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.     

Multi-input,multi-output flight control system design for the YF-16 using nonlinear QFT and pilot compensation

Nonlinear quantitative feedback theory (QFT) and pilot compensation techniques are used to design a 2 × 2 flight control system for the YF-16 aircraft over a large range of plant uncertainty. The design is based on numerical input-output time histories generated with a FORTRAN implemented nonlinear simulation of the YF-16. The first step of the design process is the generation of a set of equivalent linear time-invariant (LTI) plant models to represent the actual nonlinear plant. It has been proven that the solution to the equivalent plant problem is guaranteed to solve the original nonlinear problem. Standard QFT techniques are then used in the design synthesis based on the equivalent plant models. A detailed mathematical development of the method used to develop these equivalent LTI plant models is provided. After this inner-loop design, pilot compensation is developed to reduce the pilot's workload. This outer-loop design is also based on a set of equivalent LTI plant models. This is accomplished by modelling the pilot with parameters that result in good handling qualities ratings, and developing the necessary compensation to force the desired system responses.     

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.     

Circuits and techniques for high-resolution measurement of on-chip power supply noise

This paper presents a technique for characterizing the statistical properties and spectrum of power supply noise using only two on-chip low-throughput samplers. The samplers utilize a voltage-controlled oscillator to perform high-resolution analog-to-digital conversion with minimal hardware. The measurement system is implemented in a 0.13-/spl mu/m process along with a high-speed link transceiver. Measured results from this chip validate the accuracy of the measurement system and elucidate several aspects of power supply noise, including its cyclostationary nature.     

Xylene Isomerization in a ZSM-5/SS Membrane Reactor

A membrane reactor containing different types of ZSM-5/porous SS membranes was used to perform the xylene isomerization reaction. The parent Na-ZSM-5 layer was synthesized by secondary growth on top of porous stainless steel tubes. The xylene isomerization reaction was carried out at different temperatures in the membrane reactor and in a fixed-bed reactor of identical geometry for comparison. Two different kinds of membranes were prepared by ion exchange: a Pt/H-ZSM-5 catalytic membrane and two Ba-ZSM-5 composites with different Ba²⁺ concentration. The p-xylene production using 100% exchanged Ba-membrane was about 28% higher than the fixed-bed reactor at 370 °C, when m-xylene was fed.