Pay for performance, inequalities, and diabetes care

Background: The Quality and Outcome Framework (QOF) is a major pay for performance scheme that was introduced in 2004 in the UK. The introduction of QOF is a unique opportunity to evaluate the impact of pay for performance on inequalities and in particular on ethnic inequalities. This thesis examines the impact of QOF on ethnic inequalities and on patients with and without comorbidities in diabetes management. Methods: (1) Interrupted time series analysis of electronic medical record data of diabetes patients registered with 29 family practices in South West London for the years 2000 to 2007. (2) Cross-sectional study to examine the association between ethnicity, concordant and discordant comorbidity status and intermediate outcomes (HbA1c, blood pressure, total cholesterol). Results: The quality of diabetes care, as measured by the QOF indicators, has improved substantially throughout the study period, especially for the process aspect of care. The introduction of QOF was associated with initial additional improvements in systolic blood pressure in white and black patients but this was only sustained in black patients. Initial improvements in diastolic blood pressure in white and in cholesterol in black and white patients were not sustained in the post-QOF period. There was no beneficial impact of QOF on HbA1c in any ethnic group. The presence of ≥2 cardiovascular comorbidities was associated with similar blood pressure control among white and South Asian patients when compared with whites without comorbidity but with worse blood pressure control among black patients. Conclusion: The QOF scheme did not appear to address important inequalities in diabetes management over time. Targeted quality improvement strategies may be required to improve health care in vulnerable populations

Occupational Exposure to Blood and Bodily Fluids among Health Care Workers

Health Care workers (HCWS) must handle with a variety of occupational exposure. One significant exposure for HCWS in a hospital and Emergency Medical Services (EMS) providers in out of hospital expose to blood and bodily fluids during the performance of their duties , resulting in concerns regarding transmission of blood-borne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). To manage the unpleasant effects of exposure to blood and bodily fluids, HCWs including EMS providers and other health care occupations must completely comply with standard precautions (SPs) recommendations and to attend continuing education regarding blood borne pathogens. In this study, the extent of knowledge, consistency, and practices of SPs were assessed and characteristics of rural and urban EMS providers that predicted lacking compliance with SPs were explored. In addition, this study assessed knowledge of EMS providers regarding Needle stick injuries. Finally, this study evaluated blood and bodily fluids exposure incidents among HWCs in hospital in general

HYDROTHERMAL SYNTHESIS OF ORGANICALLY-LINKED POLYOXOMETALATES

One of the thrust areas of our research deals with exploratory synthesis of new inorganic-organic hybrid materials for energy storage. It is well-known that relevant to the research described later in this thesis, inorganic-organic hybrid solids studied thus far are largely made of coordination complexes where the organic molecules are acting like a ligand to coordinate around metal cations. In this research, we will employ polyoxometalate (POM) anions as an inorganic building block to replace otherwise oppositely charged metal cations in hopes to synthesize extended hybrid frameworks with rich redox chemistry. POM clusters are made of aggregates of transition-metal (TM) oxide units and can be employed as a charge reservoir during multi-electron chemical reactions involving multiple TM cations. These inorganic clusters possess an unmatched range of physical (such as magnetism) and chemical properties, acting as a set of transferable building blocks that can reliably be utilized in the formation of new materials with desired functionalities associated with versatile electronic structures.15,16 One of the challenges is of course to imagine how these anionic clusters could interact with organic molecules that are necessary for the formation of new hybrids. We anticipate, therefore, that the \u27coordination\u27 chemistry between POM anions and organic molecules is going to be different than that observed in the conventional hybrids based on metal cations. This thesis study will take an initial step to explore this new chemistry and to illustrate the structure and bonding of resulting solids for our continued research development in POM-based hybrids. The major focus of my study is about the synthesis and characterization of new extended solids made of, more specifically, polyoxovanadate (POV) and 4,4\u27-bipyridine (bpy) organic molecules through self-assembl

Analysis of Packet Throughput and Delay in IEEE 802.11 WLANs with TCP Traffic

The IEEE 802.11 standard is a successfulwireless local area networks (WLAN) technology,because of its easy deployment. With WLAN, theability of the IEEE802.11 standard to supportmultimedia applications with high quality of service(QoS) requirements has increased. This paperevaluates the capability of QoS support in EnhancedDistributed Channel Access (EDCA) mechanism of theIEEE 802.11e standard using TCP protocol. TheEDCA is an enhancement for QoS support in 802.11.EDCA mechanisms allow prioritized medium accessfor applications with high QoS requirements byassigning different priorities to the access categories.The current work discusses the performanceevaluation of 802.11 and 802.11e by simulations usingTCP protocol. A comparative discussion between DCFund EDCA with TCP protocol is reported for differentservices, such as voice, video, best-effort andbackground traffic. Results and simulations show thatthe TCP protocol is usable for transferring audio andvideo data within special programs and applications.Moreover, it is shown that the UDP protocol with itshigher performance is more suitable for this task