Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study

Publisher version: http://www.bmj.com/content/340/bmj.c3111.full?sid=fcb22308-64fe-4070-9067-15a172b3aea

Exploitative destruction features for detonation ultra-dispersed diamonds of initial metallic protection for abrasive powder grains to diamond-spark grinding tools

The problem of exploitation of diamond grinding wheels with metal coating for their grains including detonation ultra-dispersed diamonds to increase functional reliability to maintain the initial integrity of grains in the pressing and sintering of diamond-metal composites in the tool production is considered. One problem is that the presence of detonation ultra-dispersed diamonds in the grain metal coating of diamond powders not only improves the coating functional reliability in protection from destruction in the subsequent pressing and sintering in the production tool, but also resistance of such coating to the opening of the diamond cutting basis of the grains on the grinding wheel working surface that come into working contact with the material being processed. An analysis of the features of an effective exploitative destruction of detonation ultra-dispersed diamonds in the metal coating using electric current in the tool of the diamond-spark grinding processes is presented

Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

Analysis and comparative description of preparation methods of small cylindrical connections precision surfaces to the assembly

The article describes the methods of finishing precision surfaces of small cylindrical connections

Analysis and comparative description of preparation methods of small cylindrical connections precision surfaces to the assembly

The article describes the methods of finishing precision surfaces of small cylindrical connections

Implementation of the UN Convention on the Rights of Persons with Disabilities: A Comparison of Four European Countries with Regards to Assistive Technologies

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is an international treaty that aims to promote, protect and ensure the rights of persons with disabilities so that they can fully participate in society and enjoy the same freedoms and opportunities as others. It provides an important framework for the inclusion of persons with disabilities with the help of Assistive Technologies (AT). This paper assesses and compares the implementation of the CRPD with regards to the availability of AT in four countries (Germany, Hungary, Portugal and Sweden), which to some extent represent different European regions. The paper is based on a review of relevant academic literature, the DOTCOM database and regulatory documents as well as on five validation interviews with national experts. In the countries studied, anti-discriminatory and other legislation is included at the highest level of the legal framework and contains detailed rules on definitions, remedies and legal procedures. There are specific prohibitions in several fields, such as employment, housing, and healthcare. Nonetheless, there are still cases of non-compliance with the CRPD and of laws and regulations which discriminate against persons with a disability. Additionally, there are great variations between countries. As very positive examples of favourable regulatory frameworks for furthering inclusion with the help of ATs do exist, there may be benefit in raising awareness of such examples to support other countries in developing their own measures

Technischer Fortschritt im Gesundheitswesen: Quelle für Kostensteigerungen oder Chance für Kostensenkungen? Innovationsreport

Innovationen im Gesundheitswesen stehen im Spannungsfeld verschiedener politischer Ziele. Sie sollen zu einer qualitativ hochwertigen Gesundheitsversorgung, einer langfristigen Finanzierbarkeit des Gesundheitssystems und – analog zu anderen Wirtschaftsbereichen – auch zu wirtschaftlichem Wachstum und Beschäftigung beitragen. Dies stellt die Akteure im Innovationssystem Gesundheit vor erhebliche Herausforderungen. Dabei steht insbesondere die Befürchtung eventuell ausufernder Gesundheitskosten durch den medizinisch-technischen Fortschritt (MTF) seit Langem im Blickpunkt. Der MTF wird neben demografischen Veränderungen häufig als zentraler Kostentreiber diskutiert. Es stellt sich jedoch die Frage, welche Rolle der MTF in Bezug auf die Entwicklung der Gesundheitsausgaben tatsächlich spielt, was unter Berücksichtigung der o. g. Ziele wünschenswerte Innovationen sind und wie diese hervorgebracht und in ihrer Diffusion gefördert werden können. Zu diesem Zweck analysiert dieser TAB-Bericht die Auswirkungen des MTFs auf die Kosten des Gesundheitssystems in Wechselwirkung mit den dazugehörigen Rahmenbedingungen, aber auch auf andere Zielgrößen, insbesondere die Gesundheit der Bevölkerung sowie Wirtschaftswachstum und Beschäftigung. Die Analysen erfolgen auf zwei Betrachtungsebenen: Auf der Makroebene werden die gesamtgesellschaftlichen Implikationen des MTFs diskutiert und insbesondere eine kritische Analyse zur empirischen Evidenz der Kostenwirkungen des MTFs durchgeführt. Auf der Mikroebene werden anhand von Fallstudien die Effizienz (Kosten-Nutzen-Effekte) und Diffusion ausgewählter wichtiger Beispiele des MTFs sowie Unterschiede zwischen verschiedenen Innovationen betrachtet. Die Ergebnisse dieser Analysen zeigen, dass sich eine »Kostenexplosion« im Gesundheitswesen nicht beobachten lässt: Der Anstieg der Gesundheitsausgaben liegt nur knapp über der Wachstumsrate des Bruttoinlandprodukts (BIP). Ferner ist die Auswirkung des MTFs auf die Gesundheitsausgaben geringer als angenommen, da Ausgabeneffekte anderer Einflussgrößen (Lebensstile, politische Rahmenbedingungen) methodenbedingt dem MTF zugeschrieben werden. Das Kosten-Nutzen-Verhältnis einzelner Innovationen im Gesundheitssystem wird von einer Vielzahl innovationsspezifisch unterschiedlicher Faktoren beeinflusst (Erstattung, Kompetenz der Anwender, Therapietreue etc.) und differiert erheblich zwischen verschiedenen Innovationen. Zudem wird die Diffusion von Innovationen oft erst spät vom Kosten-Nutzen-Verhältnis beeinflusst. Bei einem Großteil der Innovationen gibt es allerdings kein klares, d.h. eindeutiges und einheitliches Kosten-Nutzen-Verhältnis, da zum einen keine relevanten Studien vorliegen, zum anderen das Kosten-Nutzen-Verhältnis einer Innovation oft davon abhängt, bei welcher Indikation, welchen Schweregraden der Erkrankung, welchen Altersgruppen etc. die betreffende Innovation zur Anwendung kommt. Der Bericht definiert eine Reihe von Handlungsoptionen für die Schaffung von Rahmenbedingungen, die zur Realisierung der gewünschten Potenziale des MTFs und zur Minimierung nichtintendierter Wirkungen beitragen können. Dazu gehören Optionen zur frühzeitigen Schaffung von Evidenz zum Kosten-Nutzen-Verhältnis, zum Setzen von Anreizen zur Verbreitung von Innovationen mit positivem Kosten-Nutzen-Verhältnis sowie zur stärkeren Orientierung der Innovationsförderung an gesundheitlichen und gesellschaftlichen Bedarfen

Assessment of nicotine for second hand smoke exposure in some public places in Romania by UPLC-MS

BACKGROUND: Air nicotine monitoring is a well-known procedure for estimation of exposure to second hand smoke. Few research studies were realized in Romania to evaluate environmental tobacco smoke (ETS) exposure of humans in different public places. The levels of airborne nicotine from environmental tobacco smoke and urinary cotinine and nicotine levels of some subjects were analyzed. In order to better implement/enforce the European legislation regarding the interdiction of smoking in the public places the national authorities need a rapid and reliable analytical method to quickly asses the state of the pollution with cigarette smoke of these populated areas. RESULTS: The nicotine concentration in the air from different types of public buildings was determined. The median concentration of nicotine in the air from 32 pubs where the smoking was allowed was 590 ng · L(-1), comparing with the pubs where the smoking was not permitted (22 locations) where the median concentration of nicotine was only 32 ng · L(-1). Similarly, the median concentration of nicotine in restaurants where the smoking was allowed (23 locations) was 510 ng · L(-1), in comparison with the restaurants where the smoking was prohibited (11 places) where the median value was 19 ng · L(-1). The lowest concentrations of nicotine were found in high schools (8 locations, median concentration 7.4 ng · L(-1)), universities (5 locations, 23 ng · L(-1)) and hospitals (6 locations, 16 ng · L(-1)). CONCLUSIONS: The method was validated and gave good linearity, precision, accuracy and limit of detection. The buildings included hospitals, high schools, universities, pubs and restaurants. The presence of air nicotine was recorded in all buildings studied. The highest median levels of air nicotine were found in pubs and restaurants. The presence of air nicotine in indoor public buildings indicates weak implementation of the smoke free law in Romania

SYNTHESIS OF MODEL THE LUENBERGER OBSERVER FOR EXTERNAL CYLINDRICAL GRINDING PROCESS

The problem of diagnosing the actual depth of cut at cylindrical grinding is considered.A mathematical model of the behavior of the grinding wheel and the workpiece during processingis worked out. According to this model it is produced a synthesis the model of the Luenbergerobserver with the Kalman filter to control the process of external cylindrical grinding. Thedeveloped approach is to improve the accuracy of control and the related with them computationalprocedures of assessment and managemen

The devil's in the detail: Final report of the independent evaluation of the Summary Care Record and HealthSpace programmes

professionals, NHS staff, service users, citizens, academics and evaluation scholars. It should be read in conjunction with our Year 1 reports on the SCR programme (May 2008) 1 and data quality (May 2008). 2 2. The SCR is an electronic summary of key health data, currently drawn from a patient’s GP-held electronic record and accessible over a secure Internet connection by authorised healthcare staff. It is one of a suite of innovations being introduced as part of the National Programme for IT in the English National Health Service (NHS) and delivered via a central ‘Spine’. Policy documents published in 2005-8 anticipated a number of benefits of the SCR, including: 3-6 a. Better care (i.e. the SCR would improve clinical decision-making); b. Safer care (i.e. the SCR would reduce risk of harm, especially medication errors); c. More efficient care (e.g. the SCR would make consultations quicker); d. More equitable care (i.e. the SCR would be particularly useful in patients unable to communicate or advocate for themselves); e. Reduction in onward referral (e.g. the SCR would avoid unnecessary ambulanc