Containing costs in public sector hospitals - a strategy for the future. Lessons from a large teaching hospital

Escalating costs of providing health care are cause for worldwide concern. In South Africa there is increasing concern about expenditure in the public and the private health care sectors. Although public sector expenditure has increased in per capita terms over the past 2 decades, at the micro-level comparison of expenditure over a 14-year period in one major teaching hospital region indicates that, despite increasing complexity and sophistication, real costs have not escalated at a greater rate than the consumer price index, if extraordinary factors are discounted. The development and utilisation of productivity and performance indicators are reviewed and some mechanisms for containing costs in public hospitals are discussed. These include formalised strategic planning and allocation of resources, rationalisation and reorganisation of services, improved productivity and utilisation of scarce health manpower, improved accounting and management information systems, and the development and use of measures of outcome. Concern is expressed regarding excessive quantification of costs and efficiency to the detriment of health care in general

Gate recess engineering of pseudomorphic In0.30GaAs/GaAs HEMTs

The authors report how the performance of 0.12 μm GaAs pHEMTs is improved by controlling both the gate recess width, using selective dry etching, and the gate position in the source drain gap, using electron beam lithography. pHEMTs with a transconductance of 600 mS/mm, off state breakdown voltages >2 V, fτ of 120 GHz, f max of 180 GHz and MAG of 13.5 dB at 60 GHz are reported

Metabolic profiling predicts response to anti-tumor necrosis factor α therapy in patients with rheumatoid arthritis

<p>Objective: Anti–tumor necrosis factor (anti-TNF) therapies are highly effective in rheumatoid arthritis (RA) and psoriatic arthritis (PsA), but a significant number of patients exhibit only a partial or no therapeutic response. Inflammation alters local and systemic metabolism, and TNF plays a role in this. We undertook this study to determine if the patient's metabolic fingerprint prior to therapy could predict responses to anti-TNF agents.</p> <p>Methods: Urine was collected from 16 RA patients and 20 PsA patients before and during therapy with infliximab or etanercept. Urine metabolic profiles were assessed using nuclear magnetic resonance spectroscopy. Discriminating metabolites were identified, and the relationship between metabolic profiles and clinical outcomes was assessed.</p> <p>Results: Baseline urine metabolic profiles discriminated between RA patients who did or did not have a good response to anti-TNF therapy according to European League Against Rheumatism criteria, with a sensitivity of 88.9% and a specificity of 85.7%, with several metabolites contributing (in particular histamine, glutamine, xanthurenic acid, and ethanolamine). There was a correlation between baseline metabolic profiles and the magnitude of change in the Disease Activity Score in 28 joints from baseline to 12 months in RA patients (P = 0.04). In both RA and PsA, urinary metabolic profiles changed between baseline and 12 weeks of anti-TNF therapy. Within the responders, urinary metabolite changes distinguished between etanercept and infliximab treatment.</p> <p>Conclusion: The clear relationship between urine metabolic profiles of RA patients at baseline and their response to anti-TNF therapy may allow development of novel approaches to the optimization of therapy. Differences in metabolic profiles during treatment with infliximab and etanercept in RA and PsA may reflect distinct mechanisms of action.</p&gt

Caribou reactions to provocation by snowmachines in Newfoundland

Caribou in Gros Morne National Park reacted to provocation by snowmachine with significant differences in their response between years. Upon exposure to snowmachines, caribou were displaced 60 to 237 m from their initial locations. Groups with calves allowed the snowmachines to approach more closely before responding (5 to 600 m) than adult-only groups (30 to 1300 m), and their overall flight distances were less. Time spent in locomotion and overall reaction time were greater for animals engaged in the most sedentary activities (eg. standing; mean = 239 s and mean = 262 s, and lying; mean = 166 s and mean = 273 s) than for animals already engaged in more dynamic activities such as walking (mean = 118 s and mean = 133 s), running (mean = 74 s and mean = 63 s) and feeding (mean = 118 s and mean = 133 s). Annual differences in the response of adult-only groups were not due to differences in the sex ratio of these groups, but may be related to annual variation in winter weather conditions

Coordination‐cage‐catalysed hydrolysis of organophosphates : cavity‐ or surface‐based?

The hydrophobic central cavity of a water‐soluble M8L12 cubic coordination cage can accommodate a range of phospho‐diester and phospho‐triester guests such as the insecticide “dichlorvos” (2,2‐dichlorovinyl dimethyl phosphate) and the chemical warfare agent analogue di(isopropyl) chlorophosphate. The accumulation of hydroxide ions around the cationic cage surface due to ion‐pairing in solution generates a high local pH around the cage, resulting in catalysed hydrolysis of the phospho‐triester guests. A series of control experiments unexpectedly demonstrates that—in marked contrast to previous cases—it is not necessary for the phospho‐triester substrates to be bound inside the cavity for catalysed hydrolysis to occur. This suggests that catalysis can occur on the exterior surface of the cage as well as the interior surface, with the exterior‐binding catalysis pathway dominating here because of the small binding constants for these phospho‐triester substrates in the cage cavity. These observations suggest that cationic but hydrophobic surfaces could act as quite general catalysts in water by bringing substrates into contact with the surface (via the hydrophobic effect) where there is also a high local concentration of anions (due to ion pairing/electrostatic effects)

Hard Thermal Loops, Gauged WZNW Action and the Energy of Hot Quark-Gluon Plasma

The generating functional for hard thermal loops in QCD is rewritten in terms of a gauged WZNW action by introducing an auxiliary field. This shows in a simple way that the contribution of hard thermal loops to the energy of the quark-gluon plasma is positive.Comment: 9 pages, CU-TP 60

On the Evolution Equation for Magnetic Geodesics

In this paper we prove the existence of long time solutions for the parabolic equation for closed magnetic geodesics.Comment: In this paper we prove the existence of long time solutions for the parabolic equation for closed magnetic geodesic

On the spherical-axial transition in supernova remnants

A new law of motion for supernova remnant (SNR) which introduces the quantity of swept matter in the thin layer approximation is introduced. This new law of motion is tested on 10 years observations of SN1993J. The introduction of an exponential gradient in the surrounding medium allows to model an aspherical expansion. A weakly asymmetric SNR, SN1006, and a strongly asymmetric SNR, SN1987a, are modeled. In the case of SN1987a the three observed rings are simulated.Comment: 19 figures and 14 pages Accepted for publication in Astrophysics & Space Science in the year 201

D0 Matrix Mechanics: New Fuzzy Solutions at Large N

We wish to consider in this report the large N limit of a particular matrix model introduced by Myers describing D-brane physics in the presence of an RR flux background. At finite N, fuzzy spheres appear naturally as non-trivial solutions to this matrix model and have been extensively studied. In this report, we wish to demonstrate several new classes of solutions which appear in the large N limit, corresponding to the fuzzy cylinder,the fuzzy plane and a warped fuzzy plane. The latter two solutions arise from a possible "central extension" to our model that arises after we account for non-trivial issues involved in the large N limit. As is the case for finite N, these new solutions are to be interpreted as constituent D0-branes forming D2 bound states describing new fuzzy geometries.Comment: revised version: references added, derivation of "central extensions" improved upon. To appear in JHE