Academic faculty practices: issues for viability in competitive managed care markets

This study compares the perspectives of eighteen managed care executives and twenty-four faculty practice executives on critical policy issues related to the managed care marketplace. Market sites studied in 1994 included four major metropolitan areas: Minneapolis-St. Paul, Los Angeles, Philadelphia, and Atlanta. These markets were selected as being representative of communities with descending degrees of managed care involvement, but with significant market activity. Study participants from both managed care systems and faculty practices examined five policy issues: (1) the importance of including academic medical centers in current and future health care plans for marketing purposes; (2) the provision of clinical services that are unique to the academic medical center, that is, unavailable elsewhere in the community; (3) the degree of financial supplement that employers might pay for including an academic medical center; (4) future restructuring of organizations to sustain the educational mission of academic faculty within a viable delivery system; (5) satisfaction of managed care providers with graduates of academic medical centers, as measured by the clinical skills of graduate physicians. The study findings showed little support among managed care plans for paying supplements to include faculty practices in a health care network. Most study participants from managed care systems and academic faculty practices identified limited competencies that are unique to academic centers. Moreover, managed care organizations were only willing to undertake limited restructuring at best to include faculty practices within their networks. General concern about the preparation of resident physicians (especially those in primary care disciplines) for practice within contemporary managed care organizations existed among managed care informants. The results of the study indicate that as traditional funding sources for medical education are reduced, schools require greater integration with managed care plans to enable academic medical centers and their faculties to continue promoting clinical enterprise.     

The CD40-CD154 system in anti-infective host defense

Research in the past few years has documented significant advances in our understanding of the CD40-CD40 ligand (CD154) system in diverse immune functions. This system influences many T cell mediated inflammatory immune responses and effector functions, unmasking a previously unexpected role for CD40-CD154 in cell mediated immunity. Manipulation of CD154 in animal models of infection by the use of CD154-deficient mice or anti-CD154 antibodies has shown the importance of this system in the initiation of the inflammatory response, in the activation of antigen-presenting cells and in resistance to infections.     

Tuning of MST neurons to spiral motions

Cells in the dorsal division of the medial superior temporal area (MSTd) have large receptive fields and respond to expansion/contraction, rotation, and translation motions. These same motions are generated as we move through the environment, leading investigators to suggest that area MSTd analyzes the optical flow. One influential idea suggests that navigation is achieved by decomposing the optical flow into the separate and discrete channels mentioned above, that is, expansion/contraction, rotation, and translation. We directly tested whether MSTd neurons perform such a decomposition by examining whether there are cells that are preferentially tuned to intermediate spiral motions, which combine both expansion/contraction and rotation components. The finding that many cells in MSTd are preferentially selective for spiral motions indicates that this simple three-channel decomposition hypothesis for MSTd does not appear to be correct. Instead, there is a continuum of patterns to which MSTd cells are selective. In addition, we find that MSTd cells maintain their selectivity when stimuli are moved to different locations in their large receptive fields. This position invariance indicates that MSTd cells selective for expansion cannot give precise information about the retinal location of the focus of expansion. Thus, individual MSTd neurons cannot code, in a precise fashion, the direction of heading by using the location of the focus of expansion. The only way this navigational information could be accurately derived from MSTd is through the use of a coarse, population encoding. Positional invariance and selectivity for a wide array of stimuli suggest that MSTd neurons encode patterns of motion per se, regardless of whether these motions are generated by moving objects or by motion induced by observer locomotion.     

Changes in Lake Ontario Total Phosphorus Concentrations 1976–1978

An apparent decrease in total phosphorus concentrations of approximately 4.l μgP/L has been reported recently for the spring values of 1977 and 1978 in Lake Ontario. Investigation of the loading reduction for this period independent of sedimentation factors can account for only 10% of the change. The results indicate that changes in the sedimentation rate of total phosphorus during this period offer an explanation for the majority of the change in concentration.     

Interval based MINLP superstructure synthesis of mass exchange networks

A new simultaneous synthesis approach for mass exchange networks (MENs) is presented. The technique is adapted from the interval based mixed integer non-linear program (MINLP) superstructure (IBMS) synthesis of heat exchanger networks (HENs). The superstructure interval boundary compositions are defined by the supply and target compositions of either the rich or lean set of streams. Each rich and lean stream in the superstructure has the potential of exchanging mass with streams of opposite kind in each interval based on mass transfer feasibility. The model harnesses the strengths of the stagewise superstructure and the pinch technology methods for mass exchange network synthesis (MENS). The IBMS approach simultaneously trades-off the capital and operating costs for MENs. The superstructure composition interval defining approach introduced in this paper enforces the mixing of split streams at equal compositions, hence there is no need to include mixing equations in the model. Fixing the interval boundaries helps to eliminate the complexities involved in initialisations, thus the region of search for the optimum solution is reduced. The IBMS model is applied to MENS problems involving continuous contact and staged columns. It is also extended to problems involving multiple mass separating agents (MSAs) and regeneration. The results obtained compare well with those in the literature.