ABSTRACT: To compete and survive in a managed care market, academic health centers must develop integrated delivery systems in general and an integrated primary care system in particular. However, the departmental-based structure at most academic health centers is ill-suited to this purpose. Service and education are usually segregated by department, and the professional activities of primary care faculty in different departments are fragmented, leaving them weakened as a political force within the institution. The University of New Mexico established a model of integrated primary care education and service by creating three interdisciplinary primary care clinics staffed by primary care residents and faculty. The clinics attracted a substantial portion of each department's faculty and residents. The clinics united primary care providers from different departments as a stronger, more unified voice in negotiating with the hospital and in fostering needed changes for primary care in the institution. Interdisciplinary teams require considerable time and labor both in planning (because of joint decision making) and in operation. Better staff structures and staff development must be learned through trial and error because there are not established benchmarks for interdisciplinary teams. Governance presents problems, primarily because loyalties to departments may supersede those to the clinic practice, and sometimes the departments' teaching priorities are challenged by clinic directors' need to ensure filling their interdisciplinary staff needs. These obstacles to collaboration can be addressed creatively, and ultimately the comprehensiveness and quality of care convinces providers and the institution.
Academic Medicine 07/1999; 74(6):659-62. · 3.52 Impact Factor
ABSTRACT: The impact of ion energy on single-event upset was investigated by
irradiating CMOS SRAMs with low and high-energy heavy ions. A variety of
CMOS SRAM technologies was studied, with gate lengths ranging from 1 to
0.5 μm and integration densities from 16 Kbit to 1 Mbit. No
significant differences were observed between the low and high-energy
single-event upset response. The results are consistent with simulations
of heavy-ion track structures that show the central fore of the track
structures are nearly identical for low and high-energy ions.
Three-dimensional simulations confirm that charge collection is similar
in the two cases. Standard low-energy heavy ion tests are more
cost-effective and appear to be sufficient for CMOS technologies down to
0.5 μm. We discuss implications for deep submicron scaling,
multiple-bit upsets, and hardness assurance
IEEE Transactions on Nuclear Science 01/1999; · 1.45 Impact Factor
ABSTRACT: Development of the newer, sensitive assay for thyrotropin (thyroid-stimulating hormone [TSH]) has simplified the diagnosis and management of hypothyroidism. Serum free thyroxine (T4) levels measured by analogue techniques or free T4 index may be used in conjunction with TSH test results to confirm the diagnosis. Treatment consists of daily doses of levothyroxine sodium (Levothroid, Levoxine, Synthroid), which are increased slowly to achieve an optimal dose. Close monitoring with TSH assay is important to ensure adequate treatment. In euthyroid sick syndrome, results of thyroid function tests are abnormal in patients with nonthyroidal illness; treatment is indicated if symptoms of hypothyroidism are present. Patients with subclinical hypothyroidism also may benefit from treatment.
Postgraduate Medicine 06/1993; 93(6):135-8, 141-5. · 1.78 Impact Factor
Journal of School Health 04/1993; 63(3):158-60. · 1.34 Impact Factor