bluuebunny/crossref_metadata_2025 huggingface dataset:
A bubbly oil-lubricated squeeze film damper. Part 1: A finite-element model
Authors: Ng W S , Levesley M C , Priest M
Published: November 2008

The non-linear vibration of a squeeze film damper (SFD) supported rotor assembly is closely linked to the presence of air bubbles in the lubricant, due to cavitation, where the discrete gas phase influences the squeeze film pressure profile and gives rise to a non-linear stiffness force. The aim of this paper is to assess the ability of a computational model for homogeneous bubbly oil to predict the influence of air bubbles on the film reaction forces under various operating parameters. The numerical model which considers the solubility of gas and the growth of gas bubbles was developed using the finite-element software, FEMLAB™. Parametric studies of eccentricity ratio, whirling frequency, and supply pressure were conducted to evaluate the influences of air bubbles on the pressure field and hence the squeeze film forces. Results show that an increase in eccentricity ratio and whirling frequency enhances the growth of air content in lubricant and hence increases the radial (stiffness) to tangential (damping) force ratio in an SFD, whereas an opposite effect is gained by applying higher supply pressure. Compared with the classical theoretical half-film model predictions, the bubbly oil model provides a more realistic estimation with respect to different damper operating conditions. From the simulation findings, it can be concluded that the homogeneous two-phase flow model reasonably describes the bubbly oil behaviour in SFDs and effectively shows the rise in stiffness force due to the growth of air bubbles. The homogeneous model can be easily applied to the well-established lubrication equation and solved with efficiency. However, any possible interfacial effects between the liquid and gas phases are inevitably concealed. The success of the current model allows its subsequent coupling with a structural rotor to form a multi-disciplinary model for unbalance analysis.
A new friction model for the slide guide in elevator systems: Experimental and theoretical investigations
Authors: Zhang X G , Guo K J , Li H G , Meng G
Published: November 2008

In the design and manufacture of elevator systems, the slide guide in elevators moves in contact against the guide rail. This kind of surface contact exhibits a highly non-linear hysteretic friction behaviour, which hampers the riding quality of the elevator systems to a great extent. First, this paper presents an experimental investigation on this type of phenomenon through the measurement of contact friction force between the interface of the slide guide and the rail under different combinations of input parameters. The experiment clearly shows various types of frictional behaviour, including presliding/gross-sliding regimes, the transition behaviour between them, friction overshoot, time lag, velocity (weakening and strengthening) dependence, etc. In addition, it is found that for different materials in contact, lubrication conditions and friction duration have strong impacts on the evaluation of their friction characteristics. Based on the observations of this test, an improved friction model derived from the Bouc—Wen model is then proposed and compared with other friction models. The Bouc—Wen model is improved by adding elements considering the velocity dependence and friction overshoot. The numerical simulations show that the proposed model can capture the behaviour found in the experiments, agrees with the experimental data reasonably well, and may be used for the dynamical analysis of the elevator systems.
A particle swarm optimization-based time-scaling method for quasi-time-optimal control of rigid spacecraft along specified paths
Authors: Ko C-N , Yang C-C , Wu C-J
Published: November 2008

Based on particle swarm optimization (PSO), a time-scaling method is proposed to determine a quasi-time-optimal movement of a rigid spacecraft along a given reference path. In the beginning, a reference trajectory that satisfies the geometric path constraints is synthesized. Then the time-scaling procedure of this trajectory is performed by utilizing integration of a time-scaling function. In this manner, the positions of the trajectory after scaling are kept the same to meet the geometric path constraints. However, the velocities and the accelerations are adjusted to meet the dynamics constraints and to minimize the travelling time simultaneously. To determine the time-scaling function, a cubic spline interpolation technique is used and control points for interpolation are determined simultaneously by a PSO method. To show the feasibility of the proposed method, simulation results are included for illustration.
Human Rights Ideology and Dimensions of Power: A Radical Approach to the State, Property, and Discrimination
Authors: Arat Zehra F. Kabasakal
Published: November 2008

This article advances the argument that there is a distinct ideology of Human Rights embedded in the International Bill of Rights (IBR). Instead of contrasting ideologies in terms of their stance on equality and liberty, it suggests employing three dimensions of power—political, economic, and social that are defined in relation to the positions taken on the state, property, and discrimination, respectively—in assessing the extent to which ideologies oppose the concentration of power and promise emancipation. It then analyzes the three documents that constitute the IBR as the textual sources of a distinct Human Rights Ideology on these three dimensions to reveal its radical and emancipatory characteristics, which tend to be missed or deliberately undermined. It questions the aptness of liberal democracy, the welfare state, and the capitalist economy for fulfilling the main premise of this ideology— equality in dignity .
Human Rights and Research on Inchoate Life: An Emerging Set of Limits for Rights Vocabularies?
Authors: Frohock Fred M.
Published: November 2008

Perhaps because we live in a time when rights are the most favored vocabularies in negotiating issues and constructing institutions, at least in the West, it is easy to miss limits on the powers of rights to do any of the things expected of them. The main argument in this article is that rights vocabularies do not refer successfully to inchoate life forms and that research into such life should be regulated by communal goods. The source of moral guidance is the set of needs in the larger human community, arguable the oldest moral map in history. On these considerations research that provides spectacular benefits to the human species may be justified even if it sacrifices infinitesimal life.
Teaching Professionalism: A Tale of Three Schools
Authors: Shah Nirav , Anderson Jeffrey , Humphrey Holly J.
Published: November 2008

This article compares professionalism education from the vantage points of three different disciplines: medicine, law, and business. In particular, it asks how each of these professions conceives of “professionalism,” and how these different conceptions affect what is taught to graduate students. The object of professionalism education differs among these three disciplines, as do the specific challenges to professionalism and professionalism education. The article offers examples of how professionalism is taught in medicine, law, and business, and what each profession might learn from the others in developing their professionalism education and pedagogy.
The Short History and Tenuous Future of Medical Professionalism: The Erosion of Medicine’s Social Contract
Authors: Wynia Matthew K.
Published: November 2008

The profession of medicine is based on a shared set of tacit and explicit agreements about what patients, doctors, and society at large should be able to expect from each other, a social contract that defines the profession. Historically, the development of this set of agreements depended upon the creation of social organizations that could speak for the entire profession. Over the last several decades, however, the perceived need for these organizations, and especially the umbrella organization for the profession, the American Medical Association, has waned. The reasons for this are complex, but the consequences are significant: an eroding social contract, fragmentation, lack of cohesion and integrity, and loss of the public’s confidence. The present social contract is one-dimensional, overly simplistic, and failing to sustain the public’s trust. To address these problems, a renewed social contract is necessary. Although this renewed contract should be based on foundations similar to the original, it must directly confront such contemporary challenges as resource allocation and conflicts of interest. Equally as important, to reinvigorate our social contract more physicians will need to come to grips with a basic truth: to sustain professionalism we need a strong, unified professional association.
Toward Reducing the Prevalence of Chronic Disease: A Life Course Perspective on Health Preservation
Authors: Barondess Jeremiah A.
Published: November 2008

Chronic disease is now hyper-endemic in the United States and is the central problem to be addressed in efforts to enhance the health of the American population. Efforts to reduce the prevalence of chronic disease through diminished exposure to risk factors have achieved significant success in recent decades, but most have been expressions of secondary or tertiary prevention. Current knowledge suggests it would be more effective to extend efforts directed at reduction of risk to earlier phases in the biology of chronic diseases, and to maintain them over the life course. This approach lends itself to a health preservation perspective—in other words, to an orientation around protection of the future health of the individual across the lifespan, from preconception to old age. This will require linked efforts of the clinical, public health, and policy communities, together with private-sector collaborators in information management, marketing, and other areas of expertise.
Professionalism Education: The Medical Student Response
Authors: Leo Troy , Eagen Kellene
Published: November 2008

We present the medical students’ perspective on the hotly contested topic of professionalism in medical education and explore why students are often hostile to education in professionalism. We then suggest ways to improve professionalism education in the medical curriculum.
Teaching Humanism
Authors: Stern David T. , Cohen Jordan J. , Bruder Ann , Packer Barbara , Sole Allison
Published: November 2008

As the “passion that animates authentic professionalism,” humanism must be infused into medical education and clinical care as a central feature of medicine’s professionalism movement. In this article, we discuss a current definition of humanism in medicine. We will also provide detailed descriptions of educational programs intended to promote humanism at a number of medical schools in the United States (and beyond) and identify the key factors that make these programs effective. Common elements of programs that effectively teach humanism include: (1) opportunities for students to gain perspective in the lives of patients; (2) structured time for reflection on those experiences; and (3) focused mentoring to ensure that these events convert to positive, formative learning experiences. By describing educational experiences that both promote and sustain humanism in doctors, we hope to stimulate the thinking of other medical educators and to disseminate the impact of these innovative educational programs to help the profession meet its obligation to provide the public with humanistic physicians.
Bargaining With Time: An Interview With Helen Pavlin
Authors: Miocevic Nada , Couper‐Smartt's John
Published: November 2008

Helen Pavlin is an accredited mental health social worker and family therapist and accredited family dispute resolution practitioner in private practice in Darwin. She has been involved in social work and family therapy since the early 1970s in Australia and internationally. In 1996 she received the 50th Anniversary Commemorative Medal from the Australian Association of Social Workers. She is one of the assessors and associate editors for the Australian and New Zealand Journal of Family Therapy. In 2007 Helen received the Journal Award for her outstanding contribution to the family therapy field in Australia. She is an accomplished writer and a member of the Australian Society of Authors. Her poems and book reviews have been published frequently in ANZJFT.
Positionierung eines Fahrzeugs in unbekannten Gebieten mit Hilfe von Laserscannern Localization in Unknown Environments Using Laser Scanner
Authors: Weiss Thorsten , Dietmayer Klaus
Published: November 2008

Viele Komfort- und Sicherheitsapplikationen benötigen eine präzise Information über die Eigenbewegung des Fahrzeugs. Aus den Daten von serienmäßig in heutigen Fahrzeugen verbauten Sensoren kann die Eigenbewegung bestimmt werden. Im Rahmen dieser Arbeit werden Algorithmen vorgestellt, die die Genauigkeit der Eigenbewegungsbestimmung mit Hilfe eines Laserscanners verbessern. Ein rasterbasierter und ein merkmalsbasierter SLAM Algorithmus für den robusten Einsatz im realen Straßenverkehr erlaubt die präzise Eigenbewegungsbestimmung in Innenstadt-, Landstraßen und Autobahnszenarien und auch in extremen Fahrmanövern wie Schleudern oder Drift.
Hilbert’s Independence Theorem and the Proof of the Second Law of Thermodynamics
Authors: Dickel Gerhard
Published: November 2008

Hamilton taking time and velocity as co-ordinates of optics induced Jacobi to take these as co-ordinates of dynamics too. Considering Hilbert’s paper „Transition of the Method of the independent integral to double Integrals“ the force dxdt double integral can be presented by an action integral thus avoiding the splitting of classic and action integrals.
Comparing Online Activities in China and South Korea: The Internet and the Political Regime
Authors: Chung Jongpil
Published: November 2008

By comparing major online activities in China and South Korea, this article analyzes how the leaders of China and South Korea have influenced the use of the Internet and how the Internet has made it possible for individuals and groups to have their views reflected in policy making processes.
Corporate Governance Reform in Taiwan: Could the Independent Director System Be an Effective Remedy?
Authors: Liu John S. , Yang Chyan
Published: November 2008

At the forefront of corporate governance reform in Taiwan is establishment of the independent director system. We report upon the reform as related to the independent director system. Listed companies have acted in response to the reform in a way that may not serve its original purpose.
Parallel Genetic Evolution Within and Between Bacteriophage Species of Varying Degrees of Divergence
Authors: Bollback Jonathan P , Huelsenbeck John P
Published: November 2008

Parallel evolution is the acquisition of identical adaptive traits in independently evolving populations. Understanding whether the genetic changes underlying adaptation to a common selective environment are parallel within and between species is interesting because it sheds light on the degree of evolutionary constraints. If parallel evolution is perfect, then the implication is that forces such as functional constraints, epistasis, and pleiotropy play an important role in shaping the outcomes of adaptive evolution. In addition, population genetic theory predicts that the probability of parallel evolution will decline with an increase in the number of adaptive solutions—if a single adaptive solution exists, then parallel evolution will be observed among highly divergent species. For this reason, it is predicted that close relatives—which likely overlap more in the details of their adaptive solutions—will show more parallel evolution. By adapting three related bacteriophage species to a novel environment we find (1) a high rate of parallel genetic evolution at orthologous nucleotide and amino acid residues within species, (2) parallel beneficial mutations do not occur in a common order in which they fix or appear in an evolving population, (3) low rates of parallel evolution and convergent evolution between species, and (4) the probability of parallel and convergent evolution between species is strongly effected by divergence.
Pds1p Is Required for Meiotic Recombination and Prophase I Progression inSaccharomyces cerevisiae
Authors: Cooper Katrina F , Mallory Michael J , Guacci Vincent , Lowe Katherine , Strich Randy
Published: November 2008

Sister-chromatid separation at the metaphase–anaphase transition is regulated by a proteolytic cascade. Destruction of the securin Pds1p liberates the Esp1p separase, which ultimately targets the mitotic cohesin Mcd1p/Scc1p for destruction. Pds1p stabilization by the spindle or DNA damage checkpoints prevents sister-chromatid separation while mutants lacking PDS1 (pds1Δ) are temperature sensitive for growth due to elevated chromosome loss. This report examined the role of the budding yeast Pds1p in meiotic progression using genetic, cytological, and biochemical assays. Similar to its mitotic function, Pds1p destruction is required for metaphase I–anaphase I transition. However, even at the permissive temperature for growth, pds1Δ mutants arrest with prophase I spindle and nuclear characteristics. This arrest was partially suppressed by preventing recombination initiation or by inactivating a subset of recombination checkpoint components. Further studies revealed that Pds1p is required for recombination in both double-strand-break formation and synaptonemal complex assembly. Although deleting PDS1 did not affect the degradation of the meiotic cohesin Rec8p, Mcd1p was precociously destroyed as cells entered the meiotic program. This role is meiosis specific as Mcd1p destruction is not altered in vegetative pds1Δ cultures. These results define a previously undescribed role for Pds1p in cohesin maintenance, recombination, and meiotic progression.
Dual Excitatory and Inhibitory Serotonergic Inputs Modulate Egg Laying inCaenorhabditis elegans
Authors: Hapiak Vera M , Hobson Robert J , Hughes Lindsay , Smith Katherine , Harris Gareth , Condon Christina , Komuniecki Patricia , Komuniecki Richard W
Published: November 2008

Serotonin (5-HT) regulates key processes in both vertebrates and invertebrates. Previously, four 5-HT receptors that contributed to the 5-HT modulation of egg laying were identified in Caenorhabditis elegans. Therefore, to assess potential receptor interactions, we generated animals containing combinations of null alleles for each receptor, especially animals expressing only individual 5-HT receptors. 5-HT-stimulated egg laying and egg retention correlated well with different combinations of predicted excitatory and inhibitory serotonergic inputs. For example, 5-HT did not stimulate egg laying in ser-1, ser-7, or ser-7 ser-1 null animals, and ser-7 ser-1 animals retained more eggs than wild-type animals. In contrast, 5-HT-stimulated egg laying in ser-4;mod-1 animals was greater than in wild-type animals, and ser-4;mod-1 animals retained fewer eggs than wild-type animals. Surprisingly, ser-4;mod-1;ser-7 ser-1 animals retained the same number of eggs as wild-type animals and exhibited significant 5-HT-stimulated egg laying that was dependent on a previously uncharacterized receptor, SER-5. 5-HT-stimulated egg laying was absent in ser-5;ser-4;mod-1;ser-7 ser-1 animals, and these animals retained more eggs than either wild-type or ser-4;mod-1;ser-7 ser-1 animals. The 5-HT sensitivity of egg laying could be restored by ser-5 muscle expression. Together, these results highlight the dual excitatory/inhibitory serotonergic inputs that combine to modulate egg laying.
Combined Spectral Index to Improve Ground‐Based Estimates of Nitrogen Status in Dryland Wheat
Authors: Eitel J. U. H. , Long D. S. , Gessler P. E. , Hunt E. R.
Published: November 2008

Spectral indices are useful for estimating crop yield potential and basing in‐season N fertilizer applications. The normalized difference vegetation index (NDVI) is positively related to crop N status and leaf area index (LAI) under N limited conditions. However, under water limited conditions, variations in LAI may be driven by soil moisture rather than plant‐available N, which will confound spectral estimates of crop N status. This study evaluated the performance of spectral indices for ground sensing of crop chlorophyll a+b content (Cab) and N status in dryland wheat (Triticum aestivum L.). Sensitivity of spectral indices to Cab and LAI was assessed using reflectance spectra simulated by the PROSPECT+SAIL model. Simulations showed the modified chlorophyll absorption ratio index and second modified triangular vegetation index in ratio (MCARI/MTVI2) to be sensitive to Cab and resistant to LAI. This conclusion was tested in dryland fields with measured canopy reflectance at Zadoks growth stages 57 to 60. NDVI and other simple indices were highly correlated with LAI (r2 ≤ 0.84) and less well correlated with chlorophyll meter readings (r2 ≤ 0.46) and flag leaf N (r2 ≤ 0.29). MCARI/MTVI2 was poorly correlated with LAI (r2 = 0.01) and more highly correlated with chlorophyll (r2 = 0.70) and flag leaf N (r2 = 0.54), agreeing with PROSPECT+SAIL. Use of MCARI/MTVI2 may improve ground estimates of crop N status where LAI variability is associated with water availability. This information is potentially useful for decisions whether to apply foliar N to enhance grain protein concentration of wheat.
Phosphorus and Nitrogen Relationships during Spring Growth of an Aging Timothy Sward
Authors: Bélanger Gilles , Ziadi Noura
Published: November 2008

Plant‐based methods of determining P and N deficiencies require critical concentration values. We studied the response of timothy (Phleum pratense L.) to P and N fertilization over 7 yr with the objective of using relationships between P and N concentrations and dry matter (DM) yield to determine critical P and N concentrations. Timothy, seeded in 1998, was harvested during spring growth from 1999 to 2005 in an experiment with four sampling dates (stem elongation, early heading, late heading, and early flowering), four P applications (0, 15, 30, and 45 kg P ha−1), and four N applications (0, 60, 120, and 180 kg N ha−1). Maximum DM yield and, therefore, nonlimiting P and N conditions, were obtained with 120 kg N ha−1 without applied P. Under these nonlimiting conditions, relationships between P and N concentrations and DM yield changed with production years. Critical N concentration (Nc) in older swards (>4 yr; Nc = 37.0 × SB−0.35; R2 = 0.79), expressed as a function of shoot biomass (SB), was less than previous reports on younger swards (Nc = 48.0 × SB−0.32). Critical P concentration (Pc) was also less in older swards (Pc = 3.27 × SB−0.20; R2 = 0.68) than in younger ones (Pc = 5.23 × SB−0.40; R2 = 0.63). Critical P concentration can also be expressed as a function of N concentration (Pc = 1.07 + 0.063N; R2 = 0.71), a relationship independent of sward age and shoot biomass but affected by N deficiency; the slope is the same but intercept values vary from 1.31 to 1.41 when N limits shoot growth. Critical P and N concentrations can then be used to quantify the degree of P and N deficiency in young and old timothy swards.
Evaluation of In‐Season Nitrogen Management Strategies for Corn Production
Authors: Ruiz Diaz D. A. , Hawkins J. A. , Sawyer J. E. , Lundvall J. P.
Published: November 2008

Nitrogen is an important and costly input for corn (Zea mays L.) production. With rising prices and environmental concerns, producers are looking for ways to better manage N fertilization. A project designed to evaluate in‐season N management strategies for adjusting N rate was conducted in 30 Iowa cornfields from 2004 to 2006. Nitrogen rates applied preplant or early sidedress (PRE‐N) and corn plant sensing with a chlorophyll meter (CM) to detect N stress was used to determine as‐needed in‐season post sensing nitrogen application (POST‐N). Field‐length strips were replicated three times with six N treatments: zero‐N control, 67 kg N ha−1 (reduced PRE‐N rate), 67+ (reduced PRE‐N rate plus POST‐N), 134 kg N ha−1 (agronomic PRE‐N rate), 134+ (agronomic PRE‐N rate plus POST‐N), and 268 kg N ha−1 (PRE‐N non‐N limiting reference rate). Nitrogen deficiency stress sensing was partially successful, with 70 to 80% correct N deficiency detection. Mean yield increased 0.5 Mg ha−1 across all sites with the POST‐N applied to the 67 kg N ha−1 PRE‐N rate. The 67+ POST‐N strategy had a similar total N applied as the agronomic 134 kg N ha−1 PRE‐N rate, but the yield was 0.5 Mg ha−1 lower. This indicates yield potential loss and poor recovery from the POST‐N applications. Economic return comparisons indicated that the agronomic 134 PRE‐N rate and 134+ POST‐N in‐season strategy were similar and had higher return than the 67+ POST‐N strategy. The agronomic PRE‐N rate, with confirmation of N stress and determination of additional N need through plant sensing, was a more cost effective in‐season strategy than starting with the reduced PRE‐N rate.
The Deepening Crisis in U.S. Health Care: A Review of Data, Spring 2008
Authors: Hellander Ida
Published: November 2008

This report presents information on the state of U.S. health care in early 2008. The numbers of uninsured and underinsured continue to rise, and the proportion of people covered by employer-sponsored private coverage decreases. For 29 percent of low- and middle-income households with credit card debt, medical bills are a contributor to their current balance. Health spending in the United States is on the increase, and projected spending in 2008 will consume 16.6 percent of gross domestic product. Health insurance premiums grew 78 percent between 2002 and 2007. Meanwhile, safety-net hospitals are facing deep deficits and service cuts across the country. Pharmaceutical and insurance companies spend millions lobbying Congress. Health industry CEOs continue to be richly rewarded, even as companies come under investigation or face fines for claims denials, manipulation of data, or violations of claims-handling regulations. Average monthly premiums for Medicare Part D increase while plans are reducing coverage for high-cost drugs. And research shows how private plans such as Medicare Advantage hurt Medicare. According to opinion polls, the majority of Americans and physicians support a single-payer health care system.
Insurance Status of U.S. Organ Donors and Transplant Recipients: The Uninsured Give, but Rarely Receive
Authors: Herring Andrew A. , Woolhandler Steffie , Himmelstein David U.
Published: November 2008

Organ transplantation is an expensive, life-saving technology. Previous studies have found that few transplant recipients in the United States lack health insurance (in part because patients may become eligible for special coverage because of their disability and transplant teams vigorously advocate for their patients). Few data are available on the insurance status of U.S. organ donors. The authors analyzed the 2003 National Inpatient Sample (NIS), a nationally representative 20 percent sample of U.S. hospital stays, and identified incident organ donors and recipients using ICD-9-CM diagnosis and procedure codes. The NIS sample included 1,447 organ donors and 4,962 transplant recipients, equivalent after weighting to 6,517 donors and 23,656 recipients nationwide; 16.9 percent of organ donors but only 0.8 percent of transplant recipients were uninsured. In multivariate analysis, compared with other inpatients organ donors were much more likely to be uninsured (OR 3.41, 95% CI 2.81–4.15), whereas transplant recipients were less likely to lack coverage (OR 0.08, 95% CI 0.06–0.12). Many uninsured Americans donate organs, but they rarely receive them.
The Role of Income and Race/Ethnicity in Experiences with Medical Care in the United States and United Kingdom
Authors: Schnittker Jason , Bhatt Mehul
Published: November 2008

Inequalities in experiences with medical care are well-known in the United States, but little is known about the shape of such inequalities in other countries. This study compares a broad spectrum of experiences in the United States and United Kingdom. Furthermore, it focuses on two of the most important dimensions of inequality, race/ethnicity and income, and two of the most widely discussed system-level factors, health insurance and emphasis on primary care. Two general conclusions are reached. First, there are broad income-based inequalities in medical care in both the United States and United Kingdom. These inequalities persist even after controlling for health insurance, including private medical insurance in the United Kingdom. Race is also related to experiences with medical care, although the effects of race are more particular and contingent than are those for income. In particular, the mapping of racial/ethnic inequality differs considerably between the United States and United Kingdom, reflecting their different sociocultural climates. Second, the health care system, especially primary care, plays a limited role in ameliorating inequalities in care, but plays a strong role in elevating the average level of quality within a country. Because inequalities in medical care reflect broader social processes, they are durable across very different health care systems and contexts.
Neoliberal Reforms in Swedish Primary Health Care: For Whom and for What Purpose?
Authors: Dahlgren Göran
Published: November 2008

The conservative government that came to power in Sweden in 2006 has initiated major market-oriented reforms in the health sector. Its first health care policy bill changed the health legislation to make it possible to sell/transfer public hospitals to commercial providers while maintaining public funding. Far-reaching market-oriented primary health care reforms are also initiated, for example in Stockholm County. They are typically presented as “free choice models” in which “the money follows the patient.” The actual and likely effects of these reforms in terms of access and quality of care are discussed in this article. One main finding is that existing social inequities in geographic access to care not only are reinforced but also become very difficult to change by democratic political decisions. Furthermore, dynamic market forces will gradually reduce the quality of care in low-income areas while both access and quality of care will be even better in high-income areas. Public funds are thus transferred from people living in low-income areas to people living in high-income areas, even though the need for good health services is much greater in the low-income areas. Certain policy options for reversing the inverse law of care are also presented.
General Practitioner Commissioning in the English National Health Service: Continuity, Change, and Future Challenges
Authors: Mannion Russell
Published: November 2008

General practitioner fundholding (GPFH) in the English National Health Service was abolished by the Blair administration in 1999 amid concerns that it was inequitable, helped to foster a “two-tier” health service, and incurred high transaction costs. In April 2005 in an apparent volte face, the Blair government reintroduced delegated budgets to individual GP practices under the banner of Practice Based Commissioning (PBC). As PBC bears many similarities to GPFH it is timely to take stock of evidence-based policy lessons from the earlier initiative in the NHS. Based on a review of the latest empirical evidence, the aim of this article is to help inform the development and implementation of PBC by identifying the policy lessons of GPFH. To do this the discussion focuses on three main areas: it (1) reviews key ideas and conceptual frameworks for understanding stability and change in health systems; (2) summarizes the origins and evolution of primary care commissioning in the NHS; and (3) examines the latest literature and empirical analysis on the impact of GPFH and assesses the success of GPFH in meeting a range of health policy objectives. The article concludes with an examination of the policy implications of the present review and a look forward at the emerging research agenda.
The Nicaraguan Pesticide Poisoning Register: Constant Underreporting
Authors: Corriols Marianela , Marín Jesús , Berroteran Jacqueline , Lozano Luz Marina , Lundberg Ingvar , Thörn Åke
Published: November 2008

This study estimated the level of underreporting of acute pesticide poisonings (APP) in the pesticide surveillance system in Nicaragua in 2000. Data on pesticide exposure and health effects were assessed in a nationally representative cross-sectional survey of 3,169 persons aged 15 years and older. The authors found 1,369 cases of APP in the official register for 2000. Responses to questionnaires revealed 22 cases of APP in which individuals sought medical attention. Most of these cases involved agricultural workers who spray organophosphate pesticides, mostly class I. In 68 percent of cases, the mean out-of-pocket cost for treatment of one APP episode was $41, almost equivalent to one month's salary. Only 1 of the 22 cases (<5%) in which the individual sought medical attention was reported to the national register. The authors estimate that, nationally, about 30,000 pesticide poisoning cases receiving medical treatment were not reported. Characterization of APP based only on official figures, without considering the underreported cases, leads to a constant inability to interpret and report acute pesticide health effects in a manner useful to policymakers. The pesticide surveillance system must be strengthened to improve registration routines, analysis and interpretation of data, health personnel training, and participation of private providers.
A Participatory Simulation for Informal Education in Restoration Ecology
Authors: Tomlinson Bill , Baumer Eric , Yau Man Lok , Carpenter F. Lynn , Black Rebecca
Published: November 2008

Constructivist pedagogical approaches have become common in many science curricula. However, while sciences such as physics and chemistry lend themselves to compelling opportunities for interaction (explosions, reactions, objects in motion), certain systems sciences are more challenging for learners to engage with on a short time scale. Applying constructivist, discovery-based methods to the teaching of restoration ecology presents a number of difficulties, including the large amount of time and space over which ecological processes occur, limitations on experiments that can be performed in classroom contexts, and limited access to certain ecological settings. To address these difficulties, a team of computer scientists, ecologists, and educators created the EcoRaft project, a participatory simulation that allows children to learn about restoration ecology by playing the role of ecologists collaborating to restore a virtual rain forest ecosystem. Through qualitative evaluations of the EcoRaft project in multiple contexts, this article explores (1) how to design simulated environments more effectively as a means of promoting collaborative, discovery-based learning of scientific concepts, and (2) how to do so in ways that balance the need for integrating content area knowledge with interactive paradigms that engage young participants.
The Impact of the Read/Write Web on Learner Agency
Authors: Hall Richard
Published: November 2008

This article scopes some of the key political elements in the higher educational use of the read/write web, or Web2.0 as it is commonly known. It investigates ways in which these tools can be used to enhance deliberative democracy, the associations between individuals and their capability for decision-making. The structuring of spaces in which individual users can come together to make decisions and act is a critical theme, and one which impacts upon the agency, access and participation, and associations that are afforded by those contexts. Where differences exist between students and/or their tutor(s), the read/write web affords tools for representing such variation. Herewith the voices of both learners and tutors are evaluated, in order to argue that the read/write web can be used positively to acknowledge difference and promote agency.
A New Age of Constructivism: ‘Mode Neutral’
Authors: Reed Peter , Smith Brian , Sherratt Cathy
Published: November 2008

This article presents work in progress exploring social constructivism within Mode Neutral, and how various conditions impact upon the student experience. Mode Neutral's three dimensions – curriculum design, the role of the tutor and communication for learning – are affected by the conditions that can vary in any given context. The authors realise that both students' and tutors' expectations may be different, thus creating a different learning experience for each individual. The article also proposes a model for teaching and learning that identifies some (but not all) of the conditions that have been resident in their (and others’) research into the use of social constructivism within the learning experience. The consideration of these conditions directly affects the three key dimensions, and ultimately shapes the learning and teaching experience for all participants.
Graphically Mapping Electronic Discussions: Understanding Online Conversational Dynamics
Authors: Duncan-Howell Jennifer
Published: November 2008

Transcripts of electronic discussions have traditionally been examined via the use of conversational analysis techniques. Coding such transcripts provides rich data regarding the content and nature of the discussions that take place. However, understanding the content of a message is not limited to the actual message itself. An electronic message is sent either in response to or to start a discussion thread. Examining the entry point of a new message can help to clarify the dynamics of the community discussion. Electronic discussions do not appear to follow traditional conversational norms. New messages may be immediate responses or they can be responses to messages posted over a longer period of time in the past. However, by graphically mapping electronic discussions, a clearer understanding of the dynamics of electronic discussions can be achieved. This article presents the findings of a study that was conducted on three online communities for teachers. The transcripts of electronic discussions were collected and examined via conversational analysis. These messages were then analysed via graphical mapping and the findings concluded that three distinct patterns exist which electronic discussions may follow. It was further discovered that each of these patterns was indicative of a distinct type of electronic discussion. The findings from this study offer further insight into the nature of online discussions and help us to understand online conversational dynamics.
A Chicken in Every Pot; One Laptop per Child: The Trouble with Global Campaign Promises
Authors: Tabb Linda Smith
Published: November 2008

The object of this article is to analyse the possible viability of the global education project One Laptop per Child (OLPC), and to trace some of the recent events impacting the project. The XO laptop, a unique machine, has itself become an iconic symbol. Its impact as a cultural product in a global market that targets the transformation of primary education in the developing world is examined. This article also looks at the larger issue of information and communication technology and its use in development (ICT4D). Intellectual property rights in the global context, the workings of global governance structures, the future of Net neutrality, and the use of open source software vs. proprietary software could each have a lasting impact on this project. This article also takes a view of the project from an educational policy perspective, looking at issues of global convergence of policies and practice.
Leptin Predicts Diabetes but Not Cardiovascular Disease
Authors: Welsh Paul , Murray Heather M. , Buckley Brendan M. , de Craen Anton J.M. , Ford Ian , Jukema J. Wouter , Macfarlane Peter W. , Packard Chris J. , Stott David J. , Westendorp Rudi G.J. , Shepherd James , Sattar Naveed
Published: November 2008

OBJECTIVE—To clarify the association of circulating levels of leptin with risk for cardiovascular disease (CVD) events and new-onset diabetes in men and women.

RESEARCH DESIGN AND METHODS—We related baseline leptin levels to CVD events (n = 864) and incident diabetes (n = 289) in an elderly population (n = 5,672) over 3.2 years of follow-up.

RESULTS—In treatment-, age-, and country-adjusted models, leptin was not associated with risk of CVD in men (hazard ratio 1.02 [95% CI 0.90–1.16] per unit log-leptin increase) or women (1.05 [0.91–1.20]) but was associated with risk of diabetes in men (2.75 [2.14–3.52]) and women (1.54 [1.22–1.94]). After adjusting for classic risk factors and BMI, C-reactive protein, and glucose, the diabetes association retained significance in men (1.85 [1.30–2.63]) but not in women (0.89 [0.64–1.26]).

CONCLUSIONS—Leptin, similar to other markers of adiposity in general, is more strongly related to risk of diabetes than CVD in the elderly.
Heterogeneity of Patients With Latent Autoimmune Diabetes in Adults: Linkage to Autoimmunity Is Apparent Only in Those With Perceived Need for Insulin Treatment
Authors: Radtke Maria A. , Midthjell Kristian , Nilsen Tom I. Lund , Grill Valdemar
Published: November 2008

OBJECTIVE—Subjects with the diagnosis of latent autoimmune diabetes in adults (LADA) are more prone to need insulin treatment than those with type 2 diabetes. However, not all patients with LADA develop the need for insulin treatment, indicating the heterogeneity of LADA. We investigated this heterogeneity by comparing phenotypes of LADA with and without perceived need for insulin treatment (data obtained at times when diagnosis of LADA was not investigated) and also compared LADA and type 2 diabetes phenotypes.

RESEARCH DESIGN AND METHODS—We used data from the all population–based Nord-Trøndelag Health study (n = 64,931), performed in 1995–1997. Data were assembled for individuals with LADA (n = 106) and type 2 diabetes (n = 943).

RESULTS—In the comparison of individuals with LADA both with and without the need for insulin, insulin-treated subjects had higher titers of GAD antibodies (P < 0.001) and lower fasting C-peptide levels (P < 0.001). GAD antibodies and C-peptide correlated negatively (r = −0.40; P = 0.009). In the comparison of individuals with LADA and type 2 diabetes, all without the need for insulin, markers of metabolic syndrome were equally prevalent and pronounced. Age, C-peptide, and glucose levels were also similar. In the comparison of insulin-treated individuals with LADA and type 2 diabetes, more patients with LADA received insulin (40 vs. 22%, P < 0.001) and C-peptide levels were lower (P < 0.001). Patients with LADA were leaner but were still overweight (mean BMI 28.7 vs. 30.9 kg/m2 in type 2 diabetes, P < 0.001). In the comparison of type 2 diabetic patients with and without insulin, insulin-treated subjects were more obese and had higher A1C and lower C-peptide levels (P < 0.001).

CONCLUSIONS—Our conclusions are that 1) the need for insulin treatment in LADA is linked to the degree of autoimmunity and β-cell failure, 2) subjects with LADA and type 2 diabetes without the need for insulin treatment are phenotypically similar, and 3) insulin treatment in type 2 diabetic patients is associated with both insulin resistance and β-cell insufficiency.
Guidelines for the Treatment of Depression in Young People
Authors: Rey Joseph M.
Published: November 2008

The National Health and Medical Research Council (NH&MRC) has recently published clinical practice guidelines for the management of depression in young people [1]. The objective of the guidelines is clearly stated by Professor Smallwood, Chairman of the NH&MRC, in the foreword: not only to assist practitioners to make decisions about appropriate health care for specific clinical circumstances, but also to assist consumers by providing them with comprehensive information about choices available in their treatment. The guidelines are of relevance to most psychiatrists. Since I was the College nominee in the Working Group, I think it is worthwhile informing my colleagues of these developments. However, these are my opinions and do not represent the views of the College, the Working Group or the NH&MRC.
Back on the Chain Gang
Authors: Ryan Christopher James
Published: November 2008

In the last three years three versions of this letter have passed across my desk. On each occasion the letters were written by a friend and colleague. Attached to each letter were ten or twelve typed pages each bearing the names and addresses often other doctors, all of whom had apparently received the letter earlier
The Imperative of the Redevelopment of Patient Record Systems for use in Mental Health Services
Authors: Callaly Tom , Hollis Graeme , Hantzand Paul , Faulkner Peter
Published: November 2008

The major reorganisational tasks which confront mental health services over the next few years are clear. Each service must adopt a comprehensive case or care management system which ensures continuity of care and develops systems which support continuous quality monitoring and clinical effectiveness including the production and implementation of evidence-based clinical guidelines, clinical outcomes measurement and cost effective delivery of care. This will demand realtime monitoring of clinical, utilisation and cost data. Although there is now a veritable avalanche of material in the literature on the development of computerised information systems, particularly in relation to management information and also on the need for focusing on outcomes measurement, we can find little by way of descriptions or advice on the development of patient records to complement these challenees.
An Historical Account of the Development of a Patient Record System for use in a Mental Health Service
Authors: Callaly Tom , Hollis Graeme , Hantz Paul , Faulkner Peter
Published: November 2008

Elsewhere, we have argued for the need to redesign patient records in psychiatric services [1] this paper we describe the process and result of the redesign of the patient record system in the Division of Psychiatry in Geelong, Victoria, and which may be Of interest to many who are embarking on or are currently engaged in a similar exercise. We could find little practical advice in available literature to assist.
A Community-Based Consultation Program for Managing Sexually Abused Young Persons
Authors: Jaworowski Sol
Published: November 2008

The author has been involved in running a training workshop for Department of Education staff on responding to suspected disclosures of sexual abuse. Many participants indicated that they felt uninformed and marginalised when dealing with other services in the community. A pilot study is under way whereby an experienced Student Welfare Coordinator acts as a contact person for accessing Department of Education requests for informal consultation regarding suspected sexual abuse in the region. A second workshop is currently being planned for workers from Protective Services and Child and Mental Health Services.
Telemedicine user Network: A Call for Interested Participants
Authors: Hawker Fiona
Published: November 2008

Telemedicine, or the use of telecommunication technologies for the delivery of medical services, has been receiving increasing attention as a possible answer to the tyranny of distance and the scarcity of specialist resources in rural and remote Australia [1,2]. While internationally teleradiology and teledermatology are the most frequent users of the technology, in Australia it is psychiatry that has been quick to recognise the potential of telemedicine and to use it for the delivery of specialist psychiatric support. In Australia telepsychiatry is one of the most common forms of telemedicine with some of the most established and successful tele-psychiatry programmes in the world.