The driving force of physician partners

The administrative team admits that involvement with physician partnerships requires a different set of management skills, but it's worth the effort to share common goals.     

Edward F. Knipling: titan and driving force in ecologically selective area-wide pest management

Few entomologists have impacted insect pest management as profoundly as Edward F Knipling (1909-2000). During WWII, Knipling and his colleagues developed highly effective measures to protect both military personnel and civilian populations from major arthropod-borne diseases. The sterile insect technique was Knipling's conception, and he successfully guided its development and use against the screwworm, Cochliomyia hominivorax Coquerel, and against various other pests. He inspired and guided the development of a wide range of ecologically selective methods of insect detection and suppression. Knipling became a leading proponent and theoretician of area-wide pest management and of the design of systems of pest population suppression to achieve synergism between control methods efficient at high pest population densities and those efficient at low densities. Knipling was convinced that many pest problems could be met without harm to the environment by the area-wide application of systems including the augmentation of natural enemies.     

Thermodiffusion in concrete slab as a driving force of indoor radon entry

The core of the hypotheses considered is that there is an additional strong driving force-the thermodiffusion of radon and soil air in concrete and soils, which can cause an intensive indoor radon entry. A vertical thermogradient in the slab causes thermodiffusion air flux through concrete into the house. The proof of this concept is based on consideration of concrete slab as a micro-porous system having a pore-size distribution that mostly pertains to Knudsen's region and a transition zone of pore sizes. The Knudsen's theory for a transition zone is developed, which is consistent with the known experimental data of thermodiffusion. Calculated thermodiffusion air flux across a concrete slab under thermogradient 80 K m(-1) approximately ranges 1 x 10(-7)-1 x 10(-6) kg x m(-2) x s(-1). The calculated typical radon-bearing advective air velocity in soil due to thermogradient in the slab is about 1 x 10(-6) m x s(-1).     

医药分业的利益驱动分析

文章认为,在现有条件下,如果我国实行“医药分业”政策,医疗机构表面上是直接的利益受损者,而广大的药品消费者或支付者将是最终的利益受损者,也就是说消费者或支付者将为“医药分业”埋单;药品流通渠道(批发和零售)和生产商是政策受益者。政府将面临提高医疗服务收费标准或增加医疗机构补偿的压力,也将面临着是让医疗机构发展停顿还是医疗服务费用非常规增长的两难抉择,还将面临着通过牺牲医疗机构利益、消费者利益或政府加大投入来扶持药品流通渠道的道义上指责。日前我国药品监督管理机构正在实行的“渐进性的医药分业”政策,这些问题已然显现雏形。实施医药分业政策的理想境界是:药品价格总体下降26％～30％,将469亿元～547亿元的药品毛利化作医疗服务收费标准的调整幅度,以后,医疗服务收费标准按物价指数逐年调整。     

Workforce planning. A force for good

A workforce development confederation facing a shortage of 2,000 clinical staff by 2004 has initiated a programme to train assistant practitioners. The programme is aimed at drawing workers into the NHS who have some care experience but not the educational requirements for traditional professional courses. The project, which involves 14 organisations across health and social care, has attracted 216 entrants. The course takes two years full time, or three years part time.     

Entrepreneurial organizations: the driving force for improving quality in the healthcare industry

Using DiMaggio and Powell's concept of institutional isomorphism, the authors explain why healthcare lags behind other industries in innovating new production functions that address quality. Healthcare finns can "learn" to be entrepreneurial organizations within Stevenson's 'entrepreneurial versus administrative behavior' framework and Covin and Slevin's model of an entrepreneurial organization's required culture and behavioral support structure.     

Dementia and driving.

Many European countries test cars, but not their drivers, as they age. There is evidence to suggest that human factors are more important than vehicular factors as causes of motor crashes. The elderly also are involved in more accidents per distance travelled than middle-aged drivers. As the UK relies on self-certification of health by drivers over the age of 70 years, we examined the driving practices of patients with dementia attending a Memory Clinic. Nearly one-fifth of 329 patients with documented dementia continued to drive after the onset of dementia, and impaired driving ability was noted in two-thirds of these. Their families experienced great difficulty in persuading patients to stop driving, and had to invoke outside help in many cases. Neuropsychological tests did not help to identify those who drove badly while activity of daily living scores were related to driving ability. These findings suggest that many patients with dementia drive in an unsafe fashion after the onset of the illness. The present system of self-certification of health by the elderly for driver-licensing purposes needs to be reassessed.     

医疗费用过快增长的动力机制和控制策略谫论

医疗费用增长的原因是多方面的、不可避免的。但从经济学分析，医疗服务具有垄断性、委托-代理双重性和需求刚性。在利益机制驱动下，医疗项目的选择变成供方偏好，是医疗费用快速攀升的症结之一。变按项目支付为按病种支付，是控制医疗费用快速上涨、深化卫生改革的重要措施之一。按病种支付的方法有多种，比较科学、合理的是按病种组合支付。     

Progesterone as the driving regulatory force behind serum FSH concentrations and antral follicular development in cycling ewes

Ovarian antral follicles in sheep grow in an orderly succession, producing typically three to four follicular waves per 17-day oestrous cycle. Each wave is preceded by a transient increase in circulating FSH concentrations. The mechanism controlling the number of recurrent FSH peaks and emerging follicular waves remains unknown. During the ewe's oestrous cycle, the time between the first two FSH peaks and days of wave emergence is longer than the intervals separating the ensuing FSH peaks and follicular waves. The prolonged interpeak and interwave interval occurs early in the luteal phase when low levels of progesterone are secreted by developing, or not fully functional, corpora lutea (CL). The purpose of the present study was to determine the effect of varying progesterone (P(4)) levels on circulating concentrations of FSH and antral follicular development in sheep. Exogenous P(4) (15 mg per ewe, i.m.) was administered twice daily to six cycling Rideau Arcott×Dorset ewes from Day 0 (ovulation) to Day 4 (the mean duration of the interwave interval); six animals served as controls. Follicular growth was monitored in all animals by daily transrectal ultrasonography (Days 0-9). Jugular blood samples were drawn twice a day from Day 0 to Day 4 and then daily until Day 9 to measure systemic concentrations of P(4), FSH and 17β-oestradiol (E(2)). The first FSH peak after ovulation was detected on Days 1.5±0.2 and 4.2±0.2 in treated and control ewes, respectively (P<0.05). The next FSH peak(s) occurred on Day 3.9±0.3 in the treated group and on Day 6.4±0.5 in the control group. Consequently, the treated group had, on average, three follicular waves emerging on Days 0, 3 and 6, whereas the control group had two waves emerging on Days 0 and 5. Mean serum E(2) concentrations were greater (P<0.05) in control compared with treated ewes on Days 1.3, 2.3, 3.3, 4.0 and 4.3 after ovulation. In summary, creation of mid-luteal phase levels of P(4) in metoestrus shortened the time to the first post-ovulatory FSH peak in ewes, resulting in the emergence of one more follicular wave compared with control ewes during the same time frame. Therefore, P(4) appears to be a key endocrine signal governing the control of periodic increases in serum FSH concentrations and the number of follicular waves in cycling sheep.     

Service improvement. In the driving seat

Overseas manufacturers and healthcare providers can provide valuable lessons to the NHS in embedding a culture of service improvement. A key lesson is that empowering staff unleashes an organisation's most powerful asset. Service improvement has been proven to enhance a organisation's year-on-year fianancial position.