bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent results of the laser ion source facility at INFN-LNS and applications to nuclear and applied research
Authors: Gammino S. , Torrisi L. , Cavallaro S. , Celona L. , Giuffrida L. , Margarone D. , Mascali D. , Miracoli R.
Published: February 2010

A pulsed neodymium-doped yttrium aluminum garnet laser ion source has been used as proton beams generator. The laser wavelength is 1064 nm, the pulse duration is 9 ns and the intensity reaches 1010 W/cm2. Laser irradiates hydrogenated polymers targets located in a chamber at 10−7 mbar. The ions are post-accelerated in a suitable chamber by 30 kV of voltage between the target, positively biased, and the following ground electrode. The extracted beams is characterized through a time-of-flight technique. Possible applications to the field of nuclear physics, such as nuclear excitation and de-excitations, nuclear reactions and nuclear fusion, will be presented and discussed.
Direct 1+→N+ conversion of stable alkali ions using an electron cyclotron resonance ion source
Authors: Méry A. , Jardin P. , Alcántara-Núñez J. , Saint-Laurent M. G. , Bajeat O. , Delahaye P. , Dubois M. , Frånberg-Delahaye H. , Lecomte P. , Lehérissier P. , Maunoury L. , Pichard A. , Pacquet J. Y. , Thomas J. C.
Published: February 2010

The production of radioactive ions using the Isotope Separation On-Line method gives rise, in most cases, to singly charged ions. In order to perform experiments with postaccelerated radioactive ion beams, these ions have to be multicharged. We describe here a new compact design for a charge breeder that will be coupled to the production target of SPIRAL1 at GANIL. We present recent results obtained offline with stable alkali ions (Na, K, Rb, and Cs) on the SIRa test bench. Particularly, 1+ to N+ conversion efficiencies and conversion times are presented. Several points have been identified for the improvements of the present performances.
Pulse modulated microwave operation on large bore electron cyclotron resonance ion source with cylindrically comb-shaped magnetic fields configuration
Authors: Hirai Yoshiaki , Kato Yushi , Sato Fuminobu , Iida Toshiyuki
Published: February 2010

In order to enhance efficiency of an electron cyclotron resonance (ECR) plasma for broad and dense ion beam source under the low pressure, the magnetic field configuration is constructed by a pair of comb-shaped magnet which has opposite polarity each other, and which cylindrically surrounds the plasma chamber. By using the pulse microwave mode operation, we aim at generation of plasma with parameters that cannot be achieved at the continuous microwave (cw) mode. The maximum beam current is obtained in the experimental condition of the pulse width 100–200 μs at the duty ratio 40%–50%. According to probe measurements of the ECR plasma, it is found the electron density in the pulse mode is larger than that in the cw mode, while the electron temperatures in the pulse mode were lower than that in the cw mode. These indirect evidences cause to enhance ion beams in the pulse mode operation, and then suggest a spread of operation windows for plasma parameters suitable to production of molecular or cluster ions.
Non-Archimedean normal operators
Authors: Kochubei Anatoly N.
Published: February 2010

We describe some classes of linear operators on Banach spaces over non-Archimedean fields, which admit orthogonal spectral decompositions. Several examples are given.
Feedback instability in the magnetosphere-ionosphere coupling system: Revisited
Authors: Watanabe T.-H.
Published: February 2010

A coupled set of the reduced magnetohydrodynamic and the two-fluid equations is applied to the magnetosphere-ionosphere (M-I) feedback interactions in relation to growth of quite auroral arcs. A theoretical analysis revisiting the linear feedback instability reveals asymptotic behaviors of the dispersion relation and a non-Hermite property in the M-I coupling. A nonlinear simulation of the feedback instability in the M-I coupling system manifests growth of the Kelvin–Helmholtz-like mode in the magnetosphere as the secondary instability. The distorted vortex and field-aligned current profiles propagating as the shear Alfvén waves lead to spontaneous deformation of ionospheric density and current structures associated with auroral arcs.
Polarization mechanisms and structural rearrangements in thermally poled sodium-alumino phosphate glasses
Authors: Dussauze Marc , Rodriguez Vincent , Velli Leoni , Varsamis Christos P. E. , Kamitsos Efstratios I.
Published: February 2010

Thermally poled glasses of composition 0.20Na2O–0.15Al2O3–0.65P2O5 were investigated by second harmonic generation (SHG) to characterize the induced second order optical nonlinearities (χ2), and by infrared reflectance and micro-Raman spectroscopy to probe structural rearrangements in the nonlinear optical (NLO) layer. The SHG signals showed anodic and bulk χ2 contributions, with the anodic response being one order of magnitude stronger. Also, a good agreement was found between the thickness of the NLO anodic layer (approximately 3 μm) and the depth where structural changes were detected. The latter include the destruction of bonds between phosphorus and nonbridging oxygen atoms, this process leads to the release and migration of sodium cations and oxide anions and to the enhancement of glass network connectivity in the anodic NLO layer.
Electron spin resonance study of proton-irradiation-induced defects in graphite
Authors: Won Lee Kyu , Kweon H. , Kweon J. J. , Lee Cheol Eui
Published: February 2010

Electron spin resonance measurements of proton-irradiated graphite have revealed detailed nature of proton-irradiation-induced defects. Our results indicate that proton-irradiation creates confined defect regions of a metallic island surrounded by an insulating magnetic region which “isolates” the metallic island inside from the metallic graphite background outside. We have thus come up with a picture of phase separation in proton-irradiated graphite comprising three regions of distinct electrical and magnetic properties.
Temperature scaling of hot electrons produced by a tightly focused relativistic-intensity laser at 0.5 kHz repetition rate
Authors: Mordovanakis Aghapi G. , Masson-Laborde Paul-Edouard , Easter James , Popov Konstantin , Hou Bixue , Mourou Gérard , Rozmus Wojciech , Haines Malcolm G. , Nees John , Krushelnick Karl
Published: February 2010

The energy spectrum of hot electrons emitted from the interaction of a relativistically intense laser with an Al plasma is measured at a repetition rate of 0.5 kHz by accumulating ∼103 highly reproducible laser shots. In the 1017–2×1018 W/cm2 range, the temperature of electrons escaping the plasma along the specular direction scales as (Iλ2)0.64±0.05 for p-polarized pulses incident at 45°. This scaling is in good agreement with three-dimensional particle-in-cell simulations and a simple model that estimates the hot-electron temperature by considering the balance between the deposited laser intensity and the energy carried away by those electrons.
Shape effects in tapered metal rods during adiabatic nanofocusing of plasmons
Authors: Vogel Michael W. , Gramotnev Dmitri K.
Published: February 2010

We studied adiabatic nanofocusing of strongly localized surface plasmons in tapered metal rods with parabolic perturbations of the conical shape of the taper. Typical plasmon propagation parameters and local field enhancements are determined along the tapered rod, depending on the shape and plasmon frequency (wavelength). In particular, it is demonstrated that metal rods with tapered convex shape are more efficient in achieving larger local field enhancements at the tip, as compared to rods with the concave shape of the taper. This is explained by weaker dissipative losses in tapered rods with convex shape. In addition, plasmon nanofocusing in tapered rods with convex shape is less sensitive to further variations of the shape. As a result, it is demonstrated that tapered rods with the convex shape could be advantageous for practical applications where strong local field enhancement near the tip is required, and/or where metal rods with relatively large dissipation are used. The obtained results will be important for optimization and practical fabrication of efficient nanofocusing structures using tapered metal rods.
Intensity-resolved IR multiple photon ionization and fragmentation of C60
Authors: Bakker Joost M. , Lapoutre Vivike J. F. , Redlich Britta , Oomens Jos , Sartakov Boris G. , Fielicke André , von Helden Gert , Meijer Gerard , van der Meer Alexander F. G.
Published: February 2010

The sequential absorption of multiple infrared (IR) photons by isolated gas-phase species can lead to their dissociation and/or ionization. Using the newly constructed “Free-Electron Laser for IntraCavity Experiments” (FELICE) beam line at the FELIX facility, neutral C60 molecules have been exposed to an extremely high number (≈1023) of photons/cm2 for a total time duration of up to 5 μs. At wavelengths around 20 μm, resonant with allowed IR transitions of C60, ionization and extensive fragmentation of the fullerenes are observed. The resulting photofragment distributions are attributed to absorption in fragmentation products formed once C60 is excited to internal energies at which fragmentation or ionization takes place within the duration of the laser pulse. The high IR intensities available combined with the large interaction volume permit spatially resolved detection of the ions inside the laser beam, thereby disentangling the contributions from different IR intensities. The use of spatial imaging reveals intensity dependent mass distributions that are substantially narrower than what has been observed previously, indicating rather narrow energy distributions. A simple rate-equation modeling of the excitation process supports the experimental observations.
Spin torque driven excitations in a synthetic antiferromagnet
Authors: Houssameddine D. , Sierra J. F. , Gusakova D. , Delaet B. , Ebels U. , Buda-Prejbeanu L. D. , Cyrille M.-C. , Dieny B. , Ocker B. , Langer J. , Maas W.
Published: February 2010

Spin polarized current induced self oscillations have been investigated in both the free layer and the synthetic antiferromagnetic (SAF) pinned layer of spin valve nanopillars. Compared with free layer excitations, the acoustic type SAF excitations are characterized by high emitted power and much narrower linewidth. Furthermore, in contrast to free layer excitations, the SAF in-plane precession mode exhibits an unexpected crossover from redshift (df/dI<0) to blueshift (df/dI>0) in frequency f versus current I as the in-plane magnetic field is increased. From simulations we identify this crossover as a signature of large amplitude spin current induced precessional dynamics in the SAF.
Fluctuation in entanglement positions via elastic slip-links
Authors: Schieber Jay D. , Horio Kazushi
Published: February 2010

We consider the spatiotemporal fluctuation of slip-link positions via the implementation of elastic slip-links. The level of description is similar to our previously proposed slip-link model, wherein we use the entanglement position in space as dynamic variables, and the number of Kuhn steps between entanglements. However, since it is a mean-field, single-chain description it has some relevance to the slip-spring simulations of Likhtman, and the phantom chain model for cross-linked networks. It might also provide a connection between slip-links and tubes. Two implementations are possible, depending on whether or not the slip-links are allowed to pass through one another. If a boundary condition on the dynamics preventing such passage is imposed, then the plateau modulus is unchanged from perfectly rigid slip-links. Only the dynamics is changed. On the other hand, for phantom slip-links the distribution of the number of entanglements changes from Poisson. Furthermore, requiring normalization of the distribution function sets a constraint on how loose the virtual springs for the elastic slip-link are. These restrictions appear to be in agreement with parameter values used for the slip-spring simulations, although nonphantom slip-links were used there. The results are completely analogous to what was found by James and Guth for ideal elastic networks, whose derivation is repeated here. Our earlier rigid slip-link model is recovered as a limiting case.
Tunable sound directional beaming assisted by acoustic surface wave
Authors: Cheng Y. , Xu J. Y. , Liu X. J.
Published: February 2010

We investigate the tunable directional beaming of sound wave from a subwavelength slit surrounded by asymmetric surface gratings. The surface gratings are optimally designed to directionally couple the modulated acoustic surface wave modes into surrounding medium along specific direction. The underlying mechanism of direction tuning is explored by the means of wave-vector analysis. The theoretical results predicated by the wave-vector analysis are in good agreement with the numerical results obtained using full-wave simulation. We observe that the full width at half maximum of the sound beam is less than 5° within a wide beaming angle region, and the beaming angle can be tuned by the structural parameters of surface grating.
Bandgap structure of thermally excited surface phonon polaritons
Authors: Balin Igal , Dahan Nir , Kleiner Vladimir , Hasman Erez
Published: February 2010

A wide bandgap of thermally excited surface phonon polaritons (SPhPs) is experimentally observed. Formation of the bandgap and coupling to radiative waves is done by a binary biharmonic structure formed on a SiC substrate. The bandgap width is controlled by the ratio of the two harmonic magnitudes of the structure’s profile. The characteristic one-dimensional Van Hove singularity is experimentally observed in the spectral density of states of the SPhPs. Moreover, an inverse relation is found between the gap width and the squared spatial coherence length of the emitted thermal radiation, as predicted by theoretical calculations.
Solvent effects in polyelectrolyte adsorption: Computer simulations with explicit and implicit solvent
Authors: Reddy Govardhan , Yethiraj Arun
Published: February 2010

The adsorption of strongly charged polyelectrolyte chains to an oppositely charged planar surface is studied using computer simulation. In addition to an explicit solvent model, two implicit solvent models are considered: one where the solvent induces an implicit Lennard-Jones (ILJ) interaction between polymer sites and one where the solvent induces a many body interaction that depends on the solvent accessible surface area (SASA) of the monomers. Molecular and Brownian dynamics simulations are reported for the explicit and implicit solvent models, respectively. All three models give similar results for the adsorption of the chains in good solvent. The electrostatic attraction between the surface and the polymers is not sufficient to drive the strong adsorption that is seen in experiments. In poor solvents, the models give different results for the adsorption excess and the mechanism for polyelectrolyte adsorption. With explicit solvent, thick adsorbed layers are formed at both charged and neutral surfaces. With the SASA model, adsorbed layers are formed on the charged but not on the neutral surface. With the ILJ model, adsorbed layers are not formed on any surfaces. The results show that the solvent plays a dominant role in the adsorption of polyelectrolytes under poor solvent conditions and that many-body solvent effects have a qualitative effect on the adsorption characteristics and mechanism. In particular, SASA and depletion effects could possibly play an important role; the former can be incorporated in the SASA model, but the latter cannot. The results suggest that accurate computational models for polymer adsorption under poor solvent conditions must incorporate the solvent explicitly.
Structure and infrared absorption of the first layer C2H2 on the NaCl(100) single-crystal surface
Authors: Cabello-Cartagena A. G. , Vogt J. , Weiss H.
Published: February 2010

The adsorbate structure of the first layer acetylene on the NaCl(100) single-crystal surface is investigated using polarization infrared spectroscopy in combination with low-energy electron diffraction (LEED) experiments, and potential calculations on the basis of pair potentials. In agreement with a previous study, a triplet of infrared absorptions in the region of the asymmetric stretch vibration of C2H2 was observed and assigned to an adsorbate phase with (32×2)R45° translational symmetry determined in the LEED experiment. The polarization dependence of the infrared spectra is consistent with a parallel orientation of the molecules with respect to the surface. The number of molecules per unit cell is four to six as determined by photometric considerations. Total energy minimizations support a new structure model which contains five inequivalent molecules per unit cell in a herringbone arrangement. The application of a vibrational exciton approach demonstrates that this new structure model can reproduce the triplet spectrum observed in the infrared experiments.
The finite size effect of monomer units on the electrostatics of polyelectrolyte solutions
Authors: Tong Chaohui
Published: February 2010

The effective interactions between two test counterions and two test solvent dipoles in a semidilute/concentrated weakly charged polyelectrolyte solution are studied using the field-theoretical approach on the mean-field level. From the effective Hamiltonians in terms of the two test counterions and the two test solvent dipoles, respectively, analytical expressions for the effective interactions in the real space are derived. It is unambiguously demonstrated that, at a Θ solvent condition, both the effective interactions between two counterions and two parallel-oriented solvent dipoles consist of an attractive part at intermediate distances of separation. As the electrostatic screening effect from counterions and salt ions quantified by the Debye–Hückel screening parameter becomes stronger, the magnitude of the attraction decreases and the minimum of the attractive profile shift to a shorter distance of separation. On the other hand, when the excluded volume effect is dominant, the effective interactions are purely repulsive. This nontrivial and seemingly counterintuitive result originates from the finite size effect of the monomer units of the polymer chains on the electrostatics of the polyelectrolyte solution. As the size of the monomer units goes to zero, at the Θ solvent condition, the effective interactions between two counterions and two parallel-oriented solvent dipoles are purely repulsive.
Balanced charge transport and enhanced white electroluminescence from a single white emissive polymer via thermal annealing
Authors: Niu Xiaodi , Zhang Baohua , Xie Zhiyuan , Cheng Yanxiang , Wang Lixiang
Published: February 2010

The effect of thermal annealing on electroluminescence of polyfluorene-based single white emissive polymer is demonstrated. Both color purity and light-emitting efficiency of the devices are enhanced via thermal annealing. It is found that thermal annealing can induce the formation of crystalline polyfluorene phase that acts as an efficient blue fluorescent dopant for enhancing blue emission and hence color purity of the white light. Most importantly, the hole and electron transport is balanced after thermal annealing that favors improving the light-emitting efficiency. A light-emitting efficiency of 10 cd/A is achieved after thermal annealing, about 30% increase compared to the as-produced device.
Evaluation of the First Strategic Plan for Aboriginal Health in South Western Sydney, 1993-98
Authors: Carriage Christine , Harris Elizabeth
Published: February 2010

The 1993-98 Aboriginal Health Strategic Plan for South Western Sydney represented the first partnership of its kindbetween an Area Health Service, local Aboriginal Health Workers and the local Aboriginal Community ControlledHealth Service in Australia. During 1998, an evaluation of the plan was undertaken as part of the preparation forthe second Aboriginal Health Plan. Of the 45 strategies in the first plan, 38% had been fully implemented, 42% hadbeen partly implemented, and 20% were not implemented at all. This paper discusses the importance of datacollection and monitoring systems, the integration of Aboriginal health into mainstream services, the furtherdevelopment of Aboriginal health infrastructure, and continued leadership by senior managers.
Characteristics of a rural geriatric rehabilitation service
Authors: Lowe Michael , Taylor Linda , King Julie
Published: February 2010

The aim of this article is to examine the role of two geriatric rehabilitation units in a largerural area, and compare them with published data about rehabilitation units in urbansettings. We look at the inputs to the units and the measurable outputs, including length ofstay, discharge disposition of patients and changes in patient activities of daily living. We- showthat rehabilitation services provided in the rural environment have lengths of stay andimprovements in activities of daily living that are similar to those found in urban areas.
Reforming Victoria's primary health and community service sector:rural implications
Authors: Alford Katrina
Published: February 2010

In 1999 the Victorian primary care and community support system began a process of substantial reform, involvingpurchasing reforms and a contested selection process between providers in large catchment areas across the State.The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questionsthe reforms from a rural perspective. They were based on a generic template that did not consider rural-urbandifferences in health needs or other differences including socio-economic status, and may have reinforced if notaggravated rural-urban differences in the quality of and access to primary health care in Victoria.
Funding issues for Victorian hospitals:the risk-adjusted vision beyond casemix funding
Authors: Antioch Kathryn , Walsh Michael
Published: February 2010

This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to beacceptable, the average price and cost weights must be set at an appropriate standard. The average price is based ona normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted insome AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexityservices such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustmentmethodologies to successfully negotiate with the Victorian State Government for specified grants for several highcomplexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patientstreated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate thedevelopment of similar models by both the Victorian and Federal governments.
Casemix and rehabilitation: evaluation of an early discharge scheme
Authors: Brandis Susan
Published: February 2010

This paper presents a case study of an early discharge scheme funded by casemix incentives and discusses limitationsof a casemix model of funding whereby hospital inpatient care is funded separately from care in other settings. ThePOSITIVE Rehabilitation program received 151 patients discharged early from hospital in a twelve-month period.Program evaluation demonstrates a 40.9% drop in the average length of stay of rehabilitation patients and a 42.6%drop in average length of stay for patients with stroke. Other benefits of the program include a high level of patientsatisfaction, improved carer support and increased continuity of care. The challenge under the Australianinterpretation of a casemix model of funding is ensuring the viability of services that extend across acute hospital, non-acutecare, and community and home settings.
Models of integrated cancer care:A critique of the literature
Authors: O'Connell Bev , Kristjanson Linda , Orb Angelica
Published: February 2010

A number of models that integrate care across the hospital-community interface have beendeveloped. Consumers and health care providers who are considering adopting this approachto service delivery need to consider which model is most suitable for implementation in theirsetting. A comprehensive review of the literature was conducted to identify and describeintegrated care delivery models. This article defines five integrated models of care, providesa critical analysis of each model, and evaluates the extent to which claims about the modelsare supported by clinical reports and empirical findings. Finally, recommendations are maderegarding implementation.
Improving clinical indicators in acute admissions to the Department of Geriatric Medicine, Royal Perth Hospital
Authors: Loh PK , Donaldson Mark
Published: February 2010

Clinical indicators are an important component of quality assessment of clinical services. We outlinethe strategies used in the department of Geriatric Medicine at Royal Perth Hospital (RPH) to reporton and improve the results. The clinical indicator for assessment of cognitive function had improvedfrom 19% in September 1998 to 64% in February 1999. The clinical indicator for assessment ofphysical function has been maintained at 80%. There have been revisions to the definitions of theclinical indicators for 1999. The current clinical indicators used in this department can be modifiedfor comparison nationwide amongst geriatric units.
Designing a nationally acceptable system of hospital peer grouping
Authors: Bridges John , Mazevska Deniza , Pearse Jim
Published: February 2010

Little has been published on the design, use and evaluation of peer groupings of hospitals.This article explores the issue in the context of public hospitals in New South Wales.The- process, established over the last two years by New South Wales Health, aims to meetsix principles of peer grouping. Through a six-step procedure, the methodology focuses on theclassification of hospitals by role, size and measure of acuity. Further research is needed tocompare benchmarking across States and to identify which of the methodologies should beadopted nationally.Background
Employment relationships in Victorian public hospitals: the Kennett years
Authors: Stanton Pauline
Published: February 2010

From 1992 to 1999, the Kennett government in Victoria moved to competitive market models of service delivery andthe measurement of service provision through casemix funding. Public hospital managers were given greateraccountability for the costs and provision of service delivery and a new range of service providers, many from theprivate sector, entered the public health market. The decentralisation of the industrial relations system led to newdevelopments in bargaining that brought both opportunities and problems. In the Victorian public health system therewas an increasing emphasis on decentralisation in both service provision and employment relations. In this paper Isuggest that there were contradictions in these developments for government, and new challenges and difficulties foremployers, employees and trade unions.
Characteristics of effective teams:a literature review
Authors: Mickan Sharon , Rodger Sylvia
Published: February 2010

Effective healthcare teams often elude consistent definition because of the complexity of teamwork. Systems theory offersa dynamic view of teamwork, in which input conditions are transformed via optimum throughput processes intomaximal output. This article describes eighteen characteristics of effective teams across input conditions and teamworkprocesses, which have been identified from the literature.
The burden of disease and injury in Australia
Authors: Mathers Colin , Vos Theo , stevenson Chris
Published: February 2010

Reviewed by Don Hindle, Visiting Professor, School of Health Services Management,University of New South Wales
Why attitudes to quality of care are changing
Authors: Gibberd Bob
Published: February 2010

The editorial by Stephen Bolsin is appropriate at this time of change in attitudes to patient safety and qualityof health care. Bolsin has indicated one method to monitor the level of care; the recent use of comparative databy anaesthetic specialists. It is interesting to document the factors that have caused this change to collectingclinical indicators.
Using program theory to develop keyperformance indicators for child andadolescent mental health services
Authors: Birleson Peter , Brann Peter , Smith Amanda
Published: February 2010

Key Performance Indicators are used increasingly by health services, but their relevance and utility may bequestionable. In this article, Program Theory is used to model the irreducible stages in the system of clinical care inChild and Adolescent Mental Health Services, define the major program operations in each of these stages, and specifythe intermediate outcomes of each stage and the final outcomes sought. National and State policy standards are used,with practice experience, to identify key program operations and intermediate outcomes sought. Systematic criteria arethen applied to select KPIs that are measurable, reliable, valid for our program theory, utilitarian, and relevant toclinicians, clients and managers.
Funding arrangements for pharmaceuticals: can economic evaluation promote efficiency?
Authors: Viney Rosalie
Published: February 2010

The media coverage of health resource allocation, even in the "quality" press, is generally simplified, reducingthe issue to winners and losers in political terms, and rarely providing any in-depth analysis of policy initiatives.Policies are generally analysed in terms of how difficult they will be for politicians to "sell" and the effect theywill have on electoral success rather than the impact they will have on the health of the population, on resourceallocation or on equity of access (Haas et al. 2001). The recent media attention on the Pharmaceutical BenefitsAdvisory Committee is a case in point.
On being more dynamic in DRG refinement
Authors: Phillips Paddy
Published: February 2010

Hindle's analysis of past and present initiatives with regard to casemix classification review is perceptive (Hindle2001). The issues he raises are important.It is clear that Australia has been innovative and led the world recently in casemix development and application.That is why other countries are using the Australian system. Involvement by federal and state governments,administrators and clinicians has led to a system broadly accepted as a lexicon for acute hospital admissionclassification and a means of payment.
Health services research in Australia
Authors: Hall Jane
Published: February 2010

The long-awaited Wills Implementation Committee Report (CoA 2000), which was completed by Novemberlast year, has now been released. Wills' earlier Report (CoA 1998) identified the need for the development ofhealth services research capacity in Australia, and this new Report recommends how this should be done,through the establishment and support of several large multi-disciplinary centres. These should be based aroundhealth services, health policy, health economics, public health and clinical practice and these are required to givescientific leadership to Australia's efforts in priority-driven research. They are to be funded through NHMRC,with funds rising to $10m per annum.
Exploring distributive justice in health care
Authors: CAPP STAN , SAVAGE SALLY , CLARKE VALERIE
Published: February 2010

The allocation of resources to providers and the way in which the resources are then prioritised to specific service areasand patients remain the critical ethical decisions which determine the type of health system a community receives.Health care providers will never be given enough resources to satisfy all the demands placed upon them by acommunity that is becoming increasingly informed and demanding. This paper discusses the matter of justice as itrelates to the distribution of health resources. It translates the theoretical constructs of distribution into a practicalsituation that arose at The Geelong Hospital. It is important to emphasise that the aim of giving the example is notnecessarily to provide the right answer but rather to assist in determining what ought to be the questions.
Cost-analysis of gym-based versus home-based cardiac rehabilitation programs
Authors: Collins Louisa , Scuffham Paul , Gargett Sue
Published: February 2010

A cost-analysis of an existing gym-based program was compared with a proposed home-based program for deliveringcardiac rehabilitation services in West Moreton, Queensland. Cost and baseline data were collected on 95 cardiacrehabilitation patients living in Ipswich and West Moreton. Cost data included costs to the program funders andpatients. The average cost per patient rehabilitated was $1,933 in the gym-based program and $1,169 in the home-basedprogram. Adopting the lower cost home-based program would allow the services to be provided to many morepatients. The relevance of home-based rehabilitation programs for rural patients facing barriers accessing traditionalhospital- or gym-based programs is significant.
Seeding information management capacity to support operational management in hospitals
Authors: Diers Donna , Pelletier Dianne
Published: February 2010

There are vast amounts of regularly reported data in the information systems of hospitals, state and federalgovernments. The increase in accessibility offered by platforms such as the Health Information Exchange (HIE) inNew South Wales (NSW) creates a new level of opportunity. Administrative data can also speak to clinical andmanagerial issues. The capacity to mine these data and use the information for improving quality and efficiency hasnot been well developed at the "coal face" of operational management. Whilst it has been both possible and useful totrack utilisation of services to hospitals and patients as cost and volume, it has not been of interest to track these samedata to the operational locus of care - the nursing unit, the operating room, the imaging department.With HIE-type systems, the information is now more readily available and operational managers know this. Thechallenge is to develop the interdisciplinary capacity to query administrative data to facilitate clinical and managerialdecision-making. We report here a possible model of a systematic approach to developing this capacity and some ofthe results of equipping operational and clinical managers to study problems in their own work settings. These effortshave required no additional internal resources, while the payoffs have been considerable.
Are survey measures of medical careutilisation misleading?
Authors: Marshall Ric , Grayson David , Jorm Anthony , O'Toole Brian
Published: February 2010

found when estimates from self-report data from anepidemiolgical study were compared to actual cost data extracted from administrative records. Even though the fewsubjects who were actually provided with two or more services in the two-week self-report period substantially under-reportedtheir medical care consumption, a large net over-estimate of medical care consumption was produced by theself-report data. This finding has important implications for use of self-report data from surveys such as the AustralianBureau of Statistics (ABS) National Health Survey for estimating health service consumption.By combining epidemiological survey data from the Australian Vietnam Veterans Health Study (AVVHS), with dataon actual medical care for which the Health Insurance Commission (HIC) or the Department of Veterans' Affairs (DVA)paid benefits, we were able to directly compare self-reported medical care consumption with actual medical careutilisation. The comparison revealed that veterans' self-reports were a valid measure of relative medical careconsumption because those who reported care over the past two weeks were much more likely to have been recentconsumers than those who did not. This relationship became even stronger if the comparison of self-report was extendedto data on benefits paid beyond the two-week self-report period. However, the HIC and DVA data confirmed only 51%of veterans self-reporting medical care consumption during the past two weeks actually received a service.
The importance of age and other variables in predicting paediatric patient flows in New South Wales
Authors: Bridges John FP , Hanson Ralph M
Published: February 2010

This research focuses upon the relationship between a child's age and the likelihood that the child was treated at aSpecialist Children's Hospital rather than at a local hospital. While it is generally regarded that younger patients aremore resource intensive, a study was required to determine whether the Specialist Children's Hospitals attractedyounger patients. The analysis is based on 42,363 children treated in Greater Metropolitan Sydney in 1996/97, andon separations classified (role delineated) as non-tertiary DRGs (defined as Level 4 activity). However, this activityis of varying degrees of severity. A number of variables were used to explain why a child was treated at either a localhospital or at a specialist children's hospital. This study clearly demonstrates that Specialist Children's Hospitals do attractyounger and more severe patients.
Health insurance in the Philippines:bold policies and socio-economic realities
Authors: Hindle Don , Acuin Lito , Valera MAdz
Published: February 2010

In 1995, the Philippines government legislated to create an income-rated and predominantly employment-baseduniversal health insurance program over a 15-year period. The program was intended to provide more and betterhealth care than was available through a combination of existing insurance schemes that covered less than half of thepopulation, and partially subsidised services provided by government facilities and funded from general taxation.The legislation was well intentioned, and the program has some skilful and imaginative staff. However, there aresignificant barriers to success including low average and widely dispersed incomes, improving but still unsatisfactoryhealth status, weak government health care services, and the sometimes negative impact of for-profit agencies.We review progress to date and conclude that, although membership numbers and benefit rates have increased, accessis still inadequate and copayments are high. We argue that strong and innovative steps are needed if the Program'sgoals are to be realised. In particular, we suggest that the focus should be on more formal and explicit rationing thattakes account of cost per quality-adjusted life-year; and radical adjustment of financial incentives for care providersincluding capitation and per case payment based on costed clinical pathways for high-volume case types. Finally, wecomment briefly on lessons that might be learned by both The Philippines and Australia.
Individual program planning as an exemplar of best practice in the delivery of consumer-oriented mental health care
Authors: Scheil Margret
Published: February 2010

Individual Program Planning is an action research tool that facilitates consumer-oriented service provision. It is basedon four guiding principles to promote constructive interaction between consumers, significant others and services.Agreements for action are cooperatively developed in relation to the identification of issues. These are documented andmonitored in the form of ongoing meetings. The process supports coordination and accountability of activity betweenthose significant to treatment outcome across the continuum of care.
International mental health outcomes and benchmarking using the FACE approach
Authors: Elzinga Rob , Meredith & Paul Clifford Fiona
Published: February 2010

This article describes and compares the nature and severity of problems encountered by persons receiving mental healthservices in the United Kingdom and Australia, and the outcome of their treatment. The perspective of service providersand service users in the two countries was strikingly similar. Treatment was effective in alleviating problems withsocial circumstances, and in increasing adaptive and interpersonal functioning. Treatment was less effective inaddressing psychological or physical problems. Service users in the United Kingdom were more involved in developingtheir treatment care plan than those in Australia. The study demonstrates how data required for benchmarking andoutcome evaluation purposes can be generated as part of routine clinical processes.
Employees' perceptions of workplace change
Authors: London Jeanette
Published: February 2010

Change is endemic, but it creates fear in the workplace. In this study, five people from a health care organisation were interviewed to gain a better understanding of their concerns in the workplace. Each person regarded the effects of workplace change somewhat differently in variety and intensity but in general terms they all identified two major spheres of influence. Each sphere represents a complex dynamic relationship of several effects. The first, which is at an individual level, includes feelings and attitudes, and behavioural, psychological and social effects. The second, which is at an organisational level, includes culture, leadership, decision making and strategy implementation. Communication and education were viewed as key elements that facilitated the change process. In the surveyed organisation, service closure was viewed as the overriding concern that dominated most participants' perceptions of change. Additional research is required to ascertain if this model can be generalised to other workplace environments.
Managing organisational change to improve health services for young people with deliberate self harm behaviour
Authors: Tobin Margaret J , Clarke Adam R , Buss Richard , Einfeld Stewart L , Beard John , Dudley Michael , Knowles Michelle , Dietrich Uta
Published: February 2010

Repeat Deliberate Self Harm is a recognised risk factor for completed suicide and therefore reduction by effective healthservice response represents a valid contribution to suicide prevention. However, only a small fraction of people withdeliberate self harm presentations to general health settings actually reach specialist mental health follow-upappointments. Therefore, even if responses at that point are known to be effective they do not make a significantcontribution to reducing repeat self-harm overall. We describe health system organisational change strategies to improvehealth service engagement for the target group, and present data demonstrating the effectiveness of these strategies.
Book review Your guide to E-Health:third millenium medicine on the Internet
Authors: Yellowlees Peter
Published: February 2010

There are two main sets of ideas in this book. The first concerns the ways that the Internet can be used by theaverage health care consumer to obtain advice from health care professionals or from other people who share hisor her health problems. The second concerns the ways in which health care professionals (and mainly doctors)can take advantage of the Internet to improve their own clinical practice, and make a contribution to improvingthe operation of the health care system as a whole.
Point of entry treatment gives best time to thrombolysis for acute myocardial infarction.
Authors: Bryant Michael , Kelly Anne-Maree
Published: February 2010

The aim was to compare time to thrombolysis for patients treated via three treatment pathways: thrombolysis in theemergency department (ED), thrombolysis following direct admission by ambulance officers to coronary care (CCU)and thrombolysis after transfer from ED to CCU. We used a retrospective study of time to thrombolysis for all patientsreceiving thrombolysis for acute myocardial infarction (AMI) at Western Hospital during 1999.The median time to thrombolysis in the ED group was 30 minutes (mean 40 minutes), compared with 60 minutesfor the CCU group (mean 63 minutes) and 40 minutes (mean 43 minutes) for the direct CCU admission group.Eighty-five percent of patients treated in ED received thrombolysis in less than 60 minutes compared with 21% ofthose transferred from the ED for treatment in CCU and 52%of those directly admitted to CCU. We conclude thatpoint of entry thrombolysis, be it in ED or in CCU after direct admission, gives shorter times to thrombolysis thanprocesses that require transfer of patients between departments.
Establishing an evidence base for the specialist breast nurse: A model for Australian breast cancer care
Authors: Liebert Barbara , Parle Michael , White Kate , Rodger Alan
Published: February 2010

The unmet needs of women with breast cancer have been extensively documented. In the United Kingdom, theintroduction of the specialist breast nurse (SBN) role has been one strategy to improve the psychological wellbeing ofwomen. This paper describes a SBN model of care and clinical pathway for Australian treatment settings, developedfrom systematic reviews of research and clinical practice guidelines for the treatment and psychosocial care of womenwith breast cancer. The model acknowledges the SBN as an integral member of the multi-disciplinary team with akey role to meet the emotional and informational needs of women diagnosed with breast cancer from the time ofdiagnosis through to follow up after treatment.Key words: breast cancer, specialist breast nurse, evidence-based, clinical practice guidelines, clinical pathway,psychosocial support
A neurobehavioural approach to use of clinical competencies in supporting individuals with multi-axial diagnoses
Authors: Sugarman Roy
Published: February 2010

Individuals with multiple diagnoses most often present with social difficulties, with either aggressive or withdrawn behaviour predominating. In individuals with behaviours that represent changes at a neural level, and in those withcomorbid psychiatric diagnoses, these behaviours often represent obstacles to rehabilitation. Consequently there is little consensus as to how such patients can be assessed, treated and interacted with, and so too there is little potential toimprove outcomes with guided training. When multiple agencies are involved, such patients may 'fall between the cracks' and undergo prolonged and disempowering interventions with poor outcomes in the absence of individual programmes. This article addresses the core issue of empowerment in the assessment and community-based rehabilitation of patients with multiple mental health issues, and utilises a case report format to illustrate the methodology.
General practice in Australia 2000
Authors: Hindle Don
Published: February 2010

Visiting Professor, University of New South Wales
Health care in Slovenia: an interview with the Minister
Authors: Keber interviewed by Don Hindle Dusan
Published: February 2010

The original intention was to ask the same questions of the Australian and Slovenian Ministers for Health, so that readers might compare the answers. The Slovenian Minister was happy to answer questions without notice, and to accept the interviewer's interpretations (as they appear below). The Australian Minister asked that questions be submitted in advance, and then prevaricated for two months. We are still waiting for a positive response: the invitation remains open. We decided to go ahead and publish the Slovenian Minister's responses. We hope that readers find them of interest on their own. In passing, it seems to me that one might reasonably conclude the Australian Minister has little interest in talking seriously to the many thousands of health care professionals who regularly read the AHR. If so, this is a sad state of affairs.Dusan Keber is a medical doctor with a distinguished clinical and medical research record. He was Director of the Department of Angiology at the Ljubljana Medical Centre a 2000-bed teaching hospital) from 1983-1996, and Medical Director of the Centre from 1996-2000. He has been Minister for Health since 2000.