Health insurance competition in Germany – the role of advertising

In the 1990s, competition among public health insurance funds (‘sickness funds’) was introduced in Germany. As one means of competition, free choice of initial health funds and subsequent switching between them was made available to all insured. Since then, the number of funds has decreased substantially, and funds have had to engage in competitive strategies to remain in the market. In this paper, we want to analyse the funds' advertising activities in the face of the changed competitive environment. This has not been possible to date due to a lack of data. We use two new datasets to get a first insight into the potential effects of competition on funds' advertising strategies; one of the volume and cost of advertisements and one of their contents. Our results suggest that competition has been associated with an increase in the amount of advertising. As to the adverts themselves, we find that there was a decrease in the share of advertisements of a ‘general’ content in favour of advertisements of a more ‘fund-specific’ content. The data therefore indicate that once the market was open to switching of funds by the insured, funds' advertising efforts changed to differentiating their own perceived strengths from those of competitor funds. These observations allow us to draw some tentative conclusions about the relevance of (attempts of) risk selection by health funds via advertisements and about the general success of the pro-competitive legislation.

A pharmacy workforce survey in the West Midlands: 3 primary care pharmacists

In a study to quantify the extent of current and planned employment of primary care pharmacists (PCPs) and to explore the experiences of PCPs and the perceptions of other pharmacists who aspire to become PCPs, it was found that the satisfaction experienced by primary care pharmacists appears to offset to some extent the dissatisfaction expressed about traditional pharmacy work in community pharmacy. The high level of interest in PCP work may also be a proxy for pharmacists' dissatisfaction.

Studies on enhanced surface disinfection and skin antisepsis using chlorhexidine and eucalyptus oil

Healthcare associated infections may arise from many sources, including patient?s own skin flora and the clinical environment, and inflict a significant burden within the health service. Adequate and effective skin antisepsis and surface disinfection are therefore essential factors in infection control. Current EPIC guidelines recommend 2 % chlorhexidine (CHG) in 70 % isopropyl alcohol (IPA) for skin antisepsis however poor penetration has been reported. Eucalyptus oil (EO) is a known permeation enhancer, producing synergistic antimicrobial activity when combined with CHG. In this current study, the antimicrobial efficacy of EO and its main constituent 1,8-cineole were assessed against a panel of clinically relevant microorganisms, alone and in combination with CHG. The superior antimicrobial efficacy of EO compared with 1,8-cineole, and synergistic effects with CHG against planktonic and biofilm cultures, confirmed its suitability for use in subsequent studies within this thesis. Impregnation of EO, CHG and IPA onto prototype hard surface disinfectant wipes demonstrated significantly improved efficacy compared with CHG/IPA wipes, with clear reductions in the time required to eliminate biofilms. Optimisation of the EO/CHG/IPA formulation resulted in the development of Euclean® wipes, with simulated-use and time kill studies confirming their ability to remove microbial surface contamination, prevent cross contamination and eliminate biofilms within 10 minutes. The employment of isothermal calorimetry provided additional information on the type and rate of antimicrobial activity possessed by Euclean® wipes. A clinical audit of the Euclean® wipes at Birmingham Children?s Hospital, Birmingham, U.K. revealed divided staff opinion, with the highest cited advantage and disadvantage concerning the odour. Finally, skin penetration and cell toxicity studies of EO/CHG biopatches and Euclean® solution developed during this study, revealed no permeation into human skin following biopatch application, and no significant toxicity. These current studies enhance the knowledge regarding EO and its potential applications.

Optical sensor based on hybrid LPG/FBG in D-fiber for simultaneous refractive index and temperature measurement

A dual-parameter optical sensor has been realized by UV-writing a long-period and a Bragg grating structure in D-fiber. The hybrid configuration permits the detection of the temperature from the latter and measuring the external refractive index from the former responses, respectively. The employment of the D-fiber allows as effective modification and enhancement of the device sensitivity by cladding etching. The grating sensor has been used to measure the concentrations of aqueous sugar solutions, demonstrating the potential capability to detect concentration changes as small as 0.01%.

Input/output deterioration in production processes

In many real applications of Data Envelopment Analysis (DEA), the decision makers have to deteriorate some inputs and some outputs. This could be because of limitation of funds available. This paper proposes a new DEA-based approach to determine highest possible reduction in the concern input variables and lowest possible deterioration in the concern output variables without reducing the efficiency in any DMU. A numerical example is used to illustrate the problem. An application in banking sector with limitation of IT investment shows the usefulness of the proposed method. © 2010 Elsevier Ltd. All rights reserved.

Emerging into the light:working children's photodiaries

These photographs were produced by secondary school children (aged between 11 and 15 years) in England and Wales. They were taken as part of a qualitative research project examining the employment of children in modern day Britain.1 Using simple and inexpensive one-use analogue cameras to make photodiaries, some of the 69 children involved in the project produced around 850 photographs of their working lives. The result is a distinctive and unique visual insight into what is a rarely discussed but nonetheless ‘majority experience’ of modern childhood.2 The children who took these photographs gave their permission for them to be published; names have been changed.

A decision support system for waste collection management and its potential improvement with Radio-Frequency Identification Technology (RFID)

Due to vigorous globalisation and product proliferation in recent years, more waste has been produced by the soaring manufacturing activities. This has contributed to the significant need for an efficient waste management system to ensure, with all efforts, the waste is properly treated for recycling or disposed. This paper presents a Decision Support System (DSS) framework, based on Constraint Logic Programming (CLP), for the collection management of industrial waste (of all kinds) and discusses the potential employment of Radio-Frequency Identification Technology (RFID) to improve several critical procedures involved in managing waste collection. This paper also demonstrates a widely distributed and semi-structured network of waste producing enterprises (e.g. manufacturers) and waste processing enterprises (i.e. waste recycling/treatment stations) improving their operations planning by means of using the proposed DSS. The potential RFID applications to update and validate information in a continuous manner to bring value-added benefits to the waste collection business are also presented. © 2012 Inderscience Enterprises Ltd.

Optical sensor based on hybrid LPG/FBG in D-fiber for simultaneous refractive index and temperature measurement

A dual-parameter optical sensor has been realized by UV-writing a long-period and a Bragg grating structure in D-fiber. The hybrid configuration permits the detection of the temperature from the latter and measuring the external refractive index from the former responses, respectively. The employment of the D-fiber allows as effective modification and enhancement of the device sensitivity by cladding etching. The grating sensor has been used to measure the concentrations of aqueous sugar solutions, demonstrating the potential capability to detect concentration changes as small as 0.01%.

Optical trapping with superfocused high-M2 laser diode beam

Many applications of high-power laser diodes demand tight focusing. This is often not possible due to the multimode nature of semiconductor laser radiation possessing beam propagation parameter M2 values in double-digits. We propose a method of 'interference' superfocusing of high-M2 diode laser beams with a technique developed for the generation of Bessel beams based on the employment of an axicon fabricated on the tip of a 100 μm diameter optical fiber with highprecision direct laser writing. Using axicons with apex angle 140º and rounded tip area as small as 10 μm diameter, we demonstrate 2-4 μm diameter focused laser 'needle' beams with approximately 20 μm propagation length generated from multimode diode laser with beam propagation parameter M2=18 and emission wavelength of 960 nm. This is a few-fold reduction compared to the minimal focal spot size of 11 μm that could be achieved if focused by an 'ideal' lens of unity numerical aperture. The same technique using a 160º axicon allowed us to demonstrate few-μm-wide laser 'needle' beams with nearly 100 μm propagation length with which to demonstrate optical trapping of 5-6 μm rat blood red cells in a water-heparin solution. Our results indicate the good potential of superfocused diode laser beams for applications relating to optical trapping and manipulation of microscopic objects including living biological objects with aspirations towards subsequent novel lab-on-chip configurations.

Phase noise tolerance study in coherent optical circular QAM transmissions with Viterbi- Viterbi carrier phase estimation

We present a performance evaluation of a non-conventional approach to implement phase noise tolerant optical systems with multilevel modulation formats. The performance of normalized Viterbi-Viterbi carrier phase estimation (V-V CPE) is investigated in detail for circular m-level quadrature amplitude modulation (C-mQAM) signals. The intrinsic property of C-mQAM constellation points with a uniform phase separation allows a straightforward employment of V-V CPE without the need to adapt constellation. Compared with conventional feed-forward CPE for square QAM signals, the simulated results show an enhanced tolerance of linewidth symbol duration product (ΔvTs) at a low sensitivity penalty by using feed-forward CPE structure with C-mQAM. This scheme can be easily upgraded to higher order modulations without inducing considerable complexity.

Biomimetic synthetic lubricants (Biosurfactants)

Poly(styrene-co-maleic anhydride) (PSMA) based copolymers are known to undergo conformational transition in response to environmental stimuli. This smart behaviour makes it possible to mimic the behaviour of native apoproteins. The primary aim of this study was to develop a better understanding of the structure-property relationships of various PSMA-based copolymers sought. The work undertaken in this thesis has revealed that the responsive behaviour of PSMA-based copolymers can be tailored by varying the molecular weight, hydrophobic (styrene) and hydrophilic (maleic acid) balance, and more so in the presence of additional hydrophobic, mono-partial ester moieties. Novel hydrophilic and hydrophobic synthetic surfactant protein analogues have successfully been prepared. These novel lipid solubilising agents possess a broad range of HLB (hydrophilic-lipophilic balance) values that have been estimated. NMR spectroscopy was utilised to confirm the structures for PSMA-based copolymers sought and proved useful in furthering understanding of the structure-property relationships of PSMA-based copolymers. The association of PSMA with the polar phospholipid, 2-dilauryl-sn-glycero-3- phosphocholine (DLPC) produces polymer-lipid complexes analogous to lipoprotein assemblies present in the blood plasma. NMR analysis reveals that the PSMA-based copolymers are not perfectly alternating. Regio-irregular structures, atactic and random monomer sequence distribution have been identified for all materials studied. Novel lipid solubilising agents (polyanionic surfactants) have successfully been synthesised from a broad range of PSMA-based copolymers with desired estimated HLB values that interact with polar phospholipids (DLPC/DPPC) uniquely. Very low static and dynamic surface tensions have been observed via the du Noϋy ring method and Langmuir techniques and correlate well with the estimated HLB values. Synthetic protein-lipid analogues have been successfully synthesised, that mimic the unique surface properties of native biological lubricants without the use of solvents. The novel PSMA-DLPC complexes have successfully been combined with hyaluronan (hyaluronic acid, HA). Today, the employment of HA is economically feasible, because it is readily available from bacterial fermentation processes in a thermally stable form - HyaCare®. The work undertaken in this thesis highlights the usage of HA in biolubrication applications and how this can be optimised and thus justified by carefully selecting the biological source, concentration, molecular weight, purity and most importantly by combining it with compatible boundary lubricating agents (polar phospholipids). Experimental evidence supports the belief that the combined HA and PSMA-DLPC complexes provide a balance of rheological, biotribological and surface properties that are composition dependent, and show competitive advantage as novel synthetic biological lubricants (biosurfactants).