Ethics and health care 'underfunding'

There are continual “crises” in health care systems worldwide as producer and patient groups unify and decry the “underfunding” of health care. Sometimes this cacophony is the self interest of profit seeking producers and often it is advocacy of unproven therapies. Such pressure is to be expected and needs careful management by explicit rationing criteria which determine who gets access to what health care. Science and rationality, however, are unfortunately, rarely the rules of conduct in the medical market-place

Reforming the contract of UK consultants

The NHS Plan expressed the intention of government to "fundamentally overhaul" the national contract for UK hospital specialists to "reward and incentivise those who do most for the NHS." How can this be achieved

Challenges for the National Institute for Clinical Excellence

Rationing health care is inevitable, and NICE should inform NHS decision making. Adoption of new technologies by NHS clinicians should be informed by costs as well as effectiveness. The NHS needs better information from NICE on the equity implications of new and existing technologies. NICE appraisal should focus not only on service enhancement but also on withdrawal of existing ineffective or inefficient therapies. Giving NICE a real budget to fund its recommendations would encourage it to examine the effect of its decisions on the whole NHS

Measurements of Heat-Transfer and Friction Coefficients for Helium Flowing in a Tube at Surface Temperatures up to 5900 Deg R

Measurements of average heat transfer and friction coefficients and local heat transfer coefficients were made with helium flowing through electrically heated smooth tubes with length-diameter ratios of 60 and 92 for the following range of conditions: Average surface temperature from 1457 to 4533 R, Reynolds numbe r from 3230 to 60,000, heat flux up to 583,200 Btu per hr per ft2 of heat transfer area, and exit Mach numbe r up to 1.0. The results indicate that, in the turbulent range of Reynolds number, good correlation of the local heat transfer coefficients is obtained when the physical properties and density of helium are evaluated at the surface temperature. The average heat transfer coefficients are best correlated on the basis that the coefficient varies with [1 + (L/D))(sup -0,7)] and that the physical properties and density are evaluated at the surface temperature. The average friction coefficients for the tests with no heat addition are in complete agreement with the Karman-Nikuradse line. The average friction coefficients for heat addition are in poor agreement with the accepted line

Evolutionarily Stable Strategies in Quantum Games

Evolutionarily Stable Strategy (ESS) in classical game theory is a refinement of Nash equilibrium concept. We investigate the consequences when a small group of mutants using quantum strategies try to invade a classical ESS in a population engaged in symmetric bimatrix game of Prisoner's Dilemma. Secondly we show that in an asymmetric quantum game between two players an ESS pair can be made to appear or disappear by resorting to entangled or unentangled initial states used to play the game even when the strategy pair remains a Nash equilibrium in both forms of the game.Comment: RevTex,contents extended to include asymmetric games,no figur

Isolated cold plasma regions: Observations and their relation to possible production mechanisms

Regions of enhanced cold plasma, isolated from the main plasmasphere along the Explorer 45 orbit on the equatorial plane, are reported using the sheath induced potentials seen by the electric field experiment. The occurrence of these regions has a strong correlation with negative enhancements of Dst, and their locations are primarily in the noon-dusk quadrant. The data support the concept that changes in large scale convection play a dominant role in the formation of these regions. Plasmatails that are predicted from enhancements of large scale convection electric fields in general define where these regions may be found. More localized processes are necessary to account for the exact configuration and structure seen in these regions and may eventually result in detachment from the main plasmasphere

The effect of sea quarks on the mass of the charm quark from Lattice QCD

We compute the mass of the charm quark using both quenched and dynamical lattice QCD calculations. We examine the effects of mass dependent lattice artifacts by comparing two different formalisms for the heavy quarks. We take the continuum limit of the charm mass in quenched QCD by extrapolating from three different lattice spacings. At a fixed lattice spacing, the mass of the charm quark is compared between quenched QCD and dynamical QCD with a sea quark mass around strange. In the continuum limit of quenched QCD, we find m_c(m_c)=1.29(7)(13) GeV. No evidence was seen for unquenching.Comment: Added NP analysis of quenched data, corrected error in PCAC RGI mass, updated strange quark mass discussion and references, unified notation and corrected typos. No change in final result. Version accepted for publication in JHE

Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series

After the introduction of Bassini's procedure in the late 19th century, methods of repairing hernias changed little until the 1990s, when synthetic mesh and laparoscopic methods arrived. In contrast to the open mesh technique, laparoscopic surgery remains uncommon. In January 2001, the National Institute for Clinical Excellence (NICE) issued guidance that stated, "For repair of primary inguinal hernia, open [mesh] should be the preferred surgical procedure." We describe patterns of surgical repair of inguinal hernias and assess the impact of NICE's guidance