Competition, quality and contract compliance: evidence from compulsory competitive tendering in local government in Great Britain, 1987-2000

The introduction of competition has frequently been found to cause costs to fall. There has, however, been a question as to whether this was partly achieved at the cost of quality. Auction theory predicts prices would fall more the greater the competition to provide the service. There has been some debate about whether the smaller budgets would make contract compliance more difficult. Evidence is found in support of this hypothesis. We also find some evidence that the better recorded performance of the in-house direct service organisations (DSOs) during this period was due to the information advantage they had from being incumbents

Caring in Kent: Patterns and Profiles, Evidence from the Kent Health and Lifestyle Survey, 2005

The ‘Caring in Kent’ report draws on the results of a Kent wide ‘Health and Lifestyle Survey’ conducted in 2005; this included a module on caring. This enables a picture of caring to be reported including: a general profile of carers, levels and types of care-giving, carers’ health, and the level and types of support they receive. ‘Carers provide unpaid care by looking after an ill, frail or disabled family member, friend or partner’. The increasingly recognised importance of the role of the ‘informal carer’ is - in good part - due to the rising proportion of older people in the UK population. Not only do people live longer but many experience a number of chronic conditions; these require support from family members if the older person is to remain living in the community

Cross-language Wikipedia Editing of Okinawa, Japan

This article analyzes users who edit Wikipedia articles about Okinawa, Japan, in English and Japanese. It finds these users are among the most active and dedicated users in their primary languages, where they make many large, high-quality edits. However, when these users edit in their non-primary languages, they tend to make edits of a different type that are overall smaller in size and more often restricted to the narrow set of articles that exist in both languages. Design changes to motivate wider contributions from users in their non-primary languages and to encourage multilingual users to transfer more information across language divides are presented.Comment: In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI 2015. AC

Does enternal nutrition affect clinical outcome? A systematic review of the randomized trials

Background: Both parenteral nutrition (PN) and enteral nutrition (EN) are widely advocated as adjunctive care in patients with various diseases. A systematic review of 82 randomized controlled trials (RCTs) of PN published in 2001 found little, if any, effect on mortality, morbidity, or duration of hospital stay; in some situations, PN increased infectious complication rates. Objective: To assess the effect of EN or volitional nutrition support (VNS) in individual disease states from available randomized controlled trials (RCTs). Design: We conducted a systematic review. RCTs comparing EN or VNS to untreated controls, or comparing EN to PN, were identified and separated according to the underlying disease state. Meta-analysis was performed when at least 3 RCTs provided data. The evidence from the RCTs was summarized into one of five grades. A or B indicated the presence of strong or weak (low quality RCTs) evidence supporting the use of the intervention. C indicated a lack of adequate evidence to make any decision about efficacy. D indicated that limited data could not support the intervention. E indicated either that strong data found no effect, or that either strong or weak data suggested that the intervention caused harm. Patients and settings: RCTs could include either hospitalized or non-hospitalized patients. The EN or VNS had to be provided as part of a treatment plan for an underlying disease process. Interventions: The RCT had to compare recipients of either EN or VNS to controls not receiving any type of artificial nutrition or had to compare recipients of EN with recipients of PN. Outcome measures: Mortality, morbidity (disease-specific), duration of hospitalization, cost, or interventional complications. Summary of grading: A – No indication was identified. B – EN or VNS in the perioperative patient or in patients with chronic liver disease; EN in critically ill patients or low birth weight infants (trophic feeding); VNS in malnourished geriatric patients. (The low quality trials found a significant difference in survival favoring the VNS recipients in the malnourished geriatric patient trials; two high quality trials found non-significant differences that favored VNS as well.) C – EN or VNS in liver transplantation, cystic fibrosis, renal failure, pediatric conditions other than low birth weight infants, well-nourished geriatric patients, non-stroke neurologic conditions, AIDS; EN in acute pancreatitis, chronic obstructive pulmonary disease, non-malnourished geriatric patients; VNS in inflammatory bowel disease, arthritis, cardiac disease, pregnancy, allergic patients, preoperative bowel preparation D – EN or VNS in patients receiving non-surgical cancer treatment or in patients with hip fractures; EN in patients with inflammatory bowel disease; VNS in patients with chronic obstructive pulmonary disease E – EN in the first week in dysphagic, or VNS at any time in non-dysphagic, stroke patients who are not malnourished; dysphagia persisting for weeks will presumably ultimately require EN. Conclusions: There is strong evidence for not using EN in the first week in dysphagic, and not using VNS at all in non-dysphagic, stroke patients who are not malnourished. There is reasonable evidence for using VNS in malnourished geriatric patients. The recommendations to consider EN/VNS in perioperative/liver/critically ill/low birth weight patients are limited by the low quality of the RCTs. No evidence could be identified to justify the use of EN/VNS in other disease states

Seeing with sound: Investigating the behavioural applications and neural correlates of human echolocation

Some blind humans use the reflected echoes from self-produced signals to perceive their silent surroundings. Although the use of echolocation is well documented in animals such as bats and dolphins, comparatively little is known about human echolocation. The overarching goal of the work presented in this thesis was to shed light on some of the basic functions of human echolocation, including the perception of the shape, size, and material. I addressed these aspects of echolocation using behavioural psychophysics and neuroimaging. In Chapter 2 I show that blind echolocators were able to accurately identify the shape of 2D objects, but that their ability to do so was dependent on the use of head and body movements to ‘scan’ the objects’ edges. I suggest that these scanning movements may be similar to the many saccades made by sighted individuals when visually surveying an object or scene. In Chapter 3 I addressed the possibility that object size perception via echolocation shows size constancy – a perceptual phenomenon associated with vision. The results revealed that an expert echolocator accurately perceived the true physical size of objects independent of their distance, even though changes to distance directly affect size-related echo information. The results of this study highlight the ‘visual’ nature of echolocation, and suggest further parallels between the two modalities than previously known or theorized. Chapter 4 presents the results of a functional neuroimaging study aimed at uncovering the neural correlates of material processing via echolocation. By having echolocators listen to recordings of echoes reflected from surfaces of different materials, I show not only that they can determine the material properties of objects, but also that the neural processing underlying this ability may make use of a visual- and auditory-material processing area in the parahippocampal cortex. Taken together, the work presented in the current thesis describes some of the recent contributions to our understanding of human echolocation, with a particular emphasis on its apparent parallels with vision and visual processing. The results of this work show that accurate and reliable information can be extracted from echoes, thus supporting echolocation as a viable resource for the blind

Pulse Width Modulated Adaptive Delta Modem Design and Analysis

A unique design of a voiceband adaptive delta modem will be presented. The modulator utilizes a constant amplitude variable width pulse combined with the principles of delta modulation. This results in a modem that has lower amplitude distortion, requires less transmission channel bandwidth, and is less prone to slope overload than conventional adaptive delta modems. The design also allows the use of a simple single integration demodulator while maintaining fidelity. The modem design and analysis is presented assuming a transmission channel which is bandwidth limited and amplitude limited