Economic analysis of the implementation of autologous transfusion technologies throughout England

Objectives: This study aims to provide the first estimates of the costs and effects of the large scale introduction of autologous transfusion technologies into the United Kingdom National Health Service. Methods: A model was constructed to allow disparate data sources to be combined to produce estimates of the scale, costs, and effects of introducing four interventions. The interventions considered were preparing patients for surgery (PPS) clinics, preoperative autologous donation (PAD), intraoperative cell salvage (ICS), and postoperative cell salvage (PoCS). Results: The key determinants of cost per operation are the anticipated level of reductions in blood use, the mean level of blood use, mean length of stay, and the cost of the technology. The results show the potential for considerable reductions in blood use. The greatest reductions are anticipated to be through the use of PPS and ICS. Vascular surgery, transplant surgery, and cardiothoracic surgery appear to be the specialties that will benefit most from the technologies. Conclusions: Several simplifications were used in the production of these estimates; consequently, caution should be used in their interpretation and use. Despite the drawbacks in the methods used in the study, the model shows the scale of the issue, the importance of gathering better data, and the form that data must take. Such preliminary modeling exercises are essential for rational policy development and to direct future research and discussion among stakeholders

The History of Transportation Advertising, 1850-1956, and A Study of Its Importance in Knoxville, Tennessee

In 1956 organized local passenger transportation agencies in the United States carried about thirty million passenger every day, 912 million every month, totaling 10.94 billion for the year. These agencies included local motor bus lines, electric street railways, elevated and subway lines, interurban electric railways, and trolley coach lines. They did not include taxicabs, suburban railroads, sightseeing buses, and school buses. Today\u27s transit industry represents a gross investment of over $35 billion. The American Transit Association listed 1,326 companies (representing more than 85 per cent of the transit industry) that own more than 70,000 passenger vehicles. Briefly, this is the present status of the transit industry in the United States. For more than a century, the transit industry has grown and expanded to become a necessity in the lives of many people in this country. Along with the growth of the transit industry, there has evolved an advertising medium appropriately called transportation advertising. From the early days of the main street horse cars to the present modern 51-passenger city-suburban bus, transportation advertising has grown along with the development of a series of public transportation systems that today carry the equivalent of the entire population of the United States within a five-day period. Today, this medium can be found in almost every city or town in the United States with a population of 15,000 or more, and also in many smaller markets

Disparities in Hospital Services Utilization Among Patients with Mental Health Issues: A Statewide Example Examining Insurance Status and Race Factors from 1999-2010

There exist many disconnects between the mental and general health care sectors. However, a goal of the Affordable Care Act (ACA) of 2010 is to change this by improving insurance access and the intersection of mental and general health care. As insurance status intersects with race, the present study examines how race, insurance status, and hospital mental health services utilization differ across groups within the state of New Jersey. The present study aims to determine trends in hospital mental health care utilization by insurance status and race from 1999 to 2010. The rate of self-pay for mental health disorders in the Black population was significantly higher than the rate for Whites and Asians during this period. However, though Asian mental health utilization increased the most over the 11-year period, the Asian population had the slowest growth in self-pay rates. ANOVA tests demonstrated significant differences in the rate of self-pay mental health cases between race groups (

A transfer matrix approach to aid in the design and optimization of hybrid advanced passive structures for enhancing photovoltaic efficiency

The addition of a luminescent down-shifting (LDS) layer directly onto a photovoltaic (PV) cell introduces additional loss mechanisms within the system. The combination of non-ideal photo-luminescent materials encapsulated within a limited range of viable host materials, with the increased reflection losses arising from the newly created interface represent losses which must be overcome for LDS to offer an enhancement to the underlying cells efficiency. Exploiting the interaction between the highly enhanced electric fields established close to a metal nanoparticles (MNP’s) surface is one route aimed at mitigating the poor optical properties of the luminophore-host combinations available. Alternative approaches, aimed at addressing the other loss mechanisms within such a system have gone relatively unexplored. Exploiting the non-ideal nature of the photo-luminescent materials available, offers a possibility of recycling the photons which previously did not undergo photoluminescence while also addressing the reflection losses through the inclusion of selectively reflecting optical structures. The hybrid device designs, incorporating single- and double layer- antireflection coatings composed of commonly available materials offer enhancements in the underlying PV cells performance of 8% - 30% depending upon the design criteria established. The transfer matrix approach adopted allowed the impact of individual design considerations on the reflection suppression capabilities of the structure, as well as their impact on the underlying cells efficiency to be readily determined

Hybridisation as an experiential phenomenon: A practice-based approach towards conceptualising musical hybridisation

Hybridisation is a multifaceted term that appears across several sociocultural contexts, while common conceptualisations of musical hybridisation in scholarship tend to be positioned in genre studies. As a result of the perceived disjunctions of taxonomical framings of genre however, analytically satisfying definitions of musical hybridity are seldom offered and this clear gap in musicological, ethnomusicological, and cultural research is yet to be adequately explored by conventional theoretical research. This thesis therefore argues that a practice-based approach is more appropriate towards contextualising and understanding this phenomenon. In doing so, it problematises language and concepts, including genre, that fail to accurately describe such phenomena and move towards a more tangible definition of hybridity. This is approached through the creation of a genre-free framework for the creation and analysis of this phenomenon, establishing the musical hybrid as an experiential product, and musical hybridisation as a process that entangles various modalities (theorised in this thesis) of construction, expression, and experience. This framework informs and contextualises a portfolio of original Scottish Gaelic-language music that exploits these modalities, providing a practical contextualisation of the hybridisation framework through the analysis of the hybridisation process and hybrid product(s) of the compositional work. Consequently, this thesis offers knowledge in the form of the theoretical framework and the musical output of my practice

Development of poly-vinyl alcohol stabilized silver nanofluids for solar thermal applications

Nanofluids offer the potential to address the low thermal conductivities found in conventional heat transfer fluids, through their unique electrical, optical and thermal properties, but their implementation remains restricted due to absorption and stability limitations. Here, we characterize and exploit the distinctive plasmonic properties exhibited by polyvinyl-alcohol stabilized silver nanostructures by tuning their absorption and thermal properties through controlling the nanoparticle size, morphology and particle-size distribution configuration at the synthesis stage. The photo-thermal efficiency of different water-based silver nanofluids under a standard AM1.5G weighted solar spectrum were explored, the influence of each of these components on the resulting fluids performance within a direct absorption solar thermal collection system being considered. Nanofluids, containing an extensive ensemble of particle size-distributions (5 nm–110 nm in diameter) in addition to anisotropic particle morphologies (e.g. prisms, hexagons and other non-spherical geometries), exhibited a significant enhancement in the absorption and photo-thermal energy transfer. Enhancements of 5%–32% in the photo-thermal conversion efficiency were achieved, the enhancement being dependent upon the presence of multiple particle size-distributions and the particle concentration. The enhancement is influenced by the interactions occurring between the individual particle size-distributions but also by the collective behaviour of the particles ensemble. The critical particle diameter, above which the photo-thermal characteristics of the nanofluid become dominated by the larger sized particles present, was identified as 150 nm. The increased performance of these nanofluids, which adopt a more complex particle-size configuration, suggests that they can represent suitable candidates for solar-thermal applications

Influence of PVAc/PVA Hydrolysis on Additive Surface Activity

This aims to establish design rules for the influence of complex polymer matrices on the surface properties of small molecules. Here, we consider the dependence of the surface behaviour of some model additives on polymer matrix hydrophobicity. With stoichiometric control over hydrolysis, we generate systematic changes in matrix chemistry from non-polar, hydrophobic PVAc to its hydrolysed and hydrophilic analogue, PVA. With the changing degree of hydrolysis (DH), the behaviour of additives can be switched in terms of compatibility and surface activity. Sorbitol, a polar sugar-alcohol of inherently high surface energy, blooms to the surface of PVAc, forming patchy domains on surfaces. With the increasing DH of the polymer matrix, its surface segregation decreases to the point where sorbitol acts as a homogeneously distributed plasticiser in PVA. Conversely, and despite its low surface energy, octanoic acid (OA) surprisingly causes the increased wettability of PVAc. We attribute these observations to the high compatibility of OA with PVAc and its ability to reorient upon exposure to water, presenting a hydrophilic COOH-rich surface. The surfactant sodium dodecyl sulfate (SDS) does not show such a clear dependence on the matrix and formed wetting layers over a wide range of DH. Interestingly, SDS appears to be most compatible with PVAc at intermediate DH, which is consistent with the amphiphilic nature of both species under these conditions. Thus, we show that the prediction of the segregation is not simple and depends on multiple factors including hydrophobicity, compatibility, blockiness, surface energy, and the mobility of the components

Use of optical fibres for multi-parameter monitoring in electrical AC machines

This paper describes a new approach to multi-parameter monitoring for electrical AC machines. It is demonstrated that speed, torque and temperature can be measured using optical fibres incorporating sensors in the form of fibre Bragg gratings (FBGs) distributed around the machine. One fibre can incorporate several FBGs and hence provide several measurements. Experimental results showing speed, torque, direction of rotation, stator housing vibration and temperature measured using the FBG method are presented and validated against measurements obtained from conventional sensors. The results show that the optical fibre based approach allows multiple parameters to be monitored accurately and simultaneously with only a fraction of the usual monitoring equipment required. Another advantage of the proposed method is the EMI immunity naturally provided by optical solutions. The presented measurement technique can also offer a new alternative approach to sensorless control

Nature and type of patient-reported safety incidents in primary care: Cross-sectional survey of patients from Australia and England

Background Patient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement. Objective The aim of this study was to characterise the nature of patient-reported safety incidents in primary care. Design Secondary analysis of two cross sectional studies. Participants Adult patients from Australian and English primary care settings. Measures Patients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented. Results A total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent. Conclusions The nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement