Designing a standard for strain mapping: HR-EBSD analysis of SiGe thin film structures on Si.

Patterned SiGe thin film structures, heteroepitaxially deposited on Si substrates, are investigated as potential reference standards to establish the accuracy of high resolution electron backscattered diffraction (HR-EBSD) strain measurement methods. The proposed standards incorporate thin films of tetragonally distorted epitaxial Si1-xGex adjacent to strain-free Si. Six films of three different nominal compositions (x=0.2, 0.3, and 0.4) and various thicknesses were studied. Film composition and out-of-plane lattice spacing measurements, by x-ray photoelectron spectroscopy and x-ray diffraction, respectively, provided independent determinations of film epitaxy and predictions of tetragonal strain for direct comparison with HR-EBSD strain measurements. Films assessed to be coherent with the substrate exhibited tetragonal strain values measured by HR-EBSD identical to those predicted from the composition and x-ray diffraction measurements, within experimental relative uncertainties of order 2%. Such films thus provide suitable prototypes for designing a strain reference standard.

The timing of medical technology acquisition: strategic decision making in turbulent environments.

Healthcare decision makers and researchers have long been interested in the factors behind medical technology acquisition. The rate of environmental change in recent years has dramatically affected technology acquisition decision making in acute care hospitals. This study examines the relative role of decision-maker influence and environmental factors on the timing of MRI acquisition in hospitals operating in three western states with different levels of environmental uncertainty. The results suggest that the relative influence of decision makers and environmental factors on innovation acquisition timing varies depending on environmental turbulence, and that hospitals acquire new technology as one way of controlling the turbulence in their environments.

What is quality, who wants it, and why?

The health services literature is replete with examples of the failure of total quality management to produce significant change in organizational performance. Some authors suggest that incremental quality improvement be abandoned in favor of structural reengineering. However, these naysayers ignore the critical impact of environmental change, managed care, and customer service as primary organizational drivers that demand an enhanced focus on continuous quality improvement. Coupled with these factors is the movement towards the creation of learning organizations. At the core of any learning organization is a commitment to quality and the empowerment of employees to identify and improve quality.

Can ethical management and managed care coexist?

The growth of for-profit managed care organizations raises serious ethical questions for managers in these settings, such as whether contemporary business ethics are most appropriate for health care organizations or how the principles of biomedical ethics can be integrated into profit-seeking firms. A model is proposed that seeks to consolidate both business ethics and biomedical ethics into a form that is useful to health service managers.

The unfocused strategic vision.

Integrated delivery systems are often seen as the answer to the question of how to deliver high quality health services to a defined population at the lowest possible cost. This case examines the birth, growth, and ultimate demise of one such system. At first glance, all of the elements necessary for a successful integration were present including visionary leadership and a well defined strategic plan. However, the senior managers did not foresee the problems that would result from a clash of organizational cultures, significant mistrust between and among staff and physicians, and inability to manage the emotional-cognitive landscape.

Factors affecting decisions to adopt medical technologies in acute care hospitals.

The results of this research have added an expanded perspective on the decision to adopt particular technologies. The perception had been that, given the current state of health care reimbursement, decisions to acquire radical and often expensive devices will center around economic or strategic considerations. However, it was discovered that technology acquisition appeared to be a physician centered activity with less consideration given to strategic or economic factors. While these data suggest that hospitals have not been listening to complaints about rising health care costs and continue to operate in a "business as usual" manner, it may because physicians continue to be the dominant players in what is for them an unrestrained free market. This trend, if continued, may ultimately lead to a reimposition of heavy handed government regulation in the adoption of even the most routine medical technology. As a result, it is vital that health care administrators begin to explore ways for moving from physician centered and tactical considerations to a more strategic focus which builds upon the needs and interests of the medical staff to serve the community in a more responsible fashion before that ability is taken away from them.

Development of a local integrated health network.

Integrated health networks are viewed as one possible organizational response to healthcare reform. This article discusses the variables that are critical to the development and success of a local integrated network. The case of a network currently under development is used to illustrate the underlying theory. Virtual integration is envisioned as the method by which the network comes together.

Physicians' influence on the decision to acquire magnetic resonance imagers in acute care hospitals.

The influences of four principal types of decision makers on the acquisition of magnetic resonance imagers were measured in hospitals in Southern California, Oregon, and Washington. We propose that of the decision makers assessed, physicians had the most influence on the acquisition of magnetic resonance imagers.

Linkage mapping of autosomal dominant retinitis pigmentosa (RP1) to the pericentric region of human chromosome 8.

Linkage mapping in a large, seven-generation family with type 2 autosomal dominant retinitis pigmentosa (ADRP) demonstrates linkage between the disease locus (RP1) and DNA markers on the short arm of human chromosome 8. Five markers were most informative for mapping ADRP in this family using two-point linkage analysis. The markers, their maximum lod scores, and recombination distances were ANK1 (ankyrin)--2.0 at 16%; D8S5 (TL11)--5.3 at 17%; D8S87 [a(CA)n repeat]--7.2 at 14%; LPL (lipoprotein lipase)--1.5 at 26%; and PLAT (plasminigen activator, tissue)--10.6 at 7%. Multipoint linkage analysis, using a simplified pedigree structure for the family (which contains 192 individuals and two inbreeding loops), gave a maximum lod score of 12.2 for RP1 at a distance 8.1 cM proximal to PLAT in the pericentric region of the chromosome. Based on linkage data from the CEPH (Paris) reference families and physical mapping information from a somatic cell hybrid panel of chromosome 8 fragments, the most likely order for four of these five loci and the diseases locus is 8pter-LPL-D8S5-D8S87-PLAT-RP1. (The precise location of ANK1 relative to PLAT in this map is not established). The most likely location for RP1 is in the pericentric region of the chromosome. Recently, several families with ADRP with tight linkage to the rhodopsin locus at 3q21-q24 were reported and a number of specific rhodopsin mutations in families with ADRP have since been reported. In other ADRP families, including the one in this study, linkage to rhodopsin has been excluded. Thus mutations at two different loci, at least, have been shown to cause ADRP. There is no remarkable clinical disparity in the expression of disease caused by these different loci.

Clinical findings and common symptoms in retinitis pigmentosa.

Data analysis was performed in a prospective study of clinical symptoms and findings in 500 patients with retinitis pigmentosa. The symptoms and findings in these patients met the usual definitions of the disease. At initial examination the patients were questioned in a standardized manner; symptoms and associated health problems were reviewed. Some patients were unable to answer all of the questions. Of the patients 274 (55%) were men and 226 (45%) were women, with a race distribution of 21 (4%) black, 47 (9%) Hispanic, 26 (5%) Oriental, three (1%) American Indian, and 403 (81%) white. Sixty-nine patients reported no symptoms of night blindness and 116 patients claimed no visual field changes; 90 stated that they saw better at dusk. The most common problem noted by 263 (53.3%) was headaches, 31 on a daily basis, 42 at least weekly, 124 infrequently, and the remainder nonspecifically. Numbness or tingling, mainly in extremities, was reported by 99 patients. The second most common problem affecting 170 patients (34.6%) was light flashes; since eight patients had retinal detachments, light flashes cannot be totally discounted. Of 143 patients who had been pregnant, 14 had visual changes.

Beating fantasies in a latency girl: their role in female sexual development.

Detailed clinical material is presented from the analysis of a latency girl whose inner life revolved around a series of beating fantasies. The clinical data support Freud's 1925 formulation that the perception of sexual differences initiates the oedipus complex in the girl. Whether a girl experiences vaginal sensations before puberty has been a controversial issue; in this girl vaginal sensations and contractions appeared prior to puberty.

Evaluation of a stroma-free hemoglobin solution for use as a plasma expander.

The preparation of large quantities of a stable, stroma-free hemoglobin solution without coagulant activity is described. Following infusion of this solution into phlebotomized dogs, there is no methemoglobin formation, no adverse effects on vital signs, and no demonstrable activation of blood coagulation. The hemoglobin maintains its oxygen-carrying capacity and liberates oxygen into tissues. Acute and chronic effects on renal function following infusion of this preparation were also studied and no effect on clearance of urea, creatinine, or P.A.H. could be demonstrated. There was no change in urinary output and histological sections revealed no lesions attributable to hemoglobin toxicity. It is concluded that a stroma-free hemoglobin solution may have use as a plasma expander.