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

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

Guidelines for fabrication of hybrid microcircuits

Document is summary of approaches that may be taken in designing hybrid microcircuits similar to those for aerospace application

Similarities and contrasts in tectonic and volcanic style and history along the Colorado plateaus-to-basin and range transition zone in Western Arizona: Geologic framework for tertiary extensional tectonics

The overall temporal and spatial relations between middle Tertiary volcanism and tectonism from the Basin and Range province onto the edge of the Colorado Plateaus province suggest that a single magnetic-tectonic episode affected the entire region more or less simultaneously during this period. The episode followed a post-Laramide (late Eocene through Oligocene) period of 25 million years of relative stability. Middle Tertiary volcanism did not migrate gradually eastward in a simple fashion onto the Colorado Plateau. In fact, late Oligocene volcanism appears to be more voluminous near the Aquarius Mountains than throughout the adjacent Basin and Range province westward to the Colorado River. Any model proposed to explain the cause of extension and detachment faulting in the eastern part of the Basin and Range province must consider that the onset of volcanism appears to have been approximately synchronous from the Colorado River region of the Basin and Range across the transition zone and onto the edge of the Colorado Plateaus

MODELING THE EFFECT OF SPATIAL EXTERNALITIES ON INVASIVE SPECIES MANAGEMENT

Changes in production conditions associated with biological invasions can be complex. As a result, modeling invasive species management decisions can be difficult. Modeling these decisions is further compounded by externalities associated with spatial relationships among growers. In order to calculate optimal management decisions, an accurate bioeconomic model of the feedback between grower decisions and the new biological interactions created by an invasive species population is needed. In this paper, a bioeconomic model is used to explicitly analyze how externalities caused by spatial relationships among agricultural producers affect optimal invasive species management decisions. The example of the coordinated greenhouse whitefly management in the Oxnard, CA, area is discussed. This is an interesting example because of the complex cycle of host crops used by the whitefly and the effect this cycle has on the optimal whitefly management decisions for strawberry growers. Three research objectives achieved in this paper include first, using the model to assess how the spatial relationship among growers affects incentives for regional invasive pest management. Second, analyze whether current policies could be adjusted to substitute for coordination among growers. Third, the use of the bioeconomic model to identify factors for this specific case that affect whether or not growers may voluntarily coordinate their management decisions. We find that spatial relationships among growers affect the need for coordination in the strawberry/whitefly case. Whitefly migrations across host crop fields require growers to manage the whitefly on a regional basis in order to maximize strawberry producer welfare. The results also indicate that the amount of effort needed to achieve coordination required is limited; the only requirement is that information related to field management be shared among growers of whitefly host crops. The results from the bioeconomic model describe the biological and economic feedback of the grower's decision which allows policymakers to identify the willingness of producers to coordinate at various times of year. In the Oxnard strawberry/whitefly case, for example, growers will not find it optimal to adjust their application timing for a second immigration of adult greenhouse whiteflies when they occur near the end of the season, such as in May or June, but will for earlier points in the season. Three policy implications of the results from the strawberry/whitefly case are also discussed in the paper. First, adjustments to current policies regulating whitefly management do not remove the need for coordination among growers to them. Also, it was found that current policies do not, by themselves, generate the need for coordination. Finally, the results show it is not always necessary to create a central agency for regional invasive species management.Invasive species, strawberry, greenhouse whitefly, externality, optimal management, Research Methods/ Statistical Methods,

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

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

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

The HEAO A-2 survey of Abell clusters and the X-ray luminosity function

The HEAO A-2 all sky data base was surveyed for 2-10KeV X-rau emission from the 225 Abell clusters og galaxies listed in Abell's (1958) catalog which are of distance class four or less, and are within the fraction of the sky surveyed completely by Abell. Thirty-two identifications of clusters with X-ray sources were made, for which 2-10 KeV fluxes and 90% error boxes are presented. Twelve of these identification are new. The X-ray luminosity function was derived for this statistically complete sample and the best exponential fit was found to be f(L) = 20.2 x 10 to the minus 8 power exp (-l(44)/1.9) per cu Mpc 2-10KeV. The relationship between X-ray luminosity and richness was examined and a correlation was found for richness classes 0, 1, and 2. The relationship of X-rau luminosity, Bautz-Morgan type, and Rood-Sastry type was examined. It was found that BM type I's and RS type cD and B have the greatest average luminosity. The contribution of clusters to the X-ray background was calculated from the luminosity function and was found to be 5%, and with 90% certainty, less than 8% in the 2-10 KeV band pass

Reconstructing Deconstruction: High-Velocity Cloud Distance Through Disruption Morphology

We present Arecibo L-band Feed Array 21-cm observations of a sub-complex of HVCs at the tip of the Anti-Center Complex. These observations show morphological details that point to interaction with the ambient halo medium and differential drag within the cloud sub-complex. We develop a new technique for measuring cloud distances, which relies upon these observed morphological and kinematic characteristics, and show that it is consistent with H-alpha distances. These results are consistent with distances to HVCs and halo densities derived from models in which HVCs are formed from cooling halo gas.Comment: 8 pages, 2 figures, 1 tabe, Accepted to Ap

A search for X-ray emission from rich clusters, extended halos around clusters, and superclusters

The all-sky data base acquired with the HEAO A-2 experiment was searched for X-ray emission on a variety of metagalactic size scales which were either predicted or previously detected. Results in the 0.2-60 keV energy range are presented. The optically richest clusters, including those from which a microwave decrement were observed, appear to be relatively underluminous in X-rays. Observations of Abell 576 show its luminosity to be less than earlier estimates, and moreover less than the luminosity predicted from its microwave decrement, unless the intracluster gas is a factor of approximately 10 hotter than in typical clusters. Near SC0627 there are two X-ray sources, and the identification of the dominant source with SCO627 is probably incorrect. New spectral observations of Abell 401 and 2147, possible superclusters, reveal that they have typical cluster spectra with iron line emission