Perspectives on the policy ‘black box’: a comparative case study of orthopaedics services in England

AbstractThere has been much recent debate on the impact of competition on the English National Health Service (NHS). However, studies have tended to view competition in isolation and are controversial. This study examines the impact of programme theories associated with the health system reforms, which sought to move from a dominant target-led ‘central control’ programme theory, to one based on ‘market forces’, on orthopaedics across six case-study local health economies. It draws on a realistic evaluation approach to open up the policy ‘black box’ across different contexts using a mixed methods approach: analysis of 152 interviews with key informants and analysis of waiting times and admissions. We find that the urban health economies were more successful in reaching the access targets than the rural health economies, although the gap in performance closed over time. Most interviewees were aware of the policies to increase choice and competition, but their role appeared comparatively weak. Local commissioners’ ability to influence demand appeared limited with providers’ incentives dominating service delivery. Looking forward, it is clear that the role of competition in the NHS has to be considered alongside, rather than in isolation from, other policy mechanisms.</jats:p

Unforeseen crystal forms of the natural osmolyte floridoside

Floridoside (2-α-O-D-galactopyranosyl glycerol) is a glycerol glycoside that is biosynthesised by most species of red algae and has been implicated as an intracellular regulator of various homeostatic functions. Here, we report the identification of two unforeseen crystal forms of the ubiquitous natural osmolyte floridoside including a seemingly unheralded second anhydrous conformational polymorph and the unambiguous description of an elusive monohydrated variant. By employing a variety of thermal and spectroscopic techniques, we begin to explore both their macro and molecular physicochemical properties, which are notably different to that of the previously reported polymorph. This work advances the characterisation of this important natural biomolecule which could aid in facilitating optimised utilisation across a variety of anthropocentric applications and improve comprehension of its role in-vivo as a preeminent compatible solute

Development of improved performance refractory liner materials for slagging gasifiers

Refractory liners for slagging gasifiers used in power generation, chemical production, or as a possible future source of hydrogen for a hydrogen based economy, suffer from a short service life. These liner materials are made of high Cr2O3 and lower levels of Al2O3 and/or ZrO2. As a working face lining in the gasifier, refractories are exposed to molten slags at elevated temperature that originate from ash in the carbon feedstock, including coal and/or petroleum coke. The molten slag causes refractory failure by corrosion dissolution and by spalling. The Albany Research Center is working to improve the performance of Cr2O3 refractories and to develop refractories without Cr2O3 or with Cr2O3 content under 30 wt pct. Research on high Cr2O3 materials has resulted in an improved refractory with phosphate additions that is undergoing field testing. Results to date of field trials, along with research direction on refractories with no or low Cr2O3, will be discussed

Optimal k-space sampling for single point imaging of transient systems

A modification of the Single Point Imaging (SPI) is presented. The novel approach aims at increasing the sensitivity of the method and hence the resulting Signal-to-Noise ratio (SNR) for a given total time interval. With prior knowledge of the shape of the object under study, a selective sparse k-space sampling can then be used to follow dynamic phenomena of transient systems, in this case the absorption of moisture by a cereal-based wafer material. Further improvement in the image quality is achieved when the un-sampled k-space points are replaced by those of the initial dry or the final wet sample acquired at the beginning and the end of the acquisition respectively when there are no acquisition time limitations

Improving thermocouple service life in slagging gasifiers

The measurement of temperature within slagging gasifiers for long periods of time is difficult/impossible because of sensor failure or blockage of inputs used to monitor gasifier temperature. One of the most common means of temperature measurement in a gasifier is physically, through the use of thermocouples in a gasifier sidewall. These units can fail during startup, standby, or during the first 40-90 days of gasifier service. Failure can be caused by a number of issues; including thermocouple design, construction, placement in the gasifier, gasifier operation, and molten slag attack of the materials used in a thermocouple assembly. Lack of temperature control in a gasifier can lead to improper preheating, slag buildup on gasifier sidewalls, slag attack of gasifier refractories used to line a gasifier, or changes in desired gas output from a gasifier. A general outline of thermocouple failure issues and attempts by the Albany Research Center to improve the service life of thermocouples will be discussed

An analysis of the causes of failure in high chrome oxide refractory materials from slagging gasifiers

High Cr2O3 refractory materials are used to line the hot face of slagging gasifiers. Gasifiers are reaction chambers that convert water, oxygen, and a carbon feedstock into CO, H2, and methane at temperatures as high as 1575DGC and pressures up to 1000 psi. Ash in the carbon feedstock liquefies, erodes and corrodes the gasifier's refractory liner, contributing to liner failure within a few months to two years. The failure of a refractory liner decreases a gasifier's on-line availability and causes costly system downtime and repairs. Many factors contribute to refractory lining failure, including slag penetration and corrosion, thermal cycling, gasifier environment, and mechanical loads. The results of refractory post-mortem failure analysis and how observations relate to gasifier service life will be discussed