Approximately 20 percent of ACP members who are involved in direct patient care are in solo physician practices. And, about 50 percent are in practices of five or fewer physicians.

On July 1, physicians face a 10.6 percent cut in Medicare reimbursements. Another 5 percent cut is anticipated on January 1, 2009. The Sustainable Growth Rate (SGR) formula that is used to calculate Medicare payments to physicians was created in 1997 and ties physician payments to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments. The SGR formula has led to scheduled annual cuts for six consecutive years.

Earlier this year, ACP surveyed its members to measure the impact of pending Medicare payment cuts on their practices and on their patients. The questionnaire asked internists to report on the changes they would be forced to make if Congress does not act. Although the survey was not designed as a scientific sample, almost 2,000 internists responded, providing ACP with first-hand accounts of how the SGR cuts are affecting millions of Medicare beneficiaries.

Dr Dale cited the story of one respondent, a Texas internist, who said:

“The practice of medicine is a calling and as such, my colleagues and I have endured more unfair revenue cuts than most businesses would have endured. Yet, a medical practice is also a small business, and there are limits to how much we can endure. We are now at the point where further cuts are not survivable. Just like any small business, our revenue has to exceed costs in order to survive. Despite everything that I have been able to do to cut costs, the margin of profit is now thin, and the proposed greater than 10 percent cut will put us out of business. The only option will be to downsize the practice and stop seeing all Medicare patients. I would hate this, but it will be the only option I have if Congress does not reverse the proposed cuts.”

ACP is asking Congress to avert the immediate SGR cut, but also go a step beyond. The College is asking Congress to set a timeline for completely eliminating the use of the SGR formula. ACP also wants Congress to direct Medicare, as part of replacing the SGR formula, to change payment policies to support patient-centered, physician-guided care management based on the patient-centered medical home model of care.

“Medicare patients deserve the best possible care,” concluded Dr. Dale. They also deserve a physician payment system that will help physicians deliver the best care possible, his testimony said.

[David Kinsman @ American College of Physicians]

Berkeley Lab has signed a collaboration agreement with Tensilica, Inc. to explore the use of Tensilica’s Xtensa processor cores as the basic building blocks in a massively parallel system design. Tensilica’s Xtensa processor is about 400 times more efficient in floating point operations per watt than the conventional server processor chip shown here.

In a paper published in the May issue of the International Journal of High Performance Computing Applications, Michael Wehner and Lenny Oliker of Berkeley Lab’s Computational Research Division, and John Shalf of the National Energy Research Scientific Computing Center (NERSC) lay out the benefit of a new class of supercomputers for modeling climate conditions and understanding climate change. Using the embedded microprocessor technology used in cell phones, iPods, toaster ovens and most other modern day electronic conveniences, they propose designing a cost-effective machine for running these models and improving climate predictions.

In April, Berkeley Lab signed a collaboration agreement with Tensilica, Inc. to explore such new design concepts for energy-efficient high-performance scientific computer systems. The joint effort is focused on novel processor and systems architectures using large numbers of small processor cores, connected together with optimized links, and tuned to the requirements of highly-parallel applications such as climate modeling.

Understanding how human activity is changing global climate is one of the great scientific challenges of our time. Scientists have tackled this issue by developing climate models that use the historical data of factors that shape the earth’s climate, such as rainfall, hurricanes, sea surface temperatures and carbon dioxide in the atmosphere. One of the greatest challenges in creating these models, however, is to develop accurate cloud simulations.

Although cloud systems have been included in climate models in the past, they lack the details that could improve the accuracy of climate predictions. Wehner, Oliker and Shalf set out to establish a practical estimate for building a supercomputer capable of creating climate models at 1-kilometer (km) scale. A cloud system model at the 1-km scale would provide rich details that are not available from existing models.

To develop a 1-km cloud model, scientists would need a supercomputer that is 1,000 times more powerful than what is available today, the researchers say. But building a supercomputer powerful enough to tackle this problem is a huge challenge.

Historically, supercomputer makers build larger and more powerful systems by increasing the number of conventional microprocessors — usually the same kinds of microprocessors used to build personal computers. Although feasible for building computers large enough to solve many scientific problems, using this approach to build a system capable of modeling clouds at a 1-km scale would cost about $1 billion. The system also would require 200 megawatts of electricity to operate, enough energy to power a small city of 100,000 residents.

In their paper, Towards Ultra-High Resolution models of Climate and Weather, the researchers present a radical alternative that would cost less to build and require less electricity to operate. They conclude that a supercomputer using about 20 million embedded microprocessors would deliver the results and cost $75 million to construct. This “climate computer” would consume less than 4 megawatts of power and achieve a peak performance of 200 petaflops.

“Without such a paradigm shift, power will ultimately limit the scale and performance of future supercomputing systems, and therefore fail to meet the demanding computational needs of important scientific challenges like the climate modeling,” Shalf said.

The researchers arrive at their findings by extrapolating performance data from the Community Atmospheric Model (CAM). CAM, developed at the National Center for Atmospheric Research in Boulder, Colorado, is a series of global atmosphere models commonly used by weather and climate researchers.

The “climate computer” is not merely a concept. Wehner, Oliker and Shalf, along with researchers from UC Berkeley, are working with scientists from Colorado State University to build a prototype system in order to run a new global atmospheric model developed at Colorado State.

“What we have demonstrated is that in the exascale computing regime, it makes more sense to target machine design for specific applications,” Wehner said. “It will be impractical from a cost and power perspective to build general-purpose machines like today’s supercomputers.”

Under the agreement with Tensilica, the team will use Tensilica’s Xtensa LX extensible processor cores as the basic building blocks in a massively parallel system design. Each processor will dissipate a few hundred milliwatts of power, yet deliver billions of floating point operations per second and be programmable using standard programming languages and tools. This equates to an order-of-magnitude improvement in floating point operations per watt, compared to conventional desktop and server processor chips. The small size and low power of these processors allows tight integration at the chip, board and rack level and scaling to millions of processors within a power budget of a few megawatts.

Berkeley Lab is a U.S. Department of Energy national laboratory located in Berkeley, California. It conducts unclassified scientific research and is managed by the University of California. Visit our Website at www.lbl.gov.

[Ucilia Wang @ DOE/Lawrence Berkeley National Laboratory]

The platypus, classified as a mammal because it produces milk and is covered in a coat of fur, also possesses features of reptiles, birds and their common ancestors, along with some curious attributes of its own. One of only two mammals that lays eggs, the platypus also sports a duck-like bill that holds a sophisticated electrosensory system used to forage for food underwater. Males possess hind leg spurs that can deliver pain-inducing venom to its foes competing for a mate or territory during the breeding season.

“The fascinating mix of features in the platypus genome provides many clues to the function and evolution of all mammalian genomes,” says Richard K. Wilson, Ph.D., director of the The Genome Center at Washington University and the paper’s senior author. “By comparing the platypus genome to other mammalian genomes, we’ll be able to study genes that have been conserved throughout evolution.”

The platypus represents the earliest offshoot of the mammalian lineage some 166 million years ago from primitive ancestors that had features of both mammals and reptiles. “What is unique about the platypus is that it has retained a large overlap between two very different classifications, while later mammals lost the features of reptiles,” says Wes Warren, Ph.D., an assistant professor of genetics, who led the project.

Comparison of the platypus genome with the DNA of humans and other mammals, which diverged later, and the genomes of birds, whose ancestors branched off an estimated 315 million years ago, can help scientists fill gaps in their understanding of mammalian evolution. The comparison also will allow scientists to date the emergence of genes and traits specific to mammals.

The Nature paper analyzes the genome sequence of a female platypus named Glennie from New South Wales, Australia. The project was largely funded by the National Human Genome Research Institute, part of the National Institutes of Health, and includes scientists from the United States, Australia, England, Germany, Israel, Japan, New Zealand and Spain.

“At first glance, the platypus appears as if it was the result of an evolutionary accident,” says Francis S. Collins, M.D., Ph.D., director of NHGRI. “But as weird as this animal looks, its genome sequence is priceless for understanding how mammalian biological processes evolved.”

“While we’ve always been able to compare and consider all of these creatures on the basis of their physical characteristics, internal anatomy and behavior, it’s truly amazing to be able to compare their genetic blueprints and begin to get a close-up look at how evolution brings about change,” Wilson says.

As part of their analysis, the researchers compared the platypus genome with genomes of the human, mouse, dog, opossum and chicken. They found that the platypus shares 82 percent of its genes with these animals. The chicken genome was chosen because it represents a group of egg-laying animals, including extinct reptiles, which passed on much of their DNA to the platypus and other mammals over the course of evolution.

The researchers also found genes that support egg laying - a feature of reptiles - as well as lactation - a characteristic of all mammals. Interestingly, the platypus lack nipples, so its young nurse through the abdominal skin.

The researchers also attempted to determine which characteristics of the platypus were linked to reptiles at the DNA level. When they analyzed the genetic sequences responsible for venom production in the male platypus, they found it arose from duplications in a group of genes that evolved from ancestral reptile genomes. Amazingly, duplications in the same genes appear to have evolved independently in venomous reptiles.

The platypus swims with its eyes, ears and nostrils closed, relying on electrosensory receptors in its bill to detect faint electric fields emitted by underwater prey. Surprisingly, the researchers found the genome contains an expansion of genes that code for a particular type of odor receptor. “We were expecting very few of these odor receptor genes because the animals spend the majority of their life in the water,” Warren says.

Similar genes are found in animals that rely on a sense of smell, such as rodents and dogs, and the scientists suspect that their addition in the platypus allows the animals to detect odors while foraging underwater.

At roughly 2.2 billion base pairs, the platypus genome is about two-thirds the size of the human genome and contains about 18,500 genes, similar to other vertebrates. The animal has 52 chromosomes, including an unusual number of sex chromosomes: 10. The platypus X chromosome bears resemblance to the sex chromosome of a bird, known as Z.

Sequencing and assembling the platypus genome proved far more daunting than sequencing any other mammalian genome to date. About 50 percent of the genome is composed of repetitive elements of DNA, which makes it a challenge to assemble properly.

The platypus genome sequence, along with those for other organisms, such as the mouse, dog, cow, and many other animals can be accessed at GenBank (www.ncbi.nih.gov/Genbank) at NIH’s National Center for Biotechnology Information.

[Caroline Arbanas @ Washington University School of Medicine]