When Patients Exit, What Happens to Solidarity?:Promoting Solidarity in the European Union

This chapter examines the EU healthcare regime under Hirschman's framework of Ext, Voice, and Loyalty in order to determine the impact of free movement on solidarity in health care.

Combustion Noise

Combustion noise is becoming increasingly important as a major noise source in aeroengines and ground based gas turbines. This is partially because advances in design have reduced the other noise sources, and partially because next generation combustion modes burn more unsteadily, resulting in increased external noise from the combustion. This review reports recent progress made in understanding combustion noise by theoretical, numerical and experimental investigations. We first discuss the fundamentals of the sound emission from a combustion region. Then the noise of open turbulent flames is summarized. We subsequently address the effects of confinement on combustion noise. In this case not only is the sound generated by the combustion influenced by its transmission through the boundaries of the combustion chamber, there is also the possibility of a significant additional source, the so-called ‘indirect’ combustion noise. This involves hot spots (entropy fluctuations) or vorticity perturbations produced by temporal variations in combustion, which generate pressure waves (sound) as they accelerate through any restriction at the exit of the combustor. We describe the general characteristics of direct and indirect noise. To gain further insight into the physical phenomena of direct and indirect sound, we investigate a simple configuration consisting of a cylindrical or annular combustor with a low Mach number flow in which a flame zone burns unsteadily. Using a low Mach number approximation, algebraic exact solutions are developed so that the parameters controlling the generation of acoustic, entropic and vortical waves can be investigated. The validity of the low Mach number approximation is then verified by solving the linearized Euler equations numerically for a wide range of inlet Mach numbers, stagnation temperature ratios, frequency and mode number of heat release fluctuations. The effects of these parameters on the magnitude of the waves produced by the unsteady combustion are investigated. In particular the magnitude of the indirect and direct noise generated in a model combustor with a choked outlet is analyzed for a wide range of frequencies, inlet Mach numbers and stagnation temperature ratios. Finally, we summarize some of the unsolved questions that need to be the focus of future research

Bespoke Radiology e-Learning

Introduction: Foundation doctors are expected to assess and interpret plain x-ray studies of the chest/abdomen before a definitive report is issued by senior staff. The Royal College of Radiologists have published guidelines (RCR curriculum) on the scope of plain film findings medical students should be familiar with.1 Studies have shown that the x-ray interpretation without feedback does not significantly improve diagnostic ability. 2 Queen’s University, Belfast Trust Radiology and Experior Medical developed an online system to assess individual student ability to interpret X-ray findings. Over a series of assessments each student’s profile is built up, identifying strengths and weakness. The system can then create bespoke individual assessments re-evaluating previously identified weak areas and quantifying interpretative skill improvement. Aim: To determine how readily an online system is adopted by senior medical students, investigating if increasing exposure to x-ray interpretation combined with cyclical formative feedback enhances performance. Methods: The system was offered to all 270 final year medical students as an online resource. The system comprised a series of 20 weekly 30 minute assessments, containing normal and abnormal x-rays within the RCR curriculum. After each assessment students were given formative feedback, including their own result, annotated answers, peer group comparison and a breakdown of areas of strength and weakness. Focus groups of 4-5 students addressed student perspectives of the system, including ease of use, image resolution, system performance across different operating platforms, perceived value of formative feedback loops, breakdown of performance and the value of bespoke personalised assessments. Research Ethics Approval was granted for the study. Data analysis was via two-sided one-sample t-test; initial minimal recruitment was estimated as 60 students, to detect a mean 10% change in performance, with a standard deviation of 20%. Results and Discussion: Over 80% (n = XXX/270) of the student cohort engaged with the study. Student baseline average was 39%, increasing to 62% by the exit test. The steadily sustained improvement (57% relative performance in interpretative diagnostic accuracy) was despite increasing test difficulty. Student feedback via focus groups was universally positive throughout the examined domains. Conclusion: The online resource proved to be valuable, with high levels of student engagement, improving performance despite increasingly difficulty testing and positive learner experience with the system. References: 1. Undergraduate Radiology Curriculum, The Royal College of Ra, April 2012. Ref No. BFCR(12)4 The Royal College of Radiologists, April 2012 2. I Satia, S Bashagha, A Bibi, R Ahmed, S Mellor, F Zaman. Assessing the accuracy and certainty in interpretating chest x-rays in the medical division. Clin Med August 2013 Vol.13 no. 4 349-352