Sustainable Health Care Systems: An International Study

In many countries, the operation of the healthcare system is an important political issue and any changes to healthcare provision are often fiercely resisted by many stakeholders and can prove difficult to implement. Such changes to the organization and/or financing of healthcare may be necessitated by factors such as the continuing increase in service demands, the development of new medical science advances and the impact of financial and economic austerity across the globe. This paper considers how well the existing healthcare systems in eleven countries and across several continents are coping with various challenges, and looks at potential best practices. The general conclusion is that many such healthcare systems are unsustainable in the longer term and are in urgent need of reform

Reliability of capturing foot parameters using digital scanning and the neutral suspension casting technique

<p>Abstract</p> <p>Background</p> <p>A clinical study was conducted to determine the intra and inter-rater reliability of digital scanning and the neutral suspension casting technique to measure six foot parameters. The neutral suspension casting technique is a commonly utilised method for obtaining a negative impression of the foot prior to orthotic fabrication. Digital scanning offers an alternative to the traditional plaster of Paris techniques.</p> <p>Methods</p> <p>Twenty one healthy participants volunteered to take part in the study. Six casts and six digital scans were obtained from each participant by two raters of differing clinical experience. The foot parameters chosen for investigation were cast length (mm), forefoot width (mm), rearfoot width (mm), medial arch height (mm), lateral arch height (mm) and forefoot to rearfoot alignment (degrees). Intraclass correlation coefficients (ICC) with 95% confidence intervals (CI) were calculated to determine the intra and inter-rater reliability. Measurement error was assessed through the calculation of the standard error of the measurement (SEM) and smallest real difference (SRD).</p> <p>Results</p> <p>ICC values for all foot parameters using digital scanning ranged between 0.81-0.99 for both intra and inter-rater reliability. For neutral suspension casting technique inter-rater reliability values ranged from 0.57-0.99 and intra-rater reliability values ranging from 0.36-0.99 for rater 1 and 0.49-0.99 for rater 2.</p> <p>Conclusions</p> <p>The findings of this study indicate that digital scanning is a reliable technique, irrespective of clinical experience, with reduced measurement variability in all foot parameters investigated when compared to neutral suspension casting.</p

Analysis of gas constituents from sealed containers of plutonium oxide materials.

The safe storage of pure and impure plutonium oxide materials in sealed containers is a current Department of Energy (DOE) concern. Plutonium oxides sorb moisture from the atmosphere, and the subsequent radiolytic and/or chemical decomposition of the water has been thought to generate excessive hydrogen pressures inside sealed containers. Eleven sealed containers with ten grams each of plutonium oxide materials have been studied for up to four years. The sealed materials were representative materials from the DOE complex and contain less than 0.5 weight percent water. The samples were kept at ambient conditions. We report the final gas analysis of the headspace gas of these containers using gas chromatography, mass spectrometry and Raman spectroscopy. The results show that none of the containers have pressurized significantly, and that hydrogen was not generated in significant quantities

Mutually beneficial host exploitation and ultra-biased sex ratios in quasisocial parasitoids

Selfish interests usually preclude resource sharing, but under some conditions collective actions enhance per capita gains. Such Allee effects underlay early explanations of social evolution but current understanding focusses on kin selection (inclusive fitness). We find an Allee effect that explains unusual quasisociality (cooperative brood care) among parasitoid wasps without invoking or precluding kin selection effects. In Sclerodermus harmandi, individual females produce most offspring when exploiting small hosts alone. However, larger hosts are more successfully exploited by larger groups of females, with the per-female benefits outweighing the costs of host sharing. Further, the extremely biased sex ratios (97% female) are better explained by mutually beneficial female–female interactions that increase the reproductive value of daughters (local resource enhancement), rather than by the usually invoked local mate competition between males. Thus, atypical quasisocial behaviour in a parasitoid wasp directly enhances reproductive success and selects for very extremely female-biased sex ratios

A case-series study to explore the efficacy of foot orthoses in treating first metatarsophalangeal joint pain

Background: First metatarsophalangeal (MTP) joint pain is a common foot complaint which is often considered to be a consequence of altered mechanics. Foot orthoses are often prescribed to reduce 1 stMTP joint pain with the aim of altering dorsiflexion at propulsion. This study explores changes in 1 stMTP joint pain and kinematics following the use of foot orthoses.Methods: The effect of modified, pre-fabricated foot orthoses (X-line ®) were evaluated in thirty-two patients with 1 stMTP joint pain of mechanical origin. The primary outcome was pain measured at baseline and 24 weeks using the pain subscale of the foot function index (FFI). In a small sub-group of patients (n = 9), the relationship between pain and kinematic variables was explored with and without their orthoses, using an electromagnetic motion tracking (EMT) system.Results: A significant reduction in pain was observed between baseline (median = 48 mm) and the 24 week endpoint (median = 14.50 mm, z = -4.88, p &lt; 0.001). In the sub-group analysis, we found no relationship between pain reduction and 1 stMTP joint motion, and no significant differences were found between the 1 stMTP joint maximum dorsiflexion or ankle/subtalar complex maximum eversion, with and without the orthoses.Conclusions: This observational study demonstrated a significant decrease in 1 stMTP joint pain associated with the use of foot orthoses. Change in pain was not shown to be associated with 1 stMTP joint dorsiflexion nor with altered ankle/subtalar complex eversion. Further research into the effect of foot orthoses on foot function is indicated. © 2010 Welsh et al; licensee BioMed Central Ltd

Gas generation over plutonium oxides in the 94-1 shelf-life surveillance program.

The Department of Energy (DOE) is embarking upon a program to store large quantities of plutonium-bearing materials for up to fifty years. The Los Alamos National Laboratory Shelf Life Project was established to bound the behavior of plutonium-bearing material meeting the DOE 3013 Standard. The shelf life study monitors temperature, pressure and gas composition over oxide materials in a limited number of large-scale 3013 inner containers and in many small-scale containers. For the large-scale study, baseline plutonium oxides, oxides exposed to high-humidity atmospheres, and oxides containing chloride salt impurities are planned. The first large-scale container represents a baseline and contains dry plutonium oxide prepared according to the 3013 Standard. This container has been observed for pressure, temperature and gas compositional changes for less than a year. Results indicate that no detectable changes in pressure and gas composition are observed

Distributions and compound-specific isotopic signatures of sedimentary chlorins reflect the composition of photoautotrophic communities and their carbon and nitrogen sources in Swiss lakes and the Black Sea

We examined the distributions of tetrapyrrole pigments (i.e. intact chlorophylls and bacteriochlorophylls, pheopigments) as well as their compound-specific carbon and nitrogen isotopic compositions in the sediments of three Swiss lakes (Lakes Rotsee, Cadagno and Zurich) and the Black Sea to investigate the biogeochemical cycling of carbon and nitrogen mediated by phototrophic eukaryotes (algae) and bacteria. The factors controlling chlorin isotope variations are discussed and the feasibility to use chlorins as indicators for reconstructions of surface water environments is evaluated. Chlorophyll a and its derivatives including pheophytin a, a pheophytin a epimer, pyropheophytin a, 132,173-cyclopheophorbide-a-enol, chlorophyllone a as well as steryl and carotenol chlorin esters were detected in all sediments. The presence of bacteriochlorophylls e and their derivatives confirmed the presence of brown strains of green phototrophic sulfur bacteria (Chlorobiaceae; GSB) in all three lakes. In the shallower Lakes Rotsee and Cadagno, purple sulfur bacteria (Chromatiaceae; PSB) were also present as confirmed by bacteriochlorophyll a derivatives. Despite the different degrees of water column hypoxia at the studied sites, the chlorins in all sediments were attributed to rapid transformation of intact tetrapyrroles and the formation of related pheopigments.The scatter of compound-specific carbon isotopic compositions of Chl a and its derivatives resulted from different timing of pheopigment formation, likely due to the interaction of blooms of various phytoplankton communities at different times of the year and the variable degrees of carbon limitation and/or different contributions of recycled organic matter (OM). The nitrogen isotopic composition of the chloropigments mainly derived from nitrate assimilation in Lake Zurich and the Black Sea, whereas ammonium and nitrate assimilation were predominant in Lake Rotsee. In the epilimnion of the meromictic Lake Cadagno, dissolved organic nitrogen (DON) supplied to the surface water from ammonium assimilation in the chemocline may be the main nitrogen source. Phototrophic sulfur bacteria in Lakes Rotsee and Cadagno thrived mainly under dissolved organic carbon depleted conditions within the chemocline and in the hypolimnion. GSB may use predominantly ammonium and at least in Lake Cadagno also perform N2 fixation. In contrast, the nitrogen source of PSB could not be reconstructed with d15N values of bacteriochlorins, because nitrogen isotopic fractionation during BChl a synthesis seems to be almost independent of the assimilated substrate