Rationing Health Care in Canada

Canada has been able to develop a fairly successful system of healthcare rationing by balancing the conflicting concerns of equal access and cost efficiency, federal funding and provincial control, and public sector management and private sector provision. Financial constraints limit the kinds of services included within the notion of equal access however, forcing healthcare providers to make difficult choices about who will receive a particular healthcare service

Farm land and debt situation in Iowa, 1935

Corporate-owned land amounted on January 1, 1935, to 10.1 percent of the 34 million acres of farm land in Iowa. Insurance companies hold over half the corporate-owned land, with deposit banks the second largest holder. Centers of concentration are in the south-central, north-central and a small area in the western part of the state. The Iowa farm mortgage debt was reduced by $74,000,000 during 1934, and now totals$924,000,000, of which 40 percent is held by insurance companies, 26 percent by the Farm Credit Administration and 12 percent by banks The debt per acre was $63 at the close of 1934 as compared with$66 in 1933. Since 1933 there has been a reduction of 2 percent in farm land mortgaged. (Forty-three percent is now mortgaged.

Digging supplementary buried channels: investigating the notch architecture within the CCD pixels on ESA's Gaia satellite

The European Space Agency (ESA) Gaia satellite has 106 CCD image sensors which will suffer from increased charge transfer inefficiency (CTI) as a result of radiation damage. To aid the mitigation at low signal levels, the CCD design includes Supplementary Buried Channels (SBCs, otherwise known as `notches') within each CCD column. We present the largest published sample of Gaia CCD SBC Full Well Capacity (FWC) laboratory measurements and simulations based on 13 devices. We find that Gaia CCDs manufactured post-2004 have SBCs with FWCs in the upper half of each CCD that are systematically smaller by two orders of magnitude (<50 electrons) compared to those manufactured pre-2004 (thousands of electrons). Gaia's faint star (13 < G < 20 mag) astrometric performance predictions by Prod'homme et al. and Holl et al. use pre-2004 SBC FWCs as inputs to their simulations. However, all the CCDs already integrated onto the satellite for the 2013 launch are post-2004. SBC FWC measurements are not available for one of our five post-2004 CCDs but the fact it meets Gaia's image location requirements suggests it has SBC FWCs similar to pre-2004. It is too late to measure the SBC FWCs onboard the satellite and it is not possible to theoretically predict them. Gaia's faint star astrometric performance predictions depend on knowledge of the onboard SBC FWCs but as these are currently unavailable, it is not known how representative of the whole focal plane the current predictions are. Therefore, we suggest Gaia's initial in-orbit calibrations should include measurement of the onboard SBC FWCs. We present a potential method to do this. Faint star astrometric performance predictions based on onboard SBC FWCs at the start of the mission would allow satellite operating conditions or CTI software mitigation to be further optimised to improve the scientific return of Gaia.Comment: Accepted for publication in MNRAS, 16 pages, 19 figure

The clinical utility of routine urinalysis in pregnancy: A prospective study

Objectives: To determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre-eclampsia. Can routine urinalysis during pregnancy be discontinue in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit? Design: Prospective observational study. Setting: A metropolitan public hospital and a private hospital in Sydney (NSW). Participants: One thousand women were enrolled at their first antenatal visit (March to November 1999), and 913 completed the study. Outcome measures: The primary outcome was a diagnosis of de novo hypertension (gestational hypertension, pre-eclampasia, or pre-eclampsia superimposed on chronic hypertension). Results: Thirty-five women had dipstick proteinuria at the first antenatal visit. In 25 (71%) of these women, further dipstick proteinuria was detected during pregnancy, and two (6%) were diagnosed with pre-eclampsia. Of the 867 without dipstick proteinuria at the first visit, 338 (39%) had dipstick proteinuria (> 1+) at some time during pregnancy. There were no statistically significant differences in the proportion of women with and without dipstick proteinuria at their first visit who developed hypertension during pregnancy. Only six women developed proteinuria before the onset of hypertension. Women who had an abnormal result of a midstream urine test at their first visit, compared with women with a normal result, were more likely to have a urinary tract infection diagnosed during pregnancy; however, the numbers were small. Conclusion: In the absence of hypertension, routine urinalysis during pregnancy is a poor predictor of pre-eclampsia. Therefore, after an initial screening urinalysis, routine urinalysis could be eliminated from antenatal care without adverse outcomes for women

Exploring the effect of ADHD traits on the moment‐to‐moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling

The relation between attention deficit hyperactivity disorder (ADHD) symptoms and aggression is well documented; however, the processes that account for higher levels of aggression associated with ADHD in the course of daily life are little understood. The current study used ecological momentary assessment to explore how ADHD traits relate to individual differences in perceiving provocation from others and the resultant aggressive behaviors; and the strengths of the links between provocation and aggression in the flow of daily life. A dynamic structural equation model was fit using data from a subpopulation of young adults involved in the longitudinal z‐proso study (n = 259, median‐age 20). Data on provocation and aggression was collected at four quasi‐random time periods per day over a 14‐day period. Individuals with higher ADHD trait levels reported higher instances of provocation and aggression, with ADHD traits significantly moderating aggression inertia such that those with higher levels of ADHD traits showed greater persistence of aggressive behavior over time. However, ADHD trait levels did not significantly moderate any of the observed cross‐lagged effects. Our findings suggest that individuals with higher levels of ADHD traits are at greater risk of exposure to interpersonal interactions involving interpersonal provocation, show higher levels of aggressive behavior in daily life, and find it more difficult to reduce their aggression once triggered. These findings support the importance of targeting factors such as social skills and emotion regulation that may underpin the increased difficulties in interpersonal interactions often experienced by individuals with high levels of ADHD symptoms

Referral for menstrual problems:cross sectional survey of symptoms, reasons for referral, and management

OBJECTIVES: To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics, and clinic outcome. DESIGN: Questionnaire survey, with partial review of case notes after 8 months. SETTING: Three hospital gynaecology clinics in Glasgow and Edinburgh. PARTICIPANTS: 952 women completed the questionnaire, and the first 665 were reviewed. OUTCOME MEASURES: Reason for referral, women's reported menstrual problems and reason for clinic attendance, diagnosis, and treatment. RESULTS: Only 38% (95% confidence interval 34% to 41%) of women reported excessive menstrual loss as a severe problem. However 60% (57-63%) gave it as reason for attending a clinic, and 76% (73-79%) of general practitioners gave it as reason for referral. Reason for referral was significantly biased towards bleeding (McNemar odds ratio 4.01, 3.0 to 5.3, P<0.001) and against pain (0.54, 0.4 to 0.7, P<0.001). Dysfunctional uterine bleeding was diagnosed in 37% (31-42%) of the 259 women who gave as reason for attendance something other than bleeding. Women who were economically disadvantaged differed in prevalence of the main diagnoses and were more likely to fail to reattend. Hysterectomy was associated with referral for bleeding (relative risk 4.9, 1.6 to 15.6, P<0.001) but not with the patient stating bleeding as the reason for clinic attendance. CONCLUSIONS: Intolerance of the volume of their bleeding is not a key feature among women attending clinics for bleeding problems. Broad menstrual complaint tends to be reframed as excessive bleeding at referral and during management. This may result in women receiving inappropriate care. Conceptualisation and assessment of menorrhagia requires reconsideration

A study of psychiatrists’ concepts of mental illness

Background: There are multiple models of mental illness that inform professional and lay understanding. Few studies have formally investigated psychiatrists' attitudes. We aimed to measure how a group of trainee psychiatrists understand familiar mental illnesses in terms of propositions drawn from different models. Method: We used a questionnaire study of a sample of trainees from South London and Maudsley National Health Service (NHS) Foundation Trust designed to assess attitudes across eight models of mental illness (e.g. biological, psychodynamic) and four psychiatric disorders. Methods for analysing repeated measures and a principal components analysis (PCA) were used. Results: No one model was endorsed by all respondents. Model endorsement varied with disorder. Attitudes to schizophrenia were expressed with the greatest conviction across models. Overall, the ‘biological’ model was the most strongly endorsed. The first three components of the PCA (interpreted as dimensions around which psychiatrists, as a group, understand mental illness) accounted for 56% of the variance. Each main component was classified in terms of its distinctive combination of statements from different models: PC1 33% biological versus non-biological; PC2 12% ‘eclectic’ (combining biological, behavioural, cognitive and spiritual models); and PC3 10% psychodynamic versus sociological. Conclusions: Trainee psychiatrists are most committed to the biological model for schizophrenia, but in general are not exclusively committed to any one model. As a group, they organize their attitudes towards mental illness in terms of a biological/non-biological contrast, an ‘eclectic’ view and a psychodynamic/sociological contrast. Better understanding of how professional group membership influences attitudes may facilitate better multidisciplinary working

The evolution of interstellar clouds in a streaming hot plasma including heat conduction

To examine the evolution of giant molecular clouds in the stream of a hot plasma we performed two-dimensional hydrodynamical simulations that take full account of self-gravity, heating and cooling effects and heat conduction by electrons. We use the thermal conductivity of a fully ionized hydrogen plasma proposed by Spitzer and a saturated heat flux according to Cowie & McKee in regions where the mean free path of the electrons is large compared to the temperature scaleheight. Significant structural and evolutionary differences occur between simulations with and without heat conduction. Dense clouds in pure dynamical models experience dynamical destruction by Kelvin-Helmholtz (KH) instability. In static models heat conduction leads to evaporation of such clouds. Heat conduction acting on clouds in a gas stream smooths out steep temperature and density gradients at the edge of the cloud because the conduction timescale is shorter than the cooling timescale. This diminishes the velocity gradient between the streaming plasma and the cloud, so that the timescale for the onset of KH instabilities increases, and the surface of the cloud becomes less susceptible to KH instabilities. The stabilisation effect of heat conduction against KH instability is more pronounced for smaller and less massive clouds. As in the static case more realistic cloud conditions allow heat conduction to transfer hot material onto the cloud's surface and to mix the accreted gas deeper into the cloud.Comment: 19 pages, 12 figures, accepted in Astronomy and Astrophysic

Enhancement of low-mass dileptons in heavy-ion collisions

Using a relativistic transport model for the expansion stage of S+Au collisions at 200 GeV/nucleon, we show that the recently observed enhancement of low-mass dileptons by the CERES collaboration can be explained by the decrease of vector meson masses in hot and dense hadronic matter.Comment: 12 pages, RevTeX, 3 figures available from [email protected]