Call for Submissions: White Paper on Universal Health Insurance - Supporting Documents

  The Department of Health has published a White Paper on Universal Health Insurance. The White Paper sets out in detail the elements of the proposed Universal Health Insurance model for Ireland. As such, it provides detail on the overall design of the model, the proposed system for deciding on the standard package of services and the financing mechanisms for the system. This is a most fundamental reform of the health system and we recognise the importance of consulting extensively and inclusively with all interested parties.  It is important to seek your views on the policy as it is set out in the White Paper, and we view this as a valuable opportunity for citizens to contribute to the development of policy on the future of their health system.  Therefore, we would like to hear from any individual, group, organisation or other body that wishes to contribute to the consultation on the White Paper. In particular, but not limited to, we would welcome your views on the following issues: A consultation document setting out a number of key questions under each of the above headings has been developed and can be downloaded here. There is an opportunity at the end of the document for views or comments on other aspects of the White Paper to be provided. Alternatively, additional views or comments can be sent as an email or hard copy to the addresses below. It is intended to establish a separate independent Expert Commission to examine the issues around the basket of services to be provided under UHI and within the overall health system. The Minister will announce details of the Commission in the near future. Therefore, it would be useful if the submissions on the White Paper refrained from commenting in detail on the services to be provided under UHI. Views on the basket of services will be sought by the Commission when it commences its consultation process. The White Paper can be downloaded here, and two further supporting documents Background Policy Paper on Designing the Future Health Basket and Background Policy Paper on Raising Resources for Universal Health Insurance, which informed the development of the White Paper are also available for download. Links to other supporting documentation that informed the White Paper are also provided below. Submissions can be submitted: By E-mail to: uhiwhitepaper@health.gov.ie By Post to: UHI White Paper UHI UnitDepartment of HealthRoom 7.26Hawkins HouseHawkins StreetDublin 2 The closing date for submissions is close of business 28th May 2014 and will be strictly adhered to. All submissions received will be subject to the Freedom of Information Acts 1997 & 2003 and may be released in response to a Freedom of Information request. Download the consultation document (MS Word) (From the website of the Health Research Board) Integration of health and wellbeing services with general health services The integration of health and social care services

Off to a good start: all you need to know about breastfeeding your baby

This book presents the reasons why mothers and babies benefit from breastfeeding and explains how to breastfeed successfully. It covers issues including how breastfeeding works, positioning and attachment, how to know if breastfeeding is going well, expressing milk, breastfeeding and babies in special care, advice on breastfeeding and bed-sharing, dealing with common problems, fitting breastfeeding into your life, and going back to work.

Fourth order pseudo maximum likelihood methods

We extend PML theory to account for information on the conditional moments up to order four, but without assuming a parametric model, to avoid a risk of misspecification of the conditional distribution. The key statistical tool is the quartic exponential family, which allows us to generalize the PML2 and QGPML1 methods proposed in Gourieroux et al. (1984) to PML4 and QGPML2 methods, respectively. An asymptotic theory is developed. The key numerical tool that we use is the Gauss-Freud integration scheme that solves a computational problem that has previously been raised in several fields. Simulation exercises demonstrate the feasibility and robustness of the methods [Authors]

Taxonomic reports of Otobothrioidea (Eucestoda, Trypanorhyncha) from elasmobranch fishes of the southern coast off Brazil

Specimens of elasmobranch fishes, captured in the states of Paraná and Santa Catarina, of the southern coast off Brazil, represented by three families, four genera, and four species, were parasitized with otobothrioid trypanorhynch cestodes: Heptranchias perlo (Bonnaterre, 1788), Squalus sp. and Carcharhinus signatus (Poey, 1868) were parasitized with Progrillotia dollfusi Carvajal & Rego,1987; Prionace glauca (Linnaeus, 1758) with Molicola horridus (Goodsir, 1841) Dollfus, 1942. Details of internal morphology and/or scolex and/or proglottids surface ultrastructure, that expanded the description of M. horridus, through observations with lightfield, and/or scanning eletronic microscopy, are provided. The known geographical distribution for the species M. horridus is enlarged. P. dollfusi is reported for the first time in elasmobranchs.

Being Recognizable in Order to Overcome the Crisis: The Ambivalence of Islamis Actor's Struggle for Visibility in France and Switzerland

Since the 1990s, and especially since the early 2000s, passionate controversies (Göle 2014) have emerged around the new visibility of Islam in the public sphere across Europe. These controversies, which crystallized in the headscarf debate, seem even more disturbing given that women who wear it are often young, urban and educated: that is to say, "modern" (Göle 1997, 2011). Indeed, these young women wearing the hijab seem to disrupt the narrative of Western modernity, including the decline in religious practice (Hervieu-Léger 2006) or the narration of the process of secularization in Europe. It is in the context of these controversies that Islam is built imaginatively as a "public problem" that has to be "solved" (Behloul 2012). Thus, this social construction of the Muslim other has nurtured an assessment of the failure of multiculturalism in some European countries and a process of convergence around a single model of civic integration in Europe (Behloul 2012, Joppke 2004, 2010).

454 Users Successfully 'weaned off' Methadone

A total of 454 methadone users successfully completed treatment programmes aimed at weaning them off the heroin substitute last year - but more than 2,000 others left the state's maintenance programme during the same period for a variety of reasons, new figures have revealed. According to statistics released under the Freedom of Information Act, there were 9,760 methadone users around the country last year, with the majority in the Dublin area. However, over 2,778 clients of the methadone maintenance service left the HSE's central treatment lists during the year. A summary of the reasons reveals that in 1,268 instances, they did so after either being released or committed to prison.This resource was contributed by The National Documentation Centre on Drug Use.

Impact of a computerized physician order entry system on compliance with prescription accuracy requirements.

OBJECTIVE: To assess the change in non-compliant items in prescription orders following the implementation of a computerized physician order entry (CPOE) system named PreDiMed. SETTING: The department of internal medicine (39 and 38 beds) in two regional hospitals in Canton Vaud, Switzerland. METHOD: The prescription lines in 100 pre- and 100 post-implementation patients' files were classified according to three modes of administration (medicines for oral or other non-parenteral uses; medicines administered parenterally or via nasogastric tube; pro re nata (PRN), as needed) and analyzed for a number of relevant variables constitutive of medical prescriptions. MAIN OUTCOME MEASURE: The monitored variables depended on the pharmaceutical category and included mainly name of medicine, pharmaceutical form, posology and route of administration, diluting solution, flow rate and identification of prescriber. RESULTS: In 2,099 prescription lines, the total number of non-compliant items was 2,265 before CPOE implementation, or 1.079 non-compliant items per line. Two-thirds of these were due to missing information, and the remaining third to incomplete information. In 2,074 prescription lines post-CPOE implementation, the number of non-compliant items had decreased to 221, or 0.107 non-compliant item per line, a dramatic 10-fold decrease (chi(2) = 4615; P < 10(-6)). Limitations of the computerized system were the risk for erroneous items in some non-prefilled fields and ambiguity due to a field with doses shown on commercial products. CONCLUSION: The deployment of PreDiMed in two departments of internal medicine has led to a major improvement in formal aspects of physicians' prescriptions. Some limitations of the first version of PreDiMed were unveiled and are being corrected.

Funding: North Dublin City & County Regional Drugs Task Force

The North Dublin City and County Regional Drugs Task Force invites applications for this once-off funding which will be provided through four pillars by way of a grant up to €3,000 for innovative initiatives: • Prevention, Education & Awareness – to develop programmes and supports in the community which offer information and education in order to generate awareness. • Treatment & Rehabilitation – to develop additional short-term supports for those undertaking treatment for drug misuse or innovative rehabilitative supports. • Research – to undertake local research into drug misuse in North Dublin within the RDTF area. • Supply Reduction – to reduce access to all drugs, in particular those that cause most harm, among young people in neighbourhoods where misuse is most prevalent. Terms and conditions apply. To request an application pack or for more information contact 01 813 1786 orThis resource was contributed by The National Documentation Centre on Drug Use.

Stratigraphic significance of siliceous microfossils collected during Nautiperc dives (Off Peru, 5°-6° S)

The geological evolution of the northern Peru convergent margin can be traced using samples collected during deep-sea dives of the submersible Nautile. In the Paita area (5 degrees-6 degrees S), the sedimentary sequence was intensively sampled along the main scarp of the middle slope area. It consists of Upper Miocene (7-9 Ma) to Pleistocene siltstone, sandstone and rare dolostone. The age distribution of these samples is the basis for a new geologic interpretation of the multichannel seismic line CDP3. Siliceous microfossils (both diatoms and radiolarians) show influence of both cold and temperate waters (local species mixed with upwelling ones). Diatom assemblages studied from the NP1-13 and NP1-15 dives bear a strong resemblance to assemblages from the Pisco Formation of southern Peru. Micropaleontological data from siliceous microfossils, provide evidence for two main unconformities, one is at the base of the Quaternary sequence and the other corresponds to a hiatus of 1 Myr, separating the Upper Miocene (7-8 Ma) sediments from uppermost Miocene (5-6 Ma) sediments. During the past 400 kyr, a wide rollover fold developed in the middle slope area associated with a major seaward dipping detachment fault. A catastrophic debris avalanche occurred as the result of an oversteepening of the landward flank of the rollover fold. The gravity failure of the slope, recognized by SeaBEAM and hydrosweep mapping, displaced enough material to produce a destructive tsunami which occurred 13.8 +/- 2.7 kyr ago.

Genome size rather than content might affect call properties in toads of three ploidy levels (Anura: Bufonidae: Bufo viridis subgroup).

In vertebrates, genome size has been shown to correlate with nuclear and cell sizes, and influences phenotypic features, such as brain complexity. In three different anuran families, advertisement calls of polyploids exhibit longer notes and intervals than diploids, and difference in cellular dimensions have been hypothesized to cause these modifications. We investigated this phenomenon in green toads (Bufo viridis subgroup) of three ploidy levels, in a different call type (release calls) that may evolve independently from advertisement calls, examining 1205 calls, from ten species, subspecies, and hybrid forms. Significant differences between pulse rates of six diploid and four polyploid (3n, 4n) green toad forms across a range of temperatures from 7 to 27 °C were found. Laboratory data supported differences in pulse rates of triploids vs. tetraploids, but failed to reach significance when including field recordings. This study supports the idea that genome size, irrespective of call type, phylogenetic context, and geographical background, might affect call properties in anurans and suggests a common principle governing this relationship. The nuclear-cell size ratio, affected by genome size, seems the most plausible explanation. However, we cannot rule out hypotheses under which call-influencing genes from an unexamined diploid ancestral species might also affect call properties in the hybrid-origin polyploids.

Off to a good start: all you need to know about breastfeeding your baby

This book presents the reasons why mothers and babies benefit from breastfeeding and explains how to breastfeed successfully. It covers issues including how breastfeeding works, positioning and attachment, how to know if breastfeeding is going well, expressing milk, breastfeeding and babies in special care, advice on breastfeeding and bed-sharing, dealing with common problems, fitting breastfeeding into your life, and going back to work.

Assessment of left coronary artery beat-to-beat repositioning in order to propose an optimal acquisition window for coronary MRA

Introduction: Coronary magnetic resonance angiography (MRA) is a medical imaging technique that involves collecting data from consecutive heartbeats, always at the same time in the cardiac cycle, in order to minimize heart motion artifacts. This technique relies on the assumption that coronary arteries always follow the same trajectory from heartbeat to heartbeat. Until now, choosing the acquisition window in the cardiac cycle was based exclusively on the position of minimal coronary motion. The goal of this study was to test the hypothesis that there are time intervals during the cardiac cycle when coronary beat-to-beat repositioning is optimal. The repositioning uncertainty values in these time intervals were then compared with the intervals of low coronary motion in order to propose an optimal acquisition window for coronary MRA. Methods: Cine breath-hold x-ray angiograms with synchronous ECG were collected from 11 patients who underwent elective routine diagnostic coronarography. Twenty-three bifurcations of the left coronary artery were selected as markers to evaluate repositioning uncertainty and velocity during cardiac cycle. Each bifurcation was tracked by two observers, with the help of a user-assisted algorithm implemented in Matlab (The Mathworks, Natick, MA, USA) that compared the trajectories of the markers coming from consecutive heartbeats and computed the coronary repositioning uncertainty with steps of 50ms until 650ms after the R-wave. Repositioning uncertainty was defined as the diameter of the smallest circle encompassing the points to be compared at the same time after the R-wave. Student's t-tests with a false discovery rate (FDR, q=0.1) correction for multiple comparison were applied to see whether coronary repositioning and velocity vary statistically during cardiac cycle. Bland-Altman plots and linear regression were used to assess intra- and inter-observer agreement. Results: The analysis of left coronary artery beat-to-beat repositioning uncertainty shows a tendency to have better repositioning in mid systole (less than 0.84±0.58mm) and mid diastole (less than 0.89±0.6mm) than in the rest of the cardiac cycle (highest value at 50ms=1.35±0.64mm). According to Student's t-tests with FDR correction for multiple comparison (q=0.1), two intervals, in mid systole (150-200ms) and mid diastole (550-600ms), provide statistically better repositioning in comparison with the early systole and the early diastole. Coronary velocity analysis reveals that left coronary artery moves more slowly in end systole (14.35±11.35mm/s at 225ms) and mid diastole (11.78±11.62mm/s at 625ms) than in the rest of the cardiac cycle (highest value at 25ms: 55.96±22.34mm/s). This was confirmed by Student's t-tests with FDR correction for multiple comparison (q=0.1, FDR-corrected p-value=0.054): coronary velocity values at 225, 575 and 625ms are not much different between them but they are statistically inferior to all others. Bland-Altman plots and linear regression show that intra-observer agreement (y=0.97x+0.02 with R²=0.93 at 150ms) is better than inter-observer (y=0.8x+0.11 with R²=0.67 at 150ms). Discussion: The present study has demonstrated that there are two time intervals in the cardiac cycle, one in mid systole and one in mid diastole, where left coronary artery repositioning uncertainty reaches points of local minima. It has also been calculated that the velocity is the lowest in end systole and mid diastole. Since systole is less influenced by heart rate variability than diastole, it was finally proposed to test an acquisition window between 150 and 200ms after the R-wave.

Interhemispheric coupling between the posterior sylvian regions impacts successful auditory temporal order judgment

Introduction: Accurate registration of the relative timing between the occurrence of sensory events on a sub-second time scale is crucial for both sensory-motor and cognitive functions (Mauk and Buonomano, 2004; Habib, 2000). Support for this assumption comes notably from evidence that temporal processing impairments are implicated in a range of neurological and psychiatric conditions (e.g. Buhusi & Meck, 2005). For instance, deficits in fast auditory temporal integration have been regularly put forward as resulting in phonologic discrimination impairments at the basis of speech comprehension deficits characterizing e.g. dyslexia (Habib, 2000). At least two aspects of the brain mechanisms of temporal order judgment remain unknown. First, it is unknown when during the course of stimulus processing a temporal ,,stamp‟ is established to guide TOJ perception. Second, the extent of interplay between the cerebral hemispheres in engendering accurate TOJ performance is unresolved Methods: We investigated the spatiotemporal brain dynamics of auditory temporal order judgment (aTOJ) using electrical neuroimaging analyses of auditory evoked potentials (AEPs) recorded while participants completed a near-threshold task requiring spatial discrimination of left-right and right-left sound sequences. Results: AEPs to sound pairs modulated topographically as a function of aTOJ accuracy over the 39-77ms post-stimulus period, indicating the engagement of distinct configurations of brain networks during early auditory processing stages. Source estimations revealed that accurate and inaccurate performance were linked to bilateral posterior sylvian regions activity (PSR). However, activity within left, but not right, PSR predicted behavioral performance suggesting that left PSR activity during early encoding phases of pairs of auditory spatial stimuli appears critical for the perception of their order of occurrence. Correlation analyses of source estimations further revealed that activity between left and right PSR was significantly correlated in the inaccurate but not accurate condition, indicating that aTOJ accuracy depends on the functional de-coupling between homotopic PSR areas. Conclusions: These results support a model of temporal order processing wherein behaviorally relevant temporal information - i.e. a temporal 'stamp'- is extracted within the early stages of cortical processes within left PSR but critically modulated by inputs from right PSR. We discuss our results with regard to current models of temporal of temporal order processing, namely gating and latency mechanisms.

Behaviour evaluation for risk-taking adolescents (BERTA): an easy to use and assess instrument to detect adolescent risky behaviours in a clinical setting.

To create an instrument to be used in an outpatient clinic to detect adolescents prone to risk-taking behaviours. Based on previous research, five identified variables (relationship with parents and teachers, liking going to school, average grades, and level of religiosity) were used to create a screening tool to detect at least one of ten risky behaviours (tobacco, alcohol, cannabis and other illegal drugs use; sexual intercourse and sexual risky behaviour; driving while intoxicated, riding with an intoxicated driver, not always using a seat belt, and not always using a helmet). The instrument was tested using the Barcelona Adolescent Health Survey 1993. A Receiver Operating Characteristics curve was used to find the best cut-off point between high and low risk score. Odds ratios and 95% confidence intervals were calculated to detect at least one risky behaviour and for each individual behaviour. In order to assess its predictive value, the analysis was repeated using the Barcelona Adolescent Health Survey 1999. In both cases, analyses were conducted for the whole sample and for younger and older adolescents. Adolescents with a high-risk score were more likely to take at least one risky behaviour both when the whole sample was analysed and by age groups. With very few exceptions, the Behaviour Evaluation for Risk-Taking Adolescents showed significant odds ratios for each individual variable. CONCLUSION: The Behaviour Evaluation for Risk-Taking Adolescents has shown its potential as an easy to use instrument to screen for risk-taking behaviours. Future research must aim towards assessing this instrument's predictive value in the clinical setting and it's application to other populations.