Integrated information systems: tools for affiliation.

The development of healthcare information systems as tools to facilitate business success traditionally has focused on a single profit center. The cataclysmic changes that are reshaping American healthcare have accelerated the affiliation of provider entities to form systems that have broader geographic coverage, deliver a larger portion of the provider continuum of care, and are more attractive partners for purchasers of healthcare services. Integrated and/or standardized information system technologies can provide great benefit in containing costs and optimizing quality among partners resulting from healthcare mergers and acquisitions as the new entity positions itself to increase market share and enhance its bottom line. Graduate Health System (GHS) in the Philadelphia area has demonstrated the efficacy of its investment to build a system-wide information network that delivers multiple standardized, integrated systems for both the financial and operational advantage of all component institutions. Building on its patient information system as the centerpiece of its information strategy, GHS has deployed a variety of tools across its network infrastructure that have brought new capabilities and savings to its member hospitals. In light of some of GHS's successes, other hospitals and healthcare systems may be able to re-create similar savings and efficiencies by applying like strategies in cooperation with their affiliated partners.

Anterior ischemic optic neuropathy in Churg-Strauss syndrome.

A patient with a history of chronic rhinitis, sinusitis, and bronchial asthma developed a unilateral anterior ischemic optic neuropathy and a mild sensory motor neuropathy as the initial manifestation of systemic vasculitis. We made a probable diagnosis of Churg-Strauss syndrome. Fluorescein angiography showed delayed choroidal perfusion in both eyes. Marked eosinophilia, increased sedimentation rate, and elevated perinuclear anti-neutrophil cytoplasmic antibody and anti-myeloperoxidase antibody titers were the main laboratory abnormalities that supported this diagnosis. Therapy with high-dose methylprednisolone and cyclophosphamide may have preserved vision in the better seeing eye, improved its choroidal circulation, and reversed the laboratory abnormalities except for a mild persistent eosinophilia. The neuropathy is gradually improving.

Children's preference for challenge: the role of perceived competence and control.

This research tested the hypothesis that children's perceptions of academic competence and their personal control over school-related performance affects subsequent intrinsic interest and preference for challenge in an evaluative setting. In a correlational study, children's self-reported perceptions of academic competence and personal control were found to relate positively to their intrinsic interest in schoolwork and preference for challenging school activities. A subset of this sample was exposed to varying levels of a controlling directive, and preference for challenge was assessed behaviorally during a free-choice period in which subjects were unaware that they were being observed. As predicted, the data indicated that when given the evaluative, controlling directive, children who had high perceptions of academic competence and control preferred a greater challenge than did children whose perceptions were low on these measures. No difference between groups in terms of preference for challenge was evident when no controlling directive was presented. These findings are discussed in terms of theories of intrinsic motivation and potential processes that underly these effects.

Flexibility and traditionality in children's gender roles.

The present study examined the correlates of variability in children's gender-role preferences. A multidimensional test battery assessed the traditionality of preferences of 376 kindergarten and third grade children in five different gender role domains, and elicited information about three significant socialization agents (parents, peers, and media). Parents of the children (N = 358) were also interviewed with regard to their attitudes and sex role socialization practices. Predictions were generated from an existing theoretical developmental model. Boys exhibited stronger sex-typed preferences than did girls. Older girls were more flexible and older boys less flexible than were their younger counterparts. In accordance with prediction, two factors were obtained; the first relevant to current gender-related activities, the other to future expectations. Present-oriented gender preferences correlated best with peer perceptions, whereas future expectations (e.g. job aspirations) were best predicted by media choices. Parental data correlated with children's preferences but not as strongly as did the peer and media scales. Predictability of children's gender-role orientations was reasonably high when a number of factors were included, thus supporting the utility of a multidimensional approach.

An intraoral self-contained artificial larynx.

It has been estimated that approximately one third to one half of persons undergoing total laryngectomy do not obtain a satisfactory voice. These patients remain aphonic or use artificial larynges to facilitate their communication. A multidisciplinary group at Thomas Jefferson University has developed a miniaturized artificial larynx that fits on a dental prosthesis or dental plate which has over a 100-dB sound pressure level output at the source and is powered by two hearing aid batteries with a life expectancy of over 100 hours of continuous use. Clinical trials have shown that persons using other artificial devices quickly adapt to this new artificial larynx, and the first person who began using the device, an Italian, commented that he could now use both hands; and felt that this was a great help because of his ethnic background.

Visual following in newborns: role of figure-ground contrast and configurational detail.

Visual pursuit was used in studying the ability of newborn infants to discriminate levels of contrast. Ratings of the degree of eye and head following were made as subjects pursued facial targets which varied in terms of the degree fo figure-gound contrast and te degree of contrast internal to the figure as defined by the presence of contrast such that the strongest pursuit occurred to stimuli which had clearly discriminable facial detailing in addition to strong figure-ground contrast. These results suggest that the newborn is sensitive not only to large border areas of high contrasting illumination but to finer configurational details of stimuli as well.