What was the programme theory of New Labour’s health system reforms?

To examine whether the Health System Reforms delivered the promise of being a coherent and mutually supporting reform programme; to identify the underlying programme theory of the reform programme; to reflect on whether lessons have been learned. \ud \ud Documentary analysis mapping the implicit and explicit programme theories about how the reforms intended to achieve its goals and outcomes. Semi-structured interviews with policy-makers to further understand the programme theory. \ud \ud The Health System Reforms assumed a ‘one size fits all’ approach to policy implementation with little recognition that some contexts can be more receptive than others. There was evidence of some policy evolution and rebalancing between the reform streams as policy-makers became aware of some perverse incentives and unforeseen consequences. Later elements aimed to restore balance to the system. \ud \ud The Health System Reforms do not appear to comprise a coherent and mutually supportive set of levers and incentives. They appear unbalanced with the centre of gravity favouring suppliers over commissioners. However, recent reform changes have sought to redress this imbalance to some extent, suggesting that lessons have been learned and policies have been adapted over time

Portfolio for METR 180: Climate Change, Energy, and the Environment

METR 180 explores several global change topics: energy, technology, population, environment, and climate. When they finish METR 180, students should be have basic knowledge of the Earth system and how humans interact with it and they should be able to understand the scientific process, how scientists understand elements of the Earth system, and how this contrasts with skepticism of science. One major challenge of the course is that it is taken by a wide range of students with different backgrounds and different goals for taking the course. The goal of this portfolio is to continue to develop METR 180 to better address this challenge and to fit into the departmental catalogue of courses better so that it is able to attract more students

Energy Audit and Optimization for Arches etc.

Arches etc. is a San Diego business, which specializes in the manufacture, distribution, and installation of custom designed doors, windows, mouldings, and hardware. Due to the recent economic downturn, which has hindered the construction industry, Arches etc. believed that an analysis and optimization of their energy usage would provide additional assistance towards their goal to lower overhead and maintain current operations. To begin this task, a comprehensive energy audit was conducted to establish an initial state from which to base improvements. Arches etc.’s current monthly utility bill averages $996, which solidifies the accuracy of this project’s performed energy audit, estimating their monthly consumption to be$985. With this energy audit as baseline to build upon, several aspects of their facility were analyzed, including: Manufacturing Processes, Equipment Capacity, Equipment Runtime, and Equipment Efficiency. After developing a collection of proposed improvements based upon these areas, the economic justification of each improvement was evaluated. Free energy saving improvements, or those that did not require an initial investment, resulted in an estimated annual savings of $2,000. Additional savings were found through equipment investment opportunities, resulting in annual savings of$958. Investment opportunities were evaluated on their payback period and Net Present Value. Investments that offered a positive NPV were included in the final recommendations. It has been recommended to Arches etc. that through implementation of these various energy saving improvements they can reduce their monthly electric utility bill by at least 26%. This reduction has the capability of bringing their current monthly electric bill from $996 to$739. To complement these improvement recommendations, Arches etc. has also been provided a series of observational energy efficient guidelines to conserve electricity throughout their facility

Simulating the Impact of X-ray Heating during the Cosmic Dawn

Upcoming observations of the 21-cm signal from the Epoch of Reionization will soon provide the first direct detection of this era. This signal is influenced by many astrophysical effects, including long range X-ray heating of the intergalactic gas. During the preceding Cosmic Dawn era the impact of this heating on the 21-cm signal is particularly prominent, especially before spin temperature saturation. We present the largest-volume (349\,Mpc comoving=244~$h^{-1}$Mpc) full numerical radiative transfer simulations to date of this epoch that include the effects of helium and multi-frequency heating, both with and without X-ray sources. We show that X-ray sources contribute significantly to early heating of the neutral intergalactic medium and, hence, to the corresponding 21-cm signal. The inclusion of hard, energetic radiation yields an earlier, extended transition from absorption to emission compared to the stellar-only case. The presence of X-ray sources decreases the absolute value of the mean 21-cm differential brightness temperature. These hard sources also significantly increase the 21-cm fluctuations compared the common assumption of temperature saturation. The 21-cm differential brightness temperature power spectrum is initially boosted on large scales, before decreasing on all scales. Compared to the case of the cold, unheated intergalactic medium, the signal has lower rms fluctuations and increased non-Gaussianity, as measured by the skewness and kurtosis of the 21-cm probability distribution functions. Images of the 21-cm signal with resolution around 11~arcmin still show fluctuations well above the expected noise for deep integrations with the SKA1-Low, indicating that direct imaging of the X-ray heating epoch could be feasible.Comment: 13 pages, 8 figure

Minimal String Unification and Hidden Sector in Z_8 Orbifold Models

We study the minimal supersymmetric standard model derived from the $Z_8$ orbifold models and its hidden sectors. We use a target-space duality anomaly cancellation so as to investigate hidden sectors consistent with the MSSM unification. For the allowed hidden sectors, we estimate the running gauge coupling constants making use of threshold corrections due to the higher massive modes. The calculation is important from the viewpoint of gaugino condensations, which is one of the most promissing mechanism to break the supersymmetry.Comment: 14 pages, KANAZAWA-93-11, LaTeX fil

From boat to beach: Using drift cards to improve our knowledge of ocean currents, areas at risk and oil spill trajectories.

In October 2013, Raincoast Conservation Foundation and Georgia Strait Alliance launched 1644 drift cards from 9 locations along the shipping route through the Salish Sea to Vancouver, British Columbia. Drift cards are 4x6” pieces of marine plywood painted bright yellow and numbered. Drift cards have historically been used to assess the way in which floating objects move in various contexts, including potential oil spills from underwater pipelines, marine park planning, sewage outflows and more. In this case, these drift cards were released in the context of Kinder Morgan’s plans to twin the Trans Mountain pipeline, which if approved would see increases in tanker traffic on the shipping route by up to 500%. Results from this study indicate that cards released in Burrard Inlet very quickly landed across many of Vancouver’s beaches, cards released in Burrard Inlet eventually moved from near Vancouver to other locations ranging from the San Juans to the Broughton Archipelago, cards released outside Burrard Inlet can disperse to distant locations relatively quickly, and card recoveries in some areas were from many different drops, indicating that some areas could be affected from incidents along much of the shipping route. Card movement is also compared to the oil spill modelling presented in Kinder Morgan’s National Energy Board application. Implications for spill response, oil spill modelling and environmental/societal impacts are also discussed

Study of Minimal String Unification in Z8Z_8 Orbifold Models

We study the construction of the minimal supersymmetric standard model from the $Z_8$ orbifold models. We use a target-space duality anomaly cancellation and a unification of gauge couplings as constraints. It is shown that some models obtained through a systematical search realize the unification of SU(3) and SU(2) coupling constants.Comment: 11 pages, KANAZAWA-93-08, LaTeX fil

On gauge unification in Type I/I' models

We discuss whether the (MSSM) unification of gauge couplings can be accommodated in string theories with a low (TeV) string scale. This requires either power law running of the couplings or logarithmic running extremely far above the string scale. In both cases it is difficult to arrange for the multiplet structure to give the MSSM result. For the case of power law running there is also enhanced sensitivity to the spectrum at the unification scale. For the case of logarithmic running there is a fine tuning problem associated with the light closed string Kaluza Klein spectrum which requires gauge mediated supersymmetry breaking on the ``visible'' brane with a dangerously low scale of supersymmetry breaking. Evading these problems in low string scale models requires a departure from the MSSM structure, which would imply that the success of gauge unification in the MSSM is just an accident.Comment: 10 pages, LaTeX, 2 figures; minor change

Impaired myocardial relaxation with exercise determines peak aerobic exercise capacity in heart failure with preserved ejection fraction

Background Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by impaired exercise capacity due to shortness of breath and/or fatigue. Assessment of diastolic dysfunction at rest and with exercise may provide insight into the pathophysiology of exercise intolerance in HFpEF. Aims To measure echocardio-Doppler-derived parameters of diastolic function as they relate to various indices of aerobic exercise capacity in HFpEF. Methods We selected 16 subjects with clinically stable HFpEF, no evidence of volume overload, but impaired functional capacity by cardiopulmonary exercise testing [peak oxygen consumption (VO2)]. We measured the transmitral E and A flow velocities, E/A ratio, and E deceleration time (DT) and tissue Doppler E′ velocity. We also indexed the E′ to the DT, as additional measure of impaired relaxation (E′DT), and calculated the diastolic functional reserve index (DFRI), as the product of E′ at rest and change in E′ with exercise. Results E′ velocity, at rest and peak exercise, as well as the DFRI positively correlated with peak VO2, whereas DT, E′DT, and E/E′ with exercise inversely correlated with peak VO2. Of note, the E′DT at rest also significantly predicted E′ velocity at peak exercise (R = +0.81, P \u3c 0.001). Exercise E′ was the only independent predictor of peak VO2 at multivariable analysis (R = +0.67, P = 0.005). Conclusions The E′ velocity at peak exercise is a strong and independent predictor of aerobic exercise capacity as measured by peak VO2 in patients with HFpEF, providing the link between abnormal myocardial relaxation with exercise and impaired aerobic exercise capacity in HFpEF

Local Health Departments' Partners and Challenges in Electronic Exchange of Health Information

BACKGROUND: Unprecedented amounts of data are produced by the health care and other sectors, presenting opportunities for local health departments (LHDs) to access these data. LHDs will need to participate in health information exchange (HIE) with a number of partners in order to benefit from these data resources. LHDs' participation in HIEs with specific partners has not been studied. OBJECTIVES: To describe the level of and challenges in LHD participation in HIE with other partners, and variation by LHD population size and governance type. DATA AND METHODS: This research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received with a 50% response rate. Survey data were cleaned, and bivariate comparisons were conducted using χ and Somer's D. RESULTS: Substantial variation existed in LHDs' participation in HIE by type of exchange partner. Although 71% participated in HIE with the state departments of health, only 12% with jail/correctional health, 14% with health or county-based purchasing plans, and 15% with home health agencies. Compared with large LHDs (jurisdiction populations of ≥500 000), smaller LHDs were more likely to participate in HIE with state departments of health, but less likely with other exchange partners. The challenges to HIE participation were technological, and organizational/interorganizational in nature and variation existed by LHDs' population size and governance structure with respect to state authority. CONCLUSIONS: Local public health agencies more commonly participate in HIE with some partners, but may need to improve HIE with many others. National strategies targeting an increase in HIE of LHDs may use our findings to focus those initiatives