Provider diversity in the English NHS: a study of recent developments in four local health economies

Objectives: The overall objective of the research was to assess the impact of provider diversity on quality and innovation in the English NHS. The aims were to map the extent of diverse provider activity, identify the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organisations within the NHS, and the factors that affect the entry and growth of new private and TSOs. Methods: Case studies of four Local Health Economies (LHEs). Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and Third Sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Results: Involvement of diverse providers in the NHS is limited. Commissioners’ local strategies influence degrees of diversity. Barriers to the entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS Trusts to respond by making improvements. Information sharing diminishes as competition intensifies. Conclusions: There is scope to increase the participation of diverse providers in the NHS, but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

The use of public participation and economic appraisal for public involvement in large-scale hydropower projects: Case study of the Nam Theun 2 Hydropower Project

Gaining public acceptance is one of the main issues with large-scale low-carbon projects such as hydropower development. It has been recommended by the World Commission on Dams that to gain public acceptance, publicinvolvement is necessary in the decision-making process (WCD, 2000). As financially-significant actors in the planning and implementation of large-scale hydropowerprojects in developing country contexts, the paper examines the ways in which publicinvolvement may be influenced by international financial institutions. Using the casestudy of the NamTheun2HydropowerProject in Laos, the paper analyses how publicinvolvement facilitated by the Asian Development Bank had a bearing on procedural and distributional justice. The paper analyses the extent of publicparticipation and the assessment of full social and environmental costs of the project in the Cost-Benefit Analysis conducted during the projectappraisal stage. It is argued that while efforts were made to involve the public, there were several factors that influenced procedural and distributional justice: the late contribution of the Asian Development Bank in the projectappraisal stage; and the issue of non-market values and discount rate to calculate the full social and environmental costs.

The gender gap in real estate sales: negotiation skill or agent selection?

This study examines differences in net selling price for residential real estate across male and female agents. A sample of 2,020 home sales transactions from Fulton County, Georgia are analyzed in a two-stage least squares, geospatial autoregressive corrected, semi-log hedonic model to test for gender and gender selection effects. Although agent gender seems to play a role in naïve models, its role becomes inconclusive as variables controlling for possible price and time on market expectations of the buyers and sellers are introduced to the models. Clear differences in real estate sales prices, time on market, and agent incomes across genders are unlikely due to differences in negotiation performance between genders or the mix of genders in a two-agent negotiation. The evidence suggests an interesting alternative to agent performance: that buyers and sellers with different reservation price and time on market expectations, such as those selling foreclosure homes, tend to select agents along gender lines.

In vivo characterization of Lactobacillus johnsonii FI9785 for use as a defined competitive exclusion agent against bacterial pathogens in poultry

Aims: To test the efficacy of Lactobacillus johnsonii FI9785 in reducing the colonization and shedding of Salmonella enterica serotype Enteritidis, Escherichia coli O78:K80 and Clostridium perfringens in poultry. Methods and Results: Specific pathogen-free chicks (1 day old) were dosed with a single oral inoculum of 1 x 10(9) CFU. Lactobacillus johnsonii FI9785 and 24 h later were challenged in separate experiments with S. Enteritidis (S1400, nal(r)) and E. coli O78:K80 (EC34195, nal(r)). There were no significant effects against S. Enteritidis whereas colonization of the small intestine by E. coli O78:K80 was reduced significantly. Both S. Enteritidis and E. coli colonized the caeca and colon to levels equivalent to control birds and there was no reduction in shedding as assessed by a semi-quantitative cloacal swabbing technique. Specific pathogen-free chicks (20 day old) were dosed with a single oral inoculum of 1 x 10(9) CFU L. johnsonii FI9785 and 24 h later were challenged with C. perfringens. A single oral dose of L. johnsonii FI9785 was sufficient to suppress all aspects of colonization and persistence of C. perfringens. Conclusions: Lactobacillus johnsonii FI9785 may be given to poultry for use as a competitive exclusion agent to control C. perfringens. Significance and Impact of the Study: Lactobacillus johnsonii FI9785 may be a valuable tool to control the endemic disease of necrotic enteritis, thereby reducing economic losses associated with reduced use of antimicrobials in the poultry industry.

A multi-agent system for pervasive healthcare

Wireless technology based pervasive healthcare has been proposed in many applications such as disease management and accident prevention for cost saving and promoting citizen’s wellbeing. However, the emphasis so far is on the artefacts with limited attentions to guiding the development of an effective and efficient solution for pervasive healthcare. Therefore, this paper aims to propose a framework of multi-agent systems design for pervasive healthcare by adopting the concept of pervasive informatics and using the methods of organisational semiotics. The proposed multi-agent system for pervasive healthcare utilises sensory information to support healthcare professionals for providing appropriate care. The key contributions contain theoretical aspect and practical aspect. In theory, this paper articulates the information interactions between the pervasive healthcare environment and stakeholders by using the methods of organisational semiotics; in practice, the proposed framework improves the healthcare quality by providing appropriate medical attentions when and as needed. In this paper, both systems and functional architecture of the multi-agent system are elaborated with the use of wireless technologies such as RFID and wireless sensor networks. The future study will focus on the implementation of the proposed framework.

Information communication technologies and distance education in Sri Lanka: a case study of two universities

Sri Lanka's participation rates in higher education are low and have risen only slightly in the last few decades; the number of places for higher education in the state university system only caters for around 3% of the university entrant age cohort. The literature reveals that the highly competitive global knowledge economy increasingly favours workers with high levels of education who are also lifelong learners. This lack of access to higher education for a sizable proportion of the labour force is identified as a severe impediment to Sri Lanka‟s competitiveness in the global knowledge economy. The literature also suggests that Information and Communication Technologies are increasingly relied upon in many contexts in order to deliver flexible learning, to cater especially for the needs of lifelong learners in today‟s higher educational landscape. The government of Sri Lanka invested heavily in ICTs for distance education during the period 2003-2009 in a bid to increase access to higher education; but there has been little research into the impact of this. To address this lack, this study investigated the impact of ICTs on distance education in Sri Lanka with respect to increasing access to higher education. In order to achieve this aim, the research focused on Sri Lanka‟s effort from three perspectives: policy perspective, implementation perspective and user perspective. A multiple case study research using an ethnographic approach was conducted to observe Orange Valley University‟s and Yellow Fields University‟s (pseudonymous) implementation of distance education programmes using questionnaires, qualitative interviewing and document analysis. In total, data for the analysis was collected from 129 questionnaires, 33 individual interviews and 2 group interviews. The research revealed that ICTs have indeed increased opportunities for higher education; but mainly for people of affluent families from the Western Province. Issues identified were categorized under the themes: quality assurance, location, language, digital literacies and access to resources. Recommendations were offered to tackle the identified issues in accordance with the study findings. The study also revealed the strong presence of a multifaceted digital divide in the country. In conclusion, this research has shown that iii although ICT-enabled distance education has the potential to increase access to higher education the present implementation of the system in Sri Lanka has been less than successful.

Multi-agent based modeling and simulation of complex system in hospital

This study puts forward a method to model and simulate the complex system of hospital on the basis of multi-agent technology. The formation of the agents of hospitals with intelligent and coordinative characteristics was designed, the message object was defined, and the model operating mechanism of autonomous activities and coordination mechanism was also designed. In addition, the Ontology library and Norm library etc. were introduced using semiotic method and theory, to enlarge the method of system modelling. Swarm was used to develop the multi-agent based simulation system, which is favorable for making guidelines for hospital's improving it's organization and management, optimizing the working procedure, improving the quality of medical care as well as reducing medical charge costs.

A semiotic approach of multi-agent simulation for policy evaluation

Nowadays the changing environment becomes the main challenge for most of organizations, since they have to evaluate proper policies to adapt to the environment. In this paper, we propose a multi-agent simulation method to evaluate policies based on complex adaptive system theory. Furthermore, we propose a semiotic EDA (Epistemic, Deontic, Axiological) agent model to simulate agent's behavior in the system by incorporating the social norms reflecting the policy. A case study is also provided to validate our approach. Our research present better adaptability and validity than the qualitative analysis and experiment approach and the semiotic agent model provides high creditability to simulate agents' behavior.

Cost function for sub-agent elements in multi-agent energy management system

Distributed generation plays a key role in reducing CO2 emissions and losses in transmission of power. However, due to the nature of renewable resources, distributed generation requires suitable control strategies to assure reliability and optimality for the grid. Multi-agent systems are perfect candidates for providing distributed control of distributed generation stations as well as providing reliability and flexibility for the grid integration. The proposed multi-agent energy management system consists of single-type agents who control one or more gird entities, which are represented as generic sub-agent elements. The agent applies one control algorithm across all elements and uses a cost function to evaluate the suitability of the element as a supplier. The behavior set by the agent's user defines which parameters of an element have greater weight in the cost function, which allows the user to specify the preference on suppliers dynamically. This study shows the ability of the multi-agent energy management system to select suppliers according to the selection behavior given by the user. The optimality of the supplier for the required demand is ensured by the cost function based on the parameters of the element.

Evaluating the potential of high pressure high temperature and thermal processing on volatile compounds, nutritional and structural properties of orange and yellow carrots

The present study compares the impact of thermal and high pressure high temperature(HPHT) processing on volatile profile (via a non-targeted headspace fingerprinting) and structural and nutritional quality parameter (via targeted approaches) of orange and yellow carrot purees. The effect of oil enrichment was also considered. Since oil enrichment affects compounds volatility, the effect of oil was not studied when comparing the volatile fraction. For the targeted part, as yellow carrot purees were shown to contain a very low amount of carotenoids, focus was given to orange carrot purees. The results of the non-targeted approach demonstrated HPHT processing exerts a distinct effect on the volatile fractions compared to thermal processing. In addition, different colored carrot varieties are characterized by distinct headspace fingerprints. From a structural point of view, limited or no difference could be observed between orange carrot purees treated with HPHT or HT processes, both for samples without and with oil. From nutritional point of view, only in samples with oil, significant isomerisation of all-trans-β-carotene occurred due to both processing. Overall, for this type of product and for the selected conditions, HPHT processing seems to have a different impact on the volatile profile but rather similar impact on the structural and nutritional attributes compared to thermal processing.

Case study on the maintenance of a construction monitoring using USN-based data acquisition

In recent years, there has been an increasing interest in the adoption of emerging ubiquitous sensor network (USN) technologies for instrumentation within a variety of sustainability systems. USN is emerging as a sensing paradigm that is being newly considered by the sustainability management field as an alternative to traditional tethered monitoring systems. Researchers have been discovering that USN is an exciting technology that should not be viewed simply as a substitute for traditional tethered monitoring systems. In this study, we investigate how a movement monitoring measurement system of a complex building is developed as a research environment for USN and related decision-supportive technologies. To address the apparent danger of building movement, agent-mediated communication concepts have been designed to autonomously manage large volumes of exchanged information. In this study, we additionally detail the design of the proposed system, including its principles, data processing algorithms, system architecture, and user interface specifics. Results of the test and case study demonstrate the effectiveness of the USN-based data acquisition system for real-time monitoring of movement operations.

Effects of orange juice formulation on prebiotic functionality using an in vitro colonic model sytem

A three-stage continuous fermentative colonic model system was used to monitor in vitro the effect of different orange juice formulations on prebiotic activity. Three different juices with and without Bimuno, a GOS mixture containing galactooligosaccharides (B-GOS) were assessed in terms of their ability to induce a bifidogenic microbiota. The recipe development was based on incorporating 2.75g B-GOS into a 250 ml serving of juice (65°Brix of concentrate juice). Alongside the production of B-GOS juice, a control juice - orange juice without any additional Bimuno and a positive control juice, containing all the components of Bimuno (glucose, galactose and lactose) in the same relative proportions with the exception of B-GOS were developed. Ion Exchange Chromotography analysis was used to test the maintenance of bimuno components after the production process. Data showed that sterilisation had no significant effect on concentration of B-GOS and simple sugars. The three juice formulations were digested under conditions resembling the gastric and small intestinal environments. Main bacterial groups of the faecal microbiota were evaluated throughout the colonic model study using 16S rRNA-based fluorescence in situ hybridization (FISH). Potential effects of supplementation of the juices on microbial metabolism were studied measuring short chain fatty acids (SCFAs) using gas chromatography. Furthermore, B-GOS juices showed positive modulations of the microbiota composition and metabolic activity. In particular, numbers of faecal bifidobacteria and lactobacilli were significantly higher when B-GOS juice was fermented compared to controls. Furthermore, fermentation of B-GOS juice resulted in an increase in Roseburia subcluster and concomitantly increased butyrate production, which is of potential benefit to the host. In conclusion, this study has shown B-GOS within orange juice can have a beneficial effect on the fecal microbiota.

CHP toolkit: case study of LAIe sensitivity to discontinuity of canopy cover in fruit plantations

This paper presents an open-source canopy height profile (CHP) toolkit designed for processing small-footprint full-waveform LiDAR data to obtain the estimates of effective leaf area index (LAIe) and CHPs. The use of the toolkit is presented with a case study of LAIe estimation in discontinuous-canopy fruit plantations. The experiments are carried out in two study areas, namely, orange and almond plantations, with different percentages of canopy cover (48% and 40%, respectively). For comparison, two commonly used discrete-point LAIe estimation methods are also tested. The LiDAR LAIe values are first computed for each of the sites and each method as a whole, providing “apparent” site-level LAIe, which disregards the discontinuity of the plantations’ canopies. Since the toolkit allows for the calculation of the study area LAIe at different spatial scales, between-tree-level clumpingcan be easily accounted for and is then used to illustrate the impact of the discontinuity of canopy cover on LAIe retrieval. The LiDAR LAIe estimates are therefore computed at smaller scales as a mean of LAIe in various grid-cell sizes, providing estimates of “actual” site-level LAIe. Subsequently, the LiDAR LAIe results are compared with theoretical models of “apparent” LAIe versus “actual” LAIe, based on known percent canopy cover in each site. The comparison of those models to LiDAR LAIe derived from the smallest grid-cell sizes against the estimates of LAIe for the whole site has shown that the LAIe estimates obtained from the CHP toolkit provided values that are closest to those of theoretical models.

Use of the checkerboard DNA-DNA hybridisation technique for in vivo detection of cariogenic microorganisms on metallic brackets, with or without use of an antimicrobial agent

Objective: Using checkerboard DNA-DNA hybridisation (CDDH) assay, this randomised clinical study evaluated the contamination of metallic brackets by four cariogenic bacterial strains (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei and Lactobacillus acidophilus) and the efficacy of 0.12% chlorhexidine gluconate (CHX) mouthwashes in reducing bacterial contamination. Methods: Thirty-nine 11-33-year-old patients under treatment with fixed orthodontic appliances were enrolled in the study and had 2 new metallic brackets bonded to premolars. Nineteen patients used a 0.12% CHX mouthwash (Periogard (R)) and 20 patients used a placebo mouthwash (control) twice a week. After 30 days, the brackets were removed and samples were obtained for analysis by CDDH. Data were analysed statistically by the Kruskal-Wallis test (alpha = 0.05) using the SAS software. Results: S. mutans, S. sobrinus, L. casei and L. acidophilus were detected in 100% of the samples from both groups. However, brackets of the control group were more heavily contaminated by S. mutans and S. sobrinus (P < 0.01). In the experimental group, although all counts decreased after rinsing with the chlorhexidine solution, there was significant difference only for S. mutans (P = 0.03). Conclusions: The use of 0.12% chlorhexidine gluconate mouthwashes can be useful in clinical practice to reduce the levels of cariogenic microorganisms in patients under treatment with fixed orthodontic appliances. (C) 2011 Elsevier Ltd. All rights reserved.

Scanning Electron Microscopic Preliminary Study of the Efficacy of SmearClear and EDTA for Smear Layer Removal after Root Canal Instrumentation in Permanent Teeth

This study aimed to evaluate the efficacy of SmearClear (SybronEndo, Orange, CA) and EDTA for smear layer removal from root canals of permanent teeth after instrumentation. Thirty extracted human permanent teeth (n = 10) were randomly assigned to the following groups: group 1 = 14.3% EDTA, group 2 = SmearClear, and group 3 = no smear layer removal procedure was undertaken (control). The specimens were submitted to scanning electron microscopy analysis. Magnifications of 200x and 750x were used to evaluate cleaning at the apical, middle, and cervical thirds according to a three-point scoring system. Data were analyzed statistically by the Mann-Whitney U test (5% significance level). Groups 1 and 2 differed significantly from group 3 (p < 0.01). However, there was no statistically significant difference (p > 0.05) between groups 1 and 2. In conclusion, SmearClear was able to remove the smear layer from the root canals of permanent teeth similarly as 14.3% EDTA, suggesting that both solutions may be indicated for such purpose. (J Endod 2008,34:1541-1544)