The dynamics of market-level change

Health care exhibits a competitive dynamic today that increasingly resembles that in other service industries. Organizations are becoming larger to achieve scale economies and to increase market power. Vertical integration, whether through ownership or complex contracts, is also being pursued both to seek efficiencies and to improve the bargaining position of the organization. External forces that are driving these changes include more aggressive activities on the part of purchasers to contain their costs, developments in information technology, management innovation in other service industries, and advances in medical technology. Within the health care industry, there is a pattern of organizations taking the initiative to respond to these external forces--often in anticipation of them--and other organizations then responding to the pressures in turn placed on them. Although information on strategies is communicated rapidly throughout the country, what is attempted and what succeeds differs a great deal across communities. The nature of current health care institutions in the community, including the presence of large entities with extensive capital and strong management in a particular segment of the health system and the community's experience with managed care are important factors in the path that change takes.     

Microwave effects on input resistance and action potential firingof snail neurons

Excitable tissues have been reported to respond to weak microwave (MW) fields, possibly by nonlinear perturbation of a cellular process such as ion conduction across membranes. We sought effects of MW (continuous wave, 2.45 GHz, specific absorption rates 12.5 or 125 mW/g) on input resistances and action potential (AP) intervals of neurons in ganglia of snails (Helix aspersa), at 20.9 +/- 0.1 degrees C. At 12.5 mW/g, input resistance did not change during irradiation, but increased (p < 0.05) afterward. At 125 mW/g, input resistance during irradiation was lower than in unirradiated controls. Serial correlograms changed marginally more frequently in MW experiments than in controls, but the changes had no consistent pattern. The AP firing rate was affected by MW, but the direction was not consistent across cells. When AP generation was modeled as being due to a neuronal input current, MW did not affect its mean, standard deviation, or autocorrelation. Unlike MW, temperature changes caused neurons to respond robustly and reversibly. Threshold for changing input resistance was 0.63 degree C. The data suggest that MW may enhance degenerative effects such as metabolic rundown or loss of ion channel patency, but do not indicate a specific mechanism for MW interaction with neurons.     

Strict interpretations of deterministic pushdown acceptors

Three results are established. The first is that every nondeterministic strict interpretation of a deterministic pushdown acceptor (dpda) has an equivalent, deterministic, strict interpretation. The second is that ifM ₁ andM ₂ are two compatible strict interpretations of the dpdaM, then there exist deterministic strict interpretationsM andM such thatL(M ) =L(M ₁)L(M ₂) andL(M ) =L(M ₁)L(M ₂). The third states that there is no dpda whose strict interpretations yield all the deterministic context-free languages.This author was supported in part by the National Science Foundation under Grant MCS-77-22323.     

Polyamide hydrolysis accelerated by small weak organic acids

It is well known that acidity, pH, of a solution accelerates the hydrolysis of soluble amides. Here we describe the unexpected result that weak small organic acids at low concentrations hydrolyze a polyamide at rates approximately twice that of a water HCl solution of the same pH. The effect of three small organic acids in dilute solutions, acetic, propanoic, and butanoic was studied. It is observed that the effect on the hydrolysis rate increases as the organic acid gets weaker. Butanoic, the weakest acid, has the strongest effect on increasing the hydrolysis rate. Measurements on the concentration of these acids in the polyamide reveal that there is a selective desire for these weak organic acids to diffuse into the polyamide. The concentration of these acids in the polyamide is found to be several multiples of the concentration in the water environment. And the acid concentration is highest for butanoic. The hydrolysis rate is shown to be governed by solubility, not pH of the water environment. The longer hydrocarbon tail on the carboxylic group increases its compatibility with the polyamide's monomer structure. Results are reported on the hydrolysis of polyamide-11 polymerized from aminoundecanoic acid, both neat and a commercial plasticized composition, placed in water at 100 °C and 120 °C under anaerobic conditions in high pressure glass tubes.     

Dual Time-Interleaved Successive Approximation Register ADCs for an Ultra-Wideband Receiver

Ultra-wideband radio requires Nyquist sampling rates of at least 500 MS/s with low resolutions. While flash is the traditional choice for these specifications, a comparative energy model is used to show the potential energy savings of the time-interleaved successive approximation register architecture, which requires only a linear number of comparisons versus exponential for flash. A dual 500-MS/s, 5-bit ADC chip is implemented in a 0.18-mum CMOS process, with both ADCs synchronized for use in an I/Q UWB receiver. Each ADC uses a 6-way time-interleaved SAR topology with full custom logic, self-timed bit-cycling, and duty cycling of the comparator preamplifiers to enable 500-MS/s operation with 7.8 mW power consumption. The output resolution is adjustable down to the 1-bit level for additional power savings     

The psychosocial impact of skin disease. An overview

When the skin is disfigured by disease, it has an impact on the afflicted person. The intensity of the effect depends on many variables including the natural history of the disease, the characteristics of the individual patients and their life situation, as well as the attitudes and assumptions of the culture at large about the meaning of skin disease. Fantasies about skin disease, shared by patients and onlookers alike, relate to guilt, control of bodily boundaries, and perfectionist yearnings. Some issues involved in these fantasies include distortions about contagion, dirt, and sexuality. Ways of helping patients to manage the impact of their skin disease include an empathic doctor-patient alliance, education of patients and the community, and if indicated, referral for psychiatric consultation.