Health region development from the perspective of system theory - An empirical cross-regional case study

Governments are increasingly establishing health regions to deal with current challenges of public health service. These regions are seen as instruments to balance public and private stakeholders, and offer health care to regional citizens as well as to medical/health tourists. However, it is still unclear how the development of such health regions as well as their governance may be conceptualized. We apply Luhmann's system theory approach in the context of a cross-regional case study that compares health region developments in the Autonomous Province of Bolzano-South Tyrol (Italy) with particular regard to the Eastern Dolomites and in the province of Zeeland (the Netherlands). We suggest that Luhmann's system theory provides a useful set of criteria to evaluate and judge health region development. Fully developed health regions can be understood as auto-poietic systems. By emphasizing programs, personnel, and communication channels, these case studies illustrate the suitability of the system theory toolset to analyze the governance and spatial embeddedness of health regions. Additionally, the study contributes to literature by indicating that health regions are closely related to identity issues and to decision making in regions

A Parallel Algorithm for Solving the 3d Schrodinger Equation

We describe a parallel algorithm for solving the time-independent 3d Schrodinger equation using the finite difference time domain (FDTD) method. We introduce an optimized parallelization scheme that reduces communication overhead between computational nodes. We demonstrate that the compute time, t, scales inversely with the number of computational nodes as t ~ N_nodes^(-0.95 +/- 0.04). This makes it possible to solve the 3d Schrodinger equation on extremely large spatial lattices using a small computing cluster. In addition, we present a new method for precisely determining the energy eigenvalues and wavefunctions of quantum states based on a symmetry constraint on the FDTD initial condition. Finally, we discuss the usage of multi-resolution techniques in order to speed up convergence on extremely large lattices.Comment: 18 pages, 7 figures; published versio

Detection of mammaglobin mRNA in peripheral blood is associated with high grade breast cancer: Interim results of a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>We sought to examine the detection rate of cancer cells in peripheral blood (PBL) and in bone marrow (BM) using an established 7-gene marker panel and evaluated whether there were any definable associations of any individual gene with traditional predictors of prognosis.</p> <p>Methods</p> <p>Patients with T1-T3 primary breast cancer were enrolled into a prospective, multi-institutional cohort study. In this interim analysis 215 PBL and 177 BM samples were analyzed by multimarker, real-time RT-PCR analysis designed to detect circulating and disseminated breast cancer cells.</p> <p>Results</p> <p>At a threshold of three standard deviations from the mean expression level of normal controls, 63% (136/215) of PBL and 11% (19/177) of BM samples were positive for at least one cancer-associated marker. Marker positivity in PBL demonstrated a statistically significant association with grade II-III (vs. grade I; p = 0.0083). Overexpression of the mammaglobin (<it>mam</it>) gene alone had a statistically significant association with high tumor grade (p = 0.0315), and showed a trend towards ER-negative tumors and a high risk category. There was no association between marker positivity in PBL and the pathologic (H&E) and/or molecular (RT-PCR) status of the axillary lymph nodes (ALN).</p> <p>Conclusion</p> <p>This study suggests that molecular detection of circulating cancer cells in PBL detected by RT-PCR is associated with high tumor grade and specifically that overexpression of the <it>mam </it>gene in PBL may be a poor prognostic indicator. There was no statistically significant association between overexpression of cancer-associated genes in PBL and ALN status, supporting the concept of two potentially separate metastatic pathways.</p

Motivations of non-Buddhists visiting Buddhist temples

The current study employs the leisure motivation scale to examine motivations of non- Buddhists visiting Buddhist temples. Specifically, this investigation builds on tourism literature to explore the motivations of non-Buddhists visiting Buddhist temples in Los Angeles, California. Motivations to Buddhist temples are of particular interest given the increasing popularity in the West of Eastern spiritual activities, such as yoga and meditation, as well as the exponential growth of Buddhist-themed tourism campaigns. The findings provide insights for tourism officials responsible for promoting ways to attract tourists to Buddhist temples within their respective destinations

Advancing science and policy through a coordinated international study of physical activity and built environments: IPEN Adult methods

Background: National and international strategies to increase physical activity emphasize environmental and policy changes that can have widespread and long-lasting impact. Evidence from multiple countries using comparable methods is required to strengthen the evidence base for such initiatives. Because some environment and policy changes could have generalizable effects and others may depend on each country&rsquo;s context, only international studies using comparable methods can identify the relevant differences. Methods: Currently 12 countries are participating in the International Physical Activity and the Environment Network (IPEN) study. The IPEN Adult study design involves recruiting adult participants from neighborhoods with wide variations in environmental walkability attributes and socioeconomic status (SES). Results: Eleven of twelve countries are providing accelerometer data and 11 are providing GIS data. Current projections indicate that 14,119 participants will provide survey data on built environments and physical activity and 7145 are likely to provide objective data on both the independent and dependent variables. Though studies are highly comparable, some adaptations are required based on the local context. Conclusions: This study was designed to inform evidence-based international and country-specific physical activity policies and interventions to help prevent obesity and other chronic diseases that are high in developed countries and growing rapidly in developing countries

An intercomparison of global oceanic precipitation climatologies

Large-scale patterns of precipitation are important for the changes they may effect upon the circulation of the ocean. However, marine precipitation is very hard to quantify accurately. Four independent climatologies are examined to compare their estimates of the annual mean precipitation, and the seasonal and interannual variations. One data set, Global Precipitation Climatology Project (GPCP), is based upon satellite data, the other three on output of weather forecast reanalyses from the National Centers for Environmental Prediction (NCEP) and the European Centre for Medium-range Weather Forecasts (ECMWF). Although all datasets have their errors, there is general agreement on the geographical patterns of precipitation. All the models had higher rain rates in the tropics than shown by the satellite data, and also greater seasonal ranges. However, GPCP has 10-25% more precipitation than NCEP and ECMWF in most of the southern regions, because of their weak representation of convergence zones; NCEP2, a more recent version of the NCEP reanalysis, shows a marked improvement in this area. However, in most regions NCEP2 exhibits a larger seasonal range than shown by other datasets, particularly for the tropical Pacific. Both NCEP and NCEP2 often show a seasonal cycle lagging two months or more behind GPCP. Of the three reanalysis climatologies, ECMWF appears best at realising the position and migration of rain features. The interannual variations are correlated between all four datasets, however the correlation coefficient is only large for regions that have a strong response to El Niño and La Niña event, or for comparisons of the two NCEP reanalyses. Of the datasets evaluated, GPCP has the most internal consistency, with no long-term trend in its regional averages, and it alone shows the deficit in Mediterranean precipitation coincident with the Eastern Mediterranean Transient