Situating care in mainstream health economics: an ethical dilemma?

Standard health economics concentrates on the provision of care by medical professionals. Yet ‘care’ receives scant analysis; it is portrayed as a spillover effect or externality in the form of interdependent utility functions. In this context care can only be conceived as either acts of altruism or as social capital. Both conceptions are subject to considerable problems stemming from mainstream health economics’ reliance on a reductionist social model built around instrumental rationality and consequentialism. Subsequently, this implies a disregard for moral rules and duties and the compassionate aspects of behaviour. Care as an externality is a second-order concern relative to self-interested utility maximization, and is therefore crowded out by the parameters of the standard model. We outline an alternative relational approach to conceptualising care based on the social embeddedness of the individual that emphasises the ethical properties of care. The deontological dimension of care suggests that standard health economics is likely to undervalue the importance of care and caring in medicine

SAM-2 ground-truth plan: Correlative measurements for the Stratospheric Aerosol Measurement-2 (SAM 2) sensor on the Nimbus G satellite

The SAM-2 will fly aboard the Nimbus-G satellite for launch in the fall of 1978 and measure stratospheric vertical profiles of aerosol extinction in high latitude bands. The plan gives details of the location and times for the simultaneous satellite/correlative measurements for the nominal launch time, the rationale and choice of the correlative sensors, their characteristics and expected accuracies, and the conversion of their data to extinction profiles. The SAM-2 expected instrument performance and data inversion results are presented. Various atmospheric models representative of polar stratospheric aerosols are used in the SAM-2 and correlative sensor analyses

The Hubble Space Telescope Treasury Program on the Orion Nebula Cluster

The Hubble Space Telescope (HST) Treasury Program on the Orion Nebula Cluster has used 104 orbits of HST time to image the Great Orion Nebula region with the Advanced Camera for Surveys (ACS), the Wide-Field/Planetary Camera 2 (WFPC2) and the Near Infrared Camera and Multi Object Spectrograph (NICMOS) instruments in 11 filters ranging from the U-band to the H-band equivalent of HST. The program has been intended to perform the definitive study of the stellar component of the ONC at visible wavelengths, addressing key questions like the cluster IMF, age spread, mass accretion, binarity and cirumstellar disk evolution. The scanning pattern allowed to cover a contiguous field of approximately 600 square arcminutes with both ACS and WFPC2, with a typical exposure time of approximately 11 minutes per ACS filter, corresponding to a point source depth AB(F435W) = 25.8 and AB(F775W)=25.2 with 0.2 magnitudes of photometric error. We describe the observations, data reduction and data products, including images, source catalogs and tools for quick look preview. In particular, we provide ACS photometry for 3399 stars, most of them detected at multiple epochs, WFPC2 photometry for 1643 stars, 1021 of them detected in the U-band, and NICMOS JH photometry for 2116 stars. We summarize the early science results that have been presented in a number of papers. The final set of images and the photometric catalogs are publicly available through the archive as High Level Science Products at the STScI Multimission Archive hosted by the Space Telescope Science Institute.Comment: Accepted for publication on the Astrophysical Journal Supplement Series, March 27, 201

Health professionals' experiences of tuberculosis cohort audit in the North West of England : a qualitative study

This research was supported by Public Health England and the Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine (LSTM).Objectives. Tuberculosis cohort audit (TBCA) was introduced across the North West (NW) of England in 2012 as an ongoing, multidisciplinary, systematic case review process, designed to improve clinical and public health practice. TBCA has not previously been introduced across such a large and socioeconomically diverse area in England, nor has it undergone formal, qualitative evaluation. This study explored health professionals' experiences of the process after 1515 cases had been reviewed. Design. Qualitative study using semistructured interviews. Respondents were purposively sampled from 3 groups involved in the NW TBCA: (1) TB nurse specialists, (2) consultant physicians and (3) public health practitioners. Data from the 26 respondents were triangulated with further interviews with key informants from the TBCA Steering Group and through observation of TBCA meetings. Analysis. Interview transcripts were analysed thematically using the framework approach. Results. Participants described the evolution of a valuable 'community of practice' where interprofessional exchange of experience and ideas has led to enhanced mutual respect between different roles and a shared sense of purpose. This multidisciplinary, regional approach to TB cohort audit has promoted local and regional team working, exchange of good practices and local initiatives to improve care. There is strong ownership of the process from public health professionals, nurses and clinicians; all groups want it to continue. TBCA is regarded as a tool for quality improvement that improves patient safety. Conclusions. TBCA provides peer support and learning for management of a relatively rare, but important infectious disease through discussion in a no-blame atmosphere. It is seen as an effective quality improvement strategy which enhances TB care, control and patient safety. Continuing success will require increased engagement of consultant physicians and public health practitioners, a secure and ongoing funding stream and establishment of clear reporting mechanisms within the public health system.Publisher PDFPeer reviewe

Liver transplantation for type I and type IV glycogen storage disease

Progressive liver failure or hepatic complications of the primary disease led to orthotopic liver transplantation in eight children with glycogen storage disease over a 9-year period. One patient had glycogen storage disease (GSD) type I (von Gierke disease) and seven patients had type IV GSD (Andersen disease). As previously reported [19], a 16.5-year-old-girl with GSD type I was successfully treated in 1982 by orthotopic liver transplantation under cyclosporine and steroid immunosuppression. The metabolic consequences of the disease have been eliminated, the renal function and size have remained normal, and the patient has lived a normal young adult life. A late portal venous thrombosis was treated successfully with a distal splenorenal shunt. Orthotopic liver transplantation was performed in seven children with type N GSD who had progressive hepatic failure. Two patients died early from technical complications. The other five have no evidence of recurrent hepatic amylopectinosis after 1.1–5.8 postoperative years. They have had good physical and intellectual maturation. Amylopectin was found in many extrahepatic tissues prior to surgery, but cardiopathy and skeletal myopathy have not developed after transplantation. Postoperative heart biopsies from patients showed either minimal amylopectin deposits as long as 4.5 years following transplantation or a dramatic reduction in sequential biopsies from one patient who initially had dense myocardial deposits. Serious hepatic derangement is seen most commonly in types T and IV GSD. Liver transplantation cures the hepatic manifestations of both types. The extrahepatic deposition of abnormal glycogen appears not to be problematic in type I disease, and while potentially more threatening in type IV disease, may actually exhibit signs of regression after hepatic allografting

Further evidence for large central mass-to-light ratios in early-type galaxies: the case of ellipticals and lenticulars in the Abell~262 cluster

We present radially resolved spectroscopy of 8 early-type galaxies in Abell~262, measuring rotation, velocity dispersion, $H_3$ and $H_4$ coefficients along three axes, and line-strength index profiles of Mg, Fe and H$\beta$. Ionized-gas velocity and velocity dispersion is included for 6 galaxies. We derive dynamical mass-to-light ratios and dark matter densities from orbit-based dynamical models, complemented by the galaxies' ages, metallicities, and $\alpha$-elements abundances. Four galaxies have significant dark matter with halos about 10 times denser than in spirals of the same stellar mass. Using dark matter densities and cosmological simulations, assembly redshifts \zdm\approx 1-3, which we found earlier for Coma. The dynamical mass following the light is larger than expected for a Kroupa stellar IMF, especially in galaxies with high velocity dispersion \sigeff inside the effective radius \reff. This could indicate a `massive' IMF in massive galaxies. Alternatively, some dark matter in massive galaxies could follow the light closely. Combining with our comparison sample of Coma early-types, we now have 5 of 24 galaxies where (1) mass follows light to 1-3\,\reff, (2) the dynamical mass-to-light ratio {of all the mass that follows the light is large ($\approx\,8-10$ in the Kron-Cousins $R$ band), (3) the dark matter fraction is negligible to 1-3\,\reff. Unless the IMF in these galaxies is particularly `massive' and somehow coupled to the dark matter content, there seems a significant degeneracy between luminous and dark matter in some early-type galaxies. The role of violent relaxation is briefly discussed.Comment: 62 pages, 13 figures, 8 tables, accepted for publication in A

Towards a balanced scorecard: A critical analysis of the Culture and Sport Evidence (CASE) programme

This article provides a critical analysis of the methods employed in the Culture and Sport Evidence (CASE) programme. Based on a comprehensive review of the arts management and cultural policy literature, it contests recent claims that the cultural sector should state its value in the economic language of policy appraisal and evaluation (O’Brien, 2010) and proposes alternative methods for evaluating the drivers, impact and value of engagement in the arts, including the balanced scorecard approach. The literature identifies a number of fundamental problems in quantifying the social and personal impact of the arts, and an underlying policy issue is that the arts have become increasingly subject to the benchmarks of incompatible disciplines and practices. This paper seeks to redress the balance by questioning the argument that economic cost benefit analysis is the best way to understand cultural value and influence public policy. As the CASE programme aimed to make the business case for optimum Government investment in sport and culture, it adopted the framework set out in HM Treasury’s Green Book and took a quantitative, evidence-based approach to measuring the drivers, impact and instrumental value of engagement, disregarding established qualitative studies and approaches, which have been shown to articulate cultural value through a more personal, intrinsic and holistic lens. This article makes the case for a more balanced approach to cultural evaluation and a more holistic articulation of cultural value, which would combine intrinsic and instrumental benefits and comprise both qualitative and quantitative methods. The key implication of this re-conception of value is that cultural policy should be evaluated not on return on investment but rather against a balanced range of objectives and articulated in a language that reflects artistic practice and speaks directly to existing and potential audiences