Estimating the scope for savings in referrals and drug prescription costs in the general Practice units of a UK primary care trust

This paper explores the potential for cost savings in the general Practice units of a Primary Care Trust (PCT) in the UK. We have used Data Envelopment Analysis (DEA) to identify benchmark Practices, which offer the lowest aggregate referral and drugs costs controlling for the number, age, gender, and deprivation level of the patients registered with each Practice. For the remaining, non-benchmark Practices, estimates of the potential for savings on referral and drug costs were obtained. Such savings could be delivered through a combination of the following actions: (i) reducing the levels of referrals and prescriptions without affecting their mix (£15.74 m savings were identified, representing 6.4% of total expenditure); (ii) switching between inpatient and outpatient referrals and/or drug treatment to exploit differences in their unit costs (£10.61 m savings were identified, representing 4.3% of total expenditure); (iii) seeking a different profile of referral and drug unit costs (£11.81 m savings were identified, representing 4.8% of total expenditure). © 2012 Elsevier B.V. All rights reserved.

Cleavage initiation in the intercritically reheated coarse-grained heat affected zone:Part II. Failure criteria and statistical effects

In part 1 of this article, cleavage initiation in the intercritically reheated coarse-grained heat affected zone (IC CG HAZ) of high-strength low-alloy (HSLA) steels was determined to occur between two closely spaced blocky MA particles. Blunt notch, crack tip opening displacement (CTOD), and precracked Charpy testing were used in this investigation to determine the failure criteria required for cleavage initiation to occur by this mechanism in the IC CG HAZ. It was found that the attainment of a critical level of strain was required in addition to a critical level of stress. This does not occur in the case of high strain rate testing, for example, during precracked Charpy testing. A different cleavage initiation mechanism is then found to operate. The precise fracture criteria and microstructural requirements (described in part I of this article) result in competition between potential cleavage initiation mechanisms in the IC CG HAZ.

Melanocytes in the developing and adult atrioventricular valves of the murine heart

The Neural Crest (NC) is a multipotential group of cells that arises from the dorsal aspect of the neural tube early in development. It is well established that a group of NC cells named Cardiac Neural Crest (CNC) migrates to the heart and plays a critical role in the remodeling of the aortic arch arteries and septation of the outflow tract. In this study, using the mouse mutant Pax3sp/sp that has CNC deficits I have identified a putative novel role for the CNC in regulating apoptosis in the atrioventricular (AV) endocardial cushion. The AV endocardial cushion undergoes remodeling to give rise to the cardiac AV valves. Using a transgenic mouse that carries the LacZ reporter gene under the control of the Dopachrome tautomerase promoter (Dct-LacZ), I found that another NC derived population, melanocyte precursors, also contribute to the AV endocardial cushion and developing AV valves. The analysis of Dct-LacZ embryos at different stages showed that NC cells already committed to the melanocytic fate migrate to the heart along the same initial pathway taken by those that will populate the skin. Hypopigmented mice carrying mutations in the Kit and Endothelin receptor b genes, that are critical for the proper development of skin melanocytes, do not have cardiac melanocytes indicating that cardiac and skin melanocyte precursors share the same initial signaling requirements. The analysis of murine adult hearts showed that melanocytes are mostly found in the atrial sides of the tricuspid and mitral valve leaflets. The distribution of melanocytes in the AV valves corresponds exactly to areas of high Versican B expression, a proteoglycan essential for the process of AV valve remodeling. To evaluate a potential role for melanocytes in the AV valves, a nanoindentation analysis of the tricuspid valves of wild type, hypopigmented and hyperpigmented mice was performed. The storage modulus, a measure of stiffness, for the leaflets obtained from hyperpigmented mice was considerably higher (10.5GPa) than that for the leaflets from wild type (7.5GPa) and hypopigmented animals (between 3.5 and 5.5 GPa) suggesting that melanocytes may contribute to the mechanical properties of the AV valves.

Cultural perceptions of space and place in the South Florida *environment

Public opinion polls in the United States reveal that a great majority of Americans are aware and show concern about ecological issues and the need to preserve natural areas. In South Florida, natural resources have been subjected to enormous strain as the pressure to accommodate a growing population has led to rapid development. Suburbs have been built on areas that were once natural wetlands and farmlands, and the impact today shows a landscape where natural places have all but disappeared. This dissertation examines the intersection between the perceptions that individuals living in the South Florida region have with respect to the natural environment and local ecological problems with where their relationship to nature takes place. ^ The research is based upon both quantitative and qualitative data. The principal methodology used in this research is the ethnographic method, which employed the data gathering techniques of in-depth interviewing and participant observation. The objective of the qualitative portion of the study was to determine how people perceive and relate to their immediate environment. The quantitative portion of the study employed telephone survey data from the FIU/Florida Poll 2000. Data collected through this survey provided the basis to statistically test responses to the research questions. ^ The findings show that people in South Florida have a general idea of the relationship between the human population and the environment but very little knowledge of how they individually affect each other. The experience of private places and public spaces in everyday life permits people to compartmentalize cultural values and understandings of the natural world in separate cognitive schemas. The appreciation of the natural world has almost no connection to their personal sense of obligation to preserve the environment. That obligation is only felt in their home space even though the South Florida environment overall struggles desperately with water shortages, land encroachment, and a rapidly expanding human population whose activities continuously aggravate an already delicate natural balance. ^

A kinetic energy budget and internal instabilities in the Fine Resolution Antarctic Model

An energy analysis of the Fine Resolution Antarctic Model (FRAM) reveals the instability processes in the model. The main source of time-mean kinetic energy is the wind stress and the main sink is transfer to mean potential energy. The wind forcing thus helps maintain the density structure. Transient motions result from internal instabilities of the Bow rather than seasonal variations of the forcing. Baroclinic instability is found to be an important mechanism in FRAM. The highest values of available potential energy are found in the western boundary regions as well as in the Antarctic Circumpolar Current (ACC) region. All subregions with predominantly zonal flow are found to be baroclinically unstable. The observed deficit of eddy kinetic energy in FRAM occurs as a result of the high lateral friction, which decreases the growth rates of the most unstable waves. This high friction is required for the numerical stability of the model and can only be made smaller by using a finer horizontal resolution. A grid spacing of at least 10-15 km would be required to resolve the most unstable waves in the southern part of the domain. Barotropic instability is also found to be important for the total domain balance. The inverse transfer (that is, transfer from eddy to mean kinetic energy) does not occur anywhere, except in very localized tight jets in the ACC. The open boundary condition at the northern edge of the model domain does not represent a significant source or sink of eddy variability. However, a large exchange between internal and external mode energies is found to occur. It is still unclear how these boundary conditions affect the dynamics of adjacent regions.

From the traditional verification approach to the spatial methods: a study of applicability of the SAL metric in the framework of the WMO project MesoVICT

Increasing in resolution of numerical weather prediction models has allowed more and more realistic forecasts of atmospheric parameters. Due to the growing variability into predicted fields the traditional verification methods are not always able to describe the model ability because they are based on a grid-point-by-grid-point matching between observation and prediction. Recently, new spatial verification methods have been developed with the aim of show the benefit associated to the high resolution forecast. Nested in among of the MesoVICT international project, the initially aim of this work is to compare the newly tecniques remarking advantages and disadvantages. First of all, the MesoVICT basic examples, represented by synthetic precipitation fields, have been examined. Giving an error evaluation in terms of structure, amplitude and localization of the precipitation fields, the SAL method has been studied more thoroughly respect to the others approaches with its implementation in the core cases of the project. The verification procedure has concerned precipitation fields over central Europe: comparisons between the forecasts performed by the 00z COSMO-2 model and the VERA (Vienna Enhanced Resolution Analysis) have been done. The study of these cases has shown some weaknesses of the methodology examined; in particular has been highlighted the presence of a correlation between the optimal domain size and the extention of the precipitation systems. In order to increase ability of SAL, a subdivision of the original domain in three subdomains has been done and the method has been applied again. Some limits have been found in cases in which at least one of the two domains does not show precipitation. The overall results for the subdomains have been summarized on scatter plots. With the aim to identify systematic errors of the model the variability of the three parameters has been studied for each subdomain.

The exploration of potato-associated bacteria in the Central Andean Highlands and their application in integrated crop management systems

Potato is the most important food crop after wheat and rice. A changing climate, coupled with a heightened consumer awareness of how food is produced and legislative changes governing the usage of agrochemicals, means that alternative more integrated and sustainable approaches are needed for crop management practices. Bioprospecting in the Central Andean Highlands resulted in the isolation and in vitro screening of 600 bacterial isolates. The best performing isolates, under in vitro conditions, were field trialled in their home countries. Six of the isolates, Pseudomonas sp. R41805 (Bolivia), Pseudomonas palleroniana R43631 (Peru), Bacillus sp. R47065, R47131, Paenibacillus sp. B3a R49541, and Bacillus simplex M3-4 R49538 (Ecuador), showed significant increase in the yield of potato. Using – omic technologies (i.e. volatilomic, transcriptomic, proteomic and metabolomic), the influence of microbial isolates on plant defence responses was determined. Volatile organic compounds of bacterial isolates were identified using GC/MS. RT-qPCR analysis revealed the significant expression of Ethylene Response Factor 3 (ERF3) and the results of this study suggest that the dual inoculation of potato with Pseudomonas sp. R41805 and Rhizophagus irregularis MUCL 41833 may play a part in the activation of plant defence system via ERF3. The proteomic analysis by 2-DE study has shown that priming by Pseudomonas sp. R41805 can induce the expression of proteins related to photosynthesis and protein folding in in vitro potato plantlets. The metabolomics study has shown that the total glycoalkaloid (TGA) content of greenhouse-grown potato tubers following inoculation with Pseudomonas sp. R41805 did not exceed the acceptable safety limit (200 mg kg-1 FW). As a result of this study, a number of bacteria have been identified with commercial potential that may offer sustainable alternatives in both Andean and European agricultural settings.

The relationship between unsafe working conditions and workers’ behavior and their impacts on injury severity in the U.S.

Unsafe acts of workers (e.g. misjudgment, inappropriate operation) become the major root causes of construction accidents when they are combined with unsafe working conditions (e.g. working surface conditions, weather) on a construction site. The overarching goal of the research presented in this paper is to explore ways to prevent unsafe acts of workers and reduce the likelihood of construction accidents occurring. The study specifically aims to (1) understand the relationships between human behavior related and working condition related risk factors, (2) identify the significant behavior and condition factors and their impacts on accident types (e.g. struck by/against, caught in/between, falling, shock, inhalation/ingestion/absorption, respiratory failure) and injury severity (e.g. fatality, hospitalized, non-hospitalized), and (3) analyze the fundamental accident-injury relationship on how each accident type contributes to the injury severity. The study reviewed 9,358 accidents which occurred in the U.S. construction industry between 2002 and 2011. The large number of accident samples supported reliable statistical analyses. The analysis identified a total of 17 significant correlations between behavior and condition factors and distinguished key risk factors that highly impacted on the determination of accident types and injury severity. The research outcomes will assist safety managers to control specific unsafe acts of workers by eliminating the associated unsafe working conditions and vice versa. They also can prioritize risk factors and pay more attention to controlling them in order to achieve a safer working environment.

The role of the Saudi government and the Saudi building code in implementing sustainable housing construction in Saudi Arabia

The housing construction industry in Saudi Arabia has been booming rapidly in the past two decades. This boom has faced multiple downfalls in relation to government regulations and building codes, one of which is the application of sustainable methods to the housing construction. This paper sheds some light on the current role of the Saudi government and the role of the Saudi Building Code (SBC) in the housing construction industry. The methodology utilised in this paper was a Delphi survey that was distributed to twenty-five key stakeholders in the housing construction industry in Saudi Arabia. The results indicate that there is a lack of integration between the Saudi Building Code and the current construction methods used in the current construction industry. Some factors and elements are recommended to be incorporated into the Saudi Building Code and to be adopted as regulations in the Saudi housing construction industry.

Phase relations and activities in the Co Ni O system at 1373 K

The tie-lines delineating equilibria between CoO-NiO and Co-Ni solid solutions in the ternary Co-Ni-O system at 1373 K have been determined by electron microprobe andedax point count analysis of the oxide phase equilibrated with the alloy. The oxygen potentials corresponding to the tie-line compositions have been measured using a solid oxide galvanic cell with calcia-stabilized zirconia electrolyte and Ni + NiO reference electrode. Activities in the metallic and oxide solid solution have been derived using a new Gibbs-Duhem integration technique. Both phases exhibit small positive deviations from ideality; the values ofG E/X 1 X 2 are 2640 J mol−1 for the metallic phase and 2870 J mol−1 for the oxide solid solution.

Phase equilibria in the Co Ni F system and activities in (CoxNi1 x)F2 solid solutions at 1373 K

The tie-lines delineating equilibria between CoF2-NiF2 and Co-Ni solid solutions in the ternary Co-Ni-F system at 1373 K have been determined by electron microprobe and EDAX point count analysis of the equilibrated phases. Activities in the fluoride solid solution have been derived from the knowledge of activitycomposition relation in the metallic solid solution and tie-line data,using a modified form of the Gibbs-Duhem integration. The fluorine potentials corresponding to the tie-line compositions have been calculated.The excess Gibbs' energy of mixing for the fluoride solid solution derived from the present data can be represented by the expression

Phase relations in the system SrO-Y2O3-CuO-O2 and CaO-Y2O3-CuO-O2 at 1173 K

Phase relations in the systems SrO-Y2O3-CuO-O2 and CaO-Y2O3-CuO-O2 at 1173 K were established by equilibrating different compositions in flowing oxygen gas at a pressure of 1.01 × 105 Pa. The quenched samples were examined by optical microscopy, X-ray diffraction (XRD), energy dispersive analysis of X-rays (EDAX), and electron spin resonance (ESR). In the system SrO-Y2O3-CuO-O2, except for the limited substitution of Y3+ for Sr2+ ions in the ternary oxide Sr14Cu24O41, no new quaternary phase was found to be stable. The compositions corresponding to the solid solution Sr14−xYxCu24O41 and the compound SrCuO2+δ lie above the plane containing SrO, Y2O3, and CuO,displaced towards the oxygen apex. However, in the system CaO-Y203-CuO-O2 at 1173 K, all the condensed phases lie on the plane containing CaO, Y203, and CuO, and a new quaternary oxide YCa2Cu306.s is present. The quaternary phase has a composition that lies at the center of the nonstoichiometric field of the analogous phase YBa2Cu307_~ in the BaO-Y203-CuO-O2 system. The compound YCa2Cu306.s has the tetragonal structure and does not become superconducting at low temperature. Surprisingly, phase relations in the three systems CaO-Y203-CuO-O2, SrO-Y203-CuO-O2, and BaO-Y203-CuO-O2 are found to be quite different.

Feeding habits and trophic levels of some demersal fish species in the Persian Gulf (Bushehr Province) using Ecopath model

A trophic study was carried out in February of 2012 to January 2013 on the ecosystem in the Persian Gulf, Bushehr provience. A total of 2,948 samples of stomach contents were analyzed based on the weight and number of food items and were identified about 40 preys. Crustacean and bony fish were as a main prey in most of the stomach contents . The mean average trophic level was estimated at 3.6 by Ecopath software. In this research, the mean level were studied between eight species varied from 3.47 to 4.61, Saurida tumbil occupy the highest and the Argyrops spinifer was the lowest level. The ranges of total mortality varied from 0.7 to 3.05 per years. The food consumption rate was estimated about 69.82 per year. The overlap index showed that the prey items such as fish, crustacean, bivalve and echinoderm were shared about 65, 15, 15 and 6 percent in all stomach of individual in respectively. Mixed trophic analysis indicates that benthos have a positive effect on most of the fish species. Most species have a negative impact on themselves, interpreted here as reflecting increased with in group competition for resources. This preliminary model can be helpful to determine the gaps in the present knowledge about demersal system of the Persian Gulf.

Plastid microsatellites for the study of genetic variability in the widespread Cephalanthera longifolia, C. damasonium and C. rubra (Neottieae, Orchidaceae), and cross-amplification in other Cephalanthera species

Plastid microsatellite loci developed for Cephalanthera longifolia were used to examine the level of genetic variation within and between populations of the three widespread Cephalanthera species (C. damasonium, C. longifolia and C. rubra). The most detailed sampling was in C. longifolia (42 localities from Ireland to China; 147 individuals). Eight haplotypes were detected. One was detected in the vast majority of individuals and occurred from Ireland to Iran. Three others were only found in Europe (Ireland to Italy, England to Italy and Austria to Croatia). Two were only found in the Middle East and two only in Asia. In C. damasonium, 21 individuals from 10 populations (England to Turkey) were sampled. Only one haplotype was detected. In C. rubra, 34 individuals from eight populations (England to Turkey) were sampled. Although it was not possible to amplify all loci for all samples of this species, nine haplotypes were detected. Short alleles for the trnS-trnG region found in two populations of C. rubra were characterized by sequencing and were caused by deletions of 26 and 30 base pairs. At this level of sampling, it appears that C. rubra shows the greatest genetic variability. Cephalanthera longifolia, C. rubra and C. damasonium have previously been characterized as outbreeding, outbreeding with facultative vegetative reproduction and inbreeding, respectively. Patterns of genetic variation here are discussed in the light of these reproductive system differences. The primers used in these three species of Cephalanthera were also demonstrated to amplify these loci in another five species (C. austiniae, C. calcarata, C. epipactoides, C. falcata and C. yunnanensis). Although it is sometimes treated as a synonym of C. damasonium, the single sample of C. yunnanensis from China had a markedly different haplotype from that found in C. damasonium. All three loci were successfully amplified in two achlorophyllous, myco-heterotrophic species, C. austinae and C. calcarata. © 2010 The Linnean Society of London.

What does “retrofit” mean, and how can we scale up action in the UK sector?

Purpose – Progress in retrofitting the UK's commercial properties continues to be slow and fragmented. New research from the UK and USA suggests that radical changes are needed to drive large-scale retrofitting, and that new and innovative models of financing can create new opportunities. The purpose of this paper is to offer insights into the terminology of retrofit and the changes in UK policy and practice that are needed to scale up activity in the sector. Design/methodology/approach – The paper reviews and synthesises key published research into commercial property retrofitting in the UK and USA and also draws on policy and practice from the EU and Australia. Findings – The paper provides a definition of “retrofit”, and compares and contrasts this with “refurbishment” and “renovation” in an international context. The paper summarises key findings from recent research and suggests that there are a number of policy and practice measures which need to be implemented in the UK for commercial retrofitting to succeed at scale. These include improved funding vehicles for retrofit; better transparency in actual energy performance; and consistency in measurement, verification and assessment standards. Practical implications – Policy and practice in the UK needs to change if large-scale commercial property retrofit is to be rolled out successfully. This requires mandatory legislation underpinned by incentives and penalties for non-compliance. Originality/value – This paper synthesises recent research to provide a set of policy and practice recommendations which draw on international experience, and can assist on implementation in the UK.