An evaluation of a health care programme approach to commissioning stroke services in Gateshead and South Tyneside

MD ThesisIntroduction The NHS emphasises programme approaches to commissioning (Health Improvement Programmes and National Service Frameworks) but research is limited. I evaluated the Health Care Programme Approach (HCPA) for stroke whose individual elements are: a co-ordinating group; a co-ordinator; a technical document; and agreement of priorities. Methods 1 Four rounds of interviews with managers and clinicians; observation at meetings; analysis of documentary sources. 2 Quantitative indicators of progress measured at two time points. 3 Estimation of the Programme Budget and Transaction Costs from published sources and local data. 4 Interviews with Directors of Public Health from nine comparator districts. Results 1A structured process led to a set of priorities, which were widely accepted across all agencies, allowing the co-ordinating group to focus on facilitating change. This group took two years to reach a stage where it could change services. Most peoples upportedth e approachb ut were not alwaysc lear aboutt he process. 2 The indicators showed improvements in some aspects of care. 3 The programme budget was £IOm, mostly in long-term care (£5.5m) and hospital care (£3m). The transaction costs amounted to 0.25% of the programme budget. Preface 4 All comparator districts reported changes to commissioning and improvements in stroke services, but I found more widespread change in the study district. Discussion The detailed description of process, and use of multiple methods, gives strength to the findings. A collaborative approach has developed across the NHS during the period of this study making the findings highly relevant. There were important lessons for multiagency groups including: the time needed to function effectively; the need for individuals to clarify whether they represent an organisation or their own perspective; the need to review the group remit and the group's routes of communication; and the ability to adapt to changes in national policy while focusing on improving the health of the patients who fall within the programme. Keywords Planning, Purchasing, Commissioning, Stroke Services, Health Care Programme Approach, Evidence-Based, Multiagency Collaboration, Triangulation, Evaluation, Case Study.NHSE Northern and Yorkshire, Research and Development: Stroke Association

A note on the expressive power of linear orders

This article shows that there exist two particular linear orders such that first-order logic with these two linear orders has the same expressive power as first-order logic with the Bit-predicate FO(Bit). As a corollary we obtain that there also exists a built-in permutation such that first-order logic with a linear order and this permutation is as expressive as FO(Bit)

Theories for TC0 and Other Small Complexity Classes

We present a general method for introducing finitely axiomatizable "minimal" two-sorted theories for various subclasses of P (problems solvable in polynomial time). The two sorts are natural numbers and finite sets of natural numbers. The latter are essentially the finite binary strings, which provide a natural domain for defining the functions and sets in small complexity classes. We concentrate on the complexity class TC^0, whose problems are defined by uniform polynomial-size families of bounded-depth Boolean circuits with majority gates. We present an elegant theory VTC^0 in which the provably-total functions are those associated with TC^0, and then prove that VTC^0 is "isomorphic" to a different-looking single-sorted theory introduced by Johannsen and Pollet. The most technical part of the isomorphism proof is defining binary number multiplication in terms a bit-counting function, and showing how to formalize the proofs of its algebraic properties.Comment: 40 pages, Logical Methods in Computer Scienc

Effect of ISPAD Anaerobic Digestion on Ammonia Volatilization from Soil Applied Swine Manure

Swine manure subjected to in-storage psychrophilic anaerobic digestion (ISPAD) undergoes proteins degradation but limited NH3 volatilization, producing an effluent rich in plant-available nitrogen. Accordingly, ISPAD effluent can offer a higher fertilizer value during land application, as compared to manure of similar age stored in an open tank. However, this additional nitrogen can also be lost by volatilization during land application. The objective of this study was therefore to measure NH3 volatilization from both ISPAD and open tank swine manures when applied to 5 different soils, namely, washed sand, a Ste Rosalie clay, an Upland sandy loam, a St Bernard loam, and an Ormstown loam. This research was conducted using laboratory wind tunnels simulating land application. The five experimental soils offered similar pH values but different water holding capacity, cation exchange capacity, cation saturation, and organic matter. After 47 h of wind tunnel monitoring, the % of total available nitrogen (TAN or NH4 + and NH3) volatilized varied with both manure and soil type. For all soil types, the ISPAD manure consistently lost less NH3 as compared to the open tank manure, averaging 53% less. Lower volatile solids content improving manure infiltration into the soil and a more complex ionic solution explain the effect of the ISPAD manure advantages. This was reinforced by the St Bernard sandy loam losing the same nitrogen mass for both manures, because of its higher pH and buffer pH coupled with an intermediate CEC resulting in more soil solution NH3. Within each manure type, % TAN volatilized was highest for washed sand and lowest for the clay soil. As a result, ISPAD manure can offer up to 21% more plant-available nitrogen fertilizer especially when the manure is not incorporated into the soil following its application

Sublogarithmic uniform Boolean proof nets

Using a proofs-as-programs correspondence, Terui was able to compare two models of parallel computation: Boolean circuits and proof nets for multiplicative linear logic. Mogbil et. al. gave a logspace translation allowing us to compare their computational power as uniform complexity classes. This paper presents a novel translation in AC0 and focuses on a simpler restricted notion of uniform Boolean proof nets. We can then encode constant-depth circuits and compare complexity classes below logspace, which were out of reach with the previous translations.Comment: In Proceedings DICE 2011, arXiv:1201.034

Searching Constant Width Mazes Captures the AC0 Hierarchy

We show that searching a width k maze is complete for Pi_k, i.e.,for the k'th level of the AC0 hierarchy. Equivalently, st-connectivityfor width k grid graphs is complete for Pi_k. As an application, weshow that there is a data structure solving dynamic st-connectivity for constant width grid graphs with time bound O(log log n) per operation on a random access machine. The dynamic algorithm is derived from the parallel one in an indirect way using algebraic tools

The Computational Power of Benenson Automata

The development of autonomous molecular computers capable of making independent decisions in vivo regarding local drug administration may revolutionize medical science. Recently Benenson at el (2004) have envisioned one form such a ``smart drug'' may take by implementing an in vitro scheme, in which a long DNA state molecule is cut repeatedly by a restriction enzyme in a manner dependent upon the presence of particular short DNA ``rule molecules.'' To analyze the potential of their scheme in terms of the kinds of computations it can perform, we study an abstraction assuming that a certain class of restriction enzymes is available and reactions occur without error. We also discuss how our molecular algorithms could perform with known restriction enzymes. By exhibiting a way to simulate arbitrary circuits, we show that these ``Benenson automata'' are capable of computing arbitrary Boolean functions. Further, we show that they are able to compute efficiently exactly those functions computable by log-depth circuits. Computationally, we formalize a new variant of limited width branching programs with a molecular implementation.Comment: 18 page

Towards Modular Attitude Determination and Control System (ADCS)

Objectives: Modular ADCS based on CubeSat flight experience, space heritage hardware and rad hard components for small satellites Project goal: Integration of independent modules based on electronic data sheets (EDS) configuration system Capabilities: Attitude determination and control Boot and self-recovery Plug and play interface to sensor and actuators Fault Detection, Isolation & Recovery (FDIR) Data management and storage External control interfac

Gonzalez v. Douglas Trial Transcript of Proceedings, Day 2

Gonzalez v. Dougla