Men without chests.
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Education, Medical↗
Biomedical subjects
J H Maxwell
Publications and source records attributed to J H Maxwell.
The first DRG: lessons from the end stage renal disease program for the prospective payment system.
When Medicare implemented the diagnosis related group (DRG) method of reimbursement for hospitals in 1983, it already had a decade of experience using a prospective payment arrangement for its end stage renal disease (ESRD) program. We reviewed this experience to determine the lessons for Medicare's reimbursement of hospital services. The use of a fixed price for renal dialysis encouraged the introduction of cost-saving techniques. Failure to reduce the price for dialysis in keeping with the cost reductions, however, prevented the government from realizing the full benefits of prospective payment. In addition, there were important changes in medical practice that had independent effects on the program. Similar influences are likely to shape the impact of prospective payment on hospital behavior.
Diagnosis-Related Groups↗
Economic incentives and organizational realities: managing hospitals under DRGs.
Diagnosis-related Groups (DRGs) offer hospitals financial incentives to improve efficiency. To be effective, DRGs require a realignment of management so that physicians' use of resources can be disciplined by administrators. The constituency for altering power relationships within hospitals, however, is, at best, a weak one: administrators see their primary task as the protection of physicians' clinical autonomy. Constraints imposed on hospitals by regulators can be accommodated by minor adjustments in behavior that ensure neither gains in efficiency nor changes in decision-making authority.
Accounting↗
Photoreceptor input and temporal summation in turtle retinal ganglion cells.
The relation between photoreceptor input and temporal summation in ganglion cells was investigated in the optical nerve of fresh-water turtle, Pseudemys. Action spectra derived for constant, high-criterion responses showed most cells to be maximally sensitive to 620 nm light, indicating dominant input from red-sensitive cones. At a lower criterion, sensitivity to 520 nm light greatly increased indicating an increase in rod input. Temporal summation curves for these intensity-dependent cells showed reciprocity between flash intensity and duration up to 128 msec for high-criterion summation curves. Low-criterion summation curves showed reciprocity up to the critical duration of 285 msec. Cells maximally sensitive to 620 nm light at all intensities often showed secondary sensitivity to 560 nm light, and were fitted by action spectra taken from red- and green-sensitive cones. Temporal summation curves for these cells had critical durations near 100 msec. Some cells responded best to light near 520 nm at all intensities and demonstrated little or no input from red-sensitive cones. These cells were fitted well by the action spectrum of rods and showed the longest critical durations of all at 375 msec. Chromatic input and temporal characteristics are intimately related: red-cone-dominated ganglion cells have the shortest critical durations while rod-dominated cells shows much longer ones. These findings are in keeping with psychophysical determinations of critical durations in this same animal.
Action Potentials↗
The iron lung: halfway technology or necessary step?
The iron lung is often used to epitomize the costly halfway technologies of modern-day medicine that fail to cure and only prolong a seriously compromised existence. Historical evidence indicates that the iron lung was not a costly instrument of last resort; instead, it was a lifesaving device that played a critical role in the evolution of modern respirators and respiratory care. Contrary to the prevailing views of the biomedical research community, the creation of new devices and instruments is often as important a source of technical change in medicine as are advances in the biological sciences.
History, 20th Century↗
An automated apparatus for the determination of visual thresholds in turtles.
An automated apparatus is described that permits precise and reliable measurements of visual thresholds in turtles using a conditioned avoidance technique. The entire sequence of stimulus management and the collection of response data are under programmed control.
Animals↗