Alignment Issues Research Articles

Physician Compensation in a World of Health System Consolidation and Integration

As U.S. healthcare market dynamics encourage increased consolidation of physician practices with community health systems, questions relating to the future of provider compensation designs loom large. A provider compensation framework becomes especially important as health systems' operating revenue structures shift and they assume financial from third-party payers, including governmental payers. To offset that risk, leaders of community health systems must determine how to align the financial incentives of employed physicians and other licensed providers with those providers practicing in the new world of value-based reimbursement models. Some of those leaders might perceive the changes in healthcare reimbursement models as disruptive to employed physician compensation models built on productivity measures--whereby physicians are encouraged to do more and bill more. However, leaders of well-established integrated health systems seem little concerned with how a reforming healthcare market may disrupt physician compensation designs. By definition, the integrated model allows for internal control over the design and management of these plans, permitting responsiveness that is unavailable to the conventional models where community hospitals and independent physicians are individually exposed to and reimbursement model disruptions. In a recent study by faculty and staff affiliated with the MHA and Executive Studies programs at the University of Minnesota on behalf of MedPAC, 15 senior leaders of integrated health systems in the United States were interviewed about the future of community health system reimbursement models and physician compensation designs (Christianson, Zismer, White, & Zeglin, 2011). A portion of the study, on the issue of alignment of incentives, was conducted in a structured interview format. Among the important insights gleaned from these leaders were the following (Christianson et al., 2011): (1) A belief that reimbursement for health services in the U.S. is likely to be somewhat of an experimental science for the foreseeable future, meaning leaders expect revenues to flow by multiple methods and models. Many of the leaders interviewed were positive toward the strategy of risk contracting as a way to effectively move market share from competitors to their organizations cost effectively (i.e. for financial for defined populations); (2) the ratio of employed physician extenders to employed physicians ranged from .6 to in excess of 1.0; meaning, if an integrated health system employs 500 physicians, it is likely it will employ from 300 to in excess of 500 licensed physician extenders; and (3) because third party methods are likely to result in disruptions in the historic operating revenue flow methods, integrated health systems have disconnected how the organization is paid from how physicians are paid. In other words, [integrated health systems] seek to provide stability in provider compensation plans even as the health system engages in methods that are strategic in nature and different from the conventional fee-for-service revenue models. STABILITY IN PROVIDER COMPENSATION The third observation is worth deeper examination. Leaders of integrated health systems who have significant experience with the integrated model emphasized the need to ensure stability of provider compensation, especially in the face of changing health system reimbursement plans. Furthermore, these leaders acknowledged a growing need to redefine the concept of provider productivity in the reform of health system payments to reflect the fact that physicians and other providers are engaged in professional activities beyond generating work relative value units (RVUs) (patients seen and charges billed). They include such compensable activities as clinical team management; clinical program leadership; and co-management of resource and capital asset-intensive centers of patient care, such as diagnostic and procedure centers, hospital beds, and large-scale ambulatory centers. …

From Prescribed Curriculum to Classroom Practice: An Examination of the Implementation of the New York State Earth Science Standards

ABSTRACTIn New York State (NYS), Earth science teachers use the National Science Education Standards (NSES), the NYS Learning Standards for Mathematics, Science and Technology (NYS Standards), and the Physical Setting/Earth Science Core Curriculum (Core Curriculum) to create local curricula and daily lessons. In this study, a purposeful sample of experienced and innovative teachers provided insight on how NYS Earth science teachers organize their scope and sequences, align their lessons with the State standards–based documents, establish internal lesson coherence, and prepare their students for the state assessment, the Physical Setting/Earth Science Regents Examination (Regents Exam). Teachers provided responses to a questionnaire regarding their scope and sequence and typical lessons they teach for each unit. These data were then reviewed by the first author as well as by a team of Earth science education experts. Teachers' scope and sequences were well aligned with the Core Curriculum and Regents, but misalignment was found between their lessons and the Core Curriculum as well as between the stated objectives for their students and evaluation of those objectives. The insights gained from this analysis of the NYS system could be helpful to other states as they move toward increased standards-based Earth science curricula. Among other suggestions, it is recommended that the Core Curriculum be revised to emphasize alignment principles and more opportunity be provided for teacher professional development focused on alignment issues relative to the state standards and enhanced internal lesson coherence.

Large-scale biomedical ontology matching with ServOMap

The proliferation of biomedical applications, which rely on different knowledge organization systems, such as ontologies and thesauri raises the issue of the automated identification of the correspondences between these models, in particular for the data integration need. A significant effort has been conducted for tackling this issue of ontology alignment. However, few systems are able to deal with ontologies containing tens of thousands of entities, as it may be the case in the biomedical domain where resources such as SNOMED-CT, the FMA or the NCI thesaurus are commonly used. We present in this paper ServOMap, an efficient system for large-scale ontology alignment. It relies on an Ontology Server (ServO) and uses Information Retrieval techniques for computing similarity between entities. The system participated with two configurations in the 2012 Ontology Alignment Evaluation Initiative campaign. We report the very promising results obtained by the system for large biomedical ontologies alignment. ServOMap is freely available for download at http://code.google.com/p/servo/.

Towards a More ‘Ethically Correct’ Governance for Economic Sustainability

In this paper, we propose that economic sustainability is seen in terms of (inter-temporal and inter-national) value creation. We claim that value appropriation (or capture), can become a constraint to economic sustainability. We propose that for sustainable value creation to be fostered, corporate governance needs to be aligned to public and supra-national governance. In order to achieve this, a hierarchically layered set of ‘agencies’, needs to be diagnosed and the issue of incentive alignment addressed. Enlightened self-interest, pluralism and diversity, as well as a representative supra-national organisation for world-wide economic sustainability can serve as a new, more ‘ethically correct’ governance for economic sustainability, but not a panacea.

THERMO-MECHANICAL ANALYSIS OF AN IMPROVED THERMAL THROUGH SILICON VIA (TTSV) STRUCTURE

Temperature and thermal stress responses of an improved TTSV structure under the impact of hotspots are numerically analyzed in this paper. A Fin structure is added to the circular TTSV to strengthen the efiect of thermo-mechanical mitigation. The nonlinear flnite element method (N-FEM) is presented to obtain the coupled thermal and mechanical flelds. Running time of the N-FEM algorithm is compared with that of commercial software to indicate its e-ciency. The model of state-of-the-art 3D Dynamic Random Access Memory (DRAM) is adopted in our simulation. Besides the single-layer TTSV and TTSV array, the extended case of multi-layer TTSVs is also investigated. To take into consideration the nonlinear efiects, the temperature dependent results for the issues of hotspot alignment and liner materials selection are provided, both of which are compared with the corresponding temperature independent results. This paper is aimed to provide some practical guidance to the design of TTSV for efiective thermo-mechanical management.

모형실험을 통한 보강토 옹벽 곡선부 거동특성

보강토 공법은 경제적으로 유리하고 환경적인 제약을 극복하는데 유리하기 때문에 옹벽, 사면, 기초, 도로, 제방 등의 구조물에 실용적으로 적용되고 있다. 하지만 곡선구간에서 충분한 안정성을 확보하지 못한 보강토 옹벽의 붕괴사례가 발생하고 있으며, 이는 보강토 옹벽 곡선구간에 대한 분석이 정립되지 않은데 원인이 있다고 할 수 있다. 따라서 본 연구에서는 곡선구간 형태별 시공성 및 구조적인 안정성을 검토하기 위한 방안으로, 수평변위 측정을 통해 곡선 형태별 수평변위 차이점을 규명하고, 이를 이용하여 곡선구간과 직선구간의 문제점 분석 및 대책강구를 위한 기초자료 연구에 목적을 두고 있다. 실험결과 하중 재하시 오목형과 볼록형 모두 곡선 중앙에서 최대 수평변위가 발생 하였으며, 오목형의 경우 토압을 받는 힘의 방향이 안쪽으로 작용하는 반면에 블록형의 경우는 힘의 방향이 바깥쪽으로 작용하기 때문에 볼록형의 경우가 오목형에 비해 수평변위가 더 발생한 것으로 나타났다. 또한 볼록형의 경우 보강토체의 주동토압 뿐만 아니라 측면토압이 추가로 발생되어 곡선구간에서의 볼록형의 수평변위가 오목형에 비해 더 발생한 것으로 나타났다. The reinforced earth method is financially viable. Furthermore, it overcomes environmental limitations and is therefore employed in retaining walls, slopes, foundations, roads, embankments, and other structures. However, in some cases, reinforced retaining walls are not strong enough in the curved sections and can collapse. Such mishaps are believed to occur because of an unsatisfactory analysis of the curved sections of a reinforced retaining wall. Accordingly, with the aim of investigating the workability and structural safety of curved sections of various types, this study investigates the differences in the estimated horizontal displacements of curved sections of various types and subsequently uses this information to study and analyze preliminary data so that appropriate measures can be taken to resolve alignment issues. The results of an experiment reveal that when a load is applied to curved sections of both concave and convex types, the largest horizontal displacement occurs at the center of the section. In the concave form, the earth pressure force is directed inward, whereas in the convex form, this force is directed outward. As a result, the horizontal displacement in convex forms is larger than that in concave forms. Convex reinforced earth structures are subjected to earth pressures as well as lateral earth pressure, therefore horizontal displacements in convex curved sections is larger than that of concave curved sections.

International Developments in Executive Compensation

International Developments in Executive Compensation

A Novel Tensile Device for In Situ Scanning Electron Microscope Mechanical Testing

To facilitate the study of deformation mechanisms and mechanical properties of bulk materials with feature size of centimeter level, a novel tensile device compatible with scanning electron microscope (SEM) was designed and built. Integrating the servo motor and three-stage reducer, the device could realize quasistatic loading mode with a loading speed of 10 nm/s. The device also presents broad compatibility with various types of SEMs due to its miniaturized dimensions and larger volume–output load ratio compared with existing and commercial tensile instruments. A small lead precise ball screw with left- and right-hand thread was adopted to keep the center of the specimen remain stationary without moving during the tensile testing. A novel gripping method was carefully taken into account to guarantee the alignment issues. The closed-loop control mode of the tensile process was developed. The displacement resolution of 40 nm was tested to verify the driving performance of the device. Furthermore, correction method on testing displacement was investigated based on the calibration experiments of the load sensor and displacement sensor, and the comparison tests based on stress–strain curve were carried out between the self-made device and the commercial tensile instrument (Instron 3345) to verify the feasibility and universality of the correction method.

Issues associated with scaling up production of a lab demonstrated MEMS mass sensor

This work reports on the development of a lab demonstrated resonant mass sensor towards mid-size production. The issues associated with scaling-up production of the microfabricated chip are discussed with particular focus on yield and device reproducibility, as well as the constraints imposed on the design and manufacturing of the device when packaging and integration must be taken into account. Issues of modal alignment and ambient operational pressure are discussed. Fabricated devices show a 4.81 Hz pg−1 mass sensitivity with a temperature sensitivity of typically 10 Hz °C−1.

0.22 THz wideband sheet electron beam traveling wave tube amplifier: Cold test measurements and beam wave interaction analysis

In this paper, we describe micro-fabrication, RF measurements, and particle-in-cell (PIC) simulation modeling analysis of the 0.22 THz double-vane half period staggered traveling wave tube amplifier (TWTA) circuit. The TWTA slow wave structure comprised of two sections separated by two sever ports loaded by loss material, with integrated broadband input/output couplers. The micro-metallic structures were fabricated using nano-CNC milling and diffusion bonded in a three layer process. The 3D optical microscopy and SEM analysis showed that the fabrication error was within 2–3 μm and surface roughness was measured within 30–50 nm. The RF measurements were conducted with an Agilent PNA-X network analyzer employing WR5.1 T/R modules with a frequency range of 178-228 GHz. The in-band insertion loss (S21) for both the short section and long section (separated by a sever) was measured as ∼−5 dB while the return loss was generally around ∼−15 dB or better. The measurements matched well with the S-matrix simulation analysis that predicted a 3 dB bandwidth of ∼45 GHz with an operating frequency at 220 GHz. However, the measured S21 was ∼3 dB less than the design values, and is attributed to surface roughness and alignment issues. The confirmation measurements were conducted over the full frequency band up to 270 GHz employing a backward wave oscillator (BWO) scalar network analyzer setup employing a BWO in the frequency range 190 GHz–270 GHz. PIC simulations were conducted for the realistic TWT output power performance analysis with incorporation of corner radius of 127 μm, which is inevitably induced by nano-machining. Furthermore, the S21 value in both sections of the TWT structure was reduced to correspond to the measurements by using a degraded conductivity of 10% International Annealed Copper Standard. At 220 GHz, for an elliptic sheet electron beam of 20 kV and 0.25 A, the average output power of the tube was predicted to be reduced from 90 W (for ideal conductivity/design S-parameters) to 70 W (for the measured S-parameters/inferred conductivity) for an average input power of 50 mW. The gain of the tube remains reasonable: ∼31.4 dB with an electronic efficiency of ∼1.4%. The same analysis was also conducted for several frequencies between 190 GHz–260 GHz. This detailed realistic PIC analysis demonstrated that this nano-machined TWT circuit has slightly reduced S-parameters and output power from design, but within an acceptable range and still have promising output power, gain, and band width as required. Thus, we expect to meet the specifications of 1000 W-GHz for the darpa program goals.

2012 White Paper on Recent Issues in Bioanalysis And Alignment of Multiple Guidelines

Over 400 professionals representing pharmaceutical companies, CROs, and multiple regulatory agencies participated in the 6th Workshop on Recent Issues in Bioanalysis (WRIB). Like the previous sessions, this event was in the format of a practical, focused, highly interactive and informative workshop aiming for high-quality, improved regulatory compliance and scientific excellence. Numerous 'hot' topics in bioanalysis of both small and large molecules were shared and discussed, leading to consensus and recommendations among panelists and attendees representing the bioanalytical community. The major outcome of this year's workshop was the noticeable alignment of multiple bioanalytical guidance/guidelines from different regulatory agencies. This represents a concrete step forward in the global harmonization of bioanalytical activities. The present 2012 White Paper acts as a practical and useful reference document that provides key information and solutions on several topics and issues in the constantly evolving world of bioanalysis.

HR practices from the perspective of managers and employees in multinational enterprises in China: Alignment issues and implications

China's significance as a destination for foreign direct investment (FDI) is a major factor in Asia-Pacific economic growth. This paper identifies important yet unexplored matters of human resource management (HRM) in multinational enterprise (MNE) subsidiaries in China. Specifically, the study explores the alignment issues between managers and employees with respect to their knowledge of HR practices, their experience of HR practices, and their perceived effectiveness of HR practices. Both interviews and a survey covering seven MNE subsidiaries operating in China finds a lack of alignment between managers and employees in each instance, for example, in their views of intended and actual HR practices and perceived effectiveness of these practices in the areas of performance assessment, recruitment and selection and career development. The implications of the differences for managers of MNEs operating in China are identified and discussed. The limitations of the study are acknowledged and areas for further study are also suggested.

Deontic Logic Based Ontology Alignment Technique for E-Learning

The recent explosion in web services usage and information technology has led to the challenging issue of Ontology Construction and Alignment in order to enhance the semantics of web documents in E-Learning scenarios. In such a circumstance, it is necessary to provide an effective solution for Ontology Alignment that can help in student performance evaluation. The authors propose a rule-based solution for evaluating the students using Ontology Alignment techniques. For this purpose, they make use of the rules based on Deontic Logic and hence make a positive attempt in analyzing the presence of some of the non-dominant categorization of words like determiners, time clauses and modal verbs occurring in the text documents using Standard Deontic rules. The experiments have been carried out on evaluating the learning of C programming language using an E-Learning framework. From these evaluations, it has been observed that the proposed evaluation technique improves the accuracy of student evaluation significantly.

Toward a new theory of the contribution of the it function in organizations

Because changes in organizations and information technology environments are enduring, the alignment of the IT function with business objectives must not only be understood, but constantly renewed and adjusted. This is amply reflected in recent surveys of CIOs, which consistently suggest that the notion of alignment is a top challenge and management priority. Many CIOs face a double challenge when addressing the issue of alignment: they must first clarify top management's expectations and assumptions about IT, which may be contradictory, and then understand their implications for how the IT department should be managed (i.e., translate the function's strategic mission into an IT management model that adds value to the organization). The characterization of the IT function has constituted a central and growing subject of research in the information systems field. Although the extant literature has much to teach us, knowledge in this area is nevertheless fragmented and has not been properly integrated. In response to these limitations, this study proposes and tests a new theory of the contribution of the IT function. Specifically, our objective is to offer an explanation of the contribution of the IT function in organizations with a typology of profiles. A field study was conducted in 24 large Canadian companies in order to validate a set of research propositions. Our results first suggest that there are five distinct ideal IT management profiles in organizations and each of these profiles tends to focus on specific sources of value. Next, we observed that IT functions that are close to the of any given profile seem to be outperforming those with hybrid profiles. Finally, our findings provide a compelling explanation as to how IT management profiles are adopted in organizations. The article concludes with a discussion of the theoretical and practical implications of the proposed theory.

Optical configurations for free electron laser resonators with theoretical and numerical simulation

Optical resonator plays a crucial role in the oscillator scheme of Free Electron Laser (FEL). In this paper, the challenges and some issues on the optical configurations for FEL resonators are presented. Firstly, the diffraction loss and power density are calculated during the preliminary parameters design. Then the detuning and alignment issues of the cavity are discussed with theoretical and numerical simulations. To minimize the influence of the harmonics components, the potential solution based on their spatial distributions is also provided.

Bilingual terminology extraction using multi‐level termhood

PurposeTerminology is the set of technical words or expressions used in specific contexts, which denotes the core concept in a formal discipline and is usually applied in the fields of machine translation, information retrieval, information extraction and text categorization, etc. Bilingual terminology extraction plays an important role in the application of bilingual dictionary compilation, bilingual ontology construction, machine translation and cross‐language information retrieval etc. This paper aims to address the issues of monolingual terminology extraction and bilingual term alignment based on multi‐level termhood.Design/methodology/approachA method based on multi‐level termhood is proposed. The new method computes the termhood of the terminology candidate as well as the sentence that includes the terminology by the comparison of the corpus. Since terminologies and general words usually have different distribution in the corpus, termhood can also be used to constrain and enhance the performance of term alignment when aligning bilingual terms on the parallel corpus. In this paper, bilingual term alignment based on termhood constraints is presented.FindingsExperimental results show multi‐level termhood can get better performance than the existing method for terminology extraction. If termhood is used as a constraining factor, the performance of bilingual term alignment can be improved.Originality/valueThe termhood of the candidate terminology and the sentence that includes the terminology is used for terminology extraction, which is called multi‐level termhood. Multi‐level termhood is computed by the comparison of the corpus. Bilingual term alignment method based on termhood constraint is put forward and termhood is used in the task of bilingual terminology extraction. Experimental results show that termhood constraints can improve the performance of terminology alignment to some extent.

Variability of kinetic variables during gait in unilateral transtibial amputees

Prosthetic gait increases demands on stability. Some variability measures can be used to investigate the stability of movement for prosthetic feet. The purpose of this study was to determine the influence of the prosthetic foot on ground reaction force variability for transtibial amputee gait. Comparative analysis. Eleven male unilateral transtibial amputees participated in this study. Each subject walked at self-selected speed with both conventional (SACH) and energy storing (Sureflex) feet. Time and ground reaction force variables and their coefficients of variation were calculated for each foot type and limb. Mediolateral force variables had high variability for all conditions. The Sureflex had a larger variability than the SACH foot for the braking peak (p < 0.05), which may have been caused by gait instability after the heel strike. There were significant differences between intact and prosthetic limbs in total loading (force impulses) with the SACH foot (p < 0.05). The prosthetic foot and alignment issues related to the foot influence GRF variability. During the braking phase the SACH foot is characterized by higher variability in mediolateral direction and Sureflex by higher variability in anterior-posterior direction. Differences in variability in ground reaction force variables can represent a person's stability. Observing variability can contribute to better understanding of critical events in gait cycle with the use of various prosthetic feet.

An Empirical Case Study of Factor Alignment Problems Using the USER Model

The practical issues that arise due to the interaction between three principal players in any quantitative strategy—namely, the alpha model, the risk model, and the constraints—are collectively referred to as factor alignment problems (FAPs). Examples of FAPs include risk-underestimation of optimized portfolios, undesirable exposure to factors with hidden and unaccounted systematic risk, consistent failure in achieving ex ante performance targets, and inability to harvest highquality alphas into an above-average information ratio (IR). This article concerns an empirical illustration of various facets of FAPs using the U.S. Expected Return (USER) model. Unlike previous studies on FAP that are either based on simulated returns or a black-box expected return model, we leverage the detailed knowledge of the USER model to create an insightful narrative. We show that optimal portfolios constructed using the USER model without taking into account the misalignment issues betray typical symptoms of FAPs and have exposure to certain hidden systematic risk factors that are not accounted for during portfolio construction. We trace the origins of these latent systematic risk factors to the constituent factors of the USER model and the turnover constraint. Finally, we leverage our understanding of the alignment issues to propose an alternative portfolio construction methodology that directly addresses FAPs. Using the proposed methodology not only gives unbiased risk forecasts, but also improves ex post performance in a statistically significant manner.

Deriving the socio-pragmatic meanings of the Japanese interactional particle ne

In my previous work, I argued that the use of ne in conversation explicitly creates a sanctioned space in which participants can negotiate issues of interactive alignment in the moment (Morita, 2005). Many sociolinguistic, psycholinguistic, and cognitive linguistic studies of ne, however, offer a wide range of higher-level interpretations that they claim speakers and listeners attribute to this particle, such that speakers use ne to mark “sharedness of information”, “politeness”, “femininity”, or “over-friendliness” – none of which seem to be relevant to the basic organizational function performed by ne itself.The purpose of this paper is to show how my previous analysis of ne as a negotiation tool for resolving contingency problems can be understood with respect to the impressionistic interpretations provided by other theorists. I argue that impressions of differential stance taking are only possible when participants can rely on ne's fundamental function at the micro-level interaction as their base. Such thematization of interactive alignment may then lead to impressionistic hearings that invoke concepts of higher-order sociality, such as “politeness”, “neediness”, “coerciveness”, and (according to certain ideologies) “femininity”. I thus attempt to show here how these seemingly incongruous understandings of the Japanese interactional particle ne can be simultaneously correct.

Information technology strategy and alignment issues in health care organizations

Information technology (IT) plays a key role in public health care management because it could improve quality, efficiency, and patient care. Researchers and practitioners repeatedly contend that a health care organization's information systems strategy should be aligned with its objectives and strategies, a notion commonly known as IT alignment. Actor-related IT alignment issues in health care institutions were explored in this study. More specifically, it explores the possibility of moving beyond the current IT alignment perspective and, in so doing, explores whether IT alignment-as currently conceptualized in the dominant body of research-is sufficient for attaining improved quality, efficiency, and patient care in health care organizations. The findings are based on a qualitative and longitudinal study of six health care organizations in the Stockholm metropolitan area. The empirical data were gathered over the 2005-2011 period from interviews, a focus group, observations, and archival material. The data suggest recurrent misalignments between IT strategy and organizational strategy and operations due to the failure to deconstruct the IT artifact and to the existence of various levels of IT maturity. A more complex picture of IT alignment in health care that goes beyond the current perspective is being offered by this study. It argues that the previously common way of handling IT as a single artifact and applying one IT strategy to the entire organizational system is obsolete. MANAGERIAL IMPLICATIONS: The article suggests that considerable benefits can be gained by assessing IT maturity and its impact on IT alignment. The article also shows that there are different kinds of IT in medical care that requires diverse decisions, investments, prioritizations, and implementation approaches.