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.     

Integrated Smart Sensor Calibration

In many applications electronic sensors are used toimprove performance and reliability of measurement systems. Suchsensors should provide a correct transfer from the physical signalto be measured to the electrical output signal. One importantstep to achieve this, is to calibrate each sensor by applyingdifferent reference input signals and adjusting the sensor transferaccordingly. Besides expensive reference equipment the calibrationprocess takes much time and attention per individual sensor,which means a considerable increase in sensor production costs.By including at the sensor or sensor interface chip a programmablecalibration facility the calibration of such smart sensors caneasily be automated and can be executed for a batch of sensorsat a time, thus minimizing the calibration time and costs. Thispaper presents a calibration method and options for integrationin the smart sensor concept, in hardware as well as in software.An advantage of the proposed method is that it does not needa large matrix of calibration data, which needs to be storedin a look-up table or converted into a correction formula, butinstead it uses a step-by-step approach to correct the sensortransfer at each calibration measurement until the error is sufficientlysmall.     

87Sr/86Sr from rock and soil into vine and wine

For provenance assignments of wines strontium isotope ratios can be used because soils from different wine-growing regions, and hence the wines grown there, each show specific ratios. Some successful applications are demonstrated.

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⁸⁷Sr/⁸⁶Sr aus Gestein und Boden in Rebe und Wein

Zusammenfassung Zur Herkunftsbestimmung von Weinen können Strontium-Isotopenverhältnisse herangezogen werden, da die Böden verschiedener Weinbaugebiete, und damit die dort gezogenen Weine, jeweils spezifische Verhältnisse aufweisen. Einige erfolgreiche Anwendungen werden demonstriert.

     

193-nm lithography

The trend in microelectronics toward printing features 0.25 μm and below has motivated the development of lithography at the 193-nm wavelength of argon fluoride excimer lasers. This technology is in its early stages, but a picture is emerging of its strengths and limitations. The change in wavelength from 248 to 193 nm will require parallel progress in projection systems, optical materials, and photo-resist chemistries and processes. This paper reviews the current status of these various topics as they have been engineered under a multiyear program at MIT Lincoln Laboratory