K-shell spectroscopy of an independently diagnosed uniaxially expanding laser-produced aluminum plasma.

We present detailed spectroscopic analysis of the primary K-shell emission lines from a uniaxially expanding laser-produced hydrogenic and heliumlike aluminum plasma. The spectroscopic measurements are found to be consistent with time-dependent hydrodynamic properties of the plasma, measured using Thomson scattering and shadowgraphy. The K-shell population kinetics code FLY with the measured hydrodynamic parameters is used to generate spectra that are compared to the experimental spectra. Excellent agreement is found between the measured and calculated spectra for a variety of experimental target widths employed to produce plasmas with different optical depths. The peak emission from the hydrogenic Lyman series is determined to be from a temporal and spatial region where the hydrodynamic parameters are essentially constant. This allows a single steady-state solution of FLY to be used to deduce the electron temperature and density, from the measured line ratios and linewidths, for comparison with the Thomson and shadowgraphy data. These measurements are found to agree well with time-dependent calculations, and provide further validation for the FLY calculations of the ionization and excitation balance for a K-shell aluminum plasma. We also discuss the possible application of this data as a benchmark for hydrodynamic simulations and ionization/excitation balance calculations.

Comparing provider perceptions of access and utilization management in full-risk and no-risk Medicaid programs for adults with serious mental illness.

This article compares provider perceptions of access to services and utilization management (UM) procedures in two Medicaid programs in the same state: a full-risk capitated managed care (MC) program and a no-risk, fee-for-service (FFS) program. Survey data were obtained from 198 mental health clinicians and administrators. The only difference found between respondents in the FFS and MC sites was that outpatient providers in the MC site reported significantly lower levels of access to high-intensity services than did providers in the FFS site (p < .001). Respondents in the two sites reported similar attitudes toward UM procedures, including a strong preference for internal over external UM procedures. These findings support the conclusion that through diffusion of UM procedures, all care in the Medicaid program for persons with a serious mental illness is managed, regardless of risk arrangement. Implications for mental health services and further research are discussed.

Getting off the bandwagon: an academic health center takes a different strategic path.

Focusing on one state university academic health center (AHC) located in a rural setting in the southeastern United States, this case study investigates the strategic response to the increasingly turbulent and competitive environment in the healthcare industry. The qualitative research reported here involved a review of pertinent documents and archival data and interviews with key informants including AHC executives and staff, community leaders, and others. Additional information was obtained from published sources, including a literature review that covers a five-year period ending in 1997 and searches conducted using the key words "academic medical or health center." The AHC in this case study demonstrates how it is possible to respond proactively to changes in the environment without sacrificing the multiple missions of the institution. This AHC implemented strategies that ensure access for both inner city and rural underserved populations while providing venues for primary care training and educational programs. In addition, the AHC positioned itself to compete more effectively by implementing a continuous quality improvement program that is aimed at maximizing quality while controlling costs. Administrators in not only AHCs but also other healthcare organizations, such as community hospitals and competing systems, should consider the findings from this case study useful in evaluating existing strategies and possible alternatives. In particular, the use of an affiliation strategy for growth in a resource-poor environment may encourage organizations located in rural areas to consider innovative expansion strategies to develop integrated systems of care.

Academic health centers in turbulent times: strategies for survival.

Given the increasingly turbulent health care environment, the strategic adaptation of academic health centers (AHCs) provides an opportunity to investigate the effects of drastic change on a population of organizations. This article identifies and categorizes the adaptive behavior using existing strategic typologies, while exploring the implications for hospital managers.

Delivering care to rural HIV/AIDS patients.

With HIV/AIDS on the rise in rural areas, health care providers must find ways of delivering care with little or no increase in resource support. This paper examines the evolution of a rural HIV/AIDS alliance using a life cycle model to identify each stage of the alliance development and the specific issues associated with each stage. The data were collected through structured interviews and by review of background materials, including budgets, grant proposals, and program reports. The findings identify alliance strategies that can be used in other rural communities facing the challenge of serving an increasing number of HIV/AIDS patients with limited resources. Differing from other models, this rural HIV/AIDS alliance emerged from local government and community support into an independent, nonprofit organization operating through a network of interorganizational relationships.

Hospital closures: what is the story?

This paper examines the data and research findings on hospital closures in order to understand better the phenomenon and to evaluate the seriousness of its impact. It presents a description of the patterns and trends and, from this, attempts to identify the factors which contribute to closings and the effects on the community, the physicians, and other hospitals. In examining the research findings, a number of managerial and research propositions are identified.

Improved stakeholder management: the key revitalizing the HMO movement?

In summary, our purpose has been to propose and to demonstrate that the survival of HMOs (in whatever form) depends on the proper identification and management of key stakeholder strategies. It is believed that identification and assessment of key stakeholders holds much promise for improving both HMO management and the future performance of HMOs.