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The Affordable Care Act encourages the formation of accountable care organizations as a new part of Medicare. Pending forthcoming federal regulations, though, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few such integrated systems exist in the United States. This paper demonstrates how Advocate Physician Partners in Illinois could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results. The partnership has signed its first commercial ACO contract effective January 1, 2011, with the largest insurer in Illinois, Blue Cross Blue Shield. Other commercial contracts are expected to follow. In a health care system still dominated by small, independent physician practices, this may constitute a more viable way to push the broader health care system toward accountable care. [PUBLICATION ABSTRACT]

In contrast to generally sparse biological communities in open-ocean settings, seamounts and ridges are perceived as areas of elevated productivity and biodiversity capable of supporting commercial fisheries. We investigated the origin of this apparent biological enhancement over a segment of the North Mid-Atlantic Ridge (MAR) using sonar, corers, trawls, traps, and a remotely operated vehicle to survey habitat, biomass, and biodiversity. Satellite remote sensing provided information on flow patterns, thermal fronts, and primary production, while sediment traps measured export flux during 2007-2010. The MAR, 3,704,404 km(2) in area, accounts for 44.7% lower bathyal habitat (800-3500 m depth) in the North Atlantic and is dominated by fine soft sediment substrate (95% of area) on a series of flat terraces with intervening slopes either side of the ridge axis contributing to habitat heterogeneity. The MAR fauna comprises mainly species known from continental margins with no evidence of greater biodiversity. Primary production and export flux over the MAR were not enhanced compared with a nearby reference station over the Porcupine Abyssal Plain. Biomasses of benthic macrofauna and megafauna were similar to global averages at the same depths totalling an estimated 258.9 kt C over the entire lower bathyal north MAR. A hypothetical flat plain at 3500 m depth in place of the MAR would contain 85.6 kt C, implying an increase of 173.3 kt C attributable to the presence of the Ridge. This is approximately equal to 167 kt C of estimated pelagic biomass displaced by the volume of the MAR. There is no enhancement of biological productivity over the MAR; oceanic bathypelagic species are replaced by benthic fauna otherwise unable to survive in the mid ocean. We propose that globally sea floor elevation has no effect on deep sea biomass; pelagic plus benthic biomass is constant within a given surface productivity regime.

Many resource-limited countries are scaling up health services and health-information systems (HISs). The HIV Cascade framework aims to link treatment services and programs to improve outcomes and impact. It has been adapted to HIV prevention services, other infectious and non-communicable diseases, and programs for specific populations. Where successful, it links the use of health services by individuals across different disease categories, time and space. This allows for the development of longitudinal health records for individuals and de-identified individual level information is used to monitor and evaluate the use, cost, outcome and impact of health services. Contemporary digital technology enables countries to develop and implement integrated HIS to support person centred services, a major aim of the Sustainable Development Goals. The key to link the diverse sources of information together is a national health identifier (NHID). In a country with robust civil protections, this should be given at birth, be unique to the individual, linked to vital registration services and recorded every time that an individual uses health services anywhere in the country: it is more than just a number as it is part of a wider system. Many countries would benefit from practical guidance on developing and implementing NHIDs. Organizations such as ASTM and ISO, describe the technical requirements for the NHID system, but few countries have received little practical guidance. A WHO/UNAIDS stake-holders workshop was held in Geneva, Switzerland in July 2016, to provide a 'road map' for countries and included policy-makers, information and healthcare professionals, and members of civil society. As part of any NHID system, countries need to strengthen and secure the protection of personal health information. While often the technology is available, the solution is not just technical. It requires political will and collaboration among all stakeholders to be successful.

Haskell's popularity has driven the need for ever more expressive type system features, most of which threaten the decidability and practicality of Damas-Milner type inference. One such feature is the ability to write functions with higher-rank types – that is, functions that take polymorphic functions as their arguments. Complete type inference is known to be undecidable for higher-rank (impredicative) type systems, but in practice programmers are more than willing to add type annotations to guide the type inference engine, and to document their code. However, the choice of just what annotations are required, and what changes are required in the type system and its inference algorithm, has been an ongoing topic of research. We take as our starting point a λ-calculus proposed by Odersky and Läufer. Their system supports arbitrary-rank polymorphism through the exploitation of type annotations on λ-bound arguments and arbitrary sub-terms. Though elegant, and more convenient than some other proposals, Odersky and Läufer's system requires many annotations. We show how to use local type inference (invented by Pierce and Turner) to greatly reduce the annotation burden, to the point where higher-rank types become eminently usable. Higher-rank types have a very modest impact on type inference. We substantiate this claim in a very concrete way, by presenting a complete type-inference engine, written in Haskell, for a traditional Damas-Milner type system, and then showing how to extend it for higher-rank types. We write the type-inference engine using a monadic framework: it turns out to be a particularly compelling example of monads in action. The paper is long, but is strongly tutorial in style. Although we use Haskell as our example source language, and our implementation language, much of our work is directly applicable to any ML-like functional language.

This study focuses on the role played by the work of Leo Tolstoy (1828–1910) in shaping socialism and agrarian-Buddhist utopianism in Japan. As Japanese translations of Tolstoy’s fiction and philosophy, and accounts of his life became more available at the end of the 19th century, his ideas on the individual, religion, society, and politics had a tremendous impact on the generation coming of age in the 1900s and his popularity grew among young intellectuals. One important legacy of Tolstoy in Japan is his particular concern with the peasantry and agricultural reform. Among those inspired by Tolstoy and the narodniki lifestyle, three individuals, Tokutomi Roka, Eto Tekirei, and Mushakōji Saneatsu illustrate how prominent writers and thinkers adopted the master’s lifestyle and attempted to put his ideas into practice. In the spirit of the New Buddhists of late Meiji, they envisioned a comprehensive lifestyle structure. As Eto Tekirei moved to the village of Takaido with the assistance of Tokutomi Roka, he called his new home Hyakushō Aidōjō (literally, Farmers Love Training Ground). He and his family endeavored to follow a Tolstoyan life, which included labor, philosophy, art, religion, society, and politics, a grand project that he saw as a “non-religious religion.” As such, Tekirei’s utopian vision might be conceived as an experiment in “alter-modernity.”

The secularization thesis, rooted in the idea that \"modernity\" brings with it the destruction—or, at least, the ruthless privatization—of religion, is clearly grounded in specific, often oversimplified, interpretations of Western historical developments since the eighteenth century. In this article, I use the case of the New Buddhist Fellowship (Shin Bukkyō Dōshikai) of the Meiji period (1868-1912) to query the category of the secular in the context of Japanese modernity. I argue that the New Buddhists, drawing on elements of classical and East Asian Buddhism as well as modern Western thought, promoted a resolutely social and this-worldly Buddhism that collapses—or preempts—the conceptual and practical boundaries between religion and the secular. In short, the New Buddhists sought a lived Buddhism rooted in a decidedly \"immanent frame\" (Taylor), even while rejecting the \"vulgar materialism\" of secular radicalism.

This article focuses on several key philosophical themes in the criticism of Sakaguchi Ango (1906—1955), one of postwar Japan's most influential and controversial writers. Associated with the underground kasutori culture as well as the Burai-ha of Tamura Taijirō (1911-1983), Oda Sakunosuke (1913-1947) and Dazai Osamu (1909-1948), Ango gained fame for two provocative essays on the theme of daraku or \"decadence\"—\"Darakuron\" and \"Zoku darakuron\"—published in 1946, in the wake of Japan's traumatic defeat and the beginnings of the Allied Occupation. Less well known is the fact that Ango spent his student years studying classical Buddhist texts in Sanskrit, Pali and Tibetan, and that at one time he aspired to the priesthood. This article analyses the concept of daraku in the two essays noted above, particularly as it relates to Ango's vision of a refashioned morality based on an interpretation of human subjectivity vis-à-vis the themes of illusion and disillusion. It argues that, despite the radical and modernist flavor of Ango's essays, his \"decadence\" is best understood in terms of Mahāyāna and Zen Buddhist concepts. Moreover, when the two essays on decadence are read in tandem with Ango's wartime essay on Japanese culture (\"Nihon bunka shikan,\" 1942), they form the foundation for a \"post-metaphysical Buddhist critique of culture,\" one that is pragmatic, humanistic, and non-reductively physicalist.

The question of Buddhist involvement—or collaboration, to use a more loaded term—in modern Japanese nationalism and militarism was reopened in the late twentieth century by a number of books, including the compilation Rude Awakenings: Zen, the Kyoto School, and the Question of Nationalism (1994) and Brian Victoria’s Zen at War (1997).¹ In Zen at War, Victoria argues that Buddhism—especially Zen—was at least partly responsible for prewar and wartime Japanese militarism. To the surprise of those who see Buddhism as avowedly pacifist in nature, the attempt to justify and support the Japanese war effort in Buddhist terms

Oklahoma public comprehensive university presidents face many challenges. Among the top challenges is the quest for adequate funding of their institutions, including adequate levels of support from state resources. For Oklahoma’s public comprehensive universities and their leaders, the low levels of public support by the state have become a pattern, rather than an anomaly. The statewide reductions in appropriations for higher education funding have had a disproportionate effect on Oklahoma’s public comprehensive universities because they have fewer diversified revenue sources. As a result, Oklahoma public comprehensive university presidents have been forced to become more adept at budgeting, financial management, fundraising, and finding the resources necessary for their institutions to not only be successful, but to simply survive.The study utilized a transcendental phenomenological research approach. A qualitative research methodology was used to explore the phenomena in a systematic manner. There were seven interview participants who were presidents of public comprehensive universities in the mid-western state of Oklahoma. A structured interview protocol that included open-ended interview questions was used to collect relevant data from interview participants regarding their roles in budgeting, financial management, and fundraising. Study findings identified eight themes that described the roles of Oklahoma public comprehensive university presidents in budgeting, financial management, and fundraising. The findings illustrated that Oklahoma public comprehensive university presidents spend most of their time on budgeting and financial management, followed closely by fundraising. The study concluded that while they spend most of their time on these areas, few have a background in financial management and fundraising, and most of their experience in these areas was acquired in their previous role prior to becoming president or while on the job.