Building on Julian Tudor Hart's example of anticipatory care

The prevention and delay of chronic disease is an increasing priority in all advanced health-care systems, but sustainable, effective and equitable approaches remain elusive. In a famous pioneering example in the UK, Julian Tudor Hart combined reactive and anticipatory care within routine consultations in primary medical care, while applying a population approach to delivery and audit. This approach combined the structural advantages of UK general practice, including universal coverage and the absence of user fees, with his long-term commitment to individual patients, and was associated with a 28% reduction in premature mortality over a 25-year period. The more recent, and comprehensively evaluated Scottish National Health Service demonstration project, ‘Have a Heart Paisley’, took a different approach to cardiovascular prevention and health improvement, using population screening for ascertainment, health coaches and referral to specific health improvement programmes for diet, smoking and exercise. We draw from both examples to construct a conceptual framework for anticipatory care, based on active ingredients, programme pathways and whole system approaches. While the strengths of a family practice approach are coverage, continuity, co-ordination and longterm relationships, the larger health improvement programme offered additional resources and expertise. As theory and evidence accrue, the challenge is to combine the strengths of primary medical care and health improvement, in integrated, sustainable systems of anticipatory care, addressing the heterogeneity of individual needs and solutions, while achieving high levels of coverage, continuity, co-ordination and outcome

Active data structures on GPGPUs

Active data structures support operations that may affect a large number of elements of an aggregate data structure. They are well suited for extremely fine grain parallel systems, including circuit parallelism. General purpose GPUs were designed to support regular graphics algorithms, but their intermediate level of granularity makes them potentially viable also for active data structures. We consider the characteristics of active data structures and discuss the feasibility of implementing them on GPGPUs. We describe the GPU implementations of two such data structures (ESF arrays and index intervals), assess their performance, and discuss the potential of active data structures as an unconventional programming model that can exploit the capabilities of emerging fine grain architectures such as GPUs

Comparing Firm Performance Using Transitive Productivity Index Numbers in a Meta-frontier Framework

The meta-frontier framework has been used extensively for evaluating the technical efficiency of heterogeneous production units that can be classified into different groups. This paper shows how the framework can also be used to make total factor productivity (TFP) comparisons within and across groups. The paper develops a new measure of the distance between a group frontier and the meta-frontier (the so-called ‘technology gap’). It then shows how a spatially- and temporally-transitive TFP index can be decomposed into measures of global technical change (measuring movements in the metafrontier), local technical change (measuring movements in the group frontiers) and efficiency change (measuring movements towards or around the group frontiers). To illustrate the methodology, the paper examines the productive performance of road authorities responsible for maintaining interstate highways in the US state of Virginia.

A biogenic amine and a neuropeptide act identically: tyramine signals through calcium in drosophila tubule stellate cells

Insect osmoregulation is subject to highly sophisticated endocrine control. In Drosophila, both Drosophila kinin and tyramine act on the Malpighian (renal) tubule stellate cell to activate chloride shunt conductance, and so increase the fluid production rate. Drosophila kinin is known to act through intracellular calcium, but the mode of action of tyramine is not known. Here, we used a transgenically encoded GFP::apoaequorin translational fusion, targeted to either principal or stellate cells under GAL4/UAS control, to demonstrate that tyramine indeed acts to raise calcium in stellate, but not principal cells. Furthermore, the EC(50) tyramine concentration for half-maximal activation of the intracellular calcium signal is the same as that calculated from previously published data on tyramine-induced increase in chloride flux. In addition, tyramine signalling to calcium is markedly reduced in mutants of NorpA (a phospholipase C) and itpr, the inositol trisphosphate receptor gene, which we have previously shown to be necessary for Drosophila kinin signalling. Therefore, tyramine and Drosophila kinin signals converge on phospholipase C, and thence on intracellular calcium; and both act to increase chloride shunt conductance by signalling through itpr. To test this model, we co-applied tyramine and Drosophila kinin, and showed that the calcium signals were neither additive nor synergistic. The two signalling pathways thus represent parallel, independent mechanisms for distinct tissues (nervous and epithelial) to control the same aspect of renal function

Development of a cantilever beam generator employing vibration energy harvesting

This paper details the development of a generator based upon a cantilever beam inertial mass system which harvests energy from ambient environmental vibrations. The paper compares the predicted results from Finite Element Analysis (FEA) of the mechanical behaviour and magnetic field simulations and experimental results from a generator. Several design changes were implemented to maximise the conversion of magnetic energy into generated power and a maximum power output of 17.8µW was achieved at a resonant frequency of 56.6Hz and an applied acceleration of 60mg (g = 9.81ms-2)

Secularizing Demons: Fundamentalist Navigations in Religion and Secularity

Since the turn of the millennium, theologians and secular scholars of religion have increasingly begun exploring the relationship between transhumanism and religion. However, analyses of anti-transhumanist apocalypticisms are still rare, and those that exist are situated mainly among broader explorations of religious and secular bioconservatism. This article addresses this lack of specificity by drawing analyses of transhumanism and religion into dialogue with explorations of contemporary demonology through a close study of the beliefs of the evangelical conspiracist Thomas Horn and the anti-transhumanist milieu around him. Exploring the milieu's multifaceted demonology of the secular world in light of genealogies of religion and secularity, the article situates Horn's demonology as one attempt to negotiate these genealogies, using what Sean McCloud terms a “‘supernatural’ hermeneutics of suspicion” that sees spiritual forces as the structural base of reality. It argues that, while fringe, milieus like Horn's illuminate broader cultural tensions and genealogical relations surrounding the place of religion in a secular(izing) world

InGaN epilayer characterization by microfocused x-ray reciprocal space mapping

We report the use of microfocused three-dimensional x-ray reciprocal space mapping to study InGaN epilayers with average InN content 20%-22%. Analysis of the full volume of reciprocal space, while probing samples on the microscale with a focused x-ray beam, allowed us to gain valuable information about the nanostructure of InN-rich InGaN epilayers. It is found that “seed” InGaN mosaic nanocrystallites are twisted with respect to the ensemble average and strain-free. The initial stages of InGaN-on-GaN epitaxial growth, therefore, conform to the Volmer-Weber growth mechanism with “seeds” nucleated on strain fields generated by the a-type edge dislocations

A “trigger”, a cause or obscured? How trauma and adversity are constructed in psychiatric stress-vulnerability accounts of “psychosis”

How do mental health professionals link adverse life experiences with the kinds of beliefs and experiences which attract a diagnosis of psychosis and what implications does this have for women with these diagnoses? Drawing on a broadly critical realist framework, we present data from two studies relevant to these questions. First, we analyse the discursive practices engaged in during a staff-only discussion of a female in-patient with a psychosis diagnosis who had been raped some years previously. Staff oriented to the irrationality and factuality of her ostensibly delusional statements about rape and pregnancy in the present and formulated adverse experience as a ‘stress factor’ triggering a manic episode, thereby precluding alternative contextualising interpretations. In a second, interview-based, study, psychiatrists drew on a range of discursive resources which differentiated psychosis from other forms of distress, constructed trauma as a stressor which could trigger psychosis because of a genetic predisposition, and constructed medication as the primary intervention whilst a focus on trauma was de-emphasised. We discuss the implications of these findings for the kinds of explanations and forms of help offered and suggest ways in which distress might be contextualised as well as possible future directions for feminist research and practic