Value for money in the English NHS: Summary of the evidence

The extent to which the English National Health Service secures value for money for taxpayers has become a central issue of political and public debate. Questions include: how much expenditure growth has been made available to the NHS? on what has that money been spent? what improvements in the volume and quality of health care have been secured? and what are the implications for productivity? There has been a flurry of research activity designed to address these and similar questions. This report seeks to bring together this research in a concise format and draws some tentative conclusions about recent productivity changes in the NHS. It finds that there is considerable evidence of growth in both the volume and quality of NHS activity. However, this has not in general kept pace with the growth in expenditure. On most measures, therefore, NHS productivity is either static or declining. However, the report highlights a large number of unresolved methodological issues that make it hard to draw any definitive conclusions. We conclude that the measurement of NHS productivity change makes an important contribution to national debate. However, there remains considerable scope for improving both the data and the methods underlying current estimates.

A finance policy for Scotland

At the national level, monetary policy is regarded as an important tool for government influence on the economy; this importance has been highlighted in the debate over the future of UK monetary policy in a European monetary union. The relevant (interrelated) questions are: how would the UK economy fare with monetary policy applied on a uniform basis across Europe, and with the full integration of national capital markets, and what would be the relative costs and benefits for the UK of a single European currency? These questions are equally valid with respect to the Scottish economy, as part of a single currency area, with a significant degree of financial integration, and with uniform UK monetary policy. It is particularly apposite at this time to consider these questions again for Scotland. Institutional change is proceeding apace within the UK financial sector, both with respect to the organisation and behaviour of the private sector, and also with respect to the policy environment within which it operates. In addition, the devolution debate raises questions about the desirability of policy-making at the Scottish level with respect to the financial sector, either within the present constitutional environment, or within the range of alternative environments under consideration

EAPC task force on education for psychologists in palliative care

It is argued that psychological aspects of care and psychosocial problems are essential components of palliative care. However, the provision of appropriate services remains somewhat arbitrary. Unlike medical and nursing care, which are clearly delivered by doctors and nurses respectively, psychological and psychosocial support in palliative care are not assigned exclusively to psychologists. It is generally expected that all professionals working in palliative care should have some knowledge of the psychological dynamics in terminal illness, as well as skills in communication and psychological risk assessment. On the one hand, palliative care education programmes for nurses and doctors comprise a considerable amount of psychological and psychosocial content. On the other hand, only a few palliative care associations provide explicit information on the role and tasks of psychologists in palliative care. Psychologists’ associations do not deal much with this issue either. If they refer to it at all, it is in the context of the care of the aged, end-of-life care or how to deal with grief

Hume e o Iluminismo Escocês: Duas Culturas

David Hume’s philosophy and economics are central to any account ofthe Scottish Enlightenment. It is now well-established that this enlightenment ischaracterised by a particular epistemological approach which distinguishes it fromother, particularly rationalist, enlightenments. While a variety of explanations hasbeen offered for this distinctive approach, little attention has been paid to the presencein Scotland of two quite different cultures: Highland (specifi cally, Gaelic) andLowland. Most Enlightenment fi gures were, like Hume, lowland (the main exceptionbeing Ferguson). But it seems implausible that the proximity to a very different culturehad no impact on enlightenment thought. Hume himself addressed issues ofGaelic culture in terms of the controversial Ossian poems, for example, and issuesof economic development of the Highlands. The purpose of this paper is to conductan initial exploration into how far it is possible to identify any Gaelic infl uences onHume in particular, and Scottish Enlightenment thought in general. This requiresin turn a characterisation of Gaelic epistemology, for which purpose we will drawon Foucault’s structuring of thought into epistemes. If we can understand Highlandand Lowland thought in terms of different epistemes, then some further refl ectionis required on Foucault’s framework of sequential epistemes.A fi losofi a e a economia de David Hume são fundamentais para qualquerconsideração do Iluminismo Escocês. Está atualmente bem estabelecido que esseiluminismo se caracterizou por uma abordagem epistemológica particular que odistingue de outros, especialmente de iluminismos racionalistas. Enquanto muitasexplicações têm sido oferecidas para essa abordagem distinta, pouca atenção tem sidodada para a presença na Escócia de duas culturas completamente distintas: Highland(especialmente a Gaélica) e Lowland. A maioria dos membros do Iluminismo pertencia,assim como Hume, à Lowland (a principal exceção foi Ferguson). No entanto,parece implausível que a proximidade a uma cultura tão diferente não tenha tidonenhum impacto no pensamento iluminista. O próprio Hume se referiu a questõesda cultura Gaélica em termos dos controversos poemas Ossiânicos, por exemplo, ea questões de desenvolvimento econômico das Highlands. A proposta deste artigoé conduzir uma exploração inicial a respeito de se é possível identifi car quaisquerinfl uências Gaélicas sobre Hume em particular e sobre o pensamento IluministaEscocês em geral. Isto, por sua vez, requer uma caracterização da epistemologiaGaélica, para o que nós recorreremos à estruturação do pensamento de acordo comepistemes tal como desenvolvida por Foucault. Se nós podemos entender o pensamentoda Highland e da Lowland em termos de epistemes, então alguma refl exãoposterior é requerida sobre a estrutura Foucauldiana de epistemes seqüenciais

The transmission of music into the human uterus and the response to music of the human fetus and neonate

The aim of this study was to investigate whether music influences human life before birth. In order to determine the existence and character of music in the uterine acoustic environment, a study was conducted involving the insertion of a hydrophone through the cervix, next to the fetal head. The investigation was conducted on eight women in early labour. The average residual uterine sound of the eight subjects was measured at 65 dBA (A-weighted) re 20 µ.Pa in a 1 O KHz band, RMS averaged over 32-second records. Above this emerged the maternal voice, an external female voice and a male voice presented at approximately 65 dB (linear weighted). Pure tones between 50 Hz and 1 O KHz and orchestral music, all presented at 80 dB (linear weighted), were also shown to emerge above the residual uterine sound. Attenuation of external sound was observed to vary as a function of frequency, with less attenuation of lower frequencies. It was determined that the music was transmitted into the uterus without sufficient distortion to significantly alter the recognisable characteristics of the music. The fetal heart rate (FHA) response to a music stimulus (MS) and a vibroacoustic stimulus (VS) was measured in 40 subjects. Gestational age of the fetuses ranged from 32 to 42 weeks. The study included a control period with no acoustic stimulation; a period with the presentation of 5 music stimuli; and a period with the presentation of 5 vibroacoustic stimuli. A change in the FHA of 15 beats per minute or greater, lasting 15 seconds and occurring within 15 seconds of at least 2 of the 5 stimuli (or a tachycardia of greater than 15 beats per minute above the resting baseline, sustained for one minute or longer) was considered to be a positive response. The MS elicited a positive response in 35 of the fetuses (the 5 non-responses occurring in a period of low FHA variability) and all 40 fetuses responded to the VS (regardless of arousal state). In the third study, mothers attending childbirth education classes volunteered to listen to a prescribed music excerpt twice daily from the 34th week of pregnancy. Ten neonates (all clinically normal) were tested betw~en the 2nd and 5th day after birth. Investigators observed the effect of two music sti:Tiuli, the prescribed stimulus and a non-prescribed stimulus, on neonatal sucking of a non-nutritive nipple. A five-minute control period with no stimulation was compared with a ten-minute period during which two music stimuli were presented. By random allocation, either the prescribed music stimulus (PM) or the nonprescribed music (NM) was presented contingent upon sucking pressure. If a sucking burst was initiated, the PM stimulus was activated. On cessation of sucking, the NM stimulus was activated. Randomly, the procedure would be reversed for some of the subjects, where initiation of sucking activated the NM stimulus and cessation of sucking activated the PM stimulus. It was determined that the inter-burst intervals during the music period were significantly extended when coinciding with the PM stimulus and significantly shortened when coinciding with the NM stimulus.The studies indicated that music is transmitted into the uterus with insufficient distortion to alter the character of the music; that the normal fetus responds to a music stimulus from at least the 32nd week of gestation; and that the neonate alters the normal sucking pattern to activate longer periods of a music stimulus which has been repeatedly presented during the intrauterine stage and shorter periods of a novel music stimulus

On iterated translated points for contactomorphisms of R^{2n+1} and R^{2n} x S^1

A point q in a contact manifold is called a translated point for a contactomorphism \phi, with respect to some fixed contact form, if \phi (q) and q belong to the same Reeb orbit and the contact form is preserved at q. The problem of existence of translated points is related to the chord conjecture and to the problem of leafwise coisotropic intersections. In the case of a compactly supported contactomorphism of R^{2n+1} or R^{2n} x S^1 contact isotopic to the identity, existence of translated points follows immediately from Chekanov's theorem on critical points of quasi-functions and Bhupal's graph construction. In this article we prove that if \phi is positive then there are infinitely many non-trivial geometrically distinct iterated translated points, i.e. translated points of some iteration \phi^k. This result can be seen as a (partial) contact analogue of the result of Viterbo on existence of infinitely many iterated fixed points for compactly supported Hamiltonian symplectomorphisms of R^{2n}, and is obtained with generating functions techniques in the setting of arXiv:0901.3112.Comment: 10 pages, revised version. I removed the discussion on linear growth of iterated translated points, because it contained a mistake. To appear in the International Journal of Mathematic