cause and championed its accomplishments during the remaining 5 years of his life.3 He had never been aware of the atrocities of Stalin’s regime and died in the conviction that the ideals of the mental hygiene movement could be achieved through structural and political means only.

Startups play an important role in creating job opportunities and promoting economic stability, growth, and development. However, it is noted that most startups collapse within the first decade of operation, and those that continue to survive will remain small. The major cause of large-scale failure is primarily the difficulty in predicting the internal and external risk factors that influence the startups’ potential success. The techno-economic feasibility study in startup financing is an effective method to safeguard against such risks preventing startup failures and the wastage of valuable investment resources. This study aims to explore the significance and the essence of the techno-economic feasibility study in stepping up the growth and advancement prospects of startups. The study findings promote useful insights into the value of techno-economic feasibility methods in startups by scholars, professionals, entrepreneurs, investors, banks, and financial institutions and provide some policy recommendations.

The Thirty Meter Telescope (TMT) has three instruments in development for first light, and another 6 notional instruments planned for implementation over the first decade of operations. All of these instruments require cryogenic cooling of detectors, as well as optics in most cases. This paper describes the instrument cooling capacity requirements, the trade study that led to the design solution, and the overall layout of the conceptual design. TMT has chosen to build an on-site liquid nitrogen generation plant, and supply liquid nitrogen to the instruments using an autofill system. TMT also supplies compressed helium to instruments with cryocoolers for optics and detectors that require cooling below the boiling point of liquid nitrogen.

The Science Advisory Committee (SAC) of the Thirty Meter Telescope Project (TMT) is nearing completion in its deliberations on defining a set of instrumentation capabilities for the first decade of operation. These are encapsulated in the SAC's Science Requirements Document (SRD). We focus here on issues related to the challenges posed by the proposed first generation requirements for both seeing-limited, wide-field spectroscopy for the UV/optical and for integral field unit (IFU) spectroscopy for the near infra-red (NIR).

Conceptual designs for O2/H2 chemical and resistojet propulsion systems for the space station was developed and evaluated. The evolution of propulsion requirements was considered as the space station configuration and its utilization as a space transportation node change over the first decade of operation. The characteristics of candidate O2/H2 auxiliary propulsion systems are determined, and opportunities for integration with the OTV tank farm and the space station life support, power and thermal control subsystems are investigated. OTV tank farm boiloff can provide a major portion of the growth station impulse requirements and CO2 from the life support system can be a significant propellant resource, provided it is not denied by closure of that subsystem. Waste heat from the thermal control system is sufficient for many propellant conditioning requirements. It is concluded that the optimum level of subsystem integration must be based on higher level space station studies.