Translating policy into practice: A case study in the secondary prevention of coronary heart disease

Background: This paper focuses on the relationships between health ‘policy’ as it is embodied in official documentation, and health ‘practice’ as reported and reflected on in the talk of policy makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland – involving as they do a predominantly state funded (National Health Service) system in the north and a mixed healthcare economy in the south. The key question is to determine how the rhetoric of health policy as contained in policy documents connects to, and gets translated into practice and action.

Methods: The data sources for the study include relevant healthcare policy documents (N=5) and progress reports (N=6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers (N=28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents’ contents and how they saw the impact of ‘policy’ on primary care practice.

Results: The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do.

Conclusion: To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements – specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required.

A European perspective on progress in moving away from the mouse bioassay for marine-toxin analysis

This review considers the ethical and technical problems currently associated with employing mouse bioassays for marine-toxin analysis and the challenges and the difficulties that alternative methods must overcome before being deemed applicable for implementation into a regulatory monitoring regime. We discuss proposed alternative methods, classified as functional, immunological and analytical, for well-established European toxins as well as emerging toxins in European waters, highlighting their advantages and disadvantages. We also consider emerging tools and technologies for future toxin analysis.

COLLISION PUMPED SOFT-X-RAY LASERS - PROGRESS AT RAL

Recent developments and progress on collision pumped soft X-ray lasers using the VULCAN glass laser at Rutherford-Appleton Laboratory are presented. This includes saturated output operation of a double target germanium system within a low Fresnel number half-cavity, measurement of the spatial coherence of the output beam in the above and other geometries, use of the beam to demonstrate almost-equal-to 0.15 mum spatial resolution in a full-field microscope and initial studies of other Ne-like and Ni-like systems. Future directions, in the light of new developments of VULCAN facilities, are outlined.

COLLISIONALLY EXCITED X-RAY LASER SCHEMES - PROGRESS AT RUTHERFORD APPLETON LABORATORY

Characteristics of the 3p-3s amplified spontaneous emission from Ne-like Ge plasma columns, generated by ablation from massive targets, have been studied in detail. In particular, the gain coefficients of the J = 2-1 lines at 23.2 and 23.6 nm have been measured as a function of incident intensity for a 1.05-mu-m wavelength pump laser beam. For 100-mu-m wide stripe targets and a fixed energy pump laser the maximum gain length product is achieved at an irradiance of