Empowering GPs as purchasers.

FHSAs have defined their role in purchasing primary care FHSAs have also found themselves intermediaries between district health authorities and general practitioners All of the purchasing authorities recognise the need to educate general practitioners on how to use their influence in the purchasing process General practitioners should be involved in the purchasing process as they purchase the bulk of health care; are the first point of contact for the users of the health service; need to have input on what is purchased; and need to be able to manage the changes resulting from the shift in the balance of power towards primary care The involvement of general practitioners in the purchasing process at present varies considerably among health authorities. Several district health authorities have developed models of purchasing that enable different levels of involvement     

Key issues in managed competition.

All managed competition proposals for health system reform must confront several key issues. The premiums paid to health care purchasing cooperatives will need to be subsidized for those who cannot pay full fare; the amount and sources of the subsidies are controversial political issues. The payments passed on by purchasing cooperatives to health plans must be risk adjusted to account for differences in the health care needs of their enrolled populations. This is essential to create a level playing field for competition and to eliminate incentives for plans to use risk assessment for attracting enrollees. The data and methods needed for risk adjustment, however, are not adequate at present. The Clinton Administration''s plan to limit expenditure increases raises a host of thorny issues. Maintaining quality of care will require health plan quality report cards to be supplemented by external quality assurance systems. Assuring quality will be particularly problematic for traditional indemnity plans. The structure and governance of the system, administration simplification, and other issues need to be addressed. The size and voluntariness of the purchasing cooperatives greatly influence all of these considerations. Physicians should inform their political representatives on how these issues should be resolved as compromise bills are drafted by the United States Congress this year.     

Deer and elk hunter recruitment,retention, and participation trends in Montana

Big game hunting is the most popular type of hunting in the United States, and deer and elk hunting are the most popular type of hunting in Montana. Similar to other states, deer and elk hunting also generates most of the revenue spent on wildlife conservation by the state of Montana. Although nationwide trends indicate a concerning decline in hunter participation, the trends in license sales and hunter participation within most states have not received as much attention. We investigated trends in resident deer and elk license sales in Montana using existing licensing databases. We then estimated hunter recruitment, hunter participation, and license purchasing probabilities using hunter education and licensing databases. We employed a multi-state mark–recapture model and 248,819 records of deer and elk license purchasing habits for individual Montana residents during 2002–2007. We used matrix population models to examine the relative influence of these parameters on trends in license sales and hunter participation. Resident deer and elk license sales increased 4% in Montana during 2002–2007. We found that males had greater recruitment rates, retention rates, and license purchasing probabilities than females, and that young adults had lesser license purchasing probabilities than other age classes. Based on analyses of matrix population models, trends in license sales in Montana are most influenced by middle-aged and baby boomer male license purchase probabilities. Trends in hunter participation are positively influenced by recruitment and retention in all male age classes, with the smallest predicted effects arising from recruitment of young adult males. Our results suggest that a focus on older age class males with programs designed to increase hunter recruitment, retention, and license purchase probabilities may have similar or larger effects on trends in license sales and hunter participation in Montana than programs directed at youth. Our analyses also provide a framework by which trends in hunter recruitment, retention, and license purchasing habits can be objectively quantified in order to inform and evaluate hunter recruitment, retention, and license purchase habit programs. © 2011 The Wildlife Society.     

CONSUMER ACCEPTANCE OF COMMERCIALLY AVAILABLE FRANKFURTERS1

Consumers want meat products that are healthful and affordable. However, consumers will repurchase a product only if it tastes good. Consumers identified reasons for purchasing frankfurters and evaluated overall acceptability of 10 commercially available frankfurters. Consumers listed “taste” as the most important factor when purchasing frankfurters; only 16% of the consumers indicated that nutrition/health was the most important criterion. Nineteen consumer-perceived sensory and liking attributes were measured for the frankfurters in this study. The intensities of the attributes ranged from low to moderately high. All the frankfurters scored in the low to moderate range for overall acceptability. Most of the scores for liking of individual attributes correlated highly with overall liking, indicating that many of the questions relating to attribute liking could be eliminated.     

General practitioners in partnership with management: an organisational model for debate.

The role of general practitioners is changing and expanding. Doctors have more control over the treatment received by their patients but remain largely unaccountable to the public and management. This article proposes an organisational model for integrating primary and secondary care which retains the advantages of fund-holding while giving management control over overall strategy. It proposes that general practitioners control funds for all primary and secondary care. Secondary care will be contracted through a joint team of managers and an elected general practice executive committee. A new health care purchasing authority will contract for primary services with individual practices or primary care provider units. General practitioners will have local contracts reflecting their desire to provide an expanded range of services and the needs of the community.     

Determining the size of a total purchasing site to manage the financial risks of rare costly referrals: computer simulation model.

OBJECTIVE: To estimate the financial risks of 15 categories of rare costly referrals for total purchasing sites of different population sizes. DESIGN: Computer simulation of 100 fund years assuming Poisson distribution of referrals. SETTING: British general practices that have opted to become total purchasing sites. Referral rates and price estimates were supplied by South and West Devon Health Commission. MAIN OUTCOME MEASURES: Variation in referral costs to purchasers in relation to size of risk pool (person years at risk). RESULTS: Random variation in referral costs increased as the size of the risk pool decreased. Variation increased greatly below 30,000 person years. The mean simulated cost of the referral categories considered was 2.8% of total NHS hospital and community service costs, and the maximum simulated cost for 7000 person years was 6.8%. Simulated variation was robust to assumption about prices and referral rates for specific types of referral. CONCLUSION: Rare costly referrals seem unlikely to bankrupt total purchasing sites. The management of risk is not in itself justification for total purchasing to be based in several general practices in order to generate large populations. There are other ways of managing risk. Sites can easily explore options by simulations using local referral rates and prices.     

Physiological rhythms, dynamical diseases and acupuncture

Physiological rhythms are ubiquitous and essential to our life. They usually interact with one another and also with the outside environment. Disappearance of normal rhythms and emergence of abnormal rhythms are called dynamical diseases. In this article, we will first review the current knowledge on the genesis of physiological rhythms. Then, models of rhythmic interactions among themselves and with external stimuli will be reviewed. Particular emphasis will be placed on the methods that can diagnose abnormal rhythms. Finally, treatment of dynamical diseases will be discussed. It turns out that the models of fractional Brownian motion and fractional Gaussian noise based on dynamical systems have the potential to become biomarkers in differentiating and evaluating normal from abnormal physiological rhythms in dynamical diseases. Meanwhile, in order to explain how acupuncture works, a feasible model of meridians based on communication networks is also included.     

HIV: evolution of a pandemic.

Although the prevalence of AIDS is still relatively low in many countries in Asia and the Pacific Rim, the rate of HIV transmission in this region continues to rise inexorably and will surpass that of sub-Saharan Africa by 1997. The challenge of mobilizing governments and communities to counter this largely invisible threat was the theme of the Third International Conference on AIDS in Asia and the Pacific, held in Chiang Mai, Thailand, in September 1995. Thailand has led the way with bold and far-reaching HIV prevention programs. Nevertheless, the long-term consequences of existing HIV infection in Thailand and elsewhere in Asia will be severe. Moreover, these repercussions will be felt globally as productivity is undermined, health care costs soar and purchasing power weakens. Supporting programs for HIV prevention and care abroad is thus an urgent matter of economic and political self-interest as well as a humanitarian imperative.     

Sexing mammalian sperm--intertwining of commerce, technology, and biology

Sperm from many mammalian species can be sexed by flow cytometry/cell sorting at about 90% accuracy without damaging them unduly. However, because sperm are evaluated one at a time, in series, the number of sexed sperm produced per unit time is limited. Furthermore, the equipment required currently is expensive, in the order of 300,000 US dollars per machine. Despite these limitations, commercialization of this technology has begun with bovine semen, in part by inseminating cattle with relatively low number of sperms. No other approach to sexing sperm in any practical way is likely to be available within the next few years. The constraints for commercial application of sexed sperm in cattle can be somewhat lowered fertility, the high costs of equipment and skilled personnel, and costs of intellectual property such as licensing fees and royalty payments. Most economic analyses indicate that farmers can afford to pay 10-20 US dollars more per dose of sexed sperm than unsexed sperm if costs must be recouped by selling milk or meat. When the product is breeding stock or for certain niche applications, a higher price for sexed semen may be justified. Sexed sperm will be used more broadly in cattle only when improved production and/or efficiency can compensate for the extra costs of purchasing sexed sperm.     

Collecting morbidity data in general practice: the Somerset morbidity project.

OBJECTIVE--To collect a valid, complete, continuous, and representative database of morbidity presenting to primary care and to use the data to help commission services on the basis of local need and effectiveness. SETTING--Computerised general practices in Somerset. METHODS--Participating general practices were selected to be representative of the district health authority population for general practice and population characteristics. All conditions presented at face to face consultations were assigned a Read code and episode type and the data were regularly validated. Data were sent by modem from the practices via a third party to the health authority each week. MAIN OUTCOME MEASURES--Proportion of consultations coded and accuracy of coding. RESULTS--11 practices agreed to participate. Validations for completeness during April 1994 to March 1995 revealed that 96.4% of the records were coded; 94% of the 1090 records validated had appropriate episode types and 87% appropriate Read codes. The results have been used to help formulate the health authority''s purchasing plans and have enabled a change in the local contracts for surgery for glue ear. CONCLUSIONS--The project has shown the feasibility of establishing a network of practices recording and reporting the morbidity seen in primary care. Early indications are that the data can be useful in evidence based purchasing.     

A purchaser experience of managing new expensive drugs: interferon beta.

Interferon beta is a new and expensive drug for treating multiple sclerosis. One published trial has shown that it reduces the exacerbation rate in patients who have relapsing-remitting disease without important disability. This paper describes the development of a strategy for purchasing the drug in one region of England before its licensing. Purchasers felt unable to decline funding for this marginally effective drug and thereby undertake explicit rationing. To ensure prescribing was within the guidelines, a vast communication network had to be sustained with managers, general practitioners, neurologists, the Multiple Sclerosis Society, and professional advisers in all the purchasing authorities. The workload involved was considerable. The dilemma of rationing in a public service with a high political profile is demonstrated.     

Sequence-similar, structure-dissimilar protein pairs in the PDB

It is often assumed that in the Protein Data Bank (PDB), two proteins with similar sequences will also have similar structures. Accordingly, it has proved useful to develop subsets of the PDB from which "redundant" structures have been removed, based on a sequence-based criterion for similarity. Similarly, when predicting protein structure using homology modeling, if a template structure for modeling a target sequence is selected by sequence alone, this implicitly assumes that all sequence-similar templates are equivalent. Here, we show that this assumption is often not correct and that standard approaches to create subsets of the PDB can lead to the loss of structurally and functionally important information. We have carried out sequence-based structural superpositions and geometry-based structural alignments of a large number of protein pairs to determine the extent to which sequence similarity ensures structural similarity. We find many examples where two proteins that are similar in sequence have structures that differ significantly from one another. The source of the structural differences usually has a functional basis. The number of such proteins pairs that are identified and the magnitude of the dissimilarity depend on the approach that is used to calculate the differences; in particular sequence-based structure superpositioning will identify a larger number of structurally dissimilar pairs than geometry-based structural alignments. When two sequences can be aligned in a statistically meaningful way, sequence-based structural superpositioning provides a meaningful measure of structural differences. This approach and geometry-based structure alignments reveal somewhat different information and one or the other might be preferable in a given application. Our results suggest that in some cases, notably homology modeling, the common use of nonredundant datasets, culled from the PDB based on sequence, may mask important structural and functional information. We have established a data base of sequence-similar, structurally dissimilar protein pairs that will help address this problem (http://luna.bioc.columbia.edu/rachel/seqsimstrdiff.htm).     

Abiotic Resource Depletion Different perceptions of the problem with mineral deposits

Goal, Scope and Background The goal of the present paper is to demonstrate how environmental product declarations (EPDs) are developed based on a set of product category rules (PCRs) in accordance with the requirements in the ISO 14025-standard. This is demonstrated by examples from the furniture industry in Norway, where several case models are evaluated. To ease the capability of developing EPDs in this industry, a database with specific environmental data for materials in furniture is developed. The database is used to produce the LCA for selected furniture models, and further, the database is the backbone of a data-assistance tool used to create the EPDs. Methods The LCA-data are produced based on traditional LCA-methodology. The PCR is based on a stakeholder analysis and the proposed methodology in the ISO 14025-standard. The EPDs developed so far, are results of close collaboration between companies and research centres in the Nordic countries. For the verification of the EPDs, auditing methodologies are used as a part of the audit of the companies' environmental management systems (EMS). Results and Conclusion Based on a hearing of a set of suggested PCRs, a consensus document for seating accommodation is developed. This is further the model for how to develop PCR-documents for all types of furniture, for example sleeping accommodations. Likewise, the database shall contain the most important data for the parts of a furniture model. Within the goal of the project period, EPDs will be developed for 80% of Norwegian furniture. The verification of the EPDs is done as a part of the certification procedures of EMS in accordance with the ISO 14001. Recommendation and Perspective The results presented in the paper are mainly for the pilot models in the project. However, the results will be further tested and the data-tool will be developed as a part of a product design tool where environmental requirements will be combined with quality requirements. The product design tool will be implemented in the furniture industry. Information on how to use EPDs in public purchasing will also be a part of future work.     

Rationing in practice: the case of in vitro fertilisation.

One of the few examples of explicit rationing in the National Health Service is provided by in vitro fertilisation. Of six purchasing authorities examined three have decided against buying in vitro fertilisation while three have decided in favour. The decisions reflect local factors such as the absence or presence of local providers and the views of the public and health professionals. But in vitro fertilisation also illustrates some of the wider issues involved in all decisions about purchasing: questions about what should be provided by the National Health Service, about what procedures should be compared when weighing up value for money, and whether equity demands national decisions about what to provide.     

Non-coding RNAs, epigenetics and complexity

Several aspects of epigenetics are strongly linked to non-coding RNAs, especially small RNAs that can direct the cytosine methylation and histone modifications that are implicated in gene expression regulation in complex organisms. A fundamental characteristic of epigenetics is that the same genome can show alternative phenotypes, which are based in different epigenetic states. Some of the most studied complex epigenetic phenomena including transposon activity and silencing recently exemplified by piRNAs (piwi-interacting RNAs), position effect variegation, X-chromosome inactivation, parental imprinting, and paramutation have direct or indirect participation of an RNA component. Conceivably, most of the non-coding RNAs with no described function yet, are players in epigenetic mechanisms that are still not completely understood. In that regard, RNAs were recently implicated in new mechanisms of genetic information transfer in yeast, plants and mice. In this review article, the hypothesis that non-coding RNAs might be the main component of complex organisms acquired during evolution will be explored. The question of how evolutionary theories have been challenged by these molecules in association with epigenetic mechanisms will also be discussed here.     

Polypeptoid polymers: Synthesis,characterization, and properties

Polypeptoids, a class of peptidomimetic polymers, have emerged at the forefront of macromolecular and supramolecular science and engineering as the technological relevance of these polymers continues to be demonstrated. The chemical and structural diversity of polypeptoids have enabled access to and adjustment of a variety of physicochemical and biological properties (eg, solubility, charge characteristics, chain conformation, HLB, thermal processability, degradability, cytotoxicity and immunogenicity). These attributes have made this synthetic polymer platform a potential candidate for various biomedical and biotechnological applications. This review will provide an overview of recent development in synthetic methods to access polypeptoid polymers with well‐defined structures and highlight some of the fundamental physicochemical and biological properties of polypeptoids that are pertinent to the future development of functional materials based on polypeptoids.     

Time-lapse infrared videography for animal behavior observations

Although videography has been used for many years to record episodes of animal behavior, the availability of increasingly complex equipment can make selection difficult. Most equipment developed for round-the-clock observations was designed for security surveillance, so informed purchasing, installation, and usage decisions need to be made to monitor animal behavior effectively. During 7 years of using video and infrared equipment for animal behavior research and monitoring in a zoo setting, we tested many models, evaluated options, and modified components. We now have well-integrated systems that are compatible with our video/computer review and analysis program. New equipment will continue to become available, but familiarity with basic features and applications can help to narrow the selection. Zoo Biol 17:535–543, 1998. © 1998 Wiley-Liss, Inc.     

Lifetime Risk of Fatal Occupational Injuries within Industries,by Occupation,Gender, and Race

Estimates of risk accumulated over a working lifetime are used to assess the significance of many workplace health hazards. Most studies which have estimated this risk have focused on a worker's lifetime risk of dying of a stated illness based on exposure to a hazard in a specific job. The concept, however, has not been widely applied to occupational injury deaths. This study examines the use of lifetime risk based on national fatal injury data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). Lifetime risks are defined by specific causal events for those groups identified as having the highest general lifetime risks. The lifetime risk model for injury used in this work can be compared with risk assessments for occupational illnesses. Fatal injury lifetime risk estimates will be useful in defining traumatic injury exposures that are appropriate for targeting research and prevention efforts needed to reduce the burden of work-related death within the United States. These estimates also provide a means of prioritizing traumatic injury research with fatal illness research, while providing the additional benefit of providing a means of informing workers of their fatal injury risks.     

Distinguishing dung from blue, red and yellow-backed duikers through noninvasive genetic techniques

Dung counts have been widely used to estimate duiker abundance and densities in tropical African forests. However, one of the major limitations of this method is that species' identification of dung based on morphological characteristics is extremely difficult in most cases. Some authors made the assumption that dung pellets could at least be distinguishable between the blue duiker, the red duikers and the yellow-backed duiker. However, this study is the first attempt to test the reliability of field identification. In this study, we suggest a method based on a noninvasive genetic protocol to identify duiker species. The comparison of field and genetic identifications shows that only dung from Cephalophus silvicultor was identified in the field without error. The rate of error for red duikers and the blue duiker is high and any attempt to distinguish among those species will result in wrong estimations for each species. We recommend the use of DNA tests to ensure reliable species' identification when duiker censuses based on dung counts are used. This methodological input will probably strengthen the dung count technique and increase its reliability for duiker species abundance estimations and spatial distribution studies.     

Mate selection,consortship formation,and reproductive tactics in adult female savanna baboons

Mate selection is a proximate mechanism influencing the probability that two individuals will engage in reproductive activity. The degree to which mate selection by female savanna baboons (Papio cynocephalus anubis) affects consortship formation and the characteristics of males that they prefer to mate with were analyzed based upon a 19-month study in Kenya. Sexual solicitations by females had a positive impact on the probability that males would establish consort relationships. The most preferred mating partners were young, high ranking, newcomer males, but these same males did not have the highest mating success. Friendships between male and female baboons almost always developed subsequent to conception cycles. Female savanna baboon reproductive tactics appear to be based upon maximizing the probability that males will provide care for offspring.