Business models and provider satisfaction in in vitro fertilization centers in the USA.

PURPOSE: The number of in vitro fertilization (IVF) cycles is increasing and the majority of patients undergoing IVF pay out of pocket. Reproductive endocrinology and infertility practitioners employ different business models to help create financial pathways for patients needing IVF but details regarding the different types of business models being used and physician satisfaction with those models have not been described previously. METHODS: A cross-sectional survey was sent to members of the Society of Reproductive Endocrinology and Infertility. The survey included 30 questions designed to assess demographics, practice patterns, and business models utilized. RESULTS: A total of 222/736 (30%) physicians responded to the survey. The majority of physicians offer a-la-carte (67%), bundled services (69%), grants (57%), and cost/risk-sharing (50%). The majority answered that the single ideal business model is bundled services (53%). There was no significant association between financial package offered and region of practice or state-mandated insurance. The largest barrier to care reported was cost with or without state-mandated coverage (94% and 99%, respectively). The majority of practices are satisfied with their business model (75%). Higher physician satisfaction was associated with private practice [69% vs 27%; OR (95%CI) = 3.8 (1.7, 8.6)], male gender [59% vs 30%; OR = 2.4 (1.1, 5.4)], and offering bundled services [83% vs 59%; OR = 2.8 (1.2, 6.7)]. CONCLUSIONS: Physicians utilize a variety of business models and most are satisfied with their current model. Cost is the major barrier to care in states with and without mandated coverage.

Radiology resident experience in a community-based residency program.

RATIONALE AND OBJECTIVES: The authors performed this study to examine the educational experience of radiology residents by evaluating exposure to total number and variety of examinations. They examined this exposure in relation to current concepts of resident education regarding exposure to difference radiologic examinations, preparation for private practice, and 4th-year resident experience. MATERIALS AND METHODS: The number of examinations performed by radiology residents and the number classified as general versus cross-sectional radiology were analyzed by calculating the average number of studies performed per academic year during the past 6 years. RESULTS: In general, there was in increase in the total number of examinations performed per resident during the past 6 years. There was no statistically significant difference in the experience with general versus cross-sectional radiologic examinations. The data support the contention that 4th-year residents perform fewer examinations. CONCLUSION: Experience with all radiologic examinations is increasing as the overall utilization of radiology services increases. Fourth-year residents read fewer images; further studies are necessary to determine whether this finding reflects a planned decrease in workload or an increase in the complexity of the workload. It may be necessary to establish a minimum number and mixture of examinations to prepare residents for private practice.

Use of oral creatine as an ergogenic aid for increased sports performance: perceptions of adolescent athletes.

BACKGROUND: Competitive athletes, including adolescents, seek ways to gain advantage over competitors. One ergogenic aid is creatine, a naturally occurring nitrogen compound found primarily in skeletal muscle. Increasing creatine levels may prolong skeletal muscle activity, enhancing work output. METHODS: A questionnaire assessing awareness and use of creatine supplementation was completed by 674 athletes from 11 high schools. Data were statistically analyzed to determine variation among groups. RESULTS: Of those surveyed, 75% had knowledge of creatine supplements, and 16% used creatine to enhance athletic performance. Percentage of use increased with age and grade level. Awareness and use were greater among boys than girls. Adverse effects were reported by 26%. Most athletes consumed creatine using a method inconsistent with scientific recommendations. CONCLUSIONS: Use of creatine by adolescent athletes is significant and inconsistent with optimal dosing. Physicians, athletic trainers, and coaches should disseminate proper information and advise these adolescent athletes.

Rate of injury in minor league baseball by level of play.

Professional baseball players are subjected to high stresses and repetitive motions that can lead to orthopedic injuries. Studies have documented significant differences in range of motion and muscle activity between professional athletes and amateurs. These differences are thought to result from adaptive changes occurring in response to repetitive microtrauma. The purpose of this study was to review rates of orthopedic injury in minor league baseball as a function of competitive level. The incidence and severity of orthopedic injuries from 1985 through 1997 were compiled for 6 minor league teams. Significantly greater injury rates were found at the rookie levels than at the higher minor league levels. Following injury, higher-level athletes were most often out 1 to 3 days, while rookies were more likely out 4 to 20 days. It is likely that some of the injuries in rookies occurred because the athletes attempted to participate in a higher level of competition without adequate conditioning and time for adaptive changes. Professional teams should not assume that amateur athletes have been properly conditioned for the increased demands of professional competition. Rookies should undergo specific conditioning and evaluation prior to competing at the professional level.

Active-passive mode-locked Nd:YAG oscillator.

An active-passive mode-locked Nd:YAG oscillator provides greatly improved shot-to-shot reproducibility compared with passive mode-locking. Effects of modulator drive power, laser cavity length, and intracavity etalons on the pulse width and stability are given. Using two-photon-fluorescence techniques the pulse width was 35.9 +/- 1.7 psec and the corresponding pulse energy was 166 +/- 6 microJ.