Large scale communication networks—Design and analysis

The paper discusses the problem of design and analysis of large scale communication systems. An iterative process, composed of a minimum cost network design algorithm and a network performance algorithm, is presented for the solution of these problems. Computational considerations, using these algorithms, are discussed.     

Surfing Stark II: prohibition against self-referrals

In 1989, the Chairman of the House Ways and Means Subcommittee on Health, Fortney (Pete) Stark (D.-Calif.), turned the health care industry on its ear by introducing the "Ethics in Patient Referrals Act" to Congress. The bill, commonly known as "Stark I," prohibited physician referrals to entities in which they held a financial interest. As Stark's bill made its way through Congress, its substance was dramatically reduced by the legislative process. Ultimately, the law was incorporated as part of the Omnibus Budget Reconciliation Act of 1990. Stark I's main thrust is that it bars physicians from referring Medicare patients to clinical laboratories with which they have a financial relationship. Furthermore, laboratories providing those services must report information concerning any ownership arrangements between the referring physician and the laboratory. Now, to complicate the picture, providers must contend with amendments to the original law that extend the reach of its prohibitions. Called "Stark II," these amendments took effect on January 1, 1995. In this article, guidelines for dealing successfully with the requirements of the law are outlined.     

Computerization: reengineering the lawyering process for the 21st century

Alvin and Heidi Toffler, describe the benefits of "informationware" and how one of the most tradition-bound organizations, the armed forces, has substantially changed its operations. According to the authors, mere knowledge is not sufficient to prevail; how one manages or uses knowledge separates winners from losers. Further, the authors say "...basically add new elements or create new combinations of old elements within an existing 'game.' A true revolution goes beyond that to change the game itself, including its rules, its equipment, the size and organization of the 'teams,' their training, doctrine, tactics, and just about everything else. Even more important, it changes the relationship of the game to society itself." Application of this theory to today's litigation is obvious and compelling. The ways in which clients and defense counsel obtain, analyze, and strategically apply evidence and legal principles must change to incorporate the informationware this society uses in other lines of business. This means more extensive and appropriate usage of computer hardware in a software environment that fully supports emerging client and defense counsel needs. The computer system must provide case direction, helpful suggestions, and direct, rapid access to data bases containing information presently available only through person-to-person networking.     

Assessing the effectiveness of strategic planning

This paper describes a method for assessing the effectiveness of strategic planning systems in terms of the results actually observed subsequent to planning activity. The paper explains in particular how, in making the assessment, one might cope with the fact of environmental change subsequent to the setting of planned goals. This ends oriented approach to measuring effectiveness is shown to be complementary to process oriented approaches and is illustrated by an example from the coal industry.     

Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands

Elissen AMJ, Van Raak AJA, Derckx EWCC, Vrijhoef HJM. Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain insight into clients' demographic characteristics, health problems and service use, and to develop an explanation for its success in increasing the latter. Our analyses are based on a combination of quantitative and qualitative data. The results of the study suggest that the success of the PCH programme can be explained by the providers' pragmatism and will to adapt their mode of care provision to the behavioural patterns and needs of their homeless clients.