Risk and the GP budget holder

For most individuals, the use made of health care in a given year is determined principally by unpredictable random incidents. Of course, some individuals have a predictably higher predisposition to illness than others. However, the general consensus is that only a fraction of individual variability in health care costs can be predicted. The purpose of this paper is to explore the implications of this inherent randomness for budget setting for GP purchasers. The paper argues that variability in utilization in the NHS is very high; that no formula will ever completely capture that variability, even for large populations; that the problem of variability is likely to be very acute for a GP practice; and that health authorities and GP budget holders will therefore need to adopt a range of strategies to manage the variability.fundholding

Further evidence on the link between health care spending and health outcomes in England

This report describes results from research funded by the Health Foundation under its Quest for Quality and Improved Performance (QQuIP) initiative. It builds on our earlier report for the Health Foundation – The link between health care spending and health outcomes: evidence from English programme budgeting data – that took advantage of the availability of a major new dataset to examine the relationship between health care expenditure and mortality rates for two disease categories (cancer and circulation problems) across 300 English Primary Care Trusts. Our results are useful from a number of perspectives. Scientifically, they confirm our previous findings that health care has an important impact on health across a range of conditions, suggesting that those results were robust across programmes of care and across years. From a policy perspective, these results can help set priorities by informing resource allocation across a larger number of programmes of care. They also add further evidence to help NICE decide whether its current QALY threshold is at the right level.

The link between health care spending and health outcomes for the new English Primary Care Trusts

English programme budgeting data have yielded major new insights into the link between health care spending and health outcomes. This paper updates two recent studies that have used programme budgeting data for 295 Primary Care Trusts (PCTs) in England to examine the link between spending and outcomes for several programmes of care. We use the same economic model employed in the two previous studies. It focuses on a decision maker who must allocate a fixed budget across programmes of care so as to maximize social welfare given a health production function for each programme. Two equations – a health outcome equation and an expenditure equation – are estimated for each programme (data permitting). The two previous studies employed expenditure data for 2004/05 and 2005/06 for 295 health authorities and found that in several care programmes – cancer, circulation problems, respiratory problems, gastro-intestinal problems, trauma burns and injury, and diabetes – expenditure had the anticipated negative effect on the mortality rate. Each health outcome equation was used to estimate the marginal cost of a life year saved. In 2006/07 the number of PCTs in England was reduced to 152, largely through a series of mergers. In addition, several changes were made to the methods employed to construct the programme budgeting data. This paper employs updated budgeting and mortality data for the new 152 PCTs to re-estimate health production and expenditure functions, and also presents updated estimates of the marginal cost of a life year saved in each programme. Although there are some differences, the results obtained are broadly similar to those presented in our two previous studies.

The Link Between Health Care Spending and Health Outcomes: Evidence from English Programme Budgeting Data

This report describes preliminary results from research funded by the Health Foundation under its Quest for Quality and Improved Performance (QQuIP) initiative.

False Persuasion, Superficial Heuristics, and the Power of Logical Form to Test the Integrity of Legal Argument

This Article will generally describe philosophical logic, logical form, and logical fallacy. Further, it will explain one specific logical fallacy—the Fallacy of Negative Premises—as well as how courts have used the Fallacy of Negative Premises to evaluate legal arguments. Last, it will explain how lawyers, judges, and law students can use the Fallacy of Negative Premises to make and evaluate legal argument

Understanding Loglan.

Thesis (M.A.) University of Alaska Fairbanks, 1994Loglan is a language designed to help test Whorf's hypothesis that language shapes thought. Specifically, Loglan should encourage more creative and logical thought in its users. Such future users will need a readable textbook of the language; that is the purpose of the present work. <p

Measuring the accuracy of page-reading systems

Given a bitmapped image of a page from any document, a page-reading system identifies the characters on the page and stores them in a text file. This OCR-generated text is represented by a string and compared with the correct string to determine the accuracy of this process. The string editing problem is applied to find an optimal correspondence of these strings using an appropriate cost function. The ISRI annual test of page-reading systems utilizes the following performance measures, which are defined in terms of this correspondence and the string edit distance: character accuracy, throughput, accuracy by character class, marked character efficiency, word accuracy, non-stopword accuracy, and phrase accuracy. It is shown that the universe of cost functions is divided into equivalence classes, and the cost functions related to the longest common subsequence (LCS) are identified. The computation of a LCS can be made faster by a linear-time preprocessing step

Tributary connectivity, confluence aggradation and network biodiversity

In fluvial networks, some confluences are associated with tributary-driven aggradation where coarse sediment is stored, downstream sediment connectivity is interrupted and substantial hydraulic and morphological heterogeneity is generated. To the extent that biological diversity is supported by physical diversity, it has been proposed that the distribution and frequency of tributary-driven aggradation is important for the magnitude and spatial structure of river biodiversity. Relevant ideas are formulated within the Link Discontinuity Concept and the Network Dynamics Hypothesis, but many of the issues raised by these conceptual models have not been systematically evaluated. This paper first tests an automated method for predicting the likelihood of tributary-driven aggradation in three large drainage networks in the Rocky Mountain foothills, Canada. The method correctly identified approximately 75% of significant tributary confluences and 97% of insignificant confluences. The method is then used to evaluate two hypotheses of the Network Dynamics Hypothesis: that linear-shaped basins are more likely to show a longitudinal, downstream decline in tributary-driven aggradation; and that larger and more compact basins contain more confluences with a high probability of impact. The use of a predictive model that included a measure of tributary basin sediment delivery, rather than symmetry ratio alone, mediated the outcomes somewhat, but as anticipated, the number of significant confluences increased with basin size and basin shape was a strong control of the number and distribution of significant confluences. Doubling basin area led to a 1.9-fold increase in the number of significant confluences and compact basins contained approximately twice as many significant confluences per unit channel length as linear basins. In compact basins, significant confluences were more widely distributed, whereas in linear basins they were concentrated in proximal reaches. Interesting outstanding issues include the possibility of using spatially-distributed sediment routing models to predict tributary-driven confluence aggradation and the need to gather ecological data sufficient to properly test for increases in local and network-scale biodiversity associated with significant confluences and their network-scale controls

Indispensable Logic: Using the Logical Fallacy of the Undistributed Middle as a Litigation Tool

This article explores the logical fallacy named the Fallacy of the Undistributed Middle and demonstrates how it can be a powerful tool for those engaged in the discipline of solving legal problems and evaluating legal arguments. First, it will explain what formal logic is, how it is different from informal conventions of logic, and describe the important role formal logic plays in skillful advocacy. Second, it will explain the Fallacy of the Undistributed Middle and why arguments falling into this fallacious pattern of reasoning are logically invalid. Third, it will examine the courts’ contemporary recognition of this formal logical fallacy as a basis for rejecting legal arguments. Last, it will explain how to identify the Fallacy of the Undistributed Middle in legal arguments and how to unmask and disarm these logically invalid arguments from a litigator’s perspective

Conspicuous Logic: Using the Logical Fallacy of Affirming the Consequent as a Litigation Tool

This article will address one of the specific logical fallacies known as the Fallacy of Affirming the Consequent, discuss the place of formal logic in legal reasoning, describe the Fallacy of Affirming the Consequent, demonstrate how courts have explicitly used the fallacy in deciding cases, and detail how litigators can use the Fallacy to win cases