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.

Secure routing and trust computation in multihop infrastructureless networks

Today's wireless networks rely mostly on infrastructural support for their operation. With the concept of ubiquitous computing growing more popular, research on infrastructureless networks have been rapidly growing. However, such types of networks face serious security challenges when deployed. This dissertation focuses on designing a secure routing solution and trust modeling for these infrastructureless networks. ^ The dissertation presents a trusted routing protocol that is capable of finding a secure end-to-end route in the presence of malicious nodes acting either independently or in collusion, The solution protects the network from active internal attacks, known to be the most severe types of attacks in an ad hoc application. Route discovery is based on trust levels of the nodes, which need to be dynamically computed to reflect the malicious behavior in the network. As such, we have developed a trust computational model in conjunction with the secure routing protocol that analyzes the different malicious behavior and quantifies them in the model itself. Our work is the first step towards protecting an ad hoc network from colluding internal attack. To demonstrate the feasibility of the approach, extensive simulation has been carried out to evaluate the protocol efficiency and scalability with both network size and mobility. ^ This research has laid the foundation for developing a variety of techniques that will permit people to justifiably trust the use of ad hoc networks to perform critical functions, as well as to process sensitive information without depending on any infrastructural support and hence will enhance the use of ad hoc applications in both military and civilian domains. ^

Placing immigrant incorporation: Identity, trust, and civic engagement in Little Havana

Immigrant incorporation in the United States has been a topic of concern and debate since the founding of the nation. Scholars have studied many aspects of the phenomenon, including economic, political, social, and spatial. The most influential paradigm of immigrant incorporation in the US has been, and continues to be, assimilation, and the most important place in and scale at which incorporation occurs is the neighborhood. This dissertation captures both of these integral aspects of immigrant incorporation through its consideration of three dimensions of assimilation – identity, trust, and civic engagement – among Latin American immigrants and American-born Latinos in Little Havana, a predominantly immigrant neighborhood in Miami, Florida. Data discussed in the dissertation were gathered through surveys and interviews as part of a National Science Foundation-funded study carried out in 2005-2006. The combination of quantitative and qualitative data allows for a nuanced understanding of how immigrant incorporation is occurring locally during the first decade of the twentieth century. Findings reveal that overall Latin American immigrants and their American-born offspring appear to be becoming American with regard to their ethnic and racial identities quickly, evidenced through the salience and active employment of panethnic labels, while at the same time they are actively reshaping the identificational structure. The Latino population, however, is not monolithic and is cleaved by diversity within the group, including country of origin and socioeconomic status. These same factors impede group cohesion in terms of trust and its correlate, community. Nevertheless, the historically dominant ancestry group in Little Havana – Cubans – has been able to reach notable levels of trust and build and conserve a more solid sense of community than non-Cuban residents. With respect to civic engagement, neighborhood residents generally participate at rates lower than the overall US population and ethnic subpopulations. This is not the case for political engagement, however, where self-reported voting registration and turnout in Little Havana surpasses that of most benchmarked populations. The empirical evidence presented in this dissertation on the case of Latinos in Little Havana challenges the ways that identity, trust, and civic engagement are conceptualized and theorized, especially among immigrants to the US.

The words of God: Religious texts and the Counter -Reformation in the Spanish world

This dissertation analyzes a variety of religious texts such as catechisms, confession manuals, ecclesiastical legislation, saints' lives, and sermons to determine the definitions of orthodoxy held by the Spanish clergy and the origins of such visions. The conclusion posited by this research was that there was a definite continuity between the process of Catholic reform in Spain and the process of Catholic expansion into the New World in that the objectives and concerns of the Spanish clergy in Europe and the New World were very similar. This dissertation also analyzes sources that predated the Council of Trent and demonstrates that within the Iberian context the Council of Trent cannot be used as a starting date for the attempts at Catholic reform. In essence, this work concludes the Spanish clergy's activities were influenced by humanist concepts of models and model behaviour which is reflected in their attempt to form model Catholics in Spain and the New World and in their impulse to produce written texts as standards. ^

Multi-Party Trust Computation in Decentralized Environments

In this paper, we describe a decentralized privacy-preserving protocol for securely casting trust ratings in distributed reputation systems. Our protocol allows n participants to cast their votes in a way that preserves the privacy of individual values against both internal and external attacks. The protocol is coupled with an extensive theoretical analysis in which we formally prove that our protocol is resistant to collusion against as many as n-1 corrupted nodes in the semi-honest model. The behavior of our protocol is tested in a real P2P network by measuring its communication delay and processing overhead. The experimental results uncover the advantages of our protocol over previous works in the area; without sacrificing security, our decentralized protocol is shown to be almost one order of magnitude faster than the previous best protocol for providing anonymous feedback.

An Assessment of Psychological Need in Emergency Medical Staff in the Northern Health and Social Care Trust Area

Setting: Psychological stress is increasingly recognised within emergency medicine, given the environmental and clinical stressors associated with the specialism. The current study assessed whether psychological distress is experienced by emergency medical staff and if so, what is the expressed need within this population? Participants: Participants included ambulance personnel, nursing staff, doctors and ancillary support staff within two Accident and Emergency (A&E) departments and twelve ambulance bases within one Trust locality in NI (N = 107). Primary and secondary outcome measures: The General Health Questionnaire (GHQ-12, Goldberg, 1972, 1978), Secondary Traumatic Stress Scale (STSS, Bride, 2004) and an assessment of need questionnaire were completed and explored using mixed method analysis. Results: Results showed elevated levels of psychological distress within each profession except ambulance service clinical support officers (CSOs). Elevated levels of secondary trauma symptomatology were also found; the highest were within some nursing grades and junior doctors. Decreased enjoyment in job over time was significantly associated with higher scores. Analysis of qualitative data identified sources of stress to include low morale. A total of 65% of participants thought that work related stressors had negatively affected their mental health. Participants explored what they felt could decrease psychological distress including improved resources and psychoeducation. Conclusion: There were elevated levels of distress and secondary traumatic stress within this population as well as an expressed level of need, on both systemic and support levels.

God and War: the Church of England and Armed Conflict in the Twentieth Century

Despite narratives of secularization, it appears that the British public persistently pay attention to clerical opinion and continually resort to popular expressions of religious faith, not least in time of war. From the throngs of men who gathered to hear the Bishop of London preach recruiting sermons during the First World War, to the attention paid to Archbishop Williams' words of conscience on Iraq, clerical rhetoric remains resonant. For the countless numbers who attended National Days of Prayer during the Second World War, and for the many who continue to find the Remembrance Day service a meaningful ritual, civil religious events provide a source of meaningful ceremony and a focus of national unity. War and religion have been linked throughout the twentieth century and this book explores these links: taking the perspective of the 'home front' rather than the battlefield. Exploring the views and accounts of Anglican clerics on the issue of warfare and international conflict across the century, the authors explore the church's stance on the causes, morality and conduct of warfare; issues of pacifism, obliteration bombing, nuclear possession and deterrence, retribution, forgiveness and reconciliation, and the spiritual opportunities presented by conflict. This book offers invaluable insights into how far the Church influenced public appraisal of war whilst illuminating the changing role of the Church across the twentieth century.

Partnering for bioregionalism in England: a case study of the Westcountry Rivers Trust

The adoption of bioregionalism by institutions that are instrumental in river basin management has significant potential to resolve complex water resource management problems. The Westcountry Rivers Trust (WRT) in England provides an example of how localized bioregional institutionalization of adaptive comanagement, consensus decision making, local participation, indigenous technical and social knowledge, and “win-win” outcomes can potentially lead to resilient partnership working. Our analysis of the WRT’s effectiveness in confronting nonpoint source water pollution, previously impervious to centralized agency responses, provides scope for lesson-drawing on institutional design, public engagement, and effective operation, although some evident issues remain.

ADMINISTRATIVE AND FUNCTIONAL ANALYSIS OF LIBRARY OF THE THEOLOGICAL STUDIES CENTER OF THE ASSEMBLIES OF GOD IN PARAÍBA (CETAD/PB): proposal for restructuring

A organização, a gestão e o planejamento de uma unidade de informação compreende várias etapas e envolve os processos e técnicas do campo de pesquisa do profissional do Bibliotecário. Neste estudo pretendemos construir uma proposta de reestruturação da Biblioteca do Centro de Estudos Teológicos das Assembléias de Deus na Paraíba - CETAD/PB. E especificamente: definir um sistema de organização para o acervo que conduza à autonomia do usuário no processo de busca e recuperação da informação; indicar um software de gerenciamento de bibliotecas que supra as necessidades da unidade de informação; conhecer o público alvo, a partir de instrumento de estudo de usuário, a fim de adequar as ferramentas tecnológicas que serão utilizadas; organizar um guia para auxiliar o processo de reestruturação e propor medidas para a regulamentação do funcionamento da biblioteca do CETAD/PB. A metodologia utiliza a abordagem de pesquisa qualitativa, com características do tipo descritiva e exploratória. Adota a pesquisa de campo, para conhecer e detalhar o universo de pesquisa que foi o Centro de Estudos Teológicos das Assembléias de Deus na Paraíba CETAD/PB, bem como os sujeitos da pesquisa, ou seja, os alunos da instituição. O instrumento de coleta dos dados utilizado foi o questionário. Para representar os dados recorre às técnicas e aos recursos estatísticos da pesquisa quantitativa. Com as análises dos dados desvenda o perfil dos seus usuários, constata a insatisfação dos mesmos com relação a organização do acervo, assim como quais ferramentas tecnológicas se adéquam a esse perfil para o aprimoramento nas etapas de tratamento e disseminação dos suportes informacionais, como também no serviços de atendimento ao usuário. Destaca o profissional da informação como gestor nas Unidades de Informação, com atuação que vai além dos procedimentos e técnicas tradicionais da profissão. Palavras-chave: Biblioteca Especializada. Biblioteca – Teologia. Organização de Bibliotecas.

Plain reasons why neither Dr. Watts' Imitations of the Psalms, nor his other poems, nor any other human composition, ought to be used in the praises of the great God our Saviour--but, that a metre version of the book of Psalms, examined, with wise and critical care by pious and learned divines, and found by them to be as near the Hebrew metre Psalms, as the idiom of the English language would admit, ought to be used.

Caption title.

The Psalms of Holy Scripture : the only songs of Zion : an appeal to the churches in behalf of this ordinance of God /

Mode of access: Internet.