Report of the Expert Group on Resource Allocation and Financing in the Health Sector

  Report of the Expert Group on Resource Allocation and Financing in the Health Sector Download this document (PDF 4.77mb) Alternatively, there is a lower resolution version available (PDF 2.31mb) Related Documents Resource Allocation, Financing and Sustainability in Health Care Evidence for the Expert Group on Resource Allocation and Financing in the Health Sector (Volume I) – PDF, 4.25mbAlternatively, a Lower Resolution version is available – PDF, 2.23mb Resource Allocation, Financing and Sustainability in Health Care Evidence for the Expert Group on Resource Allocation and Financing in the Health Sector (Volume II) – PDF 4.87mbAlternatively, a Lower Resolution version is available – PDF, 2.65mb Presentation by Professor, Frances Ruane Director , ESRI and Chair of the Expert Group. PDF 235KB Presentation by Professor Charles Normand, a member of the Expert Group. PDF 32KB

Value for Money & Policy Review: Allocation & Utilisation of Funding in Acute Services in the Southern Hospitals Group in 2006 - Final ReportRelated Documents

This report is a Value for Money (VFM) evaluation, conducted by the National Hospitals Office (NHO) of the Health Service Executive (HSE) on the allocation and utilisation of funding for expenditure in the Southern Hospitals Group (SHG) in 2006. The SHG consists of nine hospitals in the HSE South region. The 2006 expenditure for the SHG covered by the evaluation was 590.1 million. Performance trends were studied over the period 2004 to 2006. Download document here Value for Money & Policy Review of Allocation & Utilisation of Funding in Acute Services in the Southern Hospitals Group (in 2006) – Department of Health and Children Response & Implementation Plan

Regional variation in sex ratios and sex allocation in androdioecious Mercurialis annua.

In androdioecious metapopulations, where males co-occur with hermaphrodites, the absence of males from certain populations or regions may be explained by locally high selfing rates, high hermaphrodite outcross siring success (e.g. due to high pollen production by hermaphrodites), or to stochastic processes (e.g. the failure of males to invade populations or regions following colonization or range expansion by hermaphrodites). In the Iberian Peninsula and Morocco, the presence of males with hermaphrodites in the wind-pollinated androdioecious plant Mercurialis annua (Euphorbiaceae) varies both among populations within relatively small regions and among regions, with some regions lacking males from all populations. The species is known to have expanded its range into the Iberian Peninsula from a southern refugium. To account for variation in male presence in M. annua, we test the following hypotheses: (1) that males are absent in areas where plant densities are lower, because selfing rates should be correspondingly higher; (2) that males are absent in areas where hermaphrodites produce more pollen; and (3) that males are absent in areas where there is an elevated proportion of populations in which plant density and hermaphrodite pollen production disfavour their invasion. We found support for predictions two and three in Morocco (the putative Pleistocene refugium for M. annua) but no support for any hypothesis in Iberia (the expanded range). Our results are partially consistent with a hypothesis of sex-allocation equilibrium for populations in Morocco; in Iberia, the absence of males from large geographical regions is more consistent with a model of sex-ratio evolution in a metapopulation with recurrent population turnover. Our study points to the role of both frequency-dependent selection and contingencies imposed by colonization during range expansions and in metapopulations.

Review of the Primary Schools' General Allocation Model

The allocation of additional teaching resources to schools under the terms of the General Allocation Model (GAM) was intended to make possible the development of inclusive primary schools; ensure that primary schools have a means of providing additional teaching support to pupils with learning difficulties and special educational needs arising from high incidence disabilities without recourse to making applications on behalf of individual pupils and included additional teaching time that was previously allocated for learning-support teaching as well as an allocation of additional teaching time for what was termed resource teaching for pupils with special educational needs arising from high incidence disabilities.

Allocation d'organes et exigences de justice

(Résumé de l'ouvrage) Die Verteilung knapper menschlicher Organe wirft schwierige Fragen der Verteilungsgerechtigkeit und der Organisation auf. Rein medizinische Aussagen etwa über die Überlebenschance eines Organs in einem bestimmten Empfänger sind vorausgesetzt, bestimmen aber nie allein die Entscheidung. Effizienzüberlegungen sprechen zwar häufig für die primäre Berücksichtigung des Empfängers mit der grössten Lebenserwartung. Schon der Einbezug qualitativer Kriterien für die Überlebensphase kompliziert die Materie, erst recht aber die Berücksichtigung auch der Wartezeit als Element der Gleichbehandlung, der Dringlichkeit für den Empfänger oder gar von Marktkriterien. Auch die Frage einer Priorität für den seinerseits Spendewilligen wird kontrovers diskutiert. Und selbst dann, wenn man sich über die Gewichtung der unterschiedlichen Kriterien von Verteilungsgerechtigkeit einig wäre, bliebe immer noch die optimale organisatorische Durchsetzung dieser Entscheidung zu klären: soll man zum Beispiel mit regionalen, nationalen oder übernationalen Pools arbeiten? Die zweite Tagung im Tagungszyklus zu Grundsatzfragen der Transplantationsmedizin erörterte Themen rund um die Allokationproblematik bei Organen. Referenten aus verschiedenen Ländern, Sprachregionen und Disziplinen sprachen über medizinische, ethische, juristische, aber auch ökonomische Aspekte der Verteilung von Organen.

Effects of brood manipulation costs on optimal sex allocation in social hymenoptera.

In eusocial Hymenoptera, queens and workers are in conflict over optimal sex allocation. Sex ratio theory, while generating predictions on the extent of this conflict under a wide range of conditions, has largely neglected the fact that worker control of investment almost certainly requires the manipulation of brood sex ratio. This manipulation is likely to incur costs, for example, if workers eliminate male larvae or rear more females as sexuals rather than workers. In this article, we present a model of sex ratio evolution under worker control that incorporates costs of brood manipulation. We assume cost to be a continuous, increasing function of the magnitude of sex ratio manipulation. We demonstrate that costs counterselect sex ratio biasing, which leads to less female-biased population sex ratios than expected on the basis of relatedness asymmetry. Furthermore, differently shaped cost functions lead to different equilibria of manipulation at the colony level. While linear and accelerating cost functions generate monomorphic equilibria, decelerating costs lead to a process of evolutionary branching and hence split sex ratios.

Improved efficiency of a Salmonella-based vaccine against human papillomavirus type 16 virus-like particles achieved by using a codon-optimized version of L1.

Cervical cancer results from cervical infection by human papillomaviruses (HPVs), especially HPV16. An effective vaccine against these HPVs is expected to have a dramatic impact on the incidence of this cancer and its precursor lesions. The leading candidate, a subunit prophylactic HPV virus-like particle (VLP) vaccine, can protect women from HPV infection. An alternative improved vaccine that avoids parenteral injection, that is efficient with a single dose, and that induces mucosal immunity might greatly facilitate vaccine implementation in different settings. In this study, we have constructed a new generation of recombinant Salmonella organisms that assemble HPV16 VLPs and induce high titers of neutralizing antibodies in mice after a single nasal or oral immunization with live bacteria. This was achieved through the expression of a HPV16 L1 capsid gene whose codon usage was optimized to fit with the most frequently used codons in Salmonella. Interestingly, the high immunogenicity of the new recombinant bacteria did not correlate with an increased expression of L1 VLPs but with a greater stability of the L1-expressing plasmid in vitro and in vivo in absence of antibiotic selection. Anti-HPV16 humoral and neutralizing responses were also observed with different Salmonella enterica serovar Typhimurium strains whose attenuating deletions have already been shown to be safe after oral vaccination of humans. Thus, our findings are a promising improvement toward a vaccine strain that could be tested in human volunteers.

Optimized molecular resolution of cross-contamination alerts in clinical mycobacteriology laboratories

BACKGROUND. The phenomenon of misdiagnosing tuberculosis (TB) by laboratory cross-contamination when culturing Mycobacterium tuberculosis (MTB) has been widely reported and it has an obvious clinical, therapeutic and social impact. The final confirmation of a cross-contamination event requires the molecular identification of the same MTB strain cultured from both the potential source of the contamination and from the false-positive candidate. The molecular tool usually applied in this context is IS6110-RFLP which takes a long time to provide an answer, usually longer than is acceptable for microbiologists and clinicians to make decisions. Our purpose in this study is to evaluate a novel PCR-based method, MIRU-VNTR as an alternative to assure a rapid and optimized analysis of cross-contamination alerts. RESULTS. MIRU-VNTR was prospectively compared with IS6110-RFLP for clarifying 19 alerts of false positivity from other laboratories. MIRU-VNTR highly correlated with IS6110-RFLP, reduced the response time by 27 days and clarified six alerts unresolved by RFLP. Additionally, MIRU-VNTR revealed complex situations such as contamination events involving polyclonal isolates and a false-positive case due to the simultaneous cross-contamination from two independent sources. CONCLUSION. Unlike standard RFLP-based genotyping, MIRU-VNTR i) could help reduce the impact of a false positive diagnosis of TB, ii) increased the number of events that could be solved and iii) revealed the complexity of some cross-contamination events that could not be dissected by IS6110-RFLP.

Reproductive allocation strategies: a long-term study on proximate factors and temporal adjustments in a viviparous lizard.

Optimisation of reproductive investment is crucial for Darwinian fitness, and detailed long-term studies are especially suited to unravel reproductive allocation strategies. Allocation strategies depend on the timing of resource acquisition, the timing of resource allocation, and trade-offs between different life-history traits. A distinction can be made between capital breeders that fuel reproduction with stored resources and income breeders that use recently acquired resources. In capital breeders, but not in income breeders, energy allocation may be decoupled from energy acquisition. Here, we tested the influence of extrinsic (weather conditions) and intrinsic (female characteristics) factors during energy storage, vitellogenesis and early gestation on reproductive investment, including litter mass, litter size, offspring mass and the litter size and offspring mass trade-off. We used data from a long-term study of the viviparous lizard, Lacerta (Zootoca) vivipara. In terms of extrinsic factors, rainfall during vitellogenesis was positively correlated with litter size and mass, but temperature did not affect reproductive investment. With respect to intrinsic factors, litter size and mass were positively correlated with current body size and postpartum body condition of the previous year, but negatively with parturition date of the previous year. Offspring mass was negatively correlated with litter size, and the strength of this trade-off decreased with the degree of individual variation in resource acquisition, which confirms theoretical predictions. The combined effects of past intrinsic factors and current weather conditions suggest that common lizards combine both recently acquired and stored resources to fuel reproduction. The effect of past energy store points out a trade-off between current and future reproduction.

Cardenolides in nectar may be more than a consequence of allocation to other plant parts: a phylogenetic study of Asclepias

The primary function of secondary plant metabolites is thought to be defence against herbivores. The frequent occurrence of these same noxious compounds in floral nectar, which functions primarily to attract pollinators, has been seen as paradoxical. Although these compounds may have an adaptive purpose in nectar, they may also occur as a nonadaptive consequence of chemical defence in other plant parts. If nectar chemistry reflects physiological constraints or passive leakage from other tissues, we expect that the identity and relative concentration of nectar cardenolides to be correlated with those of other plant parts; in contrast, discordant distributions of compounds in nectar and other tissues may suggest adaptive roles in nectar. We compared the concentrations and identities of cardenolides in the nectar, leaves and flowers of 12 species from a monophyletic clade of Asclepias. To measure putative toxicity of nectar cardenolides, we then examined the effects of a standard cardenolide (digoxin) on the behaviour of bumblebees, a common generalist pollinator of Asclepias. We found that the average cardenolide concentrations in nectar, leaves and flowers of the 12 Asclepias species were positively correlated as predicted by nonadaptive hypotheses. However, significant differences in the identities and concentrations of individual cardenolides between nectar and leaves suggest that the production or allocation of cardenolides may be independently regulated at each plant part. In addition, cardenolide concentrations in leaves and nectar exhibited no phylogenetic signal. Surprisingly, bumblebees did not demonstrate an aversion to digoxin-rich nectar, which may indicate that nectar cardenolides have little effect on pollination. Although the idea that discordant patterns of secondary metabolites across tissue types may signal adaptive functions is attractive, there is evidence to suggest constraint contributes to nectar secondary chemistry. Further work testing the ecological impacts of such patterns will be critical in determining the functional significance of nectar cardenolides

Bandwidth allocation based on real time calculations using the convolution approach

This paper focuses on one of the methods for bandwidth allocation in an ATM network: the convolution approach. The convolution approach permits an accurate study of the system load in statistical terms by accumulated calculations, since probabilistic results of the bandwidth allocation can be obtained. Nevertheless, the convolution approach has a high cost in terms of calculation and storage requirements. This aspect makes real-time calculations difficult, so many authors do not consider this approach. With the aim of reducing the cost we propose to use the multinomial distribution function: the enhanced convolution approach (ECA). This permits direct computation of the associated probabilities of the instantaneous bandwidth requirements and makes a simple deconvolution process possible. The ECA is used in connection acceptance control, and some results are presented

Quality uncertainty and allocation of decision rights in the European protected designation of origin

The paper considers some issue in the governance of the European Protected Designation of Origin (PDO). The PDO systems are the outcomes of both farmers and consumers expectations and connect the valorisation of the agricultural and rural resources of given territories to the quality of typical products. A critical point in the governance of the PDO systems is represented by the connection between the quality strategies and the uncertainty. The paper argues that the PDO systems can be thought of as strictly coordinated subsystems in which the ex post governance play a critical role in coping with quality uncertainty. The study suggests that the society's inducements given raise to complex organizational systems in which the allocation of decision rights to PDO collective organizations play a major role. The empirical analysis is carried out by examining ten Italian PDO systems in order to identify the decision rights allocated.

Resource management research in Passive Optical Networks (PON)

Next Generation Access Networks (NGAN) are the new step forward to deliver broadband services and to facilitate the integration of different technologies. It is plausible to assume that, from a technological standpoint, the Future Internet will be composed of long-range high-speed optical networks; a number of wireless networks at the edge; and, in between, several access technologies, among which, the Passive Optical Networks (xPON) are very likely to succeed, due to their simplicity, low-cost, and increased bandwidth. Among the different PON technologies, the Ethernet-PON (EPON) is the most promising alternative to satisfy operator and user needs, due to its cost, flexibility and interoperability with other technologies. One of the most interesting challenges in such technologies relates to the scheduling and allocation of resources in the upstream (shared) channel. The aim of this research project is to study and evaluate current contributions and propose new efficient solutions to address the resource allocation issues in Next Generation EPON (NG-EPON). Key issues in this context are future end-user needs, integrated quality of service (QoS) support and optimized service provisioning for real time and elastic flows. This project will unveil research opportunities, issue recommendations and propose novel mechanisms associated with the convergence within heterogeneous access networks and will thus serve as a basis for long-term research projects in this direction. The project has served as a platform for the generation of new concepts and solutions that were published in national and international conferences, scientific journals and also in book chapter. We expect some more research publications in addition to the ones mentioned to be generated in a few months.

Solving Large Location-Allocation problems by Clustering and Simulated Annealing

Globalization involves several facility location problems that need to be handled at large scale. Location Allocation (LA) is a combinatorial problem in which the distance among points in the data space matter. Precisely, taking advantage of the distance property of the domain we exploit the capability of clustering techniques to partition the data space in order to convert an initial large LA problem into several simpler LA problems. Particularly, our motivation problem involves a huge geographical area that can be partitioned under overall conditions. We present different types of clustering techniques and then we perform a cluster analysis over our dataset in order to partition it. After that, we solve the LA problem applying simulated annealing algorithm to the clustered and non-clustered data in order to work out how profitable is the clustering and which of the presented methods is the most suitable