Managed Competition: Lessons from Britain

As phrases like “managed care backlash” become part of the lexicon in American health care policy circles, it is instructive to examine a managed competition experiment in a vastly different context. Britain’s Conservative government instituted reforms in 1991 to transform the National Health Service (NHS) from a centrally administered service to managed competition between purchasers and providers. Five years later, it replaced those reforms to promote cooperation rather than competition. This Issue Brief summarizes what the NHS can learn from decades of American experience with purchasing care, and what the American health system can learn from the British experiment with an internal market in the 1990s

Ariel - Volume 1 Number 1

Copyright 1969 Arie

Ariel - Volume 2 Number 1

Editors Delvun C. Case, Jr. Paul M. Fernhoff Associate Editors Donald Bergman Daniel B. Gould Richard Bonanno Ronald Hoffman Lay-Out Editor Carol Dolinskas Sports Editor James Nocon Business Manager Nick Grego Contributing Editors Michael J. Blecker Stephen P. Flynn Lin Sey Edwards Jack Guralnik W. Cherry Ligh

Making Practical Markets for Vaccines: Why I decided that the Center for Global Development Report, Making Markets for Vaccines, offers poor advice to government and foundation leaders

Donald Light raises concerns over the current proposal to fund vaccine development through advanced market commitments to companies

Ariel - Volume 1 Number 2

Copyright 1969 Arie

Arctic sea-ice melt in 2008 and the role of solar heating

There has been a marked decline in the summer extent of Arctic sea ice over the past few decades. Data from autonomous ice mass-balance buoys can enhance our understanding of this decline. These buoys monitor changes in snow deposition and ablation, ice growth, and ice surface and bottom melt. Results from the summer of 2008 showed considerable large-scale spatial variability in the amount of surface and bottom melt. Small amounts of melting were observed north of Greenland, while melting in the southern Beaufort Sea was quite large. Comparison of net solar heat input to the ice and heat required for surface ablation showed only modest correlation. However, there was a strong correlation between solar heat input to the ocean and bottom melting. As the ice concentration in the Beaufort Sea region decreased, there was an increase in solar heat to the ocean and an increase in bottom melting

The influence of snow on sea ice as assessed from simulations of CESM2

We assess the influence of snow on sea ice in experiments using the Community Earth System Model version 2 for a preindustrial and a 2xCO2 climate state. In the preindustrial climate, we find that increasing simulated snow accumulation on sea ice results in thicker sea ice and a cooler climate in both hemispheres. The sea ice mass budget response differs fundamentally between the two hemispheres. In the Arctic, increasing snow results in a decrease in both congelation sea ice growth and surface sea ice melt due to the snow\u27s impact on conductive heat transfer and albedo, respectively. These factors dominate in regions of perennial ice but have a smaller influence in seasonal ice areas. Overall, the mass budget changes lead to a reduced amplitude in the annual cycle of ice thickness. In the Antarctic, with increasing snow, ice growth increases due to snow-ice formation and is balanced by larger basal ice melt, which primarily occurs in regions of seasonal ice. In a warmer 2xCO2 climate, the Arctic sea ice sensitivity to snow depth is small and reduced relative to that of the preindustrial climate. In contrast, in the Antarctic, the sensitivity to snow on sea ice in the 2xCO2 climate is qualitatively similar to the sensitivity in the preindustrial climate. These results underscore the importance of accurately representing snow accumulation on sea ice in coupled Earth system models due to its impact on a number of competing processes and feedbacks that affect the melt and growth of sea ice

Practical detection of a definitive biomarker panel for Alzheimer's disease: comparisons between matched plasma and cerebrospinal fluid

Previous mass spectrometry analysis of cerebrospinal fluid (CSF) has allowed the identification of a panel of molecular markers that are associated with Alzheimer’s disease (AD). The panel comprises Amyloid beta, Apolipoprotein E, Fibrinogen alpha chain precursor, Keratin type I cytoskeletal 9, Serum albumin precursor, SPARC-like 1 protein and Tetranectin. Here we report the development and implementation of immunoassays to measure the abundance and diagnostic capacity of these putative biomarkers in matched lumbar CSF and blood plasma samples taken in life from individuals confirmed at post-mortem as suffering from AD (n=10) and from screened ‘cognitively healthy’ subjects (n=18). The inflammatory components of Alzheimer’s disease were also investigated. Employment of supervised learning techniques permitted examination of the interrelated expression patterns of the putative biomarkers and identified inflammatory components, resulting in biomarker panels with a diagnostic accuracy of 87.5% and 86.7% for the plasma and CSF datasets respectively. This is extremely important as it offers an ideal high-throughput and relatively inexpensive population screening approach. It appears possible to determine the presence or absence of AD based on our biomarker panel and it seems likely that a cheap and rapid blood test for AD is feasible