From Hippocrates to commodities: three models of NHS governance

A series of inquiries and reports suggest considerable failings in the care provided to some patients in the NHS. Although the Bristol Inquiry report of 2001 led to the creation of many new regulatory bodies to supervise the NHS, they have never enjoyed consistent support from government and the Mid Staffordshire Inquiry in 2013 suggests they made little difference. Why do some parts of the NHS disregard patients’ interests and how we should we respond to the challenge? The following discusses the evolution of approaches to NHS governance through the Hippocratic, Managerial and Commercial models, and assesses their risks and benefits. Apart from the ethical imperative, the need for effective governance is driven both by the growth in information available to the public and the resources wasted by ineffective systems of care. Appropriate solutions depend on an understanding of the perverse incentives inherent in each model and the need for greater sensitivity to the voices of patients and the public.

Visual Object Recognition Using Deformable Models of Vehicles

This workshop paper reports recent developments to a vision system for traffic interpretation which relies extensively on the use of geometrical and scene context. Firstly, a new approach to pose refinement is reported, based on forces derived from prominent image derivatives found close to an initial hypothesis. Secondly, a parameterised vehicle model is reported, able to represent different vehicle classes. This general vehicle model has been fitted to sample data, and subjected to a Principal Component Analysis to create a deformable model of common car types having 6 parameters. We show that the new pose recovery technique is also able to operate on the PCA model, to allow the structure of an initial vehicle hypothesis to be adapted to fit the prevailing context. We report initial experiments with the model, which demonstrate significant improvements to pose recovery.

Emotional interactions and an ethic of care: caring relations in families affected by HIV and AIDS

In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.

A review and classification of the existing models of cyanobacteria

Bloom-forming and toxin-producing cyanobacteria remain a persistent nuisance across the world. Modelling of cyanobacteria in freshwaters is an important tool for understanding their population dynamics and predicting bloom occurrence in lakes and rivers. In this paper existing key models of cyanobacteria are reviewed, evaluated and classified. Two major groups emerge: deterministic mathematical and artificial neural network models. Mathematical models can be further subcategorized into those models concerned with impounded water bodies and those concerned with rivers. Most existing models focus on a single aspect such as the growth of transport mechanisms, but there are a few models which couple both.

Voices from the aid 'chain': The personal dynamics of care

This paper uses a simplified model of the aid 'chain' to explore some causes and consequences of breakdown in communication. Although the rhetoric of Northern-based donors is awash with words such as 'partnership' and 'inclusion' when dealing with their Southern-based partners, the situation in practice is different. Unequal power relationships sometimes result in donor imposition of Perspectives and values. It is our contention, based on a collective experience of fifty-four years in a Nigerian-based non-governmental development organization (NGDO), the Diocesan Development Services (DDS), that much of the driving force behind the successes and problems faced by the institution was founded on relationships that evolved between individuals. In order to understand why things happened the way they did it is necessary to begin with the human element that cannot be condensed into objects or categories. While injudicious donor interference bad damaging repercussions, our experience suggests that care and consideration flow throughout the aid chain and actions are not malevolent. Breakdowns can be attributed to a number of factors, with the over-riding one being pressures operating at the personal level that emanate from within the institution itself and the larger community. The paper analyses three experiences using institutional ethnography theory and methodologies as a basis. Examples taken address the influence key donor personnel had in the function of DDS, and how these changed with time. The mission, policies and even procedures of the donor did not change markedly over thirty-two years, but each changing desk officer had their own philosophy and approach and a different interpretation of their own institutional policies. Hence while the 'macro' has an influence it is mediated via individual interpretation. In our view, the importance of people-people relationships is particularly understated in development literature where emphasis gravitates towards the aggregate and global.

High-resolution, unstructured meshes for hydrodynamic models of the Great Barrier Reef, Australia

Accuracy and mesh generation are key issues for the high-resolution hydrodynamic modelling of the whole Great Barrier Reef. Our objective is to generate suitable unstructured grids that can resolve topological and dynamical features like tidal jets and recirculation eddies in the wake of islands. A new strategy is suggested to refine the mesh in areas of interest taking into account the bathymetric field and an approximated distance to islands and reefs. Such a distance is obtained by solving an elliptic differential operator, with specific boundary conditions. Meshes produced illustrate both the validity and the efficiency of the adaptive strategy. Selection of refinement and geometrical parameters is discussed. (c) 2006 Elsevier Ltd. All rights reserved.

Consistent approximate models of the global atmosphere: shallow, deep, hydrostatic, quasi-hydrostatic and non-hydrostatic

We study global atmosphere models that are at least as accurate as the hydrostatic primitive equations (HPEs), reviewing known results and reporting some new ones. The HPEs make spherical geopotential and shallow atmosphere approximations in addition to the hydrostatic approximation. As is well known, a consistent application of the shallow atmosphere approximation requires omission of those Coriolis terms that vary as the cosine of latitude and of certain other terms in the components of the momentum equation. An approximate model is here regarded as consistent if it formally preserves conservation principles for axial angular momentum, energy and potential vorticity, and (following R. Müller) if its momentum component equations have Lagrange's form. Within these criteria, four consistent approximate global models, including the HPEs themselves, are identified in a height-coordinate framework. The four models, each of which includes the spherical geopotential approximation, correspond to whether the shallow atmosphere and hydrostatic (or quasi-hydrostatic) approximations are individually made or not made. Restrictions on representing the spatial variation of apparent gravity occur. Solution methods and the situation in a pressure-coordinate framework are discussed. © Crown copyright 2005.

Factors influencing anthropogenic carbon dioxide uptake in the North Atlantic in models of the ocean carbon cycle

The uptake and storage of anthropogenic carbon in the North Atlantic is investigated using different configurations of ocean general circulation/carbon cycle models. We investigate how different representations of the ocean physics in the models, which represent the range of models currently in use, affect the evolution of CO2 uptake in the North Atlantic. The buffer effect of the ocean carbon system would be expected to reduce ocean CO2 uptake as the ocean absorbs increasing amounts of CO2. We find that the strength of the buffer effect is very dependent on the model ocean state, as it affects both the magnitude and timing of the changes in uptake. The timescale over which uptake of CO2 in the North Atlantic drops to below preindustrial levels is particularly sensitive to the ocean state which sets the degree of buffering; it is less sensitive to the choice of atmospheric CO2 forcing scenario. Neglecting physical climate change effects, North Atlantic CO2 uptake drops below preindustrial levels between 50 and 300 years after stabilisation of atmospheric CO2 in different model configurations. Storage of anthropogenic carbon in the North Atlantic varies much less among the different model configurations, as differences in ocean transport of dissolved inorganic carbon and uptake of CO2 compensate each other. This supports the idea that measured inventories of anthropogenic carbon in the real ocean cannot be used to constrain the surface uptake. Including physical climate change effects reduces anthropogenic CO2 uptake and storage in the North Atlantic further, due to the combined effects of surface warming, increased freshwater input, and a slowdown of the meridional overturning circulation. The timescale over which North Atlantic CO2 uptake drops to below preindustrial levels is reduced by about one-third, leading to an estimate of this timescale for the real world of about 50 years after the stabilisation of atmospheric CO2. In the climate change experiment, a shallowing of the mixed layer depths in the North Atlantic results in a significant reduction in primary production, reducing the potential role for biology in drawing down anthropogenic CO2.

Review of theoretical models of electromagnetic NDT and their applications

There is an increasing interest in modelling electromagnetic methods of NDT - particularly eddy currents. A collaboration within the International Institute of Welding led to a survey intended to explain to non mathematicians the present scope of modelling. The present review commences with this survey and then points out some of the developments and some of the outstanding problems in transferring modelling into industry.

Comparison between observations and models of the Mozambique Channel transport: Seasonal cycle and eddy frequencies

A time series of the observed transport through an array of moorings across the Mozambique Channel is compared with that of six model runs with ocean general circulation models. In the observations, the seasonal cycle cannot be distinguished from red noise, while this cycle is dominant in the transport of the numerical models. It is found, however, that the seasonal cycles of the observations and numerical models are similar in strength and phase. These cycles have an amplitude of 5 Sv and a maximum in September, and can be explained by the yearly variation of the wind forcing. The seasonal cycle in the models is dominant because the spectral density at other frequencies is underrepresented. Main deviations from the observations are found at depths shallower than 1500 m and in the 5/y–6/y frequency range. Nevertheless, the structure of eddies in the models is close to the observed eddy structure. The discrepancy is found to be related to the formation mechanism and the formation position of the eddies. In the observations, eddies are frequently formed from an overshooting current near the mooring section, as proposed by Ridderinkhof and de Ruijter (2003) and Harlander et al. (2009). This causes an alternation of events at the mooring section, varying between a strong southward current, and the formation and passing of an eddy. This results in a large variation of transport in the frequency range of 5/y–6/y. In the models, the eddies are formed further north and propagate through the section. No alternation similar to the observations is observed, resulting in a more constant transport.

Demonstration models of the cost and benefits of BVD and Johne's contol on cattle farms

Demonstration models of the costs of BVD and Johnes in dairy and beef cattle and the costs and benefits of control have been developed. An example applied to BVD in dairy cattle is presented. Downloadable versions of the models, together with supporting material on how to use them are available to veterinarians from a dedicated website.