128 research outputs found

    Implementing social health insurance in Ireland: Report of a meeting and workshop held in Dublin, on December 6th 2010

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    We considered two basic questions, 'Is it possible to implement Social Health Insurance in Ireland?', and 'How can this be done?'. Can Social Health Insurance be implemented in Ireland? Our answer is a very definite yes. Furthermore, there would be many opportunities, while working towards this end, to improve the performance of our health care system. How can it be implemented? This process will need to be actively managed. There are many difficulties in the Irish health services, but also many opportunities. The greatest strengths are the talented, well-trained and very committed staff. Getting and keeping the support of these staff, for the necessary changes in service delivery, will be critical. Ireland has the capacity to make these changes, but without high quality management, a detailed focussed plan for change, and political support, little will happen. Each step in the change needs to be planned to maintain services, improve service delivery, improve service accountability, and improve service governance. Each sector of the service will need someone to lead the change, and mind that service during the change. Primary care remains under-developed. The HSE plan to develop primary care teams (PCT) has not succeeded. There are several established PCTs which work well. In other areas there are informal arrangements for collaboration, which work well. Overall, there are many useful lessons to learn from the experience so far. Future developments will need to place general practice at the centre of primary care. The mechanisms for doing this will vary from place to place, but need to be developed urgently. Acute hospitals face a crisis of governance. Maurice Hayes' (1) recent report on Tallaght hospital gives an idea of the scale of the changes needed. Tallaght is, we believe, not atypical, and is reputed to be by no means the worst governed hospital in the system. This, alone, should provide a pressing motive for change. Redesigning Irish hospitals to a new mission of supporting primary care, of supporting care in the community where possible can, and must, be done. Long-term care for older people is also a challenge. We advise moving to an integrated needs based system with smooth transitions between different degrees of support at home, and different degrees of support in specialized housing facilities including nursing homes. A similar model should apply to other forms of long-term care, for example for people with a substantial disability. Information systems and management processes both need a major overhaul. The health service remains strikingly under-managed, and fixing this will need a substantial culture change within the services. Wide use of standardized formal project management processes will be vital. There is a separate plan being developed to improve health service IT systems, and implementing this needs to be a high priority. We have not considered other key sectors, for example mental health, disability services, and social services. This does not mean that these are unimportant, merely that we had limited time, and a great deal to cover

    Molecular analysis of endocrine disruption in hornyhead turbot at wastewater outfalls in southern california using a second generation multi-species microarray.

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    Sentinel fish hornyhead turbot (Pleuronichthysverticalis) captured near wastewater outfalls are used for monitoring exposure to industrial and agricultural chemicals of ~ 20 million people living in coastal Southern California. Although analyses of hormones in blood and organ morphology and histology are useful for assessing contaminant exposure, there is a need for quantitative and sensitive molecular measurements, since contaminants of emerging concern are known to produce subtle effects. We developed a second generation multi-species microarray with expanded content and sensitivity to investigate endocrine disruption in turbot captured near wastewater outfalls in San Diego, Orange County and Los Angeles California. Analysis of expression of genes involved in hormone [e.g., estrogen, androgen, thyroid] responses and xenobiotic metabolism in turbot livers was correlated with a series of phenotypic end points. Molecular analyses of turbot livers uncovered altered expression of vitellogenin and zona pellucida protein, indicating exposure to one or more estrogenic chemicals, as well as, alterations in cytochrome P450 (CYP) 1A, CYP3A and glutathione S-transferase-α indicating induction of the detoxification response. Molecular responses indicative of exposure to endocrine disruptors were observed in field-caught hornyhead turbot captured in Southern California demonstrating the utility of molecular methods for monitoring environmental chemicals in wastewater outfalls. Moreover, this approach can be adapted to monitor other sites for contaminants of emerging concern in other fish species for which there are few available gene sequences

    Predictability of European winter 2019/20: Indian Ocean dipole impacts on the NAO

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    Northern Europe and the UK experienced an exceptionally warm and wet winter in 2019/20, driven by an anomalously positive North Atlantic Oscillation (NAO). This positive NAO was well forecast by several seasonal forecast systems, suggesting that this winter the NAO was highly predictable at seasonal lead times. A very strong positive Indian Ocean dipole (IOD) event was also observed at the start of winter. Here we use composite analysis and model experiments, to show that the IOD was a key driver of the observed positive NAO. Using model experiments that perturb the Indian Ocean initial conditions, two teleconnection pathways of the IOD to the north Atlantic emerge: a tropospheric teleconnection pathway via a Rossby wave train travelling from the Indian Ocean over the Pacific and Atlantic, and a stratospheric teleconnection pathway via the Aleutian region and the stratospheric polar vortex. These pathways are similar to those for the El Niño Southern Oscillation link to the north Atlantic which are already well documented. The anomalies in the north Atlantic jet stream location and strength, and the associated precipitation anomalies over the UK and northern Europe, as simulated by the model IOD experiments, show remarkable agreement with those forecast and observed

    Analysis of Endocrine Disruption in Southern California Coastal Fish Using an Aquatic Multispecies Microarray

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    BackgroundEndocrine disruptors include plasticizers, pesticides, detergents, and pharmaceuticals. Turbot and other flatfish are used to characterize the presence of chemicals in the marine environment. Unfortunately, there are relatively few genes of turbot and other flatfish in GenBank, which limits the use of molecular tools such as microarrays and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) to study disruption of endocrine responses in sentinel fish captured by regulatory agencies.ObjectivesWe fabricated a multigene cross-species microarray as a diagnostic tool to screen the effects of environmental chemicals in fish, for which there is minimal genomic information. The array included genes that are involved in the actions of adrenal and sex steroids, thyroid hormone, and xenobiotic responses. This microarray will provide a sensitive tool for screening for the presence of chemicals with adverse effects on endocrine responses in coastal fish species.MethodsWe used a custom multispecies microarray to study gene expression in wild hornyhead turbot (Pleuronichthys verticalis) collected from polluted and clean coastal waters and in laboratory male zebrafish (Danio rerio) after exposure to estradiol and 4-nonylphenol. We measured gene-specific expression in turbot liver by qRT-PCR and correlated it to microarray data.ResultsMicroarray and qRT-PCR analyses of livers from turbot collected from polluted areas revealed altered gene expression profiles compared with those from nonaffected areas.ConclusionsThe agreement between the array data and qRT-PCR analyses validates this multispecies microarray. The microarray measurement of gene expression in zebrafish, which are phylogenetically distant from turbot, indicates that this multispecies microarray will be useful for measuring endocrine responses in other fish

    Power and the durability of poverty: a critical exploration of the links between culture, marginality and chronic poverty

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