Containing the costs of Medicare: letter from British Columbia

No description supplie

Readability, presentation and quality of allergy-related patient information leaflets: a cross sectional and longitudinal study

Objective: Patient information leaflets (PILs) are widely used to reinforce or illustrate health information and to complement verbal consultation. The objectives of the study were to assess the readability and presentation of PILs published by Allergy UK, and to conduct a longitudinal assessment to evaluate the impact of leaflet amendment and revision on readability. Methods: Readability of Allergy UK leaflets available in 2013 was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch-Kincaid Reading Grade Formula. Leaflet presentation was evaluated using the Clear Print Guidelines of the Royal National Institute of Blind People (RNIB) and the Patient Information Appraisal System developed by the British Medical Association (BMA). Changes in the leaflets’ readability scores over five years were investigated. Results: 108 leaflets, covering a wide range of allergic conditions and treatment options, were assessed. The leaflets had average SMOG and Flesch-Kincaid scores of 13.9 (range 11-18, SD 1.2) and 10.9 (range 5-17, SD 2.1) respectively. All leaflets met the RNIB Clear Print guidelines, with the exception of font size which was universally inadequate. The leaflets scored on average 10 (median 10, range 7-15) out of a maximum of 27 on the BMA checklist. The overall average SMOG score of 31 leaflets available in both 2008 and 2013 had not changed significantly. The process of leaflet revision resulted in 1% change in readability scores overall, with a predominantly upward trend with six leaflets increasing their readability score by >10% and only three decreasing by >10%. Conclusion: Allergy-related patient information leaflets are well presented but have readability levels that are higher than those recommended for health information. Involving service users in the process of leaflet design, together with systematic pre-publication screening of readability would enhance the accessibility and comprehensibility of written information for people with allergy and their careers

Remote sensing applications to hydrologic modeling

An energy balance snowmelt model for rugged terrain was devised and coupled to a flow model. A literature review of remote sensing applications to hydrologic modeling was included along with a software development outline

Geobase Information System Impacts on Space Image Formats

As Geobase Information Systems increase in number, size and complexity, the format compatability of satellite remote sensing data becomes increasingly more important. Because of the vast and continually increasing quantity of data available from remote sensing systems the utility of these data is increasingly dependent on the degree to which their formats facilitate, or hinder, their incorporation into Geobase Information Systems. To merge satellite data into a geobase system requires that they both have a compatible geographic referencing system. Greater acceptance of satellite data by the user community will be facilitated if the data are in a form which most readily corresponds to existing geobase data structures. The conference addressed a number of specific topics and made recommendations

Remote sensing applications to hydrologic modeling in the southern Sierra Nevada and portions of the San Joaquin Valley, volume 1

The author has identified the following significant results. Characteristics of LANDSAT MSS imagery present problems in using satellite radiation measurements to estimate the shortwave albedo of an alpine snow cover. Every 15 minute USGS quadrangle contains over 100,000 pixels which poses a computation problem if each pixel is to be evaluated individually. The sampling interval may be sufficiently great to mask some effects of terrain and vegetation on reflectance. Three frames of LANDSAT imagery are needed for complete coverage of the study area, yet less than one third of the area coverage from each frame covers an area of interest. Because of distortions inherent in the imagery, information regarding spacecraft altitude, attitude, and position must be statistically derived with respect to ground control points in the image whose geodetic locations are known. An inspection of shade points indicates that up to one third of the most heavily snow covered areas may saturate in bands 4 through 6. LANDSAT's 9 day repeat cycle is not optimum for snow cover reflectance modeling because the most pronounced changes in albedo occur most nearly following a new snowfall. Such a snowfall, occurring between overpasses, is inadequately represented by extrapolation from the previous overpasses

From meadows to milk to mucosa – adaptation of Streptococcus and Lactococcus species to their nutritional environments

Lactic acid bacteria (LAB) are indigenous to food-related habitats as well as associated with the mucosal surfaces of animals. The LAB family Streptococcaceae consists of the genera Lactococcus and Streptococcus. Members of the family include the industrially important species Lactococcus lactis, which has a long history safe use in the fermentative food industry, and the disease-causing streptococci Streptococcus pneumoniae and Streptococcus pyogenes. The central metabolic pathways of the Streptococcaceae family have been extensively studied because of their relevance in the industrial use of some species, as well as their influence on virulence of others. Recent developments in high-throughput proteomic and DNA-microarray techniques, in in vivo NMR studies, and importantly in whole-genome sequencing have resulted in new insights into the metabolism of the Streptococcaceae family. The development of cost-effective high-throughput sequencing has resulted in the publication of numerous whole-genome sequences of lactococcal and streptococcal species. Comparative genomic analysis of these closely related but environmentally diverse species provides insight into the evolution of this family of LAB and shows that the relatively small genomes of members of the Streptococcaceae family have been largely shaped by the nutritionally rich environments they inhabit.

Binary Central Stars of Planetary Nebulae Discovered Through Photometric Variability III: The Central Star of Abell 65

A growing number of close binary stars are being discovered among central stars of planetary nebulae. Recent and ongoing surveys are finding new systems and contributing to our knowledge of the evolution of close binary systems. The push to find more systems was largely based on early discoveries which suggested that 10 to 15% of all central stars are close binaries. One goal of this series of papers is confirmation and classification of these systems as close binaries and determination of binary system parameters. Here we provide time-resolved multi-wavelength photometry of the central star of Abell 65 as well as further analysis of the nebula and discussion of possible binary--nebula connections. Our results for Abell 65 confirm recent work showing that it has a close, cool binary companion, though several of our model parameters disagree with the recently published values. With our longer time baseline of photometric observations from 1989--2009 we also provide a more precise orbital period of 1.0037577 days.Comment: Accepted for publication in the Astronomical Journa

LANDSAT-D investigations in snow hydrology

Work undertaken during the contract and its results are described. Many of the results from this investigation are available in journal or conference proceedings literature - published, accepted for publication, or submitted for publication. For these the reference and the abstract are given. Those results that have not yet been submitted separately for publication are described in detail. Accomplishments during the contract period are summarized as follows: (1) analysis of the snow reflectance characteristics of the LANDSAT Thematic Mapper, including spectral suitability, dynamic range, and spectral resolution; (2) development of a variety of atmospheric models for use with LANDSAT Thematic Mapper data. These include a simple but fast two-stream approximation for inhomogeneous atmospheres over irregular surfaces, and a doubling model for calculation of the angular distribution of spectral radiance at any level in an plane-parallel atmosphere; (3) incorporation of digital elevation data into the atmospheric models and into the analysis of the satellite data; and (4) textural analysis of the spatial distribution of snow cover

Measuring Health and Broader Well-Being Benefits in the Context of Opiate Dependence: The Psychometric Performance of the ICECAP-A and the EQ-5D-5L

BACKGROUND: Measuring outcomes in economic evaluations of social care interventions is challenging because both health and well-being benefits are evident. The ICEpop CAPability instrument for adults (ICECAP-A) and the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are measures potentially suitable for the economic evaluation of treatments for substance use disorders. Evidence for their validity in this context is, however, lacking. OBJECTIVES: To assess the construct validity of the ICECAP-A and the EQ-5D-5L in terms of convergent and discriminative validity and sensitivity to change on the basis of standard clinical measures (Clinical Outcomes in Routine Evaluation-Outcome Measure, Treatment Outcomes Profile, Interpersonal Support Evaluation List, Leeds Dependence Questionnaire, and Social Satisfaction Questionnaire). METHODS: A secondary analysis of pilot trial data for heroin users in opiate substitution treatment was conducted. Baseline convergence with clinical measures was assessed using the Pearson correlation coefficient. Discriminative validity was assessed using one-way analysis of variance and stepwise regressions. Sensitivity to changes in clinical indicators was assessed at 3 and 12 months using the standardized response mean statistic and parametric and nonparametric testing. RESULTS: Both measures had the same level of construct validity, except for clinical indicators of well-being, for which the ICECAP-A performed better. The ICECAP-A was sensitive to changes in both health and well-being indicators. The EQ-5D-5L had lower levels of sensitivity to change, and a ceiling effect (27%), particularly evident in the dimensions of self-care (89%), mobility (75%), and usual activities (72%). CONCLUSIONS: The findings support the construct validity of both measures, but the ICECAP-A gives more attention to broader impacts and is more sensitive to change. The ICECAP-A shows promise in evaluating treatments for substance use disorders for which recovery is the desired outcome