What is best and at what cost? Cross-national differences in the treatment of ageing-related diseases Norwegian perspective from a comparative OECD-project

Aggregated medical spending differs widely across countries and large variations exist in the frequency and the mix of medical services provided, as well as the type of technology applied. The outcomes (mostly measured as survival rates) do not, however vary to the same extent as the spending. Policy makers in many countries compare their spending to each other, with no clear consensus about how systems are effective in treating patients. In each of these debates the issue of what medical care is buying arises: When countries spend more or less on health care, how does that affect resource allocation in the medical sector and ultimately the health outcomes? The goal of the project1 was to examine how different medical care systems will affect the allocation of resources in the medical sector. As the existing available macro data at an international level does not allow for satisfactory answers to such questions, this project wanted to use a microeconomic approach. An international comparison of treatments of conditions in older populations that lead to high expenditures could help to identify treatments that might be more effective in improving outcomes at lower cost. Therefore the project focused on international comparisons of treatments for a spectrum of conditions in older populations with high aggregate medical spending, well identified episodes of care, high prevalence and high policy relevance. Norway participated in studies on myocardial infarction and breast cancer 2. The choice of focus on older patients was partly motivated by the fact that in the future the elderly will probably take an increasingly proportion of the total spending in the health care sector. See documentation from the main project: http://www.oecd.org/EN/document/0,,EN-document-194-5-no-27-32316-0,00.htmlMedical care; allocation of resources; acute myocardial infarction; breast cancer; international comparisons of treatments

A nonlinear structural subgrid-scale closure for compressible MHD. I. Derivation and energy dissipation properties

This is the final version. Available from AIP Publishing via the DOI in this recordCompressible magnetohydrodynamic (MHD) turbulence is ubiquitous in astrophysical phenomena ranging from the intergalactic to the stellar scales. In studying them, numerical simulations are nearly inescapable, due to the large degree of nonlinearity involved. However, the dynamical ranges of these phenomena are much larger than what is computationally accessible. In large eddy simulations (LESs), the resulting limited resolution effects are addressed explicitly by introducing to the equations of motion additional terms associated with the unresolved, subgrid-scale dynamics. This renders the system unclosed. We derive a set of nonlinear structural closures for the ideal MHD LES equations with particular emphasis on the effects of compressibility. The closures are based on a gradient expansion of the finite-resolution operator [W. K. Yeo (CUP, 1993)] and require no assumptions about the nature of the flow or magnetic field. Thus, the scope of their applicability ranges from the sub- to the hyper-sonic and -Alfvénic regimes. The closures support spectral energy cascades both up and down-scale, as well as direct transfer between kinetic and magnetic resolved and unresolved energy budgets. They implicitly take into account the local geometry, and in particular, the anisotropy of the flow. Their properties are a priori validated in Paper II [P. Grete et al., Phys. Plasmas 23, 062317 (2016)] against alternative closures available in the literature with respect to a wide range of simulation data of homogeneous and isotropic turbulence.University of GöttingenDeutsche Forschungsgemeinschaft (DFG)Max Planck Institute for Dynamics and Self-OrganizationConicyt Fondecyt: Fondo Nacional de Desarrollo Científico y TecnológicoNorth-German Supercomputing Allianc

Sykehuslegenes holdninger til kjøp av helsetjenester i utlandet

I Rikstrygdeverkets følgeforskning i forbindelse med ”Kjøp av helsetjenester i utlandet” (Innst.S.nr.24 2000-2001) deltok Senter for helseadministrasjon (UiO) med et prosjekt med formål å kartlegge holdninger til utenlandsbroen blant sykehusleger i Norge. Rapporten som nå er tilgjengelig, presenterer resultatene fra en spørreundersøkelse blant et tilfeldig utvalg av norske sykehusleger. I alt 852 sykehusleger (41 prosent) svarte på spørsmålene om utenlandsbroen. Rapporten viser at høsten 2001 var det fremdeles mange sykehus som ikke hadde tatt i bruk ordningen med kjøp av helsetjenester i utlandet. Kun 16 prosent av sykehuslegene arbeider ved avdelinger der de anfører at det er satt i gang tiltak for å benytte ordningen. Dette inkluderer alle typer avdelinger. Hvis man begrenser seg til de mest aktuelle avdelinger, blir bildet noe annerledes. Hele 61 prosent av legen ved ortopediske avdelinger oppgir at det er satt i gang tiltak for å benytte ordningen, tallet er tilnærmet likt for over- og underordnede leger. Legers begrunnelse for at ordningen ikke er tatt i bruk, er flere og kan sammenfattes i noen hovedtrekk. • 53 prosent mener at de ikke har relevante pasienter, selv om de ikke relevante avdelingene (laboratorier, røntgen og anestesi) er tatt ut av analysen. • Legene oppgir nødvendigheten av en viss tid for pasientene på ventelister som argument for å beholde pasientene, 54 prosent av leger som arbeider i ortopediske avdelinger, 62 prosent innenfor ØNH og hele 82 prosent av dem som arbeider innenfor gynekologi mener dette. • Kvalitetsinnvendinger står særlig sterkt blant ortopedene hvor 67 prosent frykter dårligere kvalitet, mest blant de overordnede legene. Andelen som er opptatt av kvalitet har ingen sammenheng med om legen er utdannet eller har praksis fra utlandet. • 19 prosent oppgir at lite informasjon er en grunn til at ordningen ikke er brukt. I den multivaraite analysen kommer det fram at det særlig er på Østlandet (utenom Oslo og Akershus) at argumentet r om lite informasjon brukes. • Relativt få anførte administrativt merarbeid som en forklaring på manglende bruk. Andelen var noe større blant de overordnede legene sammenlignet med underørdnede, men forskjellen var ikke signifikant i den multivariate analysen. • Analysen viste dessuten en tendes til at leger med arbeid utenom sykehuset, var mer kritisk til ordningen enn de somPasientbroen; internasjonalisering; kjøp av legetjenester; utlandet

Sprekere eldre, rimeligere eldreomsorg? - Utgiftsbehovet i eldreomsorgen i perioden 2000-2030 under ulike forutsetninger om eldres funksjonsevne

Den gjennomsnittlige levealder øker. Både som følge av dette og som følge av variasjoner i fødselsrater, blir det i Norge, som i andre deler av den vestlige verden, flere eldre i årene framover. Endringene i demografi stiller store og økende krav til eldreomsorgen i framtiden. Vi vet imidlertid lite om hvor store utfordringene blir og hva som kreves av ressursinnsats framover. Årsakene til dette er flere. En årsak er at det samtidig med økningen i antall eldre ser ut til å skje en endringer i eldres helsetilstand og deres funksjonsevne. OECD har nylig gjennomført en studie av disse forholdene i 9 av sine medlemsland (Jacobzone, m fl 1999). I denne studien var Norge ikke med. Dette var noe av bakgrunnen for at Finansdepartementet og Sosial- og helsedepartementet i samarbeid utformet et prosjekt der målet var å se på framtidig behov for helse-, omsorgs- og pleietjenester blant eldre. Prosjektet utføres av Senter for helseadministrasjon, Universitetet i Oslo (SHA) og Statistisk Sentralbyrå (SSB). Den delen som utføres av Senter for helseadministrasjon, omfatter en analyse av endringer i demografi, helsetilstand, funksjonsevne og utgiftsbehov i pleie- og omsorgssektoren i Norge. Analysen omfatter framskrivninger av flere av disse forholdene til 2030 og rapporteres i foreliggende rapport.Eldreomsorg; aldrende befolkning; ressursbehov

Kinks in the electronic dispersion of the Hubbard model away from half filling

We study kinks in the electronic dispersion of a generic strongly correlated system by dynamic mean-field theory (DMFT). The focus is on doped systems away from particle-hole symmetry where valence fluctuations matter potentially. Three different algorithms are compared to asses their strengths and weaknesses, as well as to clearly distinguish physical features from algorithmic artifacts. Our findings extend a view previously established for half-filled systems where kinks reflect the coupling of the fermionic quasiparticles to emergent collective modes, which are identified here as spin fluctuations. Kinks are observed when strong spin fluctuations are present and, additionally, a separation of energy scales for spin and charge excitations exists. Both criteria are met by strongly correlated systems close to a Mott-insulator transition. The energies of the kinks and their doping dependence fit well to the kinks in the cuprates, which is surprising in view of the spatial correlations neglected by DMFT.Comment: 13 pages, 15 figure

Comment on "Local accumulation times for source, diffusion, and degradation models in two and three dimensions" [J. Chem. Phys. 138, 104121 (2013)]

In a recent paper, Gordon, Muratov, and Shvartsman studied a partial differential equation (PDE) model describing radially symmetric diffusion and degradation in two and three dimensions. They paid particular attention to the local accumulation time (LAT), also known in the literature as the mean action time, which is a spatially dependent timescale that can be used to provide an estimate of the time required for the transient solution to effectively reach steady state. They presented exact results for three-dimensional applications and gave approximate results for the two-dimensional analogue. Here we make two generalizations of Gordon, Muratov, and Shvartsman’s work: (i) we present an exact expression for the LAT in any dimension and (ii) we present an exact expression for the variance of the distribution. The variance provides useful information regarding the spread about the mean that is not captured by the LAT. We conclude by describing further extensions of the model that were not considered by Gordon,Muratov, and Shvartsman. We have found that exact expressions for the LAT can also be derived for these important extensions..