Building on Julian Tudor Hart's example of anticipatory care

The prevention and delay of chronic disease is an increasing priority in all advanced health-care systems, but sustainable, effective and equitable approaches remain elusive. In a famous pioneering example in the UK, Julian Tudor Hart combined reactive and anticipatory care within routine consultations in primary medical care, while applying a population approach to delivery and audit. This approach combined the structural advantages of UK general practice, including universal coverage and the absence of user fees, with his long-term commitment to individual patients, and was associated with a 28% reduction in premature mortality over a 25-year period. The more recent, and comprehensively evaluated Scottish National Health Service demonstration project, ‘Have a Heart Paisley’, took a different approach to cardiovascular prevention and health improvement, using population screening for ascertainment, health coaches and referral to specific health improvement programmes for diet, smoking and exercise. We draw from both examples to construct a conceptual framework for anticipatory care, based on active ingredients, programme pathways and whole system approaches. While the strengths of a family practice approach are coverage, continuity, co-ordination and longterm relationships, the larger health improvement programme offered additional resources and expertise. As theory and evidence accrue, the challenge is to combine the strengths of primary medical care and health improvement, in integrated, sustainable systems of anticipatory care, addressing the heterogeneity of individual needs and solutions, while achieving high levels of coverage, continuity, co-ordination and outcome

InGaN epilayer characterization by microfocused x-ray reciprocal space mapping

We report the use of microfocused three-dimensional x-ray reciprocal space mapping to study InGaN epilayers with average InN content 20%-22%. Analysis of the full volume of reciprocal space, while probing samples on the microscale with a focused x-ray beam, allowed us to gain valuable information about the nanostructure of InN-rich InGaN epilayers. It is found that “seed” InGaN mosaic nanocrystallites are twisted with respect to the ensemble average and strain-free. The initial stages of InGaN-on-GaN epitaxial growth, therefore, conform to the Volmer-Weber growth mechanism with “seeds” nucleated on strain fields generated by the a-type edge dislocations

Comparing Firm Performance Using Transitive Productivity Index Numbers in a Meta-frontier Framework

The meta-frontier framework has been used extensively for evaluating the technical efficiency of heterogeneous production units that can be classified into different groups. This paper shows how the framework can also be used to make total factor productivity (TFP) comparisons within and across groups. The paper develops a new measure of the distance between a group frontier and the meta-frontier (the so-called ‘technology gap’). It then shows how a spatially- and temporally-transitive TFP index can be decomposed into measures of global technical change (measuring movements in the metafrontier), local technical change (measuring movements in the group frontiers) and efficiency change (measuring movements towards or around the group frontiers). To illustrate the methodology, the paper examines the productive performance of road authorities responsible for maintaining interstate highways in the US state of Virginia.

Secularizing Demons: Fundamentalist Navigations in Religion and Secularity

Since the turn of the millennium, theologians and secular scholars of religion have increasingly begun exploring the relationship between transhumanism and religion. However, analyses of anti-transhumanist apocalypticisms are still rare, and those that exist are situated mainly among broader explorations of religious and secular bioconservatism. This article addresses this lack of specificity by drawing analyses of transhumanism and religion into dialogue with explorations of contemporary demonology through a close study of the beliefs of the evangelical conspiracist Thomas Horn and the anti-transhumanist milieu around him. Exploring the milieu's multifaceted demonology of the secular world in light of genealogies of religion and secularity, the article situates Horn's demonology as one attempt to negotiate these genealogies, using what Sean McCloud terms a “‘supernatural’ hermeneutics of suspicion” that sees spiritual forces as the structural base of reality. It argues that, while fringe, milieus like Horn's illuminate broader cultural tensions and genealogical relations surrounding the place of religion in a secular(izing) world

Development of a cantilever beam generator employing vibration energy harvesting

This paper details the development of a generator based upon a cantilever beam inertial mass system which harvests energy from ambient environmental vibrations. The paper compares the predicted results from Finite Element Analysis (FEA) of the mechanical behaviour and magnetic field simulations and experimental results from a generator. Several design changes were implemented to maximise the conversion of magnetic energy into generated power and a maximum power output of 17.8µW was achieved at a resonant frequency of 56.6Hz and an applied acceleration of 60mg (g = 9.81ms-2)

Motor deficits in schizophrenia quantified by nonlinear analysis of postural sway.

Motor dysfunction is a consistently reported but understudied aspect of schizophrenia. Postural sway area was examined in individuals with schizophrenia under four conditions with different amounts of visual and proprioceptive feedback: eyes open or closed and feet together or shoulder width apart. The nonlinear complexity of postural sway was assessed by detrended fluctuation analysis (DFA). The schizophrenia group (n = 27) exhibited greater sway area compared to controls (n = 37). Participants with schizophrenia showed increased sway area following the removal of visual input, while this pattern was absent in controls. Examination of DFA revealed decreased complexity of postural sway and abnormal changes in complexity upon removal of visual input in individuals with schizophrenia. Additionally, less complex postural sway was associated with increased symptom severity in participants with schizophrenia. Given the critical involvement of the cerebellum and related circuits in postural stability and sensorimotor integration, these results are consistent with growing evidence of motor, cerebellar, and sensory integration dysfunction in the disorder, and with theoretical models that implicate cerebellar deficits and more general disconnection of function in schizophrenia

The transmission of nosocomial pathogens in an intensive care unit: a space–time clustering and structural equation modelling approach

We investigated the incidence of cases of nosocomial pathogens and risk factors in an intensive treatment unit ward to determine if the number of cases is dependent on location of patients and the colonization/infection history of the ward. A clustering approach method was developed to investigate the patterns of spread of cases through time for five microorganisms [methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter spp., Klebsiella spp., Candida spp., and Pseudomonas aeruginosa] using hospital microbiological monitoring data and ward records of patient-bed use. Cases of colonization/infection by MRSA, Candida and Pseudomonas were clustered in beds and through time while cases of Klebsiella and Acinetobacter were not. We used structural equation modelling to analyse interacting risk factors and the potential pathways of transmission in the ward. Prior nurse contact with colonized/infected patients, mediated by the number of patient-bed movements, were important predictors for all cases, except for those of Pseudomonas. General health and invasive surgery were significant predictors of cases of Candida and Klebsiella. We suggest that isolation and bed movement as a strategy to manage MRSA infections is likely to impact upon the incidence of cases of other opportunist pathogen

Raman-scattering study of the InGaN alloy over the whole composition range

We present Raman-scattering measurements on InxGa1−xN over the entire composition range of the alloy. The frequencies of the A1(LO) and E2 modes are reported and show a good agreement with the one-mode behavior dispersion predicted by the modified random-element isodisplacement model. The A1(LO) mode displays a high intensity relative to the E2 mode due to resonant enhancement. For above band-gap excitation, the A1(LO) peak displays frequency shifts as a function of the excitation energy due to selective excitation of regions with different In contents, and strong multiphonon scattering up to 3LO is observed in outgoing resonance conditions

Examination of the Resonance Contributions to Dileptonic Rare B-Decays

We analyse the long-distance contribution to $B\to X_s\ell^+\ell^-$ differential decay rate when the momentum dependence of $\psi$ and $\psi'$-$\gamma$ conversion strength is taken into account. The results indicate that the resonance to nonresonance interference in the dilepton invariant mass distribution is substantially reduced.Comment: 10 pages, Latex, one figure (included