Reform Model Research Articles

Unwarranted Variation in Healthcare: Impacts of Test-Order Practice Variation on Care-Delivery Cost

Motivated by payment reform model policies that aim to reduce practice variation, this study explores whether and how lower variations in clinical practice relate to hospital resource usage. Specifically, we focus on practice variation in test-ordering (e.g., laboratory and radiology tests) stage and use the statistical process control as a theoretical lens to hypothesize its negative impacts on subsequent care-delivery costs. We define practice variation as all variation not resulting from patient mix, and construct a measure using inpatient discharge data for each patient cohort having an identical medical condition. The high underuse practice variation in test-ordering implies that a hospital is more likely to fail to order proper tests for some patients. Thus, such a hospital may spend extra efforts in care-delivery stages to alleviate potential adverse effects of the test underuse. We also consider the intervening effects of two quality initiatives on the relationship: process quality (i.e., how well a hospital adheres to evidence-based medical guidelines to diagnose and treat patients) and experiential quality (i.e., external perceptions of care quality from a patient’s perspective). Based on a comprehensive six-year inpatient data from New York and Florida states, we find that higher underuse variation in the test-ordering lead to higher care-delivery cost. Interestingly, this phenomenon is even stronger when a hospital provides a higher-quality patient experience because such a hospital tends to provide more responsive care, which is often resource-intensive. Therefore, hospitals may be improperly rewarded for quality improvements if practice variation is ignored, implying that incentives and penalties for hospital operations should be designed to account for such effects. We discuss our findings and policy implications.

Steam methane reforming in a microchannel reformer: Experiment, CFD-modelling and numerical study

This paper is devoted to the investigation of the steam methane reforming process in a microchannel reformer over a Ni-based catalyst. The composition of reforming products and temperature at a reformer outlet was measured experimentally as well as with the help of CFD-modeling and numerical study. The presented new direct numerical method for modeling of steam methane reforming. The study of steam methane reforming was performed for the inlet temperatures (Tin) of 600–1000 K, for Re = 10, 50, 100, and heat flux through the walls of qw = 1000 W/m2 and qw = 500 W/m2. It was found that the methane conversion in the reformer decreases with increasing Reynolds number, heat flux through the wall, and inlet temperature. For Re = 10, qw = 1000 W/m2 and Tin = 1000 K the methane conversion is 39% while equilibrium methane conversion is 63%. The temperature profiles in the reaction zone were determined. The temperature of the reaction mixture monotonically increases for all Reynolds numbers.

A Muslim Dualism? Inter-Imperial History and Austria-Hungary in Ottoman Thought, 1867–1921

Historians often look for genealogies of nationalism in Austro-Hungarian and Ottoman imperial history. In this article, I use an inter-imperial framework to argue that the formative period of contemporary Eastern Mediterranean-European regionalism was the last five decades of these two empires. The diplomatic, economic and cultural relations between the two middle powers compose an alternative history to national narratives. I show that dualism (‘independence’ within empire) was an attractive imperial reform model for Ottoman Muslim intellectuals. I describe first a forgotten Egyptian-Ottoman dualist vision, and then I analyse the more well-known Arab-Turkish dualist plans up to 1921.

Coupling effects of fuel reforming process and fuel utilization on the system performance of a natural gas solid oxide fuel cell/gas turbine hybrid system

A design study was undertaken of a 100 kW natural gas solid oxide fuel cell (SOFC)/gas turbine (GT) hybrid system to evaluate the impacts of the reforming process under a broad range of SOFC fuel utilizations. An equilibrium reformer model and a one-dimensional SOFC model are employed to perform system study for this hybrid, while balance of plant model is built in Ebsion to simulate the associated performance of GT cycle. Fifty design cases with varied external fuel reforming temperatures are analyzed based on different SOFC fuel utilization levels. With the decrease of reforming temperature, optimal fuel utilization in terms of efficiency shift from 90% with external reforming to 60% with internal reforming. Highest efficiency up to 74% was achieved with internal reforming, but this came with 1275 K cathode inlet air temperature and 1673 K turbine inlet temperature, which no current fuel cell and few GTs can tolerate. High fuel pre-reforming rates provided a higher design flexibility and showed opportunities of efficiency improvement with appropriate thermal integration strategy. And the feasibility of achieving high efficiencies in the hybrid system with thermally integrated external reforming will be explored in our future work. Novelty Statement Both fuel reforming process and fuel utilization could affect the heat and energy balance in the hybrid gas solid oxide fuel cell (SOFC)-gas turbine (GT) system. However, the optimal design condition considering different fuel reforming approaches and SOFC fuel utilization levels was not determined in the literature. In addition, appropriate integration strategies, used to balance the heat and power between the two subsystems (SOFC and GT), are imperative under different fuel reforming approaches and SOFC fuel utilization levels. But, the feasibility of those thermal integration strategies has not been examined in existing studies. This work studied the coupling effects of SOFC fuel utilization and fuel reforming process on system performance of a natural gas hybrid SOFC/GT cycle. Highest efficiency up to 74% was achieved with internal reforming, but this came with 1275 K cathode inlet air temperature and 1673 K turbine inlet temperature, which no current fuel cell and few GTs can tolerate. High fuel pre-reforming rates provided a higher design flexibility and showed opportunities of efficiency improvement with appropriate thermal integration strategy.

The HMCS Unconscionability: adrift in the Atlantic

ABSTRACT This paper traces the Canadian doctrine of unconscionability’s distant voyage in Uber Technologies v Heller 2020 SCC 16 from the familiar waters of the English ‘unconscionable bargains’ family of doctrines, found in various common law jurisdictions. Since the 19th century, those jurisdictions had included Canada. However, in this important decision of the Supreme Court of Canada, the position of the doctrine shifted significantly. Its movement can be identified as towards the American doctrine of unconscionability, a distinct doctrine not part of the English family, based rather on §2-302 of the Uniform Commercial Code. Court-watchers in the United Kingdom and other Commonwealth jurisdictions wondering whether this reinterpretation of unconscionability might represent a model for progressive reform should understand why it does not. Adrift between two doctrines with different purposes, it is insufficiently suited to serve either. Meanwhile, it may disrupt business reliance on standard form contracts, and cause tremendous contractual instability.

From Passive Application to Active Design -Restructuring and Reshaping of Core Specialty Knowledge Systems of Biomedical Engineering (Biomedical Materials Track) Undergraduate Education

Biomedical engineering (BME) (biomedical materials track) is a typical field of interdisciplinary integration. Its specialty education simultaneously undertakes the duo reformation responsibilities for the new engineering education and the new medical education due to its unique strengths in interdisciplinary nature, comprehensive scope of knowledge, and status of being on the cutting edge of technology. We made an analysis, in this paper, of the opportunities and challenges faced by BME (biomedical materials track) specialty education on the basis of the trends and frontiers of development in biomedical materials in the world. From the perspective of new requirements raised by major national strategies and industrial development for the qualifications and competence of professionals specializing in biomedical materials, thorough reflections were made on the specialized education of BME (biomedical materials track) under the background of the new engineering education and the new medical education. Furthermore, we proposed herein to reconstruct the specialized core knowledge system according to the main line of the reactions and the responses between the biomedical materials and human bodies at different levels and set up a series of courses of biomedical materials science centered on Materiobiology as the core. We also proposed to establish a diversified integrated reform model of the training system incorporating production, learning, research and application for highly competent BME (biomedical materials track) professionals. This paper attempts to contribute to the solution of the major issue of how to train the innovative talents and leaders who will pioneer a new round of diagnosis and treatment technology revolution and the development of the medical device industry.

Residency Education Reform Program in Department of Anesthesiology and Critical Care: An Academic Reform Model.

BackgroundReform in medical education is a basic process in every academic department, especially in residency programs.ObjectivesThis study was designed to assess the indices of education and research as part of the Medical Education Reform program (MERP) in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU) for four years.MethodsMERP in DACC, SBMU was designed and implemented as a modern academic reform model; different outcome measures in education and research were assessed to demonstrate the effects of the reform plan in academic improvements.Resultsthere were significant improvements regarding education indices (i.e., teaching methods, passing comprehensive exams, mentorship, assessment methods, faculty development, professionalism in medical education, integration in education, and crisis management) and research indices (targeted research activities, innovation in research approaches, increasing the impact of research).ConclusionsBased on the experiences of DACC, SBMU regarding clinical anesthesiology residency, reform could be achieved using painstaking plans and continuous efforts with tangible documented outcomes. Often, the management period is not durable, and these reforms require meticulous care to sustain.

Research on English teaching reform based on artificial intelligence matching model

In the context of information education, English teaching needs to match the development of artificial intelligence to improve the intelligence of English teaching. Based on the artificial intelligence matching model, this paper constructs an English teaching reform model based on artificial intelligence algorithms. Moreover, based on the FISST multi-target tracking method, this paper firstly models the target state and measurement as RFS, and then uses the Bayesian filtering method to recursively calculate the target posterior PDF, which can estimate the number and state of targets in real time and make up for the shortcomings of traditional tracking methods. In addition, the system proposed in this article can be applied to online English teaching. Through this system, teachers can realize one-to-one matching of students, identify the status of students in time, and give corresponding English teaching methods to different students. Finally, this paper designs a controlled experiment to analyze the performance of the algorithm proposed in this paper. The research results show that the model constructed in this paper has certain practical effects.

A Descriptive Model for Hybrid Administrative Reforms: Public Administration-On-Demand

A Descriptive Model for Hybrid Administrative Reforms: Public Administration-On-Demand

Environmental Judge Certification in an Effort to Realize the Green Legislation Concept in Indonesia

The purpose of this research is to find out, analyze, and explain the certification of environmental judges in an effort to realize the concept of green legislation in Indonesia. This research is a normative or doctrinal legal research. The data analysis was carried out qualitatively, so it is hoped that the discussion can accurately answer the problem formulation. This research resulted in the following conclusions: first; Environmental judge certification is important in the effort to implement green legislation in Indonesia based on four considerations, namely: in the context of realizing the 1945 Indonesian Constitution as a green constitution, the strategic role of judges’ decisions in realizing human and environmental justice, contributing to the effectiveness of environmental law enforcement. as well as for the integrated exercise of judicial or judicial powers in the principles of trias politica. Second, that with regard to the application of environmental judge certification in an effort to realize green legislation, the government has issued the RI KMA Decree Number: 134/KMA/SK/IX/2011 which regulates Certification of Environmental Judges which is used as a reference point for legal development regarding the judge certification system. environment in the settlement of civil, criminal and state administration cases in the environmental field. At the same time, judges training and coaching are conducted every year so that the need for the number of certified environmental judges is met in each region. Third, that the direction of legal reform relating to the provisions of environmental judge certification in an effort to realize green legislation can be carried out through guarding the environmental judge certification policy by cooperating with various parties; increase the capability of judges in the field of environmental science; as well as strengthening the judges’ thinking paradigm so that it is pro-environment or pro-natura (green thinking) as a form of embodiment of environmental legal norms according to the green constitution and green legislation in Indonesia. The benefit of this research is in the context of gaining insight among legal experts and legislative parties in improving the substance of law, especially environmental law which represents the concept of green legislation. This research contains novelty and differences from other research in terms of discouraging ideas and models of public policy reform with the concept of green legislation which is used as a legal umbrella in the form of laws on legal substances related to environmental judge certification.

Impact of kinetic models in the prediction accuracy of an industrial steam methane reforming unit

• Comparison of kinetic models and their influence on the reformer performance. • The different kinetic models converge fast to equilibrium. • The kinetics have little influence on the reformer's performance. • Simplest kinetic models present advantages compared to traditional ones. Catalyzed chemical reactions inside tubular reactors play a key role in steam methane reforming process, as they define the temperature and composition profiles of the reformer and, consequently, its efficiency. Although the kinetic modeling of reforming reactions has already been widely discussed, studies that carry out the comparison between kinetic reform models are still scarce. In this context, this work aims to evaluate the influence of different kinetics on the stationary behavior of industrial reformer. The kinetic models of Singh and Saraf (1979), Numaguchi and Kikuchi (1988), Xu and Froment (1989a), and Hou and Hughes (2001) were analyzed and compared with each other. All models describe the reformer satisfactorily with relative deviations around 3.5% compared to experimental and literature data. The results show that the simplest kinetic models present advantages compared to traditional models, such as Xu and Froment (1989a), which is widely used without any prior analysis.

The blurred distinction between therapeutic and non-therapeutic medical interventions for intersex children in Australia

ABSTRACT The international community’s response to intersex children’s issues lacks consensus, particularly in the context of medical interventions. Some States prohibit non-consensual genital normalising surgeries, while others encourage this harmful practice. This article employs a human rights lens to analyse and critique Australia’s inaction regarding unnecessary medical interventions on intersex children. It demonstrates that Australia’s current distinction between therapeutic and non-therapeutic medical interventions is underpinned by outdated gender essentialist attitudes, which irrationally characterise variations of sex characteristics as disorders. It examines models of reform adopted internationally to shape recommendations for Australia. This article implores the Australian Government to take legislative action to protect the rights of intersex children, in line with its obligations under international law.

Luther’s Reception in China and the Evolution of His Image (1840–2020)

ABSTRACT Luther was first recognized in China in the first half of the nineteenth century. Missionaries and Chinese intellectuals formed the two routes publicizing his work and his ideas in China. However, Luther's reception in China was not a holistic copy from the West, but a reshaping process which was greatly influenced by the context of Chinese history and culture. This article explores how Luther was accepted and how his image developed within this historical context from 1840 to the present day, namely how he was perceived as a negative ‘divider,' Catholic ‘evil destroyer' and Protestant ‘great reformer,' a positive ‘great reform model,' and an ‘enemy of the working and peasant classes.’ Today a multiple, tri-dimensional, and more comprehensive perspective on Luther exists.

A field guide to U.S. healthcare reform: The evolution to value-based healthcare.

ObjectiveA consolidated state‐of‐the‐art review of U.S. healthcare reform efforts that documents the evolution towards value‐based healthcare (VBH) is lacking in peer‐review literature. This field guide attempts to clarify working definitions and conceptual boundaries within the lexicon of U.S. healthcare reform efforts that predated and have common thematic perspectives within the evolving VBH reform paradigm.Data SourcesPubmed/MEDLINE/Google search.Review MethodsPubmed/MEDLINE/Google search was performed during August 1, 2020‐January14, 2021 for U.S. healthcare reform terms, legislative and government agency publications. Those citing relevant legislative, regulatory, philosophical and technological advancements integral to the development and function of VBH were catalogued according to the targeted stakeholders and evolving reform strategy or technology.ConclusionsEight healthcare reform paradigms were identified as influential precursors to VBH: Patient‐Centered Care Model, Patient‐Centered Medical Home, Population Health, Personalized Medicine, P4 Medicine, Precision Medicine, Managed Care, and Accountable Care. Several of these models have similar nomenclature and, confusingly, many have multiple interpretations of the terms used to describe these models. However, consistent stakeholders identified within these paradigms are key to VBH; notably the patient, the physician and the payer (the “Big 3”). Demonstrable healthcare spending reductions have been best achieved when the Big 3 stakeholder interests are aligned within healthcare reform legislation. The definition of “Value” within each reform model was found to be based upon the perspective of the targeted stakeholder. Within VBH, the perspectives of the Big 3 stakeholders form a multidimensional meaning of “Value” that can be represented by the equation Value = Patient Experience Management 3.

Construction of BMP Education Reform Model Based on Multi-Element Information for Automation Teaching System

With the arrival of the fourth industrial revolution, modern society is accelerating into the era of full intelligence automation. According to the requirements of new engineering construction, guided by the needs of advanced industry and economic development, combining theory education with practice training, a talent education model with general higher education and application-oriented teaching is constructed in this paper. The dynamic model is based on multi-elements including brain training, morality cultivation and practice improvement (BMP). The BMP model for automation teaching system combines the three elements to highlight the characteristics of modern application-oriented professional education, and provide reference for professional education system of automation technology.

The Need for Context-specificity in Global Educational Policy Transfer by Non-state Actors

The revitalised role of non-state actors such as non-profit organisations and education reform movements in educational provision and delivery has contributed to the global circulation of uninformed transnational adaptation of ideas and practices around educational change. In adapting models in one place for emulation in another place, educational non-profits often lose sight of the local realities, thereby decontextualizing cultural differences and normalizing the language of generalization. Such is the case of the Teach for India (TFI), a non-governmental organization (NGO) working in marginalized districts of India to provide quality education to disadvantaged children through its alternative teacher credentialing program. TFI’s theory of change and intervention approach revolves around the model of Teach for All (TFA), an international movement whose model and belief of equitable educational access and opportunity continues to spread on a global scale through transnational actors. Through an extensive literature review, this article analyses critically and discusses how the TFAll’s Model is operationalised in India, through TFI that was established in 2009 to promote the universalization of Elementary Education (UEE) in India. While examining the underlying assumptions that inform the de-contextualisation of the globalised and philanthropy backed reform model, it analyses the key features of the intervention approach and presents the critiques and limitations. Beyond contextualisation, the paper makes a case for the need for non-state actors to take into account significant sociocultural and political differences in voluntary transfer of reform ideas. While acknowledging the significance of policy mobilities in bringing entrepreneurial solutions to educational problems across continents, the article recommends that such transfer must be driven by perceived necessity within local contexts.

RETRACTED: College Business English teaching in the context of multimedia network

With the advent of the Internet age, network information technology is rapidly entering college English classes, which fundamentally changes the mode of college English teaching. In college English classroom teaching mode, as a brand teaching form, College English multimedia network teaching environment has brought advantages to classroom teaching, but also brought about impacts on teaching concepts, teaching models, teaching methods and other aspects. There are some phenomena that are inconsistent with the reform model at the students, teachers and the environment. The balance of traditional English classroom teaching has been broken, which has affected the smooth progress of college business English classroom teaching mode reform. It is very important to analyze and resolve these imbalances and find ecological methods for optimizing university English education. In this context, the advent of multimedia-assisted education technology has provided better conditions for the implementation of Business English classroom education in universities. Multimedia-powered business English education allows teachers to create a better language learning environment in class more conveniently and quickly, helping students acquire grammar knowledge and achieve their educational objectives.

The Silver Lining of Crises – A Loss Aversion Based Model of Reform

We explore how and when crises can help firms, organizations, and societies undertake beneficial reforms. In our model, a loss averse decision maker decides whether she should undertake a new project (a reform), characterized by a sequence of cash-flows, or stick with the status quo. In normal times, the decision maker may not pursue a beneficial project, a project with a positive net-present-value, for she places a greater emphasis on losses than on (equal sized) gains. We show that a sufficiently bad crisis guarantees that she undertakes the most beneficial project and characterize when a crisis begets change. When choosing between a single project and the status quo, a crisis can only shape preferences for the better. When choosing among multiple projects, it may distort choices. However, the crisis will always push the decision maker towards implementing a project that is better than the status quo. Implications for economic reforms and policy changes are discussed.

Towards Reforming Sri Lanka Railways: Insights from International Experience and Industry Expert Opinion

Growing of the automobile industry and the demand for personal car use and chronic financial deficits in the balance sheets of rail operators have significantly affected the rail industry deterioration since 1970. However, gradual rail reforms were carried out by many countries to eliminate financial and operational issues and to develop their rail transportation systems. Sri Lanka has more than 150 years of history in railway operations, yet it is still in a weak position in terms of the operational efficiency and the financial position. The main purpose of this paper is to explore the key issues and root causes for the operational and financial deficiencies of Sri Lanka Railways and identify the best reform model in the light of world rail reform experiences and rail industry experts’ opinion. A semi-structured questionnaire was employed to interview twelve railway industry experts. Content analysis, Analytical Hierarchy Process (AHP) Method, and Policy Delphi Method were the main analytical techniques employed in the study. The results of the analysis showed that the vertical separation of the ownership between rail service operation and rail infrastructure provision is suitable for Sri Lanka Railways and, given the existing operational and financial characteristics, the reform steps should mostly be designed as in the case of the German- Sweden hybrid model of rail reforms.

Kinetic modeling and experimental investigations of dry reforming of methanol over a Cr-Mo-Mn/SiO2 catalyst

To derive a kinetic model for dry reforming of methanol, the experimental investigations were accomplished at vast working conditions (i.e., temperature: 500 °C–900 °C and CO2/CH3OH ratio (C/M) of 1–2.5) on Cr-Mo-Mn/SiO2 catalyst. The kinetic model developed based on the Langmuir–Hinshelwood (LH) approach and mechanism contained three reversible reactions on three types of active sites. The results of the statistical analysis presented that kinetic model parameters were statistically significant. The error of the suggested kinetic model was 9.87% using equation state (EoS) of Soave–Redlich–Kwong on the basis of modified Huron–Vidal mixing rule (SRK/MHV2) applied to evaluate vapor–liquid equilibrium behavior. The highest precision in predicting the experimental data by the suggested kinetic model was assigned to methanol conversion. The outcomes presented the high temperature is suitable for higher CO yield, methanol and CO2 conversions. An augmentation in carbon dioxide percentage of the inlet feed led to enhance in CO yield, methanol and CO2 conversions, while H2 yield was decreased.