Reduced occupancy of the deeply bound 0d(5/2) neutron state in 32Ar.

The 9Be(32Ar, 31Ar)X reaction, leading to the 5/2+ ground state of a nucleus at the proton drip line, has a cross section of 10.4(13) mb at a beam energy of 65.1 MeV/nucleon. This translates into a spectroscopic factor that is only 24(3)% of that predicted by the many-body shell-model theory. We introduce refinements to the eikonal reaction theory used to extract the spectroscopic factor to clarify that this very strong reduction represents an effect of nuclear structure. We suggest that it reflects correlation effects linked to the high neutron separation energy (22.0 MeV) for this state.

New direct reaction: two-proton knockout from neutron-rich nuclei.

The reaction 9Be(28Mg,26Ne+gamma)X has been studied at 82 MeV/nucleon together with two similar cases, 30Mg and 34Si. Strong evidence that the reactions are direct is offered by the parallel-momentum distributions of the reaction residues and by the inclusive cross sections. The pattern of the partial cross sections for 28Mg suggests the presence of correlations. A preliminary theoretical discussion based on eikonal reaction theory and the many-body shell model is presented. The reaction holds great promise for the study of neutron-rich nuclei.

What health plans should know about clinical practice guidelines--round-table discussion.

Quality is the watchword for health plans that wish to survive to see the new century, and accreditation by the National Committee for Quality Assurance is becoming quality's indispensable stamp. Practice guidelines are an imperative for that accreditation. Here's what seven managed care leaders had to say about guidelines in a recent round-table discussion.

Choosing quality of care measures based on the expected impact of improved care on health.

Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health.

1H magnetic resonance imaging study of bovine ocular tissue.

The present study used magnetic resonance imaging (MRI) to study bovine eyes using proton magnetic resonance at a 7-tesla field. The MRI images provide detailed structural information on various sections of the ocular tissues. Detailed images of the lens show several well-defined areas of water content. Relative rankings of various structures of the eye are obtained based on T1, T2 and spin density.

Quality management in a staff model HMO.

Group Health Cooperative of Puget Sound is gradually developing a quality management approach to the delivery of health care. Derived from the strong commitment of its medical staff and operations management to providing optimal health care and building on the best aspects of traditional quality assurance, the quality management approach provides a realistic program that makes a meaningful difference to the quality of patient care. This paper describes the various components of the evolving approach including physician performance management, departmental activities, multidiciplinary review, and the activities of the centralized office of quality of care assessment and regional quality action committees.

Falls among the elderly living in high-rise apartments.

A study of 64 elderly people living in high-rise apartments found that 37.5 percent reported falling in the previous year. The annual reported fall rate was 625 per 1,000 persons per year. Fifty-eight percent of those who fell received medical treatment. Dizziness and syncope were reported to be the cause of 80 percent of falls. Self-reported poor health status and disability in vision and gait were strongly associated with falling. The sex of the subject, marital status, advanced age, and alcohol and sedative use were less associated with falling.

Falls among the elderly: a review of the methods and conclusions of epidemiologic studies.

This paper summarizes the medical literature relevant to falls sustained by the elderly to highlight what is known about the magnitude of the problem, to identify those aged at risk, and to ascertain the risk factors for falling. While searching for general trends in the literature, the analysis concentrates on several characteristics of such studies, including the study populations, the measurement of risk factors, the measurement of outcome, and the systematic biases involved. Possible mechanisms are suggested for use of the profound influence of pre-existing disease in the elderly as a predictor of falling and subsequent injury. On the basis of this analysis of the literature, suggestions are made about avenues for future research that would answer more definitively the questions remaining about falls among the elderly.

Workers' compensation file as a potential source for community diagnosis.

In providing comprehensive care, family physicians may utilize community diagnosis to analyze the needs of their local community. Existing data bases such as Medicaid and workers' compensation can provide an inexpensive source for community diagnosis. This paper compares the data from an in-depth survey of trauma in a rural community with the medical files of the Washington State workers' compensation insurance for the same time period. Only 45 percent of those patients claiming on-the-job injury when initially treated actually appear on medical claim files of workers' compensation. However, when comparing the categorical distributions for type, mechanism, and body part of injury, the two data sets are similar. Thus, workers' compensation files may potentially be useful as a source of data for community diagnosis.

A practice based study of trauma in a rural community.

A three-month study of trauma seen by a rural family practice in an isolated community found that 17.3 percent of all visits were for treatment of injuries. Falls caused the most injuries (28.7 percent), but accidents involving motorcycles, horses, and automobiles cause the more severe injuries. Orthopedic problems, lacerations, and eye injuries accounted for 64.0 percent of the injuries. Consultation was obtained in 9.9 percent of the episodes. This paper offers a model of trauma surveillance utilizing practice based studies and presents information that underscores the need for more intensive training in trauma care for family practice residents who plan to enter rural practice.