Performance indicators for primary care groups; an evidence-based approach

The NHS Executive and Department of Health have proposed a wide range of performance indicators many of which are applicable to future primary care groups Some of these indicators reflect access and efficiency, but few of the effectiveness indicators are based on primary care interventions for which there is evidence that increased uptake results in improved health outcomes We present a method to identify important primary care interventions of proved efficacy and suggest performance indicators that could monitor their use Our evidence based approach may be a complementary way of identifying areas for performance indicators to those proposed by the NHS Executive and Department of Health Our suggested indicators are more likely to help turn evidence into everyday practice and to have an impact on the population's healt

Colour image quantisation and coding for optimal perception

Once a digital image is processed in some way and the reconstruction is compared to the original, the final arbiter of reconstruction quality is the human to whom the images are presented. The research presented here is concerned with the development of schemes for the quantisation of colour images and for the encoding of colour images for transmission, with the goal of minimising the perceived image distortion rather than minimising a traditional error signal statistic. In order to quantise colour images with minimum perceived distortion, a colour space is sought in which Euclidean distances correspond linearly to perceived colour difference. The response of the visual system to colour and colour difference is investigated. A new quantisation scheme is developed and implemented to achieve a colour image compression ratio of approximately 6: 1. Three variations on the basic quantiser algorithm are considered and results of applying each variation to three test images are presented. Two-component encoding of colour images for low bit-rate transmission is investigated. A new method of encoding the contents of the image regions following contour extraction is developed. Rather than using parametric surface descriptions, a quad-tree is constructed and a simple measure of perceived image contrast threshold is used to determine the transmitted data. Arithmetic entropy coding is used to discard statistical redundancy in the signal . A colour wash process recreates the colour in each region. Implementation details are presented and several examples are given to illustrate differing contrast thresholds with compression rates of up to 50: 1. An analysis of the textures in certain regions of the test images leads to the development of an algorithm to synthesise the appearance of the textures following extraction of a small block which may be repeated across the region, leading to dramatic compression rates in · some instances

Bcl-2 functionally interacts with inositol 1,4,5-trisphosphate receptors to regulate calcium release from the ER in response to inositol 1,4,5-trisphosphate

Inositol 1,4,5-trisphosphate (InsP3) receptors (InsP3Rs) are channels responsible for calcium release from the endoplasmic reticulum (ER). We show that the anti-apoptotic protein Bcl-2 (either wild type or selectively localized to the ER) significantly inhibited InsP3-mediated calcium release and elevation of cytosolic calcium in WEHI7.2 T cells. This inhibition was due to an effect of Bcl-2 at the level of InsP3Rs because responses to both anti-CD3 antibody and a cell-permeant InsP3 ester were decreased. Bcl-2 inhibited the extent of calcium release from the ER of permeabilized WEHI7.2 cells, even at saturating concentrations of InsP3, without decreasing luminal calcium concentration. Furthermore, Bcl-2 reduced the open probability of purified InsP3Rs reconstituted into lipid bilayers. Bcl-2 and InsP3Rs were detected together in macromolecular complexes by coimmunoprecipitation and blue native gel electrophoresis. We suggest that this functional interaction of Bcl-2 with InsP3Rs inhibits InsP3R activation and thereby regulates InsP3-induced calcium release from the ER

Hip fracture incidence and mortality in an English Region: a study using routine National Health Service data.

BACKGROUND: We investigated the validity of routine hospital and mortality hip fracture data in one English Region and estimated trends in hip fracture between 1978-1981 and 1993-1995. METHODS: We identified from Hospital Episode System (HES) data for 1993-1995 all hip fracture episodes relating to individual patients aged over 65 years resident in Wessex. We determined from the discharge method code whether an individual had died during that admission. The number of individual regional and district admissions and deaths were compared with those presented in the Public Health Common Data Set. We compared regional admission rates with data for 1978-1981 from a previous study. RESULTS: National comparative indicators for hip fracture overestimated individual admissions in Wessex by 17 per cent (in health authorities by 1-56 per cent). National comparative indicators for hip fracture mortality underestimated individual deaths in Wessex by 48 per cent. Between 1978-1981 and 1993-1995 the age-sex-standardized hip fracture rates rose from 1.90 to 2.63 per 1000 per year for men and from 5.70 to 7.70 per 1000 per year for women. Rates increased in all age groups except those aged 65-69 years. There was also a small fall in absolute mean annual numbers in this age group. The rates also fell in females aged 70-74. CONCLUSIONS: It is possible to adjust routine national HES data to take account of multiple episodes within a single admission. These methods should be applied to national comparative indicators for hip fracture admission and deaths. Hip fracture rates continue to rise in those aged over 70 years. There may be a cohort effect with those born after 1925 showing stable rates which needs further investigation

Hemodynamic differences in children with dichotic listening deficits: Preliminary results from an fMRI study during a cued listening task

Functional magnetic resonance images were acquired while children with and without dyslexia identified incongruous words embedded within fairy tale segments in a quasidichotic listening task. All children produced greater activation in the left hemisphere than in the right hemisphere during the binaural separation listening task. Children with dyslexia, who had a higher incidence of a dichotic left ear deficit from prescanning behavioral tests, produced fewer hits and more misses than control children while monitoring their left ears in the scanner. Control children produced stronger left hemispheric activation for ipsilateral left ear input than right hemispheric activation for ipsilateral right ear input, but ipsilateral activation patterns in children with dyslexia were symmetrical. Children with dyslexia who monitored their right ears first produced the lowest left hemispheric activation overall, suggesting that priming of the right ear may have inhibited the ability of children with a left ear deficit to adequately identify target words presented toward their left ears while in the scanner