Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

Forty-eight hour access to primary care: practice factors predicting patients' perceptions

Background: The government has proposed a 48-hour target for GP availability. Although many practices are moving towards delivering that goal, recent national patient surveys have reported a deterioration in patients' reports of doctor availability. What practice factors contribute to patients' perceptions of doctor availability? Method: A cross sectional patient survey (11 000 patients from 54 inner London practices, 7247 (66%) respondents) using the General Practice Assessment Survey. We asked patients how soon they could be seen in their practice following non-urgent consultation requests and related their aggregated responses to the characteristics of their practice. Results: Three factors relating to practice administration and appointments systems operation independently predicted patients' reports of doctor availability. These were the proportion of patients asked to attend the surgery and wait to be seen, the proportion of patients seen using an emergency surgery arrangement, and the extent of practice computerization. Conclusion: Some practices may have difficulty in meeting the target for GP availability. Meeting the target will involve careful review of practice administrative procedures.

An enhanced relay-enabled medium access control protocol for wireless ad hoc networks

In this paper we propose an enhanced relay-enabled distributed coordination function (rDCF) for wireless ad hoc networks. The idea of rDCF is to use high data rate nodes to work as relays for the low data rate nodes. The relay helps to increase the throughput and lower overall blocking time of nodes due to faster dual-hop transmission. rDCF achieves higher throughput over IEEE 802.11 distributed coordination function (DCF). The protocol is further enhanced for higher throughput and reduced energy. These enhancements result from the use of a dynamic preamble (i.e. using short preamble for the relay transmission) and also by reducing unnecessary overhearing (by other nodes not involved in transmission). We have modeled the energy consumption of rDCF, showing that rDCF provides an energy efficiency of 21.7% at 50 nodes over 802.11 DCF. Compared with the existing rDCF, the enhanced rDCF (ErDCF) scheme proposed in this paper yields a throughput improvement of 16.54% (at the packet length of 1000 bytes) and an energy saving of 53% at 50 nodes.

How can a blind engineer access the curriculum?

The arrival of a student who is Blind in the School of Systems Engineering at the University of Reading has made it an interesting and challenging year for all. Visually impaired students have already graduated from other Schools of the University and the School of Systems Engineering has seen three students with visual impairment graduate recently with good degrees. These students could access materials - and do assessments - essentially by means of enlargement and judicious choice of options. The new student had previously been supported by a specialist college. She is a proficient typist and also a user of both Braille and JAWS screen reader, and she is doing a joint course in Cybernetics and Computer Science. The course requires mathematics which itself includes graphs, and also many diagrams including numerous circuit diagrams. The University bought proven equipment such as a scanner to process books into speech or Braille, and screen reading software as well as a specialist machine for producing tactile diagrams for educational use. Clearly it is also important that the student can access assessments and examinations and present answers for marking or feedback (by sighted staff). So the School also used innovative in-house tactile methods to represent diagrams. This paper discusses the success or otherwise of various modifications of course delivery and the way forward for the next three years.

KAIFIA: Knowledge assisted intelligent framework for information access

Accessing information, which is spread across multiple sources, in a structured and connected way, is a general problem for enterprises. A unified structure for knowledge representation is urgently needed to enable integration of heterogeneous information resources. Topic Maps seem to be a solution for this problem. The Topic Map technology enables connecting information, through concepts and relationships, and their occurrences across multiple systems. In this paper, we address this problem by describing a framework built on topic maps, to support the current need of knowledge management. New approaches for information integration, intelligent search and topic map exploration are introduced within this framework.