On May 29, 2005, 73 men and women received the Doctor of Medicine degree from Brown University representing the 31st class of physicians graduated from that institution since 1975. Of the 2312 physician graduates of previous classes, approximately 416 (18%) are currently licensed to practice in Rhode Island.

The purpose of this article is to introduce the graduates of the MD Class of 2005 to the physician community in Rhode Island, as many will be your future professional colleagues.

Thirty-four graduates were men (47%) and 39 were women (53%). The racial/ethnic composition of the class, as shown in Table 1, shows a lower proportion of students from CaucasianAmerican backgrounds (42%) than the previous year (45%). Nineteen percent of the graduates are members of minority groups underrepresented in medicine (10 African Americans, and 4 Mexican American) as defined by the Association of American Medical Colleges (AAMC). This number is higher than the 9.2% underrepresented minorities (URM) reported for last year’s graduates. The proportion of URM students among all four years of Brown medical students is 19%.

Nine graduates are residents of Rhode Island. The Rhode Island students in this year’s graduating class came from eight different communities in the state, with two students from Providence, and one student each from Bradford, E. Greenwich, E. Providence, Newport, Portsmouth, Riverside, and Westerly. The high schools from which the students graduated also reflect this diversity, with students having attended Classical, Claremont, E. Greenwich, Rogers, St. Mary Academy-Bayview, St. Paul’s, and Westerly high schools.

The largest proportion of students in the MD Class of 2005 comes from the Program in Liberal Medical Education (PLME), with 41 such graduates (56%) having come through that route. The second largest cohort of students (12 graduates) came through the combined Brown-Dartmouth Medical Education Program in which students spend their first two years of medical school at Dartmouth, then transfer to Brown for the final two years.

The medical school entered into special agreements with postbaccalaureate premedical programs at Bryn Mawr College and Columbia University shortly after the PLME was inaugurated. Students from these programs decided upon a career in medicine only after completing college. Typically, they have been engaged in other careers for several years following college. The goals in establishing this new route of admission were to maintain a rich diversity in the student body by admitting students who were older and who had different academic and life experiences as well as rounding out the total class size to compensate for the expected attrition from the PLME. Six members (8%) of the class were postbaccalaureate students, three from Bryn Mawr College and three from Columbia University.

Among the remainder of the class, six students were part of the Early Identification Program (EIP), three from Tougaloo College, two from Providence College, and one student from University of Rhode Island. EIP students are offered provisional admission to the medical school during their sophomore year at their respective undergraduate colleges. Of the remaining graduates, three entered medical school through the MD/PhD program, two through the Brown Avenue (current or former Brown students who were not in the PLME), and three through advanced transfer.

Brown University was the most common undergraduate college among the graduates accounting for 44 graduates. Tougaloo College came second with three members, followed by Haverford College, Providence College, and University of California Berkeley each with two members from the Class of 2005.

The most common undergraduate major (56%) among the class members was biology (including subdisciplines such as biochemistry, neural sciences, and microbiology). Science majors taken together (including psychology) accounted for 72% of all majors, while 18% of majors were in the humanities and 12% in the social sciences. Among the humanities majors, English was the most common choice, while community health was the most popular choice among those majoring in the social sciences. Nine students double majored.

WHERE THEY ARE GOING

Internal medicine remained the most frequently selected specialty, with 32 students selecting that specialty, and family medicine came in second place with 7 graduates choosing that specialty. Table 2 lists the number of students selecting different types of residency programs.

The proportion of the class entering specialties in primary care fell to 44% this year, continuing a 4-year slide. This includes the fields of internal medicine, pediatrics, family practice, medicine/pediatrics, and obstetrics and gynecology. Figure 1 illustrates the specialty choices of the Class of 2005.

The actual number of graduates who will eventually practice primary care after completing their graduate medical education will be smaller than the 44% reported here. Based on previous data from the AAMC that tracked graduates, approximately 22 graduates (30%) will actually practice primary care.

Medical schools around the world are moving from the traditional discipline-oriented curriculum toward an integrated curriculum. The Medical Curriculum Committee at Brown Medical School approved a vision for curriculum transformation that would create an integrated, patientcentered curriculum. In this article, I describe the historical evolution of curricula in American medical schools, the definition of integration, the rationale for integrated curricula and the evidence supporting it, concerns about potential negative consequences, and how the Brown curriculum may develop.

Throughout the nineteenth century, many American medical schools relied primarily on an apprenticeship model of education.1 Yet even in these schools, students undertook a course of study in the basic medical sciences during the first two preclinical years that consisted of anatomy (including histology and embryology), physiology (including biochemistry), pharmacology, pathology, and bacteriology.2 As the twentieth century progressed, new areas of knowledge were added, such as immunology, virology, and genetics, but stayed within the discipline-oriented structure.

Case Western Reserve School of Medicine pioneered an organ-system based structure to its curriculum in the late 1950s.3 Most U.S. medical schools utilize an organ-system structure in the second year of the medical school curriculum, but maintain a disciplineoriented structure in the first year of medical school, though there are many variations on the theme.

The Liaison Committee on Medical Education (LCME), the accrediting body for medical schools, still refers to the traditional disciplines in its standards when specifying what the content of medical school curricula should contain. However, the LCME has also been stressing the idea of a “coherent and coordinated curriculum” in which content is integrated within and across the academic periods of study (horizontal and vertical integration).4

DEFINITIONS OF INTEGRATION

Harden offered a very useful construct for viewing integration as steps in a ladder.5 Hardens ladder of integration has 11 steps, each reflecting a greater effort at integration. (Figure 1)

At the lowest rung, labeled “isolation,” each course is taught in isolation with the instructors of each course largely unaware of the content of the other courses. No attempt is made to modify what is taught based on what is being taught in the other courses.

At the next rung, teachers are made aware of what is being taught in other courses. Then come efforts to make connections between courses, followed by incorporation of common themes within separate courses.

The fifth rung in Hardens ladder is called “temporal coordination,” in which the instruction in separate courses is deliberately lined up with one another. For example, lectures in the pathology of lung disease occur in the same week as lectures in the pharmacology of asthma. Many medical schools have reached this level of integration, which might better be referred to as coordination, or, as some have uncharitably called them, “stapled-together courses.”

The higher rungs on the integtation ladder are much less common in medical education and are the ones that Brown Medical School aspires to reach. The sixth rung -sharing-involves joint planning and teaching in a deliberate way. A good example of this actually occurred already within the Brown medical curriculum. The human reproduction, growth, and development section of the former Integrated Medical Sciences course brought together teachers from pediatrics (Robert Schwartz), pathology (Donald Singer), and obstetrics and gynecology (John Evrard) during the 1970s. Dr. Schwartz had previously been on the faculty at case Western Reserve, so understood their model of integration. The faculty met nearly every weekend throughout the year to plan and refine the course. They planned the lectures together and attended each other’s lectures.

At even higher rungs, the proportion of student time spent in specific subjects or disciplines recedes as the amount of time in tasks that involve an integrated approach to learning increases. At the highest level, the boundaries between disciplines disappear and the students focus entirely on a new construct of understanding that transcends the disciplines.

RATIONALE FOR INTEGRATION

Dividing medicine into disciplines is an artificial construct. The real world of medical practice is transdisciplinary in large part. Physicians begin their interactions with patients in an open-ended way, even if they are specialists. The internist must consider a surgical or obstetrical or psychiatric cause of abdominal pain when first encountering a patient with that complaint.

Dividing the basic sciences into disciplines is also an artificial scheme that serves a specific purpose, namely, scientific investigation. Medical research is largely a reductionistic enterprise, delving more deeply into ever more focused areas of research. This disciplinary approach has been very successful in advancing scientific knowledge.

I was extremely pleased with the quality of the material, lectures and
discussions. The format made me feel like I had a personal relationship
with the instructors, even though this is distance learning.
–William Biermann, MD
Vice President, Blue Bell, PA

InterAct courses come in many shapes and sizes.

Some InterAct courses include video on CD, some come with an audio track with PowerPoint presentations, and others are completely Web-based text courses. No matter what the format, InterAct courses can be taken on virtually any home or office computer.

Full InterAct courses include online sessions with faculty. These sessions are 3 to 6 weeks in length, but you don’t ever have to be online at a particular time of day. The discussions and case studies that take place during the scheduled online sessions are required for graduate degree or board certification credit.

InterAct Express courses do not include a scheduled online session. These are complete, self-study courses that you take at your own pace as your schedule permits.

Essentials of Health Law

** This course will give you an understanding of laws pertaining to health care organizations.

** You’ll also focus on specific areas, including:

- HIPAA and patient rights

- Stark legislation, antitrust traps, employment contracts

- Peer review, disruptive practitioners, practitioner health

** Plus current legal trends and rulings and how they apply to your organization.

Faculty: Susan Lapenta, JD * Henry Casale, JD

Full Interact       Express Version
Course              (self study)

CME                 14                  8
Graduate Credits    14 Core             –
Online Session      Yes (3 weeks)*      No
Technology          Video on CD         Video on CD
Price               $625 members        $325 members
$700 non-members    $400 non-members

Financial Decision Making

** The ability to apply financial principles and concepts to decision making is critical for the physician executive, but is often a mystifying blend of mechanical calculation and confusing theories.

** This course provides the knowledge and skills to turn the mysteries into tools you can use to shape your organization’s strategic future.

Sudden cardiac arrest (SCA) can happen to anyone at any time–without warning. And school-aged children are not immune. An estimated 5,000-7,000 children die from SCA each year. (1) Some of them on school grounds.

For the greatest chance of survival from the most common cause of SCA, a shock from a defibrillator must be delivered within the first few minutes of collapse. (2) That’s why America’s largest school districts, including Chicago, New York City and Los Angeles have chosen Philips HeartStart Defibrillators to protect their schools.

Specifically designed for the minimally trained responder, HeartStart Defibrillators provide clear, easy-to-follow voice instructions and a simple user interface to guide the responder through an emergency. In fact, with minimal instruction, 6th-grade students were able to deliver a shock in a mock SCA event in just 90 seconds–only 30 seconds longer than it took emergency medical personnel to administer a shock. (3)

HeartStart Defibrillators are safe. Based on industry-leading technology, HeartStart Defibrillators determine whether the patient’s heart requires a shock, which is delivered only if one is needed. They are also safe to use on infants and young children. Dependable and built to last, HeartStart Defibrillators perform comprehensive daily, weekly and monthly self-tests to help ensure readiness. A visible status indicator shows at a glance that the device has passed its last self-test and is ready for use.

Most everything needed for a successful program

Philips provides site assessments, program management, medical direction, training and a wide range of financing and funding options.

Legislation for early defibrillation programs in schools

Lawmakers are also seeing the importance of school defibrillation programs. A New York law requires defibrillators to be in school facilities and at athletic events, and requires certain schools to have defibrillators capable of providing therapy for children under eight years of age and/or 55 pounds. Other states have legislation, both passed and pending, as well.

In 2000, Congress enacted the Cardiac Arrest Survival Act, extending Good Samaritan laws to protect laypersons from liability associated with good faith use of public defibrillators. Today, all 50 states have passed Good Samaritan legislation.

MEXICO CITY (Reuters)—Faced with a growing number of medical students and few training hospitals, a Mexican university is turning to robotic patients to better train future doctors.

On Monday, Mexico City’s UNAM University opened the world’s largest “robotic hospital” where medical students practice on everything from delivering a baby from a robotic dummy to injecting the arm of a plastic toddler.

The robots are dummies complete with mechanical organs, synthetic blood and mechanical breathing systems.

“The country’s rapid increase of medical students has not kept up with the number of medical facilities,” said Joaquin Lopez Barcena, an associate dean at the university’s medical school. “This a very a good learning opportunity for our students.”

The $1.3 million facility has 24 robotic patients and a computer software program that can simulate illnesses ranging from diabetes to a heart attack.

For Paola Mendoza Cortez, a first-year medical student, the robotic patients offer peace of mind.

“I would feel nervous if this was (a) real patient,” said Mendoza after drawing blood from a plastic arm. “With this (dummy patient) I can practice many times.”

With close to 15,000 enrolled students, UNAM has one of the largest medical school in Latin America. There are about 70,000 medical students enrolled in Mexico, according to the Mexican association of medical schools.

“There are medical schools sprouting out everywhere in this country,” said Martha Hijar, a medical researcher of the Mexican Institute of Public Health. “This is a very well paid major that offers status and that is why it is attracting so many into the field.”

In late August of 2005 Hurricane Katrina began a path of unparalleled destruction throughout the Gulf States, leaving tens of thousands of people homeless, and without hope of shelter, food, water, electricity or even basic medical care. Little did anyone know that within a day’s journey two massive military convoys laid waiting at the Naval Expeditionary Medical Support Command (NEMSCOM), a military medical warehouse facility located at Cheatham Annex, Virginia, ready to make way and render aid.

The convoys, outfitted with fresh water tanker trucks, generators, telescoping light stations, air conditioners, medical supplies, diesel fuel, food blankets, toiletries, shelters, portable bathroom facilities, mobile communication centers, ambulances, fire engines, cranes, and bull dozers laid waiting to respond. The call never came, despite the most valiant efforts of NEMSCOM’s Commanding Officer, CAPT Larry Arcement.

Disaster relief materials, like any material inventory assets, are only good if you know what you have, how many you have and where they are located. That is where automated asset tracking, utilizing automated identification technology (AIT), comes into play. Automated identification technology can come in a variety of forms ranging from highly sophisticated active and passive radio frequency identification (RFID) systems used by the vast majority of manufacturers today to its lesser known counterparts, consisting of Contact Memory Buttons, Iridium Tracking and Info Dot recognition systems. Regardless of the technology used they all share a common trait, the rapid identification and location of assets available.

In a highly dynamic medical environment, the identification and tracking of medical assets has become increasingly difficult. Perhaps no other military command has realized that more than NEMSCOM, which constructs and deploys fleet hospitals and numerous expeditionary medical facilities worldwide in response to military conflicts and humanitarian disasters. With more than $340 million dollars in medical assets located worldwide, optimum operational efficiency must be realized.

In 2004, in conjunction with the Navy AIT Project Office, NEMSCOM embarked on a series of initiatives to develop automatic identification and data capture (AIDC) technology to help manage medical material and provide total asset visibility. These projects reviewed the possible integration of AIDC into medical logistics business processes. NEMSCOM’s goal was to facilitate the collection of initial source data, and collect and pass the AIDC data to reduce processing times, improve inventory accuracy, increase production efficiency and enhance “total” asset visibility.

The first key initiative came in the form of surgical instrument identification. At the conclusion of a medical mission, expeditionary hospitals, consisting of tens of thousands of components, equipment, and supplies, are rapidly packed and returned to NEMSCOM for cleaning, repackaging and introduction into the next expeditionary medical platform build. Thousands of surgical instruments, which have no manufacturer markings or means of identification, are returned in boxes, barrels and footlockers. With more than 14,000 different types of medical instruments, made by a myriad of manufacturers, the process of trying to identify these instruments can be daunting.

The identification process required the skills of numerous senior medical technicians and countless hours of research, with each instrument requiring 15 to 30 minutes for identification. Even with these efforts, identification accuracy was limited to approximately 60%. Many of the surgical instruments cost several thousand dollars, have limited availability and require significant lead times to obtain, which makes the correct identification of current assets vital.

In an effort to dramatically increase medical asset identification, NEMSCOM embarked on a pilot program to develop effortless recognition of all medical assets. The marking system needed to be highly accurate, durable, inexpensive, easy to operate and needed to increase production efficiency. The end result of this effort was the implementation of info dots in conjunction with a newly developed asset tracking software program called MAAT (Material Automated Asset Tracking).

The info dot is a two dimensional data matrix mark, available as a 3 mil and 10 mil barcode, which is less than a tenth of the size of most common barcodes. This DataMatrix barcode is a small, flexible and unobtrusive label that is virtually indestructible. More than 60% of the label can be torn away and still allow for a 100% percent read rate. It is easily attached to any surface using a pressure-sensitive acrylic adhesive. The info dot has a high degree of redundancy, making it highly reliable, and its symbology can be read with charged couple device scanners. The info dot can withstand temperatures of nearly 500°F short-term and nearly 400°F over a long-term period. It resists solvents, caustics, and acids as well as oils, grease, fuels and salts.

The proliferation of health information has created a rich field of resources that many lay people can use to make informed health care decisions. For a large segment of the population, these resources will go unseen and unused because they are written at a level that exceeds their reading recognition and comprehension skills. The study discussed in this article assessed the readability of information on six adult and two juvenile diseases in ten medical textbooks. Students in two library and information science (LIS) schools read the same information and indicated the words they did not understand. Results showed that the medical material is written well above the average person’s reading ability. Words the students could not understand included anatomical and disease-related terms and drug names. More research needs to be done on lay people’s comprehension of medical information.

On their Web site the National Center for the Study of Adult Learning and Literacy (n.d.) states that “more than 40 percent of working-age adults in the United States lack the skills and education needed to succeed in family, work, and community life today.” This figure indicates that almost half of the population may not be able to find, read, or understand health information and thus cannot make informed health care decisions.

A considerable amount of research exists on the need to improve access to health information by making it more readable for average readers. Lowering the readability level alone may not adequately address the issue of illiteracy because other factors may affect a person’s ability to read and comprehend written material. For example, Parikh, Parker, Nurss, Baker, and Williams noted that “the shame and embarrassment felt by some low literate patients may pose an important psychological barrier to asking for help or requesting low literate materials, even when they are available” (1996, p. 34). They found that some patients “did not seek care because of embarrassment about their illiteracy” (p. 34). Estey, Musseau, and Keehan included “anxiety, physical discomfort, and unfamiliarity with the hospital environment” (1994, p. 74) as further impediments to understanding health instruction. Weaver (2003), one of the presenters in the Medical Library Association’s teleconference, Reading Between the Lines, noted that unfamiliarity with an environment is often an overlooked factor in health literacy. Labeling this concept “contextual literacy,” she explained that a person might be “health literate” in one’s own country, but she/he may not be in another country (Weaver, 2003, p. 4). Furthermore, while some people may be “comfortable and know what to expect in … hospitals and clinics,” other people “don’t and their anxiety at being in a totally alien setting impairs their coping abilities even more” (Weaver, 2003, p. 4). Thus, a variety of factors may affect people’s ability to read and understand printed health information, written instructions, consent forms, or other healthrelated materials.

DEFINITIONS OF HEALTH LITERACY

What is health literacy? Several definitions were found in the literature. Healthy People 2010, the ongoing national promotion and prevention initiative aimed at improving the health status of individuals in the United States, defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Office of Disease Prevention and Health Promotion, 2001, p. 15). The Medical Library Association’s (MLA Net, 2003) definition goes further and includes the following set of abilities:

* Recognize a health information need

* Identify likely information sources and use them to retrieve relevant information

* Assess the quality of the information and its applicability to a specific situation

* Analyze, understand, and use the information to make good health decisions.

This definition incorporates elements of evidence-based practice and puts the onus on lay people to find quality information, analyze it, and use the evidence as a basis for making their decision.

LITERATURE REVIEW

The key elements in making an informed health care decision are the person’s ability to read and understand the information. According to Davis, Crouch, Wills, Miller, and Abdehou, “educators have measured the readability of written materials since the 1940s” but “medicine has only recently recognized problems in this area” (1990, p. 533). Health care professionals, they suggest, have taken “patients’ educational and reading recognition levels to estimate literacy levels” (Davis et al, 1990, p. 533). While reading recognition (the ability to pronounce words) is important, “reading comprehension is the most important” of all the literacy skills needed in health care (p. 533).

Q: I have been hearing a lot about software piracy in the workplace, even radio ads encouraging businesses to “update their licenses” and encouraging people to report software piracy. How important is this issue to the lab?

A: Any work environment that uses computers and employs human beings is at risk for software piracy, especially if there is no clear understanding of the underlying law and good policy in place. You’re right–software developers are becoming increasingly worried by the unauthorized use of their products and have taken steps to reduce infringement by encouraging whistleblowers, and by making changes that limit the ability of a purchaser to duplicate or re-use software.

Software isn’t a tangible item, like a car or laboratory instrument. Such things, once purchased, are the property of the owner, who can do with them as he pleases: use them, rent them out, take them apart or reconfigure them. Computer software, on the other hand, is really a license to use a copyrighted intellectual property that happens to come encoded on a computer disc or CD. In general, licenses give the buyer the right to load the software onto one computer only, and to make a single back-up copy for archival purposes. Loading the software onto multiple computers without purchasing individual licenses for each one (softloading) is a violation of the copyright laws and a violation of the license.

Employees or independent contractors (such as outside computer technicians) may be tempted to pirate expensive software to their home computers, or to bring in outside programs for office use. Both should be clearly discouraged by well-publicized and well-enforced policy respecting software copyrights (check the Better Business Bureau website for a sample policy: http://www.cbbb.org/features/samplepolicy.asp.

In addition, licenses should be checked and verified on a regular basis to insure that no unauthorized software is installed and no unauthorized use is occurring. Hard copies of the software should be kept secured and not generally available, except to those with a legitimate need to access them. Downloads from the Internet should be discouraged, in part to prevent piracy, but also because of the increased risk of virus infection.

The law holds employers generally responsible for the actions of employees in the course of business. Consequently, piracy by employees under company auspices, even if unknown, may still be imputed to the employer, particularly in the absence of a program to prevent software theft. Copyright laws provide for fines of up to $100,000 for each infringement (for example, each of the extra computers onto which a single copy of software is illegally loaded). If it can be shown that the infringement was “willful and knowing” and “for commercial gain or advantage,” criminal penalties of $250,000 and imprisonment for up to five years can result. In either case, the fines are much more than the cost of purchasing valid licenses to begin with. And as is the case with all such illicit activities, it only takes a single disgruntled employee to blow the whistle.

Barbara Harty-Golder is a pathologist-attorney in Sarasota, FL. She directs the clinical laboratory at Health South Rehabilitation Hospital in Sarasota, and maintains a law practice with a special interest in medical law. She writes and lectures extensively on healthcare law, risk management and human resources management.

RELATED ARTICLE: TYPES OF PIRACY

There are five common types of software piracy. Understanding each will help users avoid problems associated with illegal software.

End-user piracy:

This occurs when a company employee reproduces copies of software without authorization. End-user piracy can take the following forms:

* Using one licensed copy to install a program on multiple computers.

* Copying disks for installation and distribution.

* Taking advantage of upgrade offers without having a legal copy of the version to be upgraded.

* Acquiring academic or other restricted or nonretail software without a license for commercial use.

* Swapping disks in or outside the workplace.

Client-server overuse:

This type of piracy occurs when too many employees on a network are using a central copy of a program at the same time. If you have a local-area network and install programs on the server for several people to use, you have to be sure your license entitles you to do so. If you have more users than allowed by the license, that’s “overuse.”

Internet piracy:

This occurs when software is downloaded from the Internet. The same purchasing rules should apply to online software purchase as for those bought in traditional ways. Internet piracy can take the following forms:

* Pirate websites that make software available for free download or in exchange for uploaded programs.

* Internet auction sites that offer counterfeit, out-of-channel, infringing copyright software.

* Peer-to-peer networks that enable unauthorized transfer of copyrighted programs.

For small, delicate part applications, lasers deliver stable, accurate energy for cutting, marking, and welding

Doctors are understandably sensitive about the tools they use-every dimension, joint, or mark can add to or detract from performance, depending on how well the tool features are made. So for medical devices, the pinpoint precision of lasers is valuable for cutting, welding, or marking the smallest of devices.

Lot sizes and part styles for medical parts can vary wildly, from customized implants to relatively mass-produced tools and devices. “Nonetheless, every single instrument is subject to the highest quality standards,” says Alexander Knitsch, application specialist for Trumpf Laser (Farmington, CT). For implants in particular, the main priorities include long lifecycles and biocompatibility.

“Medical devices are especially suited to laser processing, because they require extremely tight tolerances and advanced materials processing,” says Larry Green, industrial product manager, Spiricon Inc. (of Ophir Optronics Ltd., Logan, UT). “It’s also evident that the laser performance must be well characterized for the process to be repeatable, robust, and profitable.”

The key to laser-machining small medical applications is to use a laser beam with a narrow, stable, and focused energy profile, even for laser spot diameters under 100 µ More stringent requirements for stents, pacemakers, implants, catheters, and other medical products require better beam profiling and delivery tools, adds Green. Along with added quality and capability, such tools can improve device manufacturers’ cost profile through reduced downtime.

Some problems can be fixed just by checking the beam profile with real-time diagnostics and re-adjusting the laser. Green points to a medical-device manufacturer (the company requested that its name not be used) that laser-marks its product with a logo whose edges were no longer acceptable to the customer. “Since an illegibly marked product cannot be sold, they were discarding perfectly good product because of the poor identification of the part.” Here, laser-beam profiling showed that at certain power settings the beam profile had more than one peak, instead of a single peak at the center of its spot. “Readjusting the laser power settings to eliminate the multiple peaks solved the problem.”

In another case, a medical manufacturer (which, again, does not wish to be named) traced poor welds to a laser beam spot whose focus location varied randomly over time, causing spots of varying size on the product, says Green. The solution was to change the beamdelivery system from “hard” laser optics to fiber delivery-a common trend in laser/medical applications, as we’ll see below.

Bone screws and other medical hardware may look simple, but their manufacturing processes use the most advanced laser technologies. The laser, motion control, part positioning, and even vision software for beam delivery come together to create the small features that doctors need for stabilizing damaged bone or fixing other problems.

“The medical devices industry is now looking for a new generation of lasers that can offer better value and additional functionality over their existing laser technology,” says Linda McIntosh, product manager for Virtek Laser Systems North America Inc. (Waterloo, Ontario). This applies to marking lasers, which have been used for years for writing identifying information and other marks on metal and plastic medical tools.

“Laser marking on metals creates a very high quality, permanent mark, and it does not require inks, solvents, etc.-which means lower operational costs.” Lasers avoid the FDA-approval issues involved with ink, and they can mark surfaces without creating crevices, a feature to avoid on implants, McIntosh adds.

To improve the marking of bone screws, Virtek’s laser-marking systems integrator, FOBA Technology + Service GmbH (Ludenscheid, Germany) integrates a vision system called Intelligent Mark Positioning (IMP). The system is integrated with the laser system’s lens, feeding back data to reduce position errors when marking 0.5-mm characters on 3-mm-diam screw heads. Essentially, the system “puts eyes and intelligence” in the laser, says McIntosh, comparing a model of the part with what it sees for proper positioning. This capability reduces scrapped parts, minimizes fixture costs and laser setup time, and improves machine-to-machine consistency.

Tools used to create the holes for bone screws also require detailed marking, such as depth gaging on the shaft to guide the surgeon. Since these marks must go around a drill or tap’s shaft, the tools must be rotated while being marked, a complicated task better suited for automation, according to system supplier Telesis Technologies Inc. (Circleville, OH). The company’s system incorporates a six-axis robot for handling, a 100-W Nd:YAG laser, and Telesis software. The system “takes a pallet of 100 parts at a time through the complicated marking cycles in a matter of minutes,” says the company’s Ralph Villiotti.

Accounting and personal finance software expert Intuit had a great idea: Use its expertise to help families track medical expenses, payments, and insurance reimbursements. But while we applaud the attempt, this first version of Quicken Medical Expense Manager leaves us wanting more.

Medical Expense Manager is a slightly modified blank slate, a framework for entering the bills and statements you receive from suppliers of medical services and the companies that insure you. From this, you can see quick overviews of what you’re spending and receiving, and track missing money.

Like every other Intuit product, Medical Expense Manager is exceedingly easy to use. Prefab, customizable fields let you record things like provider, service, and reason; insurance and co-pays; and additional payments. Other fields in the detail box can hold provider billing amount and write-off, insurance payment, mileage, FSA status, and notes. Reports show you any claims in dispute (dispute letter models are included), any claims pending, tax deductions, and other groupings.

That’s all fine, but it’s not enough—and it’s not up to Intuit standards. There are many omissions, like the ability to track insurance premiums and deductibles more intuitively, partial payment and refund processing, and in-depth tools for medication management. Smaller changes (like customizable columns, keyboard shortcuts, better help, and more flexibility in field definition) would make the program more usable, too. Medical Expense Manager does not import or export even existing medical payments and deposits from Quicken or data to Excel.

That said, the shortcomings are not all Intuit’s fault. We pulled out a stack of old medical bills and tried to enter them. We were quickly stymied by several things, including billing line item differences among providers and insurers, and unfamiliar breakdowns of insurance payments, discounts, adjustments, and so on. Still, we say wait until the next version.