Circumcision. The uniquely American medical enigma.

Ritual circumcision of males has been practiced for millennia, but was limited to fewer than 20 per cent of the world's population. About a century ago, only the English-speaking countries adopted non-religious circumcision as a prophylactic or therapeutic panacea for myriad ailments. Since these "health" claims are now known to be unsubstantiated, the English-speaking countries either abandoned the practice or reduced the frequency of its performance; the only exception is the United States. This article examines the background for this enigma and suggests solutions.

Applying pressure to financial bleeding. Medical group stanches the flow of red ink with an ASP.

UNLABELLED: San Jose Medical Group, San Jose, Calif. PROBLEM: A manual referral and authorization process resulting in significant monetary losses. SOLUTION: Contracting with an application service provider that could provide real-time data on a continual basis. RESULTS: Timely information on eligibility, referrals and authorizations before the patient leaves the office--patients going to the right doctors for the right services--and an in-depth understanding of associated costs. KEYS TO SUCCESS: Taking a chance by going with an ASP--a company with little history.

Air gauge measurement and driven lap polishing in the production of aspheric surfaces.

The increased demand for aspheric surfaces in optical systems has required refinements and advances in optical shop technology. Air gauges have been used to measure aspheric surfaces in prepolished and polished conditions to accuracies on the order of one wavelength of visible light. Small, synchronously driven laps have been used in the polishing and figuring of aspheric surfaces with good results regarding speed, accuracy, and smoothness. Both techniques provide interesting possibilities for future development.

Cost factors in urban telemedicine.

This paper reports on the cost effectiveness of a pediatric primary care system utilizing nurse practitioners (NPs) linked to a physician consultant through bidirectional interactive cable television. In addition, it discusses ways in which multiple uses enhance the economic feasibility of a telemedicine consultation link in a given geographic area. The overall consultation rate during periods of remote physician coverage was 21 per cent, compared with 24 per cent during on-site coverage. The telephone became a partial substitute for the TV for some uses but could not replace it in diagnostic decisions. As telemedicine is obviously underutilized in a one-satellite system, we compare a five-satellite network with other ways of delivering service. The resulting estimated cost of $18.50 an hour, or 2/3 of the cost of a physician providing direct care, includes a TV component of $5.30 an hour of use in a 1,750-hour year. The critical factor is that the NP can be a physician substitute if there is TV backup. The TV appears to prevent unnecessary referrals compared to a physician on site. Whether TV increases the length of the consult compared to the phone for conditions of equal severity is not entirely clear. If TV is compared to transporting a patient to a central place, the implicit value of transport time and disutility required to justify using TV is $7.55 per consult in a five-clinic network. Geographic and other barriers to physician availability enhance the potential for application fo telemedicine.