Healing the health care system: Summaries from the Department of Health Policy Summer Seminar

Editorial Introduction: The disease management field continues to evolve. The range of chronic diseases treated has expanded to include such conditions as obesity and pain management, and the care continuum now encompasses wellness, prevention, and population health. One population that is an ideal candidate for our collective efforts is that of older adults. Global and national population projections reveal the impending staggering increase in the age 65+ cohort, which will cause a sharp increase in the demand for health care and other services due to such age-related issues as multiple chronic conditions, falls, and depression. To begin to address these issues, the Department of Health Policy at Jefferson Medical College devoted its annual Summer Seminar to providing a forum for collaborative discussion focusing on the needs of the aging population. Two of the presentations focused on Pennsylvania, although the demographics presented by Nora Dowd Eisenhower reflect national and global trends, and the recently passed legislation outlined by Rosemarie Greco can be used as a yardstick against which other states can judge their own progress. Dr Susan Reinhard\u27s presentation keys in on the need for expansion of scope of practice and consumer-oriented care. Our keynote speaker, Dr Robert Butler, details the challenging issues we must face and resolve in order to cope with the impending crisis. And finally, a panel, comprising representatives from payor, practitioner, and consumer groups, offer their candid, unscripted reactions to the presentations in a segment titled Bridging the Gap Between the Vision and Implementation. Summaries of these presentations follow. I hope that you will invest your time in reviewing these materials, and begin to think about the significant role that disease management can play in reforming the health care system to meet the needs of the older adult population. I am, as always, interested in your feedback. You can reach me via email at [email protected]

From the Open Skies proposal of 1955 to the Norstad Plan 1960: a plan too far

A proposal drafted by General Lauris Norstad for the creation of a limited inspection zone in Central Europe and in the Arctic Circle—a proposal that came to be known as the Norstad Plan—evolved out of President Dwight D. Eisenhower's Open Skies proposal. The proposal, based on ideas promoted by Eisenhower's disarmament adviser, Harold Stassen, departed from traditional U.S. disarmament policy. The plan was eventually aborted by West Germany and France, but the document heralded a shift in Eisenhower's disarmament policy. The president was ready to give up the all-or-nothing approach and adopt an incremental approach. To this end, the United States would make concessions that would render U.S. proposals more acceptable to the Soviet Union. The plan adumbrated the conceptual change that paved the way for the Limited Nuclear Test Ban Treaty and the Non-Proliferation Treaty

The James Webb Space Telescope Mission: Optical Telescope Element Design, Development, and Performance

The James Webb Space Telescope (JWST) is a large, infrared space telescope that has recently started its science program which will enable breakthroughs in astrophysics and planetary science. Notably, JWST will provide the very first observations of the earliest luminous objects in the Universe and start a new era of exoplanet atmospheric characterization. This transformative science is enabled by a 6.6 m telescope that is passively cooled with a 5-layer sunshield. The primary mirror is comprised of 18 controllable, low areal density hexagonal segments, that were aligned and phased relative to each other in orbit using innovative image-based wavefront sensing and control algorithms. This revolutionary telescope took more than two decades to develop with a widely distributed team across engineering disciplines. We present an overview of the telescope requirements, architecture, development, superb on-orbit performance, and lessons learned. JWST successfully demonstrates a segmented aperture space telescope and establishes a path to building even larger space telescopes.Comment: accepted by PASP for JWST Overview Special Issue; 34 pages, 25 figure

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

The role of war in deep transitions: exploring mechanisms, imprints and rules in sociotechnical systems

This paper explores in what ways the two world wars influenced the development of sociotechnical systems underpinning the culmination of the first deep transition. The role of war is an underexplored aspect in both the Techno-Economic Paradigms (TEP) approach and the Multi-level perspective (MLP) which form the two key conceptual building blocks of the Deep Transitions (DT) framework. Thus, we develop a conceptual approach tailored to this particular topic which integrates accounts of total war and mechanisms of war from historical studies and imprinting from organisational studies with the DT framework’s attention towards rules and meta-rules. We explore in what ways the three sociotechnical systems of energy, food, and transport were affected by the emergence of new demand pressures and logistical challenges during conditions of total war; how war impacted the directionality of sociotechnical systems; the extent to which new national and international policy capacities emerged during wartime in the energy, food, and transport systems; and the extent to which these systems were influenced by cooperation and shared sacrifice under wartime conditions. We then explore what lasting changes were influenced by the two wars in the energy, food, and transport systems across the transatlantic zone. This paper seeks to open up a hitherto neglected area in analysis on sociotechnical transitions and we discuss the importance of further research that is attentive towards entanglements of warfare and the military particularly in the field of sustainability transitions

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure