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News Article | May 3, 2017
Site: motherboard.vice.com

What's come to be known as the "drone war" is almost always portrayed as soulless, clinical remote killing carried out by machines operating thousands of miles away. But drone warfare isn't just about machines. There are real humans piloting the drones, just as there are real victims. Hollywood has tried to shine a light on the psychological pressures these drone pilots face; sitting in air-conditioned, lifeless shipping containers in Creech Air Force Base, Nevada. But nothing can compete with real life testimonials. A study into the stress and dissatisfaction of the US Air Force's remotely piloted aircraft community, conducted by RAND, offers a chilling and humanising glimpse into the world of US Air Force drone pilots. The report concludes that there are indeed several psychological stressors placed upon drone pilots, ranging from the long hours to the general morale of the teams, but it's the anonymous comments from USAF drone pilots that stand out the most. We fly all the friggin time, constantly, never stops. I'm stressed. I'm the only instructor. I was training a student for eight hours. Then in the last two hours, I was asked more questions than all day. I was so all over the place, my brain was overworked. I was trying not to get too short-tempered with him. [The worst part is] the drive, the drive, the drive. A lot has to do with local community and will not support a growing Air Force base, not willing to accept any sort of drinking. I can't feel my toes, even though I wear warmers [in the Remotely Piloted Aircraft Operations Center]. It blows my mind that we have eight squadrons that are 24- hours operations, but there is not a single 24-hour service on this base. • They won't let us PT [physical training] test at Nellis, just because we're from Creech. The Air Force public affairs office never lets anyone know the value of what we do. They want an RPA everywhere, so combatant command [COCOM] wants a drone on something, but doesn't realize the strain. "How is our mission helping end the war(s)? With every IED [improvised explosive device] emplace we kill, are we any closer to ending the overall conflict? . . . Is there any end in sight?" I get burned out mentally from eight consecutive instruction days. "Seven out of the ten airmen I've had here are trying or are going to get out or have expressed extreme depression or talked of suicide." Can be hard to "off someone" and then go back home and hug the kids. The transition is hard. Everything is classified, everything that we do you can't talk to your friends, coworkers, and family outside of work. I know a lot of people that need to talk to someone but won't do it on their own, because they don't want to hurt the rest and people shut down. That's just a sampling. The RAND study conducted 28 hour-and-a-half focus group sessions with some 180 USAF airmen, assigned to pilot, sensor operator, and intelligence positions. Several previous studies have already exposed the high rate of 'burnout' and unique stressors drone pilots experience, but these sorts of raw testimonials are still rare in the relatively new era of drones. For remote pilots, they are indicative of a psychologically traumatic style of future warfare. To learn more about America's drone pilots, watch Motherboard's sit-down with Brandon Bryant, a former drone pilot and sensor operator for the of the US Air Force.


News Article | April 10, 2017
Site: www.csmonitor.com

Students participate in an updated version of the classic Prisoner's Dilemma social experiment at Yunnan University of Finance and Economics in China. —Dale Carnegie famously called one's own name the “sweetest, most important sound in any language.” And according to new research, knowing each other's names might also help bring out the best in us. A study published earlier this month in the journal Science Advances examines the effects of onymity – that is, the opposite of anonymity – on Chinese students in a classic two-player social experiment in which the most rational choice is betrayal. What researchers found, however, seems to defy rationality: Participants who learned each other’s names opted for cooperation over treachery. In an age marked by xenophobia and political polarization, studying onymity may offer insight into practical ways of helping strangers get along. This particular study suggests that even small steps toward getting to know one another can bring big benefits for society as a whole, whether it's in a town hall meeting, on a jammed roadway, or in an online discussion forum. “Since the spirit of cooperation that social cohesion is based upon is crumbling away in some places, be it on Facebook or in societies that are about to be torn apart about issues such as immigration, we sought insight into what enhances cooperation,” said co-author Jürgen Kurths from the Potsdam Institute for Climate Impact Research, Germany, who contributed statistical analyses, in a statement. Humans have been engaging with the concept of anonymity since the dawn of civilization, with the oldest known masks dating back 9,000 years. The idea of a link between anonymity and immorality goes back at least to the 4th century BC, when Plato discussed the potentially corrupting effects of a magical ring of Gyges that would render its wearer invisible. More recently, psychologists have examined the role that anonymity plays in promoting impulsivity and a disregard for social norms and reducing one's ability to accurately weigh risks. In 2004, John Suler coined the term "online disinhibition effect" to describe how anonymity, when combined with the absence of a recognized authority and face-to-face real-time interaction, results in people behaving in ways that they would not in the real world. "Our focus was on onymity as the opposite of anonymity," says Marko Jusup, an assistant professor of mathematics at Hokkaido University in Sapporo, Japan. Rather than explore how anonymity erodes civil discourse, Professor Jusup and his colleagues sought to understand how onymity might promote cooperation by adapting a classic social experiment known as the Prisoner's Dilemma. Developed in the 1950s by researchers at the RAND Corp., the classical formulation of the Prisoner's Dilemma supposes that two criminals are under arrest and held separately. Each prisoner can choose either to testify against the other or to remain silent. If both prisoners testify, each serves two years in prison. If the one testifies and the other remains silent, the silent one gets three years and the stool pigeon walks free. If both keep mum, they each serve just one year on a lesser charge. Because snitching on your partner results in a sentence of either zero years or two years, and keeping quiet results in a sentence of one year or three years, from a purely self-interested standpoint, you should always betray your partner, even though you would both be better off by cooperating. “A purely rational perspective then dictates that onymity should have been disregarded, and people should have kept playing the game as if they were anonymous,” says Jusup. “Rationality, however, is just a part of human psyche, which is nicely emphasized by the results of our experiment.” Jusup and his colleagues found that, when the participants did not know each other’s names, they cooperated about 25 percent of the time. When they did know each other’s names, they cooperated between 50 percent and 75 percent of the time. In this particular game, onymity offers no additional benefit, suggesting that this willingness to cooperate may be driven by deeper psychological mechanisms that can potentially be leveraged, for good or ill, in the real world. The researchers added a few twists to the classic game, including a 75 percent chance of there being an additional round and the option for one player to "punish" another player by incurring a small cost to make that player pay an even greater one. But "punishment did nothing to promote cooperation," says Jusup. Rather, it prompted players to betray their partners again or to retaliate with a counter-punishment. Overall, the participants in the experiment acted on short-term thinking, mostly just responding to the previous move. "This would suggest that one bad (or good) move may outweigh a series of good (or bad) prior moves," says Jusup. "We must acknowledge that human decision-making is a combination of rational thinking and quirky cognitive biases," he says. But Justin Grana, a postdoctoral fellow at New Mexico's Santa Fe Institute who specializes in game theory and who was not part of this study, is hesitant to describe the player's cooperation under onymity as a cognitive bias, instead seeing the players as incorporating their anticipated feelings into their cost-benefit calculations. "These people are actually incurring a cost," says Dr. Grana. "They don't like it when other people see them as selfish. They care about their self image." Grana also speculates that familiarity may increase sympathy between the players, and that acting against feelings of sympathy may make them feel bad. The idea that something as simple as a name encourages people to be more sympathetic is particularly intriguing for researchers and developers who study interactions in online communities. "People act differently when their identity is intact. If you know my name, if you know my face then I'm apt to be a more humane person," says Arthur Santana an assistant professor at San Diego State University's School of Journalism and Media Studies who was not part of this study. In 2014 Professor Santana published a study of newspaper comment boards that found that more than half of anonymous comments included language that was vulgar, racist, profane, or hateful, compared with less than a third of non-anonymous comments. "People's inhibitions drop when they are anonymous," he says. Grana interprets the online disinhibition effect in traditional economic terms, noting that anonymity greatly reduces the cost of leaving a comment: "If costs go down to do something, more people will do it, especially the people who possibly value it less or maybe put less time into it," he says. That said, eradicating anonymity online entirely might not be desirable. "Before we all jump on this bandwagon that we say anonymity is terrible, it's important to recognize the counterargument, that there might be some value in anonymity in the sense that you get the raw, unfiltered comment," Santana says. "Of course, there's no value in hate speech online," he adds, "but I think we're making a mistake in completely removing a person's ability to speak openly and freely." For his part, Jusup was wary of extrapolating these findings to address real-world problems, pointing out how marketers have used behavioral economics exploit and manipulate our cognitive biases. "How far we should go in using these biases to achieve certain goals – even if these goals are geared towards improving the society – is first and foremost a matter of an ethical debate," he says. [Editor's note: An earlier version misstated the location of the Santa Fe Institute.]


News Article | May 8, 2017
Site: www.eurekalert.org

Longstanding weaknesses in America's Middle East strategy, spanning at least four decades, mean new options are needed to defeat the Islamic State (IS) in Iraq and Syria, stabilize the Middle East and reestablish a sense of domestic security in the U.S. and Europe, according to a new RAND report. The report recommends that the new U.S. administration undertake a bottom-up review of the counter-IS strategy and offers three options for a strategic design. It finds that success against IS can best be achieved by removing the political, social and physical space that it needs to survive. This will entail a long-term commitment, including the establishment of legitimate governance in Iraq and Syria - a complex problem for which there is little hope of immediate resolution. Stability is most consistent and enduring when it emerges naturally from popular satisfaction with governance and other socioeconomic conditions, rather than from government oppression or military action by external powers, according to the report. "Any new strategy that fails to pursue long-term resolution of root cause issues will have to recognize the likelihood of continuing instability, the periodic recurrence of destabilizing, large-scale social violence, and the continual reemergence of international terror groups like IS," said Ben Connable, lead author of the report and a senior international policy analyst at the RAND Corporation, a nonprofit research organization. Each of the options that the report offers represents a broad strategic approach to defeating IS. One, continuous counterterror, focuses on containing and suppressing ISIS while accepting ongoing instability in Iraq and Syria. Another, practical stability, seeks to reestablish the pre-Arab Spring order in Iraq and Syria, building stable states at the probable expense of democracy and human rights. The report recommends instead a third option: legitimated stability. This approach pursues a long-term strategy that seeks to address the root causes of the conflicts in Iraq and Syria, reconciling the disenfranchised Sunni Arab populations with their governments, and thereby removing the conditions that allowed IS to emerge and thrive. Other alternatives that fail to address root cause issues are likely to condemn the United States and its allies to continual crisis and unpredictable and unending reinvestment of resources, with little gain in security or reduction of international terror. Other authors of the report, "Beating the Islamic State: Selecting a New Strategy for Iraq and Syria," include Natasha Lander and Kimberly Jackson. This research was sponsored by the Office of the Secretary of Defense and conducted within the International Security and Defense Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies and the defense Intelligence Community.


News Article | April 17, 2017
Site: co.newswire.com

An invite-only audience of VIPs and press will experience the world's finest innovations in electronics, luxury and technology RAND Luxury’s 2017 Luxury Technology Show is ready to showcase in New York on March 23, 2017. The world's finest luxury technology brands will be displaying their latest, best-in-class products and services to affluent consumers and the press. These VIP guests, retail executives, media and entertainment industry professionals will have an outstanding opportunity to experience signature cocktails, fine wine and hors d'oeuvres from while interfacing with tech's most future-looking innovators and products. The show will premiere the latest innovations from Turing Robotic Industries, Thiel Audio, Blackberry, simplehuman, ONO 3D, Tidal Force and over 40 other companies. Brand ambassadors from a wide variety of industries will again be on site to highlight their latest technology. Product categories will include, but are not limited to: photography, smart watches, robotics, wearable technology, 3D printing, home & business automation, high-end personal audio, exquisite home appliances, technology-advanced performance automobiles, smart watches, and wellness & fitness devices. A few of the premieres to be unveiled at the 2017 LTS include: Turing Robotic Industries (TRI), The LTS’s Presenting Sponsor will provide a sneak peek into the Turing Phone Appassionato, the world’s first Amplified Intelligence Android mobile phone built from Liquidmorphium alloy with DLC (diamond like carbon) coating with a software platform focusing on small data and digital privacy to present the best experience in mobile luxury tech. T.R.I. is working with world class partners to manufacture the Turing Phone Appassionato that is due for distribution by September 2017. THIEL Audio will introduce the newest addition to their product line signaling a bold entrance into the wireless streaming/multi-room speaker category. The AURORA LifeStream family of products that included the battery powered LifeStream TOURTM, and the more robust LifeStream HOMETM The AURORA LifeStream systems each won a CES Best of Show award in the Connected Home Products category, and THIEL Audio packed these products with plenty to talk about. BlackBerry - Impressively designed to be distinctly different, the award-winning BlackBerry® KEYone from TCL Communication reimagines how we communicate by offering unmatched productivity and the world’s most secure Android™ smartphone experience. An iconic BlackBerry smartphone made for the modern user, the BlackBerry KEYone combines a touch display with an physical keyboard that includes enhanced functionality such as a built-in fingerprint sensor and programmable shortcuts to access your frequent contacts and favorite apps. ONO 3D, Inc. the Inventors of the first smartphone 3D printer through a system that allows resin to harden under the light of your smartphone screen. Half of the 3D printer is already in your pocket. ONO was designed for beginners, students, enthusiasts, modelers, designers, and everyone else to be the most affordable 3D printer available. “The 2016 New York City event was a sold-out success with hundreds of Media and VIP guests. This year will be another exciting experience with the addition of multiple exclusive premieres from our sponsors,” states Bradford Rand, CEO of RAND Luxury. “New York City is a magnet for luxury trend-setters and press and all of our guests will have the unique opportunity to review and acquire the latest in elite electronics, many of which are not event available yet in the marketplace!” SPONSORS: Partial list of confirmed brands at the NY LTS Turing Robotic Industries, Audio Command Systems, Crazy 4 VR, D’Angelico Guitars of America, Double H, DropCar, EchoBox Audio, Fizzics, Global Aiptek, Greater NY Chamber of Commerce, HiFiMAN, Infinity One/IRING, Inspero, ITEX, La Marzocco, LightStim, Lomography, Macaron Bites, ManCan, Micro Kickboard, Mobilize Rescue Systems, Mr. Speakers, NEOFECT USA, Inc., ONO 3D Printing, Pangeabed, Petcube, Planter Speakers, Rem-Fit, simplehuman, Sirin Labs  AG, SOL Republic, Stromer, TCT Mobile / BlackBerry, TechniVorm-Moccamaster, Tesla Motors, The John Allan Company, Thiel Audio, Tidal Force, Vifa America’s Inc. &  Yamaha WaterCraft Cuisine provided by Boss Tweed’s and cocktails sponsored by TRUE Premium Vodka, Forever Young Wine, Alacran Tequila, Southern Tier Distilling & Cusquena. RAND Luxury, the producer of The Luxury Technology Show, was founded by entrepreneur Bradford Rand. The team’s first event was in 1993 and since then has produced 1,100 shows globally in variety of industries. Based in Manhattan, the team is known for their Invitation-Only Luxury Tech Shows in NYC & LA, brunch events in the Hamptons & Greenwich and luxury lounges during the Sundance & Toronto Int’l Film Festivals. RAND Luxury has produced unveilings for such elite brands such as Lamborghini, Rolls-Royce, Aston Martin, Bentley & Maserati. Other events produced by the team include TECHEXPO hiring events and the Cyber Security Summit Series along with charity events for The Red Cross, City Harvest, Riverkeeper, Sea Shepherd Conservation Society & The Breast Cancer Research Foundation.  Details: RandLuxury.com and TheLTS.com.


News Article | April 27, 2017
Site: www.eurekalert.org

A new RAND report identifies the likely concerns of North Korean elites about their possible fates under various unification scenarios and recommends actions that the Republic of Korea (ROK), also known as South Korea, could take now to help North Korean elites feel more positive about, or at least less resistant to, unification. While Korean unification is a major issue in South Korea, North Korean propaganda suggests that an ROK-led unification would be a disaster for North Korean elites, using this fear to bind elites closer to the regime and make them more hostile and resistant to ideas of unification. Without changing those views of North Korean elites it is difficult to imagine how peaceful unification could be achieved, the report finds. "There are five conditions that would likely help North Korean elites feel that unification could be good for them," said Bruce Bennett, author of the report and a senior international defense researcher at the RAND Corporation, a nonprofit, nonpartisan research organization. "These include ensuring their individual safety and security, maintaining their positions, maintaining their wealth, ensuring their family's safety and privileges, and being able to do something meaningful for their country." The report does not predict unification but notes that conditions for unification could develop at any time, warranting preparation. It proposes unification policies in each of these areas that the South Korean government should consider with urgency. It would take time (perhaps years) for the North Korean elites to believe the sincerity of these policies. If the South Korean government were to wait until just before or after unification to announce such policies, many North Korean elites would not believe them. The report notes that South Korea could address the unification issue by planning to continue the role of many elites in the combined Korean government and/or the combined Korean economy. Given the limitations of the South Korean legal system (only 50,000 prison spaces and a judiciary sized for the expected number of convicted South Korean criminals), South Korea would potentially need to consider extending amnesty to perhaps millions of North Koreans who have engaged in giving or taking bribes and other lesser crimes defined by South Korean law. "South Korea could also be assembling funds to support the costs of unification to clarify to North Koreans the reality of South Korean planning, consistent with the vision for unification put forward by South Korean President Lee Myung-bak," Bennett said. "South Korea would need to communicate these efforts to North Korea." It is impossible to determine how Korean unification might actually occur. While peaceful transition would clearly be the most desired option, unification could also occur as the result of conflict or a North Korean government collapse. Across these scenarios, a favorable outcome to unification would depend on convincing Northern elites that unification would be something they could live with, and not something unacceptably bad, the report concluded. The report, "Preparing North Korean Elites for Unification," was sponsored by the Korea Foundation and conducted within the International Security and Defense Policy Center of the RAND National Security Research Division (NSRD). NSRD conducts research and analysis on defense and national security topics for the U.S. and allied defense, foreign policy, homeland security, and intelligence communities and foundations and other non-governmental organizations that support defense and national security analysis.


News Article | April 17, 2017
Site: www.marketwired.com

BUFFALO, NY--(Marketwired - April 12, 2017) - Rand Capital Corporation ( : RAND) ("Rand"), a venture capital company, which invests in early stage and emerging growth businesses with unique product, service or technology concepts, today announced that it completed and filed its license application to the U.S. Small Business Administration ("SBA") to form a new Small Business Investment Company ("SBIC"). The application was filed pursuant to the "Green Light" letter received from the SBA in December 2016 inviting Rand to continue its license application process. If approved, the license will provide Rand with a source of attractive long-term capital through the use of SBA debentures. Rand anticipates contributing $7.5 million of existing capital to the second SBIC and receiving approval for up to $15 million in debentures. This will create a $22.5 million SBIC fund. The second SBIC fund supports Rand's long-term strategy to drive growth. ABOUT RAND CAPITAL Rand Capital ( : RAND) provides investors the ability to participate in venture capital opportunities through an investment in the Company's stock. Rand is a Business Development Company (BDC), and its wholly-owned subsidiary is licensed by the U.S. Small Business Administration (SBA) as a Small Business Investment Company (SBIC). Rand focuses its equity investments in early or expansion stage companies and generally lends to more mature companies. Rand looks for strong leadership who is bringing to market new or unique products, technologies or services that have a high potential for growth. Additional information can be found at the Company's website where it regularly posts information: http://www.randcapital.com/. Safe Harbor Statement This news release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. Such statements include, but are not limited to, statements concerning receiving a new SBIC license and funding, future net asset value growth, investment returns and opportunities as well as Rand's plans for utilizing proceeds from sales of portfolio companies when and if received. These statements involve known and unknown risks, uncertainties and other factors that could cause the actual results to differ materially from the results expressed or implied by such statements, including general economic and business conditions, conditions affecting the portfolio companies' markets, competitor responses, and market acceptance of their products and services and other factors disclosed in the Corporation's periodic reports filed with the Securities and Exchange Commission. Consequently, such forward looking statements should be regarded as the Corporation's current plans, estimates and beliefs. The Corporation assumes no obligation to update the forward-looking information contained in this release.


News Article | May 4, 2017
Site: www.prweb.com

Rand Group, a multi-platform systems integrator based in Houston, Texas, is proud to announce the appointment of one of the company’s Senior Managers as the 2017-2019 National Association of Women in Construction (NAWIC) South Central Regional (SCR) Director. Laurie Jimenez was recognized by the membership for her hard work and dedication to NAWIC at the 2017 SCR Forum on April 8th, where she was elected Director for the next two years. NAWIC is a national organization created to empower women in the construction industry. Members of NAWIC are business owners and executives, subcontractors, managers, accountants, estimators and tradeswomen that are employed in the construction trades. Since joining the Houston Chapter of NAWIC in 2003, Laurie has served on both the regional and national level as PR/Marketing Chair and at the local level as Treasurer, Secretary, and President. “I’m thankful that, over the years, our National and Regional leaders have provided me with opportunities to serve our organization on so many levels,” said Laurie. “Each of these positions have provided wonderful learning and service opportunities for all facets of the NAWIC organization as well as hands-on learning for skills I use on a daily basis with my position at Rand Group.” With over 25 years working in the construction industry, Laurie has demonstrated proven leadership skills in the construction field. As Senior Manager, Manufacturing at Rand Group, Laurie’s expertise has been pivotal in the company’s expansion into construction services. Working with developers, general contractors, home builders, and property management organizations, Laurie specializes in project management, process improvement, and end user development to meet these specific industry needs. ABOUT RAND GROUP Rand Group (http://www.randgroup.com) is a professional services firm that helps clients use technology for business success. As a multi-platform systems integrator, Rand Group’s experienced, certified consultants build, manage, and support business solutions from back office to front office through a single point of contact. Fast growing, highly accredited, and motivated by the success of our clients, Rand Group offers the right combination of ingenuity, dedication and professionalism to help drive real business results. Headquartered in Texas, with two offices in Houston, and another in Vancouver, Rand Group has repeatedly appeared in Accounting Today’s Top 100 VAR listing, and holds 6 Microsoft Business Competencies.


Jena A.B.,Harvard University | Seabury S.,RAND | Lakdawalla D.,University of Southern California | Chandra A.,Harvard University
New England Journal of Medicine | Year: 2011

BACKGROUND: Data are lacking on the proportion of physicians who face malpractice claims in a year, the size of those claims, and the cumulative career malpractice risk according to specialty. METHODS: We analyzed malpractice data from 1991 through 2005 for all physicians who were covered by a large professional liability insurer with a nationwide client base (40,916 physicians and 233,738 physician-years of coverage). For 25 specialties, we reported the proportion of physicians who had malpractice claims in a year, the proportion of claims leading to an indemnity payment (compensation paid to a plaintiff), and the size of indemnity payments. We estimated the cumulative risk of ever being sued among physicians in high- and low-risk specialties. RESULTS: Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic-cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in lowrisk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties. CONCLUSIONS: There is substantial variation in the likelihood of malpractice suits and the size of indemnity payments across specialties. The cumulative risk of facing a malpractice claim is high in all specialties, although most claims do not lead to payments to plaintiffs. (Funded by the RAND Institute for Civil Justice and the National Institute on Aging.) Copyright © 2011 Massachusetts Medical Society. All rights reserved.


Hussey P.S.,South Hayes Street W7W | Wertheimer S.,Harvard University | Mehrotra A.,RAND
Annals of Internal Medicine | Year: 2013

Background: Although there is broad policy consensus that both cost containment and quality improvement are critical, the association between costs and quality is poorly understood. Purpose: To systematically review evidence of the association between health care quality and cost. Data Sources: Electronic literature search of PubMed, EconLit, and EMBASE databases for U.S.-based studies published between 1990 and 2012. Study Selection: Title, abstract, and full-text review to identify relevant studies. Data Extraction: Two reviewers independently abstracted data with differences reconciled by consensus. Studies were categorized by level of analysis, type of quality measure, type of cost measure, and method of addressing confounders. Data Synthesis: Of 61 included studies, 21 (34%) reported a positive or mixed-positive association (higher cost associated with higher quality); 18 (30%) reported a negative or mixed-negative association; and 22 (36%) reported no difference, an imprecise orindeterminate association, or a mixed association. The associations were of low to moderate clinical significance in many studies. Of 9 studies using instrumental variables analysis to address confounding by unobserved patient health status, 7 (78%) reported a positive association, but other characteristics of these studies may have affected their findings. Limitations: Studies used widely heterogeneous methods and measures. The review is limited by the quality of underlying studies. Conclusion: Evidence of the direction of association between health care cost and quality is inconsistent. Most studies have found that the association between cost and quality is small to moderate, regardless of whether the direction is positive or negative. Future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste. Primary Funding Source: Robert Wood Johnson Foundation. © 2013 American College of Physicians.


Lempert R.,RAND
Climatic Change | Year: 2013

Scenarios exist so that decision makers and those who provide them with information can make statements about the future that claim less confidence than do predictions, projections, and forecasts. Despite their prevalence, fundamental questions remain about how scenarios should best be developed and used. This paper proposes a particular conceptualization of scenarios that aims to address many of the challenges faced when using scenarios to inform contentious policy debates. The concept envisions scenarios as illuminating the vulnerabilities of proposed policies, that is, as concise summaries of the future states of the world in which a proposed policy would fail to meet its goals. Such scenarios emerge from a decision support process that begins with a proposed policy, seeks to understand the conditions under which it would fail, and then uses this information to identify and evaluate potential alternative policies that are robust over a wide range of future conditions. Statistical cluster analyses applied to databases of simulation model results can help identify scenarios as part of this process. Drawing on themes from the decision support literature, this paper first reviews difficulties faced when using scenarios to inform climate-related decisions, describes the proposed approach to address these challenges, illustrates the approach with applications for three different types of users, and concludes with some thoughts on implications for the provision of climate information and for future scenario processes. © 2012 RAND Corporation.

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