Using Evidence in the development of local health policies : Some Evidence from the United Kingdom

Objectives: This paper explores the use of evidence, focusing on economic evidence in particular, in the development of local health policies through an in-depth study of Health Improvement Programmes (HImPs) in England. Methods: A questionnaire was sent to the person responsible for coordinating the development of the HImP in each of the 102 English health authorities. In addition, semi-structured interviews were conducted with 10 HImP leaders, and a random sample of 26 HImP documents was reviewed using a standard pro forma. Results: Of the 102 mail questionnaires sent out, 68 (67%) were returned. It was found that those developing HImPs had multiple objectives, only some of which (e.g., efficiency in healthcare provision) would necessarily require evidence.Where evidence was used, this was a mixture of internal (experiential) and external (empirical) evidence, with the balance (66%) being in favor of the latter. Government reports and guidance from the National Institute for Clinical Excellence (NICE), were the main sources of external evidence, rather than published papers. Key barriers to the use of economic evidence were lack of time and availability and the difficulties in synthesizing information at the local level. Conclusions: Based on responses to our survey, the main ways of increasing the use of evidence in the development of local health policies in England are to produce more evidence-based national guidance and to produce accessible summaries of the available literature for local decision makers

Reusable silica surface-insulation material

Material was specifically developed for manufacture of insulating tiles, but it can be molded into other shapes as required. Basic raw materials are high-purity silica fiber, fumed-silica powder, and reagent-grade starch. Only purest materials are used, and care must be taken to avoid contamination during processing

Optimization guide for programs compiled under IBM FORTRAN H (OPT=2)

Guidelines are given to provide the programmer with various techniques for optimizing programs when the FORTRAN IV H compiler is used with OPT=2. Subroutines and programs are described in the appendices along with a timing summary of all the examples given in the manual

Viscosity and Thermal Relaxation for a resonantly interacting Fermi gas

The viscous and thermal relaxation rates of an interacting fermion gas are calculated as functions of temperature and scattering length, using a many-body scattering matrix which incorporates medium effects due to Fermi blocking of intermediate states. These effects are demonstrated to be large close to the transition temperature $T_c$ to the superfluid state. For a homogeneous gas in the unitarity limit, the relaxation rates are increased by nearly an order of magnitude compared to their value obtained in the absence of medium effects due to the Cooper instability at $T_c$. For trapped gases the corresponding ratio is found to be about three due to the averaging over the inhomogeneous density distribution. The effect of superfluidity below $T_c$ is considered to leading order in the ratio between the energy gap and the transition temperature.Comment: 7 pages, 3 figure

Fibrous refractory composite insulation

A refractory composite insulating material was prepared from silica fibers and aluminosilicate fibers in a weight ratio ranging from 1:19 to 19:1, and about 0.5 to 30% boron oxide, based on the total fiber weight. The aluminosilicate fiber and boron oxide requirements may be satisfied by using aluminoborosilicate fibers and, in such instances, additional free boron oxide may be incorporated in the mix up to the 30% limit. Small quantities of refractory opacifiers, such as silicon carbide, may be also added. The composites just described are characterized by the absence of a nonfibrous matrix

Silica reusable surface insulation

A reusable silica surface insulation material is provided by bonding amorphous silica fibers with colloidal silica at an elevated temperature. The surface insulation is ordinarily manufactured in the form of blocks (i.e., tiles)

On the variance of sums of arithmetic functions over primes in short intervals and pair correlation for L-functions in the Selberg class

We establish the equivalence of conjectures concerning the pair correlation of zeros of $L$-functions in the Selberg class and the variances of sums of a related class of arithmetic functions over primes in short intervals. This extends the results of Goldston & Montgomery [7] and Montgomery & Soundararajan [11] for the Riemann zeta-function to other $L$-functions in the Selberg class. Our approach is based on the statistics of the zeros because the analogue of the Hardy-Littlewood conjecture for the auto-correlation of the arithmetic functions we consider is not available in general. One of our main findings is that the variances of sums of these arithmetic functions over primes in short intervals have a different form when the degree of the associated $L$-functions is 2 or higher to that which holds when the degree is 1 (e.g. the Riemann zeta-function). Specifically, when the degree is 2 or higher there are two regimes in which the variances take qualitatively different forms, whilst in the degree-1 case there is a single regime

Does Maternal Methadone Dose Correlate with Severity of Intrauterine Growth Restriction in Infants with Neonatal Abstinence Syndrome?

Introduction : Previous studies demonstrate a relationship between maternal opioid use during pregnancy and smaller head circumference of infants with neonatal abstinence syndrome (NAS). The goal of this study is to correlate maternal methadone dose and severity of growth restriction in infants with NAS admitted to the neonatal intensive care unit (NICU). Methods: This is a retrospective analysis of infants (≥35 weeks gestation) exposed to in utero methadone, born between August 2006 and May 2018, and admitted to a Philadelphia NICU for medical therapy for NAS. Growth parameters (birth weight, birth length, and birth head circumference) were compared between infants exposed various doses of methadone. The groups were compared using ANOVA, Post-Hoc Tukey, Chi-square and extended Fisher exact tests. Results: A total of 686 infants met the study criteria; 109 in the High dose group, 359 in the Intermediate dose group, and 218 in the Low dose group. There was no significant difference in the use of other drugs or smoking during the pregnancy. Infants exposed to higher doses of methadone displayed significantly smaller head circumferences and lengths at birth. The mean birth weight was similar between the three groups. Discussion: There may be a danger in prescribing high doses of methadone to pregnant mothers, as they may hinder the growth of the infant. We need to conduct more studies investigating how low head circumference and length affect long term developmental outcomes. These findings may help guide physicians toward the optimum dose of methadone for mothers

Some Properties of Amplitudes at Multi Boson Thresholds in Spontaneously Broken Scalar Theory

It is shown that in a $\lambda \phi^4$ theory of one real scalar field with spontaneous breaking of symmetry a calculation of the amplitudes of production by a virtual field $\phi$ of $n$ on-mass-shell bosons all being exactly at rest is equivalent in any order of the loop expansion to a Euclidean space calculation of the mean field of a kink-type configuration. Using this equivalence it is found that all the $1 \to n$ amplitudes have no absorptive part at the thresholds to any order of perturbation theory. This implies non-trivial relations between multi-boson threshold production amplitudes. In particular the on-mass-shell amplitude of the process $2 \to 3$ should vanish at the threshold in all loops. It is also shown that the factor $n!$ in the $1 \to n$ amplitudes at the threshold is not eliminated by loop effects.Comment: 11 pages including 3 figures, LaTeX, TPI-MINN-92/61-