Nanoporous antireflection coating for high-temperature applications in the infrared.

Antireflection (AR) coatings are essential to the performance of optical systems; without them, surface reflections increase significantly at steep angles and become detrimental to the functionality. AR coatings apply to a wide range of applications from solar cells and laser optics to optical windows. Many times, operational conditions include high temperatures and steep angles of incidence (AOIs). The implementation of AR coatings is extremely challenging in these conditions. Nanoporous coatings made from high-temperature-tolerant materials offer a solution to this problem. The careful selection of materials is needed to prevent delamination when exposed to high temperatures, and an optimal optical design is needed to lower surface reflections at both the normal incidence and steep AOIs. This paper presents nanoporous silicon dioxide and hafnium dioxide coatings deposited on a sapphire substrate using oblique angle deposition by electron beam evaporation, a highly accurate deposition technique for thin films. Developed coatings were tested in a controlled temperature environment and demonstrated thermal stability at temperatures up to 800°C. Additional testing at room temperature demonstrated the reduction of power reflections near optimal for AOIs up to 70° for a design wavelength of 1550 nm. These findings are promising to help extend the operation of technology at extreme temperatures and steep angles.

What does an MRI scan cost?

Historically, hospital departments have computed the costs of individual tests or procedures using the ratio of cost to charges (RCC) method, which can produce inaccurate results. To determine a more accurate cost of a test or procedure, the activity-based costing (ABC) method must be used. Accurate cost calculations will ensure reliable information about the profitability of a hospital's DRGs.

Antenna gain of actively compensated free-space optical communication systems under strong turbulence conditions.

Current Strehl ratio models for actively compensated free-space optical communications terminals do not accurately predict system performance under strong turbulence conditions as they are based on weak turbulence theory. For evaluation of compensated systems, we present an approach for simulating the Strehl ratio with both low-order (tip/tilt) and higher-order (adaptive optics) correction. Our simulation results are then compared to the published models and their range of turbulence validity is assessed. Finally, we propose a new Strehl ratio model and antenna gain equation that are valid for general turbulence conditions independent of the degree of compensation.

Fiscal strategy in an era of reform.

In a reform environment, hospitals and health systems should be able to control-rather than simply understand-their costs. Senior managers and line managers throughout a healthcare organization should be solidly behind-and deeply involved in-the organization's cost-control efforts. Physicians also should be heavily engaged in cost control, as they are the only ones who can both establish clinical pathways and monitor their colleagues' use of them.

High-sensitivity DPSK receiver for high-bandwidth free-space optical communication links.

A high-sensitivity modem and high-dynamic range optical automatic gain controller (OAGC) have been developed to provide maximum link margin and to overcome the dynamic nature of free-space optical links. A sensitivity of -48.9 dBm (10 photons per bit) at 10 Gbps was achieved employing a return-to-zero differential phase shift keying based modem and a commercial Reed-Solomon forward error correction system. Low-noise optical gain was provided by an OAGC with a noise figure of 4.1 dB (including system required input loses) and a dynamic range of greater than 60 dB.

Bumps along the ACO road.

The success of ACOs will depend on whether they can avoid difficulties inherent in six areas: Measuring costs. Computing expected costs. Managing prevention and wellness. Managing resources per case type. Managing the direct cost of resource units and fixed costs. Addressing conflicting incentives.

Profit centers in clinical care departments: an idea whose time has gone.

If a hospital is to use profit centers successfully, it should resolve several philosophical, organizational, and accounting matters, including: How much decisionmaking latitude clinical care chiefs should have. Whether to take a cross-subsidization approach. What role clinical care departments should take in a service line strategy.

Using bundled prices and deep discounts to obtain managed care contracts: seller beware!

To achieve the potential of bundled pricing, and thereby help align the incentives of your medical staff and hospital, keep in mind the following points: *Balancing risk, reward, and control; *Aligning responsibility with control; *Linking costs and features; *Developing appropriate information.

The folly of using RCCs and RVUs for intermediate product costing.

Two measures for computing the cost of intermediate projects--a ratio of cost to charges and relative value units--are highly flawed and can have serious financial implications for the hospitals that use them. Full-cost accounting, using the principles of activity-based costing, enables hospitals to measure their costs more accurately, both for competitive bidding purposes and to manage them more effectively.

Missing elements in the healthcare debate.

Financial flows in the U.S. healthcare system could be restructured in several ways to ensure that individuals and institutions pay their fair share: Eliminate subsidies for people with preventable illnesses and/or large families. Require not-for-profit hospitals to donate their tax exemptions to a state fund to help pay for care for the uninsured. Require health insurance companies to pay a percentage of their total premium revenue into a fund for graduate medical education. Eliminate copayments for pharmaceuticals, but require patients to pay the brand-generic cost difference if they wish to use brand-name drugs when generic drugs are available.

Strategic decision making: it's time for healthcare organizations to get serious.

To get serious about its strategic decision making, a healthcare organization needs to know what it does not intent to be. Organizations make trade-offs along three dimensions: service or customer needs, and customer access. Strategic trade-offs also should be assessed in terms of competitive scope and pricing policy.

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups.

UNLABELLED: OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries. CLINICAL SETTING: Nurseries, health centres and dental clinics in 17 countries. PARTICIPANTS: 2822 children aged 3 to 4 years and their parents. MAIN OUTCOME MEASURES: Dental examination of children and questionnaire to parents. RESULTS: Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group. CONCLUSIONS: This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

Improving operating room performance in a center of excellence.

The financial success of centers of excellence typically depends on effective utilization of the OR. Therefore, it's important to align the strategy, structure, information and reporting systems, culture, and behavior of both entities. Moving from management based on anecdote to a data-driven process can enhance the quality of decision-making.

GME: at what cost?

Current computing methods impede determining the real cost of graduate medical education. However, a more accurate estimate could be obtained if policy makers would allow for the application of basic cost-accounting principles, including consideration of department-level costs, unbundling of joint costs, and other factors.

Strategic decision-making in healthcare organizations: it is time to get serious.

New and continuing environmental demands and competitive forces require healthcare organizations to be increasingly careful in thinking about their strategies. They must do so in a highly unusual (multi-actor) marketplace where a variety of system interdependencies complicate decision-making. A good strategy requires an attempt to understand the real, as distinct from the perceived, environment, and is characterized by explicit tradeoffs along three dimensions: service or program variety, patient needs, and patient access. The quality of these tradeoffs can be assessed in terms of whether the strategy is (a) attuned to critical success factors in the organization's environment, (b) highly focused, (c) linked to the organization's capabilities, and (d) accompanied by an activity set that is difficult for competitors to imitate. An organization also must be capable of adapting appropriately to changes in its environment. Thus, even the best strategy must be reviewed constantly if it is to remain viable. A strategy's sustainability can be adversely affected by increased buyer or supplier power, lowered barriers to entry, growing rivalry, the threat of substitutes, and increased slack in resource usage. By thinking more creatively in the future than they have in the past, healthcare organizations can make tradeoffs and choose a focused strategic position. They then can design an activity set that is appropriate for that position, and that will assist them to achieve both financial viability and superior programmatic performance. A well-designed activity set also will assist them to sustain their performance in the face of changing environmental demands and competitive forces.