8,182 research outputs found

    Strategies for health services

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    The GPRIME approach to finite element modeling

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    GPRIME, an interactive modeling system, runs on the CDC 6000 computers and the DEC VAX 11/780 minicomputer. This system includes three components: (1) GPRIME, a user friendly geometric language and a processor to translate that language into geometric entities, (2) GGEN, an interactive data generator for 2-D models; and (3) SOLIDGEN, a 3-D solid modeling program. Each component has a computer user interface of an extensive command set. All of these programs make use of a comprehensive B-spline mathematics subroutine library, which can be used for a wide variety of interpolation problems and other geometric calculations. Many other user aids, such as automatic saving of the geometric and finite element data bases and hidden line removal, are available. This interactive finite element modeling capability can produce a complete finite element model, producing an output file of grid and element data

    Saccadic latency in amblyopia.

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    We measured saccadic latencies in a large sample (total n = 459) of individuals with amblyopia or risk factors for amblyopia, e.g., strabismus or anisometropia, and normal control subjects. We presented an easily visible target randomly to the left or right, 3.5° from fixation. The interocular difference in saccadic latency is highly correlated with the interocular difference in LogMAR (Snellen) acuity-as the acuity difference increases, so does the latency difference. Strabismic and strabismic-anisometropic amblyopes have, on average, a larger difference between their eyes in LogMAR acuity than anisometropic amblyopes and thus their interocular latency difference is, on average, significantly larger than anisometropic amblyopes. Despite its relation to LogMAR acuity, the longer latency in strabismic amblyopes cannot be attributed either to poor resolution or to reduced contrast sensitivity, because their interocular differences in grating acuity and in contrast sensitivity are roughly the same as for anisometropic amblyopes. The correlation between LogMAR acuity and saccadic latency arises because of the confluence of two separable effects in the strabismic amblyopic eye-poor letter recognition impairs LogMAR acuity while an intrinsic sluggishness delays reaction time. We speculate that the frequent microsaccades and the accompanying attentional shifts, made while strabismic amblyopes struggle to maintain fixation with their amblyopic eyes, result in all types of reactions being irreducibly delayed

    The impact of private sector provision on equitable provision of coronary revascularisation

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    Objective: To investigate the impact of including private sector data on assessments of equity of coronary revascularisation provision using NHS data only. Design: Analyses of Hospital Episodes Statistics and private sector data by age, sex, and PCT of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. GINI coefficients were derived to provide an index of inequality across sub-populations, with parametric bootstrapping to estimate confidence intervals. Setting: London Participants London residents undergoing coronary revascularisation April 2001 - December 2003. Intervention Coronary artery bypass graft or angioplasty Main outcome measures: Directly-standardised revascularisation rates, GINI coefficients. Results: NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p=0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately-funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS funded care alone. Conclusion: Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place

    Health needs of the Roma population in the Czech and Slovak Republics.

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    In the growing literature on the human rights of Roma people in Central Europe, their relatively poor health status is often mentioned. However, little concrete information exists about the contemporary health status of the Roma in this region. We sought information on the health of the Roma in two of countries with significant Roma minorities, the Czech and Slovak Republics, by means of systematic searches for literature on the health of Roma people published in Czech or Slovak or by authors from the two countries. Published research on health of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. What limited evidence exists indicates that the health needs of the Roma population are considerable. With very few exceptions, the health status of Roma is worse than that of non-Roma population in both countries. The burden of communicable disease among Roma is high and diseases associated with poor hygiene seem to be particularly important. Evidence on health care suggests poor communication between Roma and health workers and low uptake of preventative care. The health needs of Roma lack visibility, not only because of the absence of research but also the absence of advocacy on their behalf. Since 1989, Czech and Slovak researchers have largely turned away from health research on particular ethnic groups. This probably reflects a growing sensitivity about stigmatising Roma, but it also makes it difficult to know how their circumstances might be improved. There is a need for further research into the health of Roma people with particular emphasis on non-communicable disease and for interventions that would improve their health

    Active management of multi-service networks.

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    Future multiservice networks will be extremely large and complex. Novel management solutions will be required to keep the management costs reasonable. Active networking enables management to be delegated to network users as a large set of independent small scale management systems. A novel architecture for an active network based management solution for multiservice networking is presented

    De resultaten van het Nederlandse gezondheidsbeleid: een Europese vergelijking

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    Conceptual design studies of candidate V/STOL lift fan commercial short haul transport for 1980 - 1985 V/STOL lift fan study

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    Conceptual designs of V/STOL lift fan commercial short haul transport aircraft for the 1980-85 time period were studied to determine their technical and economic feasibility. The engine concepts included both integral and remote fans. The scope of the study included definition of the hover control concept for each propulsion system, aircraft design, aircraft mass properties, cruise performance, noise and ride qualities evaluation. Economic evaluating was also studied on a basis of direct operating costs and route structure

    The Propagation and Survival of Interstellar Grains

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    In this paper we discuss the propagation of dust through the interstellar medium (ISM), and describe the destructive effects of stellar winds, jets, and supernova shock waves on interstellar dust. We review the probability that grains formed in stellar outflows or supernovae survive processing in and propagation through the ISM, and incorporate themselves relatively unprocessed into meteoritic bodies in the solar system. We show that very large (radii >= 5 micron) and very small grains (radii <= 100 Angstrom) with sizes similar to the pre-solar SiC and diamond grains extracted from meteorites, can survive the passage through 100\kms shock waves relatively unscathed. High velocity (>= 250 km/s) shocks destroy dust efficiently. However, a small (~10%) fraction of the stardust never encountered such fast shocks before incorporation into the solar system. All grains should therefore retain traces of their passage through interstellar shocks during their propagation through the ISM. The grain surfaces should show evidence of processing due to sputtering and pitting due to small grain cratering collisions on the micron-sized grains. This conclusion seems to be in conflict with the evidence from the large grains recovered from meteorites which seem to show little interstellar processing.Comment: 19 pages, 5 figures (.eps), LaTeX, to appear in "Astrophysical Implications of the Laboratory Study of Presolar Materials" AIP Conference Proceedings, 1997 T.J. Bernatowicz and E. Zinner (eds.

    Regulating Scotland's social landlords: localised resistance to technologies of performance management

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    Influenced by Foucault's later work on governmentality, this paper explores the regulation of social landlords as a 'technology of performance' concerned with governing the conduct of dispersed welfare agencies and the professionals within them. This is a mode of power that is both voluntary and coercive; it seeks to realise its ambitions not through direct acts of intervention, but by promoting the responsible self-governance of autonomous subjects. Through an analysis of the regulatory framework for social landlords in Scotland, this paper highlights the creation of a performance culture that seeks to mobilise housing organisations to reconcile their local management systems and service provision to external standards, whilst simultaneously wielding punitive interventions for non-compliance. However, housing professionals are not passive in all of this, and indeed, actively challenged and resisted these top-down attempts to govern them at arm's-length
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