DEFINING CORE HEALTH SERVICES: THE NEW ZEALAND EXPERIENCE

The New Zealand health service has been extensively changed over the past four years, with the introduction of Jour new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a "core" and no list, either positive (inclusions) or negative (exclusions) has been defined. Instead general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scare resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need.     

One third of a million days of care at home, 1959 to 1975.

Although articles on studies of organized home care programs are numerous, reports of long-term effectiveness of these programs are scanty. While government spokesmen appear to advocate more widespread use of alternatives to hospitalization, there has been serious criticism of the efficiency and accomplishments of home care services. A medically oriented home care program in Saskatoon (population, less than 150 000) has grown steadily over a 16-year period and is now serving a daily average of 200 individuals. All patients have required "hospital-like care" at home and most have not ordinarily been sufficiently mobile during their time in the program to attend hospital outpatient services. Many have required "concentrated care" through daily visits of professional health personnel. The program is designed for the physically ill and disabled and is administered by the major teaching hospital in the city, although it provides services to the whole community. Over one third of the patients referred in recent years had been at home. Almost one half of the patients have undergone satisfactory rehabilitation at home. The program has also proven to be an acceptable alternative to long-term institutional care for the permanently seriously disabled, a large number of whom are elderly. The program has been able to operate at considerably less cost to the public than inpatient (hospital or institutional) services would have entailed.     

Community care for the elderly 1976-84.

The aging of the elderly population is of crucial importance as people who are over 80 make far greater use of health and social services than any other age group. Government guidelines on the provision of services, which are generally related to the whole population aged 65 and over, fail to take account of this change in the age structure of the elderly population and are no longer appropriate. Recent trends in the provision of domiciliary services, day care, specialist housing for the elderly, and residential care have been related to changes in the number of potential consumers. Ironically, despite the government''s stated commitment to "community care," the chief growth area has been private institutional care. The number of day care places and sheltered housing units has also increased in real terms, but the provision of domiciliary services, such as home help and health visitor visits to the elderly, has either fallen behind or barely matched the increase in the number of very old people. If community care is to be made a reality and if the present inadequate levels of service are to be maintained, let alone improved, then additional resources, greater cooperation among agencies, and a more imaginative approach to the development and delivery of services are urgently needed.     

Hospital and community health service costs: England and Scotland compared.

In publications which have compared the health expenditure in the component parts of the United Kingdom by applying the Resource Allocation Working Party (RAWP) formula to the health budget of England, Scotland, Wales, and Northern Ireland it has been previously concluded that Scotland''s hospital and community health services expenditure is more than 19% above what would be a fair distribution. It has also been implied that Scotland''s allocation should be cut substantially to improve services in England. On the assumption that the purpose of examining the distribution of the health and community health service budget is to ensure "equal opportunity of access to health care for people at equal risk" it is concluded that simple RAWPing of the United Kingdom budget is flawed and a conclusion based on this is therefore untenable.     

基于生态系统服务供需的景感尺度特征分析和应用

自然生态系统与人类感知的交互作用是景感生态学关注的焦点,与生态系统服务的供需紧密关联。生态系统、生态过程、生态系统服务以及人的需求均具有一定的时空尺度特征,因此,由这些过程产生的"景感"也具有时空尺度特征,并依赖于这个过程的尺度特征相互作用。梳理生态系统服务供需关系与景感营造规划的尺度特征,探索二者相互联系,进而提出基于景感生态学理论,通过景感营造实现生态系统服务供需平衡的多尺度实现路径。从空间维度,体现从"社区-城市-流域-区域"的多尺度景感规划框架,从应用维度,体现从生态系统服务需求探索-关键指标体系识别-多源谜码数据感知-景感营造与规划设计的具体流程。通过多尺度的联合景感营造,调整自然供给水平与人类不同尺度的生态系统服务需求以期达到平衡,从而实现人类生存环境福利与居民福祉提升的目标。在此基础上,结合雄安新区规划建设实例,从多尺度景感营造的角度为城市绿色生态建设与可持续发展提出优化建议。主要结论：（1）基于"社区-城市-流域-区域"的多尺度景感分析框架,将景感要素与生态系统服务供需思想融入城市规划,在不同尺度上趋善优化,对于实现可持续发展城市规划和管理具有重要指示意义;（2）雄安新区规划设计需更系统和细致地考虑人类感知需求,通过多尺度景感营造设计,共同实现雄安新区的可持续发展与人居环境提升。其中,在社区尺度,需重点关注社区植被配置和居民的休闲游憩;在新区尺度重点关注绿地系统网络构建;在大清河流域尺度重点关注河流健康与水文调节;在京津冀区域尺度需注重山体通风廊道与生态屏障的构建与优化。     

Variation in grazing management practices supports diverse butterfly communities across grassland working landscapes

Landscape changes and resource exploitation have driven global biodiversity declines and reduced provision of ecological functions and services. In grassland working landscapes managed for ecological services and livestock production, it is essential to understand the influence of grazing practices on biodiversity to guide conservation. We used grassland butterflies to investigate the effects of four grazing management practices on biodiversity and pollination services from 2015 to 2016. We hypothesized grazing management practices would generate differing floristic resources that would thereby influence grassland butterfly community composition. To address our hypothesis, we sampled floral resources using belt transects and butterfly community and species level dynamics using line-transect distance sampling. We detected 2578 butterflies representing 34 species. Management practice was not a significant predictor of floral (p?=?0.319) or butterfly community composition (p?=?0.604), and sites under the same management showed dissimilarity in ordination space, indicating differences that may not be associated with grazing practices. At the species level, management explained density for six of nine butterfly species, but no individual management practice was optimal for a majority of detected species. Thus, over the timeframe of this study, grazing management practices did not generate differences in floristic community composition to drive community-level responses in grassland butterflies. Rather, management drove differences in individual species’ abundance within the butterfly community, likely contributing to the butterfly diversity observed at a broader scale.     

Falling rate of provision of residential care for the elderly.

The rapid increase in the number of very aged people has not been accompanied by appropriate expansion of local authority residential facilities. The rate of provision in 1976 was already acknowledged to be inadequate, but data are now presented to show that since then there has been an effective fall in the rate of provision of some 9000 places equivalent to, say, 180 old people''s homes of 50 places each. The prospects for the future are even gloomier: public spending cuts and local authority priorities suggest a continuing fall in the rate of provision that can be expected to have a profound effect on the National Health Service, on the burden on families, and on the condition in which old people are obliged to remain "in the community" (where support services have likewise failed to keep pace with demographic change).     

Research needs for incorporating the ecosystem service approach into EU biodiversity conservation policy

Using a range of different methods including extensive reviews, workshops and an electronic conference, 70 key research recommendations and 12 priority research needs to integrate the ecosystem services approach into biodiversity conservation policy and funding were identified by a cross-disciplinary group of over 100 scientists and 50 stakeholders, including research funders and policy-makers. These recommendations focus on the ecological underpinning of ecosystem services, drivers that affect ecosystems and their services, biological traits and ecosystem services, the valuation of ecosystem services, spatial and temporal scales in ecosystem service assessment, indicators of ecosystem services, and habitat management, conservation policy and ecosystem services. The recommendations in this paper help steer the research agenda on ecosystem services into policy-relevant areas, agreed upon by funders, researchers and policy-makers. This research agenda will only succeed with increased collaboration between researchers across disciplines, thereby providing a challenge to the research community and research funders to work in new, interdisciplinary ways.     

In vitro toxicity: mechanisms,alternatives and validation - a report from the 19th annual scientific meeting of the Scandinavian Society for Cell Toxicology

The Scandinavian Society for Cell Toxicology (SSCT) has arranged annual scientific meetings since 1983. These workshops were the forum for the Multicentre Evaluation of In Vitro Cytotoxicity (MEIC) programme. Along with the MEIC programme, which was completed in 1998, a wide range of topics relating to cytotoxicity have been discussed. The meetings have also given an opportunity for graduate students and young scientists to present their work to an international audience. At the same time, experts in the fields of in vitro toxicity have been invited as speakers. The 19th SSCT scientific meeting, which was held at S?rup Manor in Ringsted, Denmark, was no exception. The meeting consisted of four sessions: mechanisms of toxicity; environmental toxicological testing; alternatives to animal experiments; and validation of in vitro tests.     

Meeting Report from the Genomic Standards Consortium (GSC) Workshops 6 and 7

This report summarizes the proceedings of the 6th and 7th workshops of the Genomic Standards Consortium (GSC), held back-to-back in 2008. GSC 6 focused on furthering the activities of GSC working groups, GSC 7 focused on outreach to the wider community. GSC 6 was held October 10-14, 2008 at the European Bioinformatics Institute, Cambridge, United Kingdom and included a two-day workshop focused on the refinement of the Genomic Contextual Data Markup Language (GCDML). GSC 7 was held as the opening day of the International Congress on Metagenomics 2008 in San Diego California. Major achievements of these combined meetings included an agreement from the International Nucleotide Sequence Database Consortium (INSDC) to create a "MIGS" keyword for capturing "Minimum Information about a Genome Sequence" compliant information within INSDC (DDBJ/EMBL /Genbank) records, launch of GCDML 1.0, MIGS compliance of the first set of "Genomic Encyclopedia of Bacteria and Archaea" project genomes, approval of a proposal to extend MIGS to 16S rRNA sequences within a "Minimum Information about an Environmental Sequence", finalization of plans for the GSC eJournal, "Standards in Genomic Sciences" (SIGS), and the formation of a GSC Board. Subsequently, the GSC has been awarded a Research Co-ordination Network (RCN4GSC) grant from the National Science Foundation, held the first SIGS workshop and launched the journal. The GSC will also be hosting outreach workshops at both ISMB 2009 and PSB 2010 focused on "Metagenomics, Metadata and MetaAnalysis" (M(3)). Further information about the GSC and its range of activities can be found at http://gensc.org, including videos of all the presentations at GSC 7.     

From genes to therapeutics: educating the government and the public on biomedical sciences-a Singapore experience

Singapore has a highly developed economy and has been recognized to have one of the best business environments in Asia. Her success is based largely on focused developments of key industries in traded services and manufacturing sectors. The challenge for Singapore is to utilize her small human resource to transform the present economy to a more knowledge-intensive economy. Singapore has recently embarked on the ambitious goal of developing Biomedical Sciences as an industry. Educating the government and the public on various aspects of this new industry was identified as one of the essential steps towards this goal. The challenge was to inspire non-biologists to embrace the life sciences. This review describes how a series of workshops were developed to address the needs and the challenges of educating the public and the government.     

植被群落特征对城市生态系统服务的影响研究进展

生态空间（林地、灌木、草地、水体）所产生的生态系统服务极大的改善了人类的生存环境，在城市绿地破碎化日益严重、绿地质量逐渐降低、乡土植物逐渐减少、入侵风险逐渐加剧等生态背景下，如何维持稳定而持续增长的城市生态系统服务供给，一直困扰着当下从事城市生态学领域研究的学者和城市管理者。植被群落作为城市绿地系统的基本组成单元，在绿地破碎化趋势下，可作为研究内容来探讨城市生态系统服务维持或提升策略；植被群落泛指城市中常见的、具有明显边界的、按照一定分布规则的植物群落单元，既包括道路绿地、居住区绿地、公园绿地等，也包括城市郊野自然林地。但对植被群落生态功能的研究也多停留在对某一生态问题的简单相关性研究，缺乏系统性和整体性。从微观层面的植被群落角度，整合相关文献研究，介绍了受植被群落特征影响的6种典型城市生态系统服务，综述了植被群落特征对这6种城市生态系统服务的影响机理，对植被群落特征因子进行总结、归类，从树种特性、垂直结构、水平结构、其他4个角度构建了"植被群落特征因子对城市生态系统服务影响关系表"。最后面向典型生态系统服务提升提出了城市低质量植被群落地区的营建和更新原则，以期为今后城市园林部门、规划部门制定城市绿地系统规划提供基础性技术支撑。     

Teacher training for medical faculty and residents.

Since 1984 the University of British Columbia''s School of Medicine has offered teaching improvement project systems (TIPS) workshops on effective teaching techniques; two workshops a year are given for medical faculty members and two a year for residents. The faculty members who conduct the workshops have received training on how to present them. The most powerful learning experience offered by TIPS is the opportunity for participants to present 10-minute teaching segments that are videotaped and later viewed privately by the participants. Eight workshops have been attended by 166 faculty members, and two others have been attended by 42 residents. This project demonstrates faculty development for both the participants and the people who teach the workshops.     

Promoting proteomics knowledge in Europe: report on the activities of the EuPA Education Committee 2006-2007

The early transition of knowledge from highly specialised and sophisticated proteomics research to a diverse community in need of know-how is a challenge that requires backing from advanced research centres and groups, and a coordinating body for the dissemination of this knowledge. The European Proteomics Association (EuPA) Education Committee signified this as a priority area when the EuPA was formed, and began its program to coordinate proteomics training and knowledge dissemination in 2006. This report serves as an update of our past activities and an announcement of upcoming events. Over the last year the EuPA Education Committee has coordinated or supported different educational activities including basic and advanced courses, a summer school, workshops and tutorials. A new programme of basic courses dubbed "Teaching the Teachers" has been initiated. These courses reach a larger, Europe wide, audience in a short timeframe, thus improving the opportunities for trainees of elementary proteomics techniques. Another important event has been the merger of the EuPA and HUPO (Human Proteome Organisation) Education Committees into a single one in order to combine ideas and ef for ts that will favour global education in proteomics.     

Changing patterns of resource allocation in a London teaching district.

The health plans of the Tower Hamlets district management team were studied to determine what effects the report of the Resource Allocation Working Party and the White Paper "Priorities in the Health and Social Services" have had on resource allocation in a teaching district. The study showed that at present acute services are allocated a greater proportion of the district budget than occurs nationally, while geriatrics, mental health, and community services receive proportionately less. In the next three years spending on acute services is expected to decrease, while spending on geriatric facilities and community services will increase. Nevertheless, cuts in acute services will take place mainly through a reduction in the number of beds serving a community function, concentrating all acute services in the teaching hospital. Services to the district might be better maintained by creating a community hospital to meet the needs of patients who would otherwise need to be accommodated in acute beds with unnecessarily expensive support services.     

Continuing Education Workshops in Bioinformatics Positively Impact Research and Careers

Bioinformatics.ca has been hosting continuing education programs in introductory and advanced bioinformatics topics in Canada since 1999 and has trained more than 2,000 participants to date. These workshops have been adapted over the years to keep pace with advances in both science and technology as well as the changing landscape in available learning modalities and the bioinformatics training needs of our audience. Post-workshop surveys have been a mandatory component of each workshop and are used to ensure appropriate adjustments are made to workshops to maximize learning. However, neither bioinformatics.ca nor others offering similar training programs have explored the long-term impact of bioinformatics continuing education training. Bioinformatics.ca recently initiated a look back on the impact its workshops have had on the career trajectories, research outcomes, publications, and collaborations of its participants. Using an anonymous online survey, bioinformatics.ca analyzed responses from those surveyed and discovered its workshops have had a positive impact on collaborations, research, publications, and career progression.B. F. Francis Ouellette is an Education Editor for PLOS Computational Biology     

The rise of counselling and the return of alienism.

Current services for those with mental disorders show two trends. Psychiatric services are becoming concentrated on the care of those with "severe mental illness," largely (but unjustifiably) synonymous with chronic psychosis. The retreat of psychiatry from the care of those with non-psychotic mental disorders has helped the growth of counselling services for these patients. However, there is no evidence that non-directive counselling is effective for such disorders, in contrast to the evidence for the effectiveness of other treatments that are usually delivered by psychologists or community psychiatric nurses. By retreating from the concerns of general practice and general medicine, psychiatry is returning to the days of alienism: in Victorian terms, the care of "the mad." Possible consequences include increasing expectations of psychiatric services that cannot be met, a loss of skills within psychiatry, and increased demoralisation in the mental health services.     

The ECVAM workshops: a critical assessment of their impact on the development,validation and acceptance of alternative methods

ECVAM initiated its workshop programme in 1994, to enable it to become well informed about the state of the art of non-animal test development and validation, and about the possible incorporation of alternatives into regulatory requirements for safety testing. Fifty-one such workshops have been held on specific topics, up to 2002. In these workshops, the current status of in vitro tests and their potential uses were reviewed and recommendations were made as to the best ways forward to progress and enhance the utilisation of in vitro methods. Reports for 46 of these workshops have been published in ATLA. Most of the workshops focused on in vitro replacement methods, although an increasing number have dealt with reduction and refinement. The recommendations in the ECVAM workshops have been progressed further by: a) the formation of ECVAM task forces; b) the organisation of further workshops; c) the activities of scientific committees; d) the provision of earmarked research funding; and e) the conduct of validation studies. Examples of each of these activities are discussed. Some individual workshops are covered in more detail and several recommendations that have so far not been acted on are also considered. The workshops and their reports have had a substantial effect on the development and implementation of alternative methods, and have been a major factor in contributing to the success of the first nine years of ECVAM's existence. It is strongly recommended that ECVAM continues to organise workshops and to publish their findings, and several suggestions are made for topics of future workshops.     

Gene Flow Happens

Debate over what is a species was already considered old hat when Darwin wrote his seminal abstract (as he called it) more than 150 years ago.¹ Endless papers, workshops, and symposia have been presented in an effort to "solve" the species problem. Yet, here we are, at it again. Has there been any progress? I believe that there has been, and that among the many advances enabled by the genomics revolution, progress on species concepts and species recognition is among them. To quote Feder and colleagues,² we are on the brink of a “unified theory of speciation genomics.”     

Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: After diagnosis of a dementing illness patients and their spouses have many concerns related to the disease and their future. This often leads to poor psychological well-being and reduced health related quality of life (HRQoL) of the family. Support for self-management skills has been proven to be an effective method to improve prognosis of asthma, heart failure and osteoarthritis. However, self-management interventions have not been studied in dementia. Therefore, our aim was to examine in an objective-oriented group intervention the efficacy of self-management support program (SMP) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of care-givers. METHODS: During the years 2011-12, 160 dementia patients and their spouses will be recruited from memory clinics and randomized into two arms: 80 patients for group-based SMP sessions including topics selected by the participants, 80 patients will serve as controls in for usual community care. Sessions may include topics on dementia, community services, active lifestyle and prevention for cognitive decline, spousal relationship, future planning and emotional well-being. The patients and spouses will have their separate group sessions (10 participants/group) once a week for 8 weeks. Main outcome measures will be patients' HRQoL (15D) and spousal caregivers' HRQoL (RAND-36), and sense of competence (SCQ). Secondary measures will be caregivers' psychological well-being (GHQ-12) and coping resources, patients' depression, cognition and signs of frailty. Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up. DISCUSSION: This is a "proof -of-concept" study to explore the efficacy of group support for self-management skills among dementia families. It will also provide data on cost-effectiveness of the intervention.