Primary care in the twenty-first century

Summary • The NHS remains one of the world’s better health care systems. But the proportion of the UK’s GDP allocated to health and social care is only about three quarters of that now spent by leading European nations. To meet changing needs health and social care providers in England must improve their capacity to offer convenient access to preventive and ‘common need’ diagnostic and treatment services to people of all ages, and also to provide well-coordinated social and health care to individuals at high risk of suffering avoidable episodes of serious illness and needlessly losing their independence. • If personal and public health is to be raised to the highest possible level improving primary health and health related social care – which together represent little more than a fifth of combined NHS and local authority social service outlays – is vital. Health care will in future move more towards professionally facilitated prevention and primary care supported self-care in the community, backed by the relatively infrequent use of highly specialised services supplied in hospitals. • The unique attributes of British general medical practice will allow it to serve as a central plank for continuing service development. The formation of local Health Federations and related primary care focused organisations could in future lend itself to holding single budgets for health and related social care along the lines proposed by advocates of the Primary Care Home approach to service improvement. This would offer significant gains for service users. Wherever cost effective, services ought to be ‘made’ by local care providers. Where necessary they should be purchased from other sources. • There is a large body of evidence indicating that Community Pharmacy can play an extended part in delivering accessible health care, alongside roles like reducing prescription errors and facilitating better medicines use. Increasing the number of clinical pharmacists working in GP practices is a valuable step. But it cannot substitute for a clear vision for the future of community pharmacies as ‘first contact’ health care providers. • If community pharmacists successfully extend their clinical care roles this would free general practice and linked community capacity to work towards reducing inappropriate hospital admissions and unduly long inpatient stays. Without well planned, pro-active, interventions pharmacy skills will be under-used and the established community pharmacy network lost. Yet if each community pharmacy in England were able to take on just 10 per cent of the average general practice’s existing workload over the next five years, this will release approaching 5,000 GPs and similar volumes of practice staff for additional service provision. • Responsibility for achieving more effective primary care working arrangements lies mainly with GPs, nurses, social workers and pharmacists themselves, because only they are in a position to adequately understand the tasks with which they are engaged and the detailed needs of the people they serve. However, individual professionals alone cannot transform the NHS. Excellent national leadership and appropriate funding and governance systems are also vital for nation-wide success. • Nine out of 10 people in England currently live within a 20 minute walk of a community pharmacy. Some planners may wish to see savings made via concentrating dispensing in warehouse-like facilities and increasing the use of medicines home delivery services. Yet at a system-wide level a potentially more desirable way forward could be to extend pharmacist prescribing and improve shared health record systems. This would combine convenient local medicines supply with more accessible forms of ‘pharmacist first’ care in areas ranging from managing blood pressure to providing better chronic obstructive pulmonary disease (COPD) and type 2 diabetes prevention and care. • The health and social care system in England has been affected by imbalances that are linked to the fact that social care is means tested while NHS care is free. This has created perverse incentives that may in the past have undermined services such as community nursing. Inadequate high level leadership also impairs service quality. But if health gain focused co-operative professional enterprise can be combined with well-informed decision making and robust national and local resource allocation strategies that effectively support the delivery of well-coordinated primary care, further improvements in individual and population health will be achieved

Resolution of Linear Algebra for the Discrete Logarithm Problem Using GPU and Multi-core Architectures

In cryptanalysis, solving the discrete logarithm problem (DLP) is key to assessing the security of many public-key cryptosystems. The index-calculus methods, that attack the DLP in multiplicative subgroups of finite fields, require solving large sparse systems of linear equations modulo large primes. This article deals with how we can run this computation on GPU- and multi-core-based clusters, featuring InfiniBand networking. More specifically, we present the sparse linear algebra algorithms that are proposed in the literature, in particular the block Wiedemann algorithm. We discuss the parallelization of the central matrix--vector product operation from both algorithmic and practical points of view, and illustrate how our approach has contributed to the recent record-sized DLP computation in GF($2^{809}$).Comment: Euro-Par 2014 Parallel Processing, Aug 2014, Porto, Portugal. \<http://europar2014.dcc.fc.up.pt/\&gt

Estratégia competitiva de uma multinacional estrangeira na avicultura de postura no Brasil.

Este estudo aborda a questão das estratégias envolvidas no processo de importação de gaiolas para aves de postura, direcionadas ao centro de distribuição de uma multinacional estrangeira localizada em Araraquara, São Paulo. Identifica as razões que levam uma empresa multinacional a aumentar seus investimentos no Brasil, onde está implantando um centro de distribuição (CD). Para estudar as estratégias envolvidas no processo, realizou-se pesquisa exploratória sobre o atual processo logístico da empresa, buscando identificar tais estratégias e as vantagens do novo processo. O trabalho apoia-se nas cinco forças competitivas de Porter, na análise SWOT, nas estratégias genéricas adotadas para obtenção de retorno sobre os investimentos e ainda, fundamenta-se em temas como, importação, logística, armazenagem e centro de distribuição. A pesquisa demonstra que a implantação do CD envolve a estratégia de inserção do produto no mercado nacional, especificamente em São Paulo, onde está o maior mercado de aves de postura do País. Para obter vantagem competitiva, a multinacional adota ainda a estratégia genérica da diferenciação, com foco em tecnologia e qualidade do produto. Apesar dos altos custos da construção e manutenção do CD representarem uma barreira de entrada no mercado, o investimento não representa risco financeiro, já que aumentará a demanda pelo produto, resultando maior retorno sobre o capital investido

Competitividade de um grupo de produtores da cadeia produtiva da maçã na região de Vacaria/RS.

O objetivo deste trabalho foi identificar se um grupo de produtores da cadeia produtiva da maçã na microrregião dos Campos de Cima da Serra está enfrentando dificuldades, e quais seriam elas, bem como identificar possíveis oportunidades que possam impactar na continuidade desta cadeia, através da metodologia de pesquisa exploratória, com caráter qualitativo e quantitativo quanto à abordagem metodológica, e, descritivo-explicativa quanto aos objetivos e levantamento de bibliografia. A coleta de informações foi realizada pelo método de entrevistas semiestruturadas, por meio de questionário. Os resultados indicaram que os produtores vêm enfrentando problemas de ordem produtiva e comercial, como fatores vinculados à mão de obra e clima, estabilização de preços, baixo consumo nacional da fruta, dentre outros, podendo ser amenizados pela introdução de técnicas, variedades e controle de custos. Além disso, a introdução paralela de novas culturas similares, como uva e pêra, pode aperfeiçoar o processo produtivo pela redução do custo. Palavras-chave: Maleicultura, produtividade, competitividade

Fluctuations in Hadronic and Nuclear Collisions

We investigate several fluctuation effects in high-energy hadronic and nuclear collisions through the analysis of different observables. To introduce fluctuations in the initial stage of collisions, we use the Interacting Gluon Model (IGM) modified by the inclusion of the impact parameter. The inelasticity and leading-particle distributions follow directly from this model. The fluctuation effects on rapidity distributions are then studied by using Landau's Hydrodynamic Model in one dimension. To investigate further the effects of the multiplicity fluctuation, we use the Longitudinal Phase-Space Model, with the multiplicity distribution calculated within the hydrodynamic model, and the initial conditions given by the IGM. Forward-backward correlation is obtained in this way.Comment: 22 pages, RevTex, 8 figures (included); Invited paper to the special issue of Foundation of Physics dedicated to Mikio Namiki's 70th. birthda

The Saffman-Taylor problem on a sphere

The Saffman-Taylor problem addresses the morphological instability of an interface separating two immiscible, viscous fluids when they move in a narrow gap between two flat parallel plates (Hele-Shaw cell). In this work, we extend the classic Saffman-Taylor situation, by considering the flow between two curved, closely spaced, concentric spheres (spherical Hele-Shaw cell). We derive the mode-coupling differential equation for the interface perturbation amplitudes and study both linear and nonlinear flow regimes. The effect of the spherical cell (positive) spatial curvature on the shape of the interfacial patterns is investigated. We show that stability properties of the fluid-fluid interface are sensitive to the curvature of the surface. In particular, it is found that positive spatial curvature inhibits finger tip-splitting. Hele-Shaw flow on weakly negative, curved surfaces is briefly discussed.Comment: 26 pages, 4 figures, RevTex, accepted for publication in Phys. Rev.

A kilobit hidden SNFS discrete logarithm computation

We perform a special number field sieve discrete logarithm computation in a 1024-bit prime field. To our knowledge, this is the first kilobit-sized discrete logarithm computation ever reported for prime fields. This computation took a little over two months of calendar time on an academic cluster using the open-source CADO-NFS software. Our chosen prime $p$ looks random, and $p--1$ has a 160-bit prime factor, in line with recommended parameters for the Digital Signature Algorithm. However, our p has been trapdoored in such a way that the special number field sieve can be used to compute discrete logarithms in $\mathbb{F}\_p^*$ , yet detecting that p has this trapdoor seems out of reach. Twenty-five years ago, there was considerable controversy around the possibility of back-doored parameters for DSA. Our computations show that trapdoored primes are entirely feasible with current computing technology. We also describe special number field sieve discrete log computations carried out for multiple weak primes found in use in the wild. As can be expected from a trapdoor mechanism which we say is hard to detect, our research did not reveal any trapdoored prime in wide use. The only way for a user to defend against a hypothetical trapdoor of this kind is to require verifiably random primes

Understanding and simulating the material behavior during multi-particle irradiations

A number of studies have suggested that the irradiation behavior and damage processes occurring during sequential and simultaneous particle irradiations can significantly differ. Currently, there is no definite answer as to why and when such differences are seen. Additionally, the conventional multi-particle irradiation facilities cannot correctly reproduce the complex irradiation scenarios experienced in a number of environments like space and nuclear reactors. Therefore, a better understanding of multi-particle irradiation problems and possible alternatives are needed. This study shows ionization induced thermal spike and defect recovery during sequential and simultaneous ion irradiation of amorphous silica. The simultaneous irradiation scenario is shown to be equivalent to multiple small sequential irradiation scenarios containing latent damage formation and recovery mechanisms. The results highlight the absence of any new damage mechanism and time-space correlation between various damage events during simultaneous irradiation of amorphous silica. This offers a new and convenient way to simulate and understand complex multi-particle irradiation problems

Two-Center Integrals for r_{ij}^{n} Polynomial Correlated Wave Functions

All integrals needed to evaluate the correlated wave functions with polynomial terms of inter-electronic distance are included. For this form of the wave function, the integrals needed can be expressed as a product of integrals involving at most four electrons