Towards locally based resource allocation in the NHS

In a health care system where resources are scarce and the principle of equity is of central concern, mechanisms for the appropriate allocation of resources based on the notion of relating resource use to some concept of need are essential. Two key issues raised in the UK government’s White Paper The New NHS: modern, dependable are the ability first to define health care budgets at a local level and second to integrate budgets to encompass all relevant aspects of health care delivery. This paper considers the theoretical and practical implications of devolving NHS budgets to primary care groups. The paper advocates the development of a patient-based survey of all NHS health care utilization, which could serve as the basis for integrated global budgets for use at a local level.resource allocation; health care budgets; primary care; health need; general practice

Three-body interactions in complex fluids: virial coefficients from simulation finite-size effects

A simulation technique is described for quantifying the contribution of three-body interactions to the thermodynamical properties of coarse-grained representations of complex fluids. The method is based on comparing the third virial coefficient $B_3$ for a complex fluid with that of an approximate coarse-grained model described by a pair potential. To obtain $B_3$ we introduce a new technique which expresses its value in terms of the measured volume-dependent asymptote of a certain structural function. The strategy is applicable to both Molecular Dynamics and Monte Carlo simulation. Its utility is illustrated via measurements of three-body effects in models of star polymer and highly size-asymmetrical colloid-polymer mixtures.Comment: 13 pages, 8 figure

Effects of sublethal doses of pyrethroids on malaria vectors

Pyrethroids are currently the most widespread class of insecticide in public health use, although their future may be limited by resistance. The present study investigates the effects of these compounds on mosquitoes, other than mortality immediately after exposure. Longevity of both male and female An. gambiae was found to be significantly curtailed following sublethal exposure to the most commonly used pyrethroids, permethrin, deltamethrin and lambda-cyhalothrin. There was no direct effect observed on fecundity. Irritancy on direct contact with all 3 compounds was recorded, particularly with permethrin. Evening host-seeking flight activity was greatly reduced, and when females were treated with permethrin before release into a flight chamber, significantly fewer flew to a host to feed. Experiments investigating Plasmodium yoelii and P. falciparum development in the Asian vector An. stephensi revealed that sublethal exposure to pyrethroids inhibited development of oocysts in the midgut. Similar experiments using organochlorine, organophosphate and carbamate insecticides found no effect. Radio-labeled permethrin was traced inside the blood meal following exposure. However, none of the 3 pyrethroids were found to have a direct anti-malarial activity on cultured gametocytes. Likewise, permethrin did not affect exflagellation of P. yoelii. Time course experiments determined that for the reduction in oocysts there was a critical period of between 18 and 48 hours after the infective feed. Permethrin was not found to inhibit trypsin activity in assays, and the levels of trypsin in the midgut of blood fed treated and untreated females was not found to differ in a manner which could explain reduced infection rates. It is clear that sublethal exposure of mosquitoes can lead to a wide range of potentially important effects in terms of the impact of pyrethroids in malaria vector control.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Does group assessment impact BME attainment?

Assessment of student learning is fundamental in Higher Education (HE) reflecting academic standards and impacting on student satisfaction, position in league tables and graduate employment. Nonetheless, there is a BME (Black and Minority Ethnic) attainment gap, the difference in the proportion of BME and White students who attain a first class or 2.1 honours degree (even when controlled for prior attainment and entry profile), which is persistent across the HE sector. As assessment strategies play an essential role in determining degree attainment, we have reviewed the role of group assessment and whether this form of assessment specifically impacts on the BME attainment gap. Overall, this study provided evidence that assessed group work does not adversely impact BME students. In addition, the performance in BME/non-BME/mixed groups did not suggest any consistent difference, suggesting that the demographic composition of groups does not affect BME performance. Therefore, group work would appear to be an inclusive form of assessment that does not appear to lead or contribute to exacerbating the BME attainment gap

A model of the determinants of expenditure on children's personal social services

Every year the United Kingdom central government assesses the relative spending needs of English local authorities in respect of the services for which is it responsible. This is done by estimating a Standard Spending Assessment (SSA) for each service, which is intended to indicate the spending requirements of an authority if it were to adopt a standard level of services, given the circumstances in its area. In practice, statistical methods are used to develop SSAs for most services. This report describes the findings of a study designed to review the methods for setting SSAs for a single service: personal social services (PSS) for children, which in 1995/96 accounting for about £1.8 billion of expenditure (4.4% of total local government expenditure). The study was commissioned by the Department of Health and undertaken by a consortium which comprised The University of York, MORI and the National Children’s Bureau. The study was guided by a technical advisory group, comprising representatives from the local authority associations and the Department of Health. In seeking to limit the length of the report, the authors have necessarily omitted a great deal of the technical material produced in the course of the study. We understand that the Department of Health is willing to make this material and the data used in the study available to interested parties, subject to certain confidentiality restrictions. Existing methodology for constructing SSAs had been the subject of some criticism, both in general and specifically in respect of children’s PSS. This document reports the results of a study designed to apply a radically new statistical approach to estimating the SSA for children’s PSS. Previous methods were based on statistical analysis of local authority aggregate data. In contrast, this study is based on an analysis of PSS spending in 1,036 small areas (with populations of about 10,000) within 25 local authorities. A relatively new statistical method known as multilevel modelling, which was originally developed in the educational sector, was used for this purpose.children, SSA, social services

Lambda-prophage induction modeled as a cooperative failure mode of lytic repression

We analyze a system-level model for lytic repression of lambda-phage in E. coli using reliability theory, showing that the repressor circuit comprises 4 redundant components whose failure mode is prophage induction. Our model reflects the specific biochemical mechanisms involved in regulation, including long-range cooperative binding, and its detailed predictions for prophage induction in E. coli under ultra-violet radiation are in good agreement with experimental data.Comment: added referenc

The Lennard-Jones-Devonshire cell model revisited

We reanalyse the cell theory of Lennard-Jones and Devonshire and find that in addition to the critical point originally reported for the 12-6 potential (and widely quoted in standard textbooks), the model exhibits a further critical point. We show that the latter is actually a more appropriate candidate for liquid-gas criticality than the original critical point.Comment: 5 pages, 3 figures, submitted to Mol. Phy

The Papacy and the Eastern Mediterranean 1305 - 1362

The papacy was actively involved in the Eastern Mediterranean throughout the fourteenth century, and evidence of much of its activity can be found in the registers preserved in the Vatican Archives. By using a source base of nearly 1,300 letters drawn from the registers directly relating to activity in the Eastern Mediterranean and supporting non-papal evidence, this thesis explores the aims, intentions, and outcomes of papal policy toward the East. The Eastern Mediterranean during the Avignon period was a site of exchange, trade, and conflict, and the papacy was actively involved in controlling behaviour and propagating its own agenda. An analysis of these policies and interventions allows for an evaluation of the papacy’s ability to establish and maintain authority and exercise power. This thesis contextualises the reasons why the papacy was able to act, or was unable to act, alongside the intentions of the papacy, for a greater understanding of the popes’ influence and activity in the region. The papacy clearly maintained a consistent interest in the East throughout the Avignon period and enacted a series of policies designed to control the behaviour of Catholics living and working in the East, increase its influence over other Christian Churches, and engage with non-Christian political powers. Most individuals, institutions, and polities accepted the authority of the papacy, but the power of the papacy was limited. It was largely unable to enforce its will even though most actors in the Eastern Mediterranean accepted its right to impose its agenda. Despite this lack of power, respect for the papacy’s authority led to some significant achievements, and the evidence base demonstrates a complicated series of policies aimed at securing Catholic interests

Bi-Directional Exchange of Membrane Components Occurs during Co-Culture of Mesenchymal Stem Cells and Nucleus Pulposus Cells

Mesenchymal stem cell (MSC)-based therapies have been proposed as novel treatments for intervertebral disc (IVD) degeneration. We have previously demonstrated that when MSCs are co-cultured with nucleus pulposus (NP) cells with direct cell-cell contact, they differentiate along the NP lineage and simultaneously stimulate the degenerate NP cell population to regain a normal (non-degenerate) phenotype, an effect which requires cell-cell communication. However, the mechanisms by which NP cells and MSCs interact in this system are currently unclear. Thus, in this study we investigated a range of potential mechanisms for exchange of cellular components or information that may direct these changes, including cell fusion, gap-junctional communication and exchange of membrane components by direct transfer or via microvesicle formation. Flow cytometry of fluorescently labeled MSCs and NP cells revealed evidence of some cell fusion and formation of gapjunctions, although at the three timepoints studied these phenomena were detectable only in a small proportion of cells. While these mechanisms may play a role in cell-cell communication, the data suggests they are not the predominant mechanism of interaction. However, flow cytometry of fluorescently dual-labeled cells showed that extensive bi-directional transfer of membrane components is operational during direct co-culture of MSCs and NP cells. Furthermore, there was also evidence for secretion and internalization of membrane-bound microvesicles by both cell types. Thus, this study highlights bi-directional intercellular transfer of membrane components as a possible mechanism of cellular communication between MSC and NP cells