bluuebunny/crossref_metadata_2025 huggingface dataset:
Stereotactic radiosurgery alone versus resection plus whole‐brain radiotherapy for 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients
Authors: Rades Dirk , Bohlen Guenther , Pluemer Andre , Veninga Theo , Hanssens Patrick , Dunst Juergen , Schild Steven E.
Published: May 2007

BACKGROUND.

The objective of this study was to compare stereotactic radiosurgery (SRS) alone with resection plus whole‐brain radiotherapy (WBRT) for the treatment of patients in recursive partitioning analysis (RPA) class 1 and 2 who had 1 or 2 brain metastases.

METHODS.

Two hundred six patients in RPA class 1 and 2 who had 1 or 2 brain metastases were analyzed retrospectively. Patients in Group A (n = 94) received from 18 grays (Gy) to 25 Gy SRS, and patients in Group B (n = 112) underwent resection of their metastases and received 10 × 3 Gy/20 × 2 Gy WBRT. Eight other potential prognostic factors were evaluated regarding overall survival (OS), brain control (BC), and local control (LC) of treated metastases: age, sex, performance status, tumor type, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment of brain metastases.

RESULTS.

A comparison of the 2 treatment groups did not reveal significantly different OS (P = .19), BC (P = .52), or LC (P = .25). In RPA subgroup analyses, outcome also did not differ significantly for either RPA class of patients (P values from .21 to .83). On multivariate analysis, improved OS was associated with age ≤60 years (relative risk [RR], 1.75; P = .002), better performance status (RR, 1.67; P = .015), no extracranial metastases (RR, 2.84; P < .001), interval from tumor diagnosis to treatment >12 months (RR, 1.70; P = .003), and RPA class 1 (RR, 1.51; P = .016). Improved BC was associated with a single metastasis (RR, 1.54; P = .034) and an interval from tumor diagnosis to treatment >12 months (RR, 1.58; P = .019), and improved LC was associated with an interval from tumor diagnosis to treatment >12 months (RR, 1.59; P = .047).

CONCLUSIONS.

SRS alone appeared to be as effective as resection plus WBRT in the treatment of 1 or 2 brain metastases for patients in RPA class 1 and 2. Patient outcomes were associated with age, Karnofsky performance status, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment. Cancer 2007. © 2007 American Cancer Society.
Universal current‐mode filters and parasitic impedance effects on the filter performances
Authors: Yuce Erkan , Minaei Shahram
Published: May 2007

In this letter, two universal current‐mode (CM) filters for simultaneously realizing low‐pass, band‐pass and high‐pass characteristics are proposed. Both of the presented filters can also realize notch and all‐pass responses with interconnection of the relevant output currents. They employ second‐generation current‐controlled conveyors (CCCIIs) and only grounded capacitors. They also have low active and passive element sensitivities along with electronically adjustable angular resonance frequency (ω0) and quality factor (Q). Based on the first developed filter, the parasitic impedance effects of the conveyors on the filter performances are investigated in detail. Simulation results using SPICE simulation program are included to verify the theory. Copyright © 2007 John Wiley & Sons, Ltd.
Severe interference between retinal angiography and automated four‐color flow cytometry analysis of blood mononuclear cells
Authors: Bürgisser Philippe , Vaudaux Jean , Bart Pierre‐Alexandre
Published: May 2007

Background:

Retinal angiography has become a widely used diagnostic tool. It requires the intravenous administration of the fluorescent dyes fluorescein and indocyanin green. We recently received blood taken 8 h after retinal angiography, without our knowing it. We describe the failure of an automated flow cytometry system in the enumeration of lymphocyte subpopulations in this sample.

Methods:

Cell enumeration was achieved by the use of the lyse‐no wash MultiTEST procedure (Becton‐Dickinson) together with the FACSCalibur cytometer. Absolute cell counts were obtained using TruCount beads. Data were analyzed automatically by the MultiSET and manually with the CellQuest softwares.

Results:

The dot plots obtained with this sample looked quite abnormal. All monuclear cells stained brightly in the FITC channel irrespective of anti‐CD3‐FITC conjugate binding. This resulted in a major undercompensation for the increased spillover of the fluorescein emission into the PE‐channel. PE‐labeled cell and TruCount bead events coalesced. The MultiSET software failed to draw proper gatings and proved useless. Alternative manual gatings could partially rescue the analysis.

Conclusions:

Clinicians and cytometrists should be aware that, because of dye entry or binding, blood mononuclear cells collected shortly after retinal angiography are not suitable even for common cytometry applications. © 2007 International Society for Analytical Cytology.
Structures of the b‐ and d‐Acid Derivatives of Vitamin B12 and Their Complexes with [M(CO)3]+ (M = 99mTc, Re)
Authors: Spingler Bernhard , Mundwiler Stefan , Ruiz‐Sánchez Pilar , van Staveren Dave R. , Alberto Roger
Published: May 2007

The acid hydrolysis of natural vitamin B12 yields several products in which the acetamide or propionamide side chains on the corrin framework are converted into the corresponding acids. These acids can be derivatised with further functionalities. We have separated in particular the b‐ and the d‐acid derivatives 1 and 2, respectively, since functionalisation at these positions of the corrin ring generally keeps the affinity for vitamin B12 transport proteins intact. Although the authenticity of 1 and 2 seemed evident from 1H NMR investigations, it has not been supported by X‐ray structure analysis. The coupling of ethyl N‐(3‐aminopropyl)‐N‐(pyridin‐2‐ylmethyl)glycinate (3) to the carboxylate groups in 1 and 2 by peptide synthetic methods gave the vitamin B12 derivatives 4 and 5, respectively. The structures of 4 and 5 could be characterised by X‐ray analysis, which unambiguously confirmed the presence of the b‐ and d‐acid in 1 and 2, respectively. The reaction of 4 and 5 with the complex [Re(OH2)3(CO)3]+ in water gave the corresponding vitamin B12 derivatives 8 and 9, and the aqueous reaction of 4 and 5 with the complex [99mTc(OH2)3(CO)3]+ afforded the 99mTc homologues 10 and 11, respectively.(© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)
The Role of Water in the Stereoselective Hydrogenation of 1,2‐Diphenylacetylene Catalyzed by the Water‐Soluble [{RuCl2(mtppms)2}2]
Authors: Kovács Gábor , Ujaque Gregori , Lledós Agustí , Joó Ferenc
Published: May 2007

Density functional theory with dielectric continuum models was applied to describe the reaction mechanism of thestereoselective hydrogenation of phenyl‐substituted alkynes with the water‐soluble ruthenium complex [{RuCl2(mtppms)2}2] mtppms [(meta‐sulfonatophenyl)diphenylphosphane] in acidic aqueous solutions. The water solvent is modelled by the inclusion of a small cluster of three water molecules in addition to a continuum model. The possible reaction mechanisms leading to the formation of the different (Z and E) stereoisomers are computationally evaluated. It was shown that the reaction takes place in two steps; one hydrogen comes from the hydrido complex, whereas the second hydrogen is transferred from the hydroxonium ions present in the solution. The formation of the different stereoisomers is determined by the order of the two hydrogenation steps, and the analysis suggests that the formation of the (Z)‐isomer is more favourable, which is consistent with the experimental results. (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)
Inter‐ and Intramolecular Electron Transfer in Modified Azurin Dimers
Authors: de Jongh Thyra E. , Hoffmann Maren , Einsle Oliver , Cavazzini Davide , Rossi Gian‐Luigi , Ubbink Marcellus , Canters Gerard W.
Published: May 2007

A dimer of N42C azurin (P. aeruginosa), formed by intermolecular disulfide bond formation between the introduced surface‐exposed cysteine residues, was previously shown to exhibit low rates of intramolecular electron self‐exchange. The work presented here aims to render the construct sensitive to pH by the introduction of an additional surface mutation (M64E). The structural and mechanistic effects of ionisable residues in the hydrophobic patch were analysed as a function of pH. A crystal structure of the dimer at pH = 3.1, solved to 2.3 Å resolution, displays an orientation distinct from other known azurin complexes. The dimer exhibits slow intramolecular self‐exchange at pH* = 4.5 (keseintra ≈ 25 s–1), in line with the Cu–Cu distance of 20.5 Å observed in the crystal structure of the dimer. The intermolecular electron self‐exchange rate constant amounts to kinter = (1.8 ± 0.1) ×104 M–1 s–1. Thus, at protein concentrations less than 1 mm, the intramolecular process dominates the electron self‐exchange. A change from low to high pH results in a slowing down of the electron‐exchange processes. A partitioning between intra‐ and intermolecular exchange proved impossible at low pH due to the limited precision of the experimental data. (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)
Conformational Analysis of One‐Dimensional Coordination Polymers Based on [Cp2Cr2(CO)4(μ,η2‐P2)] by Solid‐State Multinuclear NMR Spectroscopy and Density Functional Calculations
Authors: Scheer Manfred , Gregoriades Laurence J. , Zabel Manfred , Sierka Marek , Zhang Long , Eckert Hellmut
Published: May 2007

Reaction of the complex [Cp2Cr2(CO)4(μ,η2‐P2)] (2) with copper(I) halides leads to the quantitative formation of the new one‐dimensional (1D) linear polymers [CuX{Cp2Cr2(CO)4(μ,η2:η1:η1‐P2)}]n [X = Cl (3), Br (4), I (5)]. Polymers 3–5 are the first examples of supramolecular aggregates incorporating 2 as a connecting moiety. The solid‐state structures of 3–5 are compared and their remarkable influence on the respective solid‐state 31P magic angle spinning (MAS) NMR spectra is interpreted with the help of density functional theory (DFT) calculations, which suggest that the 31P chemical shifts are extremely sensitive to the position of the phosphorus atoms with respect to the cones of anisotropy of the carbonyl ligands. (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)
Synthesis, Spectroscopic and Structural Systematics of Complexes of Germanium(IV) Halides (GeX4, X = F, Cl, Br or I) with Phosphane Oxides and Related Oxygen Donor Ligands
Authors: Cheng Fei , Davis Martin F. , Hector Andrew L. , Levason William , Reid Gillian , Webster Michael , Zhang Wenjian
Published: May 2007

The first series of phosphane oxide complexes of germanium(IV) halides have been prepared, including trans‐[GeF4(R3PO)2] (R = Me, Et or Ph), trans‐[GeCl4(Et3PO)2], fac‐[GeCl3(Me3PO)3]2[GeCl6] and cis‐[GeX2(Me3PO)4]X2 (X = Cl or Br) and characterised by IR and multinuclear NMR (1H, 19F{1H} and 31P{1H}) spectroscopy. Crystal structures of all the above (except trans‐[GeCl4(Et3PO)2]) are described. Remarkably, under mild conditions Me3PO displaces halide ligands from GeX4 (X = Cl, Br) to form the cationic species above. Ph3AsO forms trans‐[GeF4(Ph3AsO)2], but reaction of Ph3AsO or Me3AsO with GeCl4 leads to the corresponding R3AsCl2. The complexes [GeF4(MeCN)2], [GeF4(thf)2] and [GeF4(MeOCH2CH2OMe)] are also described and the relative Lewis acidities of GeX4 established. (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)
Development of an integrated approach for evaluation of 2‐D gel image analysis: Impact of multiple proteins in single spots on comparative proteomics in conventional 2‐D gel/MALDI workflow
Authors: Yang Yong , Thannhauser Theodore W. , Li Li , Zhang Sheng
Published: May 2007

With 2‐D gel mapping, it is often observed that essentially identical proteins migrate to different positions in the gel, while some seemingly well‐resolved protein spots consist of multiple proteins. These observations can undermine the validity of gel‐based comparative proteomic studies. Through a comparison of protein identifications using direct MALDI‐TOF/TOF and LC‐ESI‐MS/MS analyses of 2‐D gel separated proteins from cauliflower florets, we have developed an integrated approach to improve the accuracy and reliability of comparative 2‐D electrophoresis. From 46 spots of interest, we identified 51 proteins by MALDI‐TOF/TOF analysis and 108 proteins by LC‐ESI‐MS/MS. The results indicate that 75% of the analyzed spots contained multiple proteins. A comparison of hit rank for protein identifications showed that 37 out of 43 spots identified by MALDI matched the top‐ranked hit from the ESI‐MS/MS. By using the exponentially modified protein abundance index (emPAI) to determine the abundance of the individual component proteins for the spots containing multiple proteins, we found that the top‐hit proteins from 40 out of 43 spots identified by MALDI matched the most abundant proteins determined by LC‐MS/MS. Furthermore, our 2‐D‐GeLC‐MS/MS results show that the top‐hit proteins in 44 identified spots contributed on average 81% of the spots' staining intensity. This is the first quantitative measurement of the average rate of false assignment for direct MALDI analysis of 2‐D gel spots using a new integrated workflow (2‐D gel imaging, “2‐D GeLC‐MS/MS”, and emPAI analysis). Here, the new approach is proposed as an alternative to traditional gel‐based quantitative proteomics studies.
Global analysis of dynamic changes in lipid raft proteins during T‐cell activation
Authors: Kobayashi Michimoto , Katagiri Takuya , Kosako Hidetaka , Iida Naoyuki , Hattori Seisuke
Published: May 2007

Lipid rafts are considered as specialized microdomains within the plasma membrane with unique lipid compositions different from surrounding membranes. Following T‐cell receptor (TCR) stimulation, lipid rafts assemble in T‐cell/antigen‐presenting cell (APC) contact site known as the immunological synapse, inner leaflets of which serve as activation or docking sites for downstream signaling components. To understand the signaling events occurring in lipid rafts, we globally analyzed dynamic changes in lipid raft proteins during TCR/CD28 costimulation using 2‐D fluorescence difference gel electrophoresis. We detected multiple spots whose intensities were enhanced after costimulation, and identified proteins in these spots by PMF. Identified proteins include Src family tyrosine kinases, tyrosine phosphatase, phosphatidylinositol 3‐kinase (PI3‐kinase), actin‐binding proteins, and regulators for small GTPases. Of particular interest, a number of pleckstrin homology (PH) domain‐containing proteins were identified. Biochemical and histochemical analyses confirmed the translocation of these proteins from cytosol to lipid rafts. We also demonstrated that these proteins assembled at the T‐cell/APC interface. These results indicate the efficacy of our system to systematically analyze dynamics of lipid raft proteins during extracellular stimulation.
Separable approximations of space‐time covariance matrices
Authors: Genton Marc G.
Published: May 2007

Statistical modeling of space‐time data has often been based on separable covariance functions, that is, covariances that can be written as a product of a purely spatial covariance and a purely temporal covariance. The main reason is that the structure of separable covariances dramatically reduces the number of parameters in the covariance matrix and thus facilitates computational procedures for large space‐time data sets. In this paper, we discuss separable approximations of nonseparable space‐time covariance matrices. Specifically, we describe the nearest Kronecker product approximation, in the Frobenius norm, of a space‐time covariance matrix. The algorithm is simple to implement and the solution preserves properties of the space‐time covariance matrix, such as symmetry, positive definiteness, and other structures. The separable approximation allows for fast kriging of large space‐time data sets. We present several illustrative examples based on an application to data of Irish wind speeds, showing that only small differences in prediction error arise while computational savings for large data sets can be obtained. Copyright © 2007 John Wiley & Sons, Ltd.
Simple statistical structure in time series for daily air flow characteristics
Authors: Post Piia , Kärner Olavi
Published: May 2007

The structure function is used for quantifying of non‐stationarity in time series for certain daily air flow characteristics (DAFC). The National Center for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) reanalysis 30 year (1968–97) dataset given over 5° × 10° latitude longitude grid is used to calculate the DAFC series for the Baltic Sea region. The quantification on the basis of the Hurst exponent H enables us to discriminate between the strong synoptic scale non‐stationarity and a mild large‐scale one. Presented examples show that the change of H is accompanied by a change of the distribution for the series' increments. Long‐range increments for various DAFC appear to be approximately normally distributed with approximately constant variance independent of the increment length over a remarkably wide range. The property might be useful in describing a long‐range variability of the air flow characteristics. Copyright © 2007 John Wiley & Sons, Ltd.
A seismic retrofit method by connecting viscous dampers for microelectronics factories
Authors: Hwang Jenn‐Shin , Wang Shiang‐Jung , Huang Yin‐Nan , Chen Jay‐Fu
Published: May 2007

The implementation of viscous dampers to microelectronics factories has been previously proved not to affect the micro‐vibration of the factories in operation so that the vibration‐sensitive manufacturing process will not be interfered. Therefore, a seismic retrofit strategy which employs the viscous dampers installed in between the exterior and interior structures of the ‘fab’ structure is proposed in the study. The design formulas corresponding to the proposed retrofit method are derived using the non‐proportional damping theory. Based on the study, it is found that the added damping ratio to the fab structure depends greatly on the frequency ratio of the two structures in addition to the damping coefficients of the added dampers. Outside the bandwidth of the frequency ratio in which the added damping ratio is very sensitive to the variation of the frequency ratio, the added damping ratio can be well captured using the classical damping theory. Copyright © 2007 John Wiley & Sons, Ltd.
Simplified probabilistic seismic performance assessment of plan‐asymmetric buildings
Authors: Dolšek Matjaž , Fajfar Peter
Published: May 2007

A relatively simple approach for the probabilistic seismic performance assessment of plan‐asymmetric structures has been proposed. It is based on the PEER probabilistic framework, in which the most demanding part, i.e. the incremental dynamic analysis (IDA), is replaced by the much simpler Incremental N2 (IN2) analysis. Predetermined default values for dispersion measures are needed for the practical implementation of this approach, which can be used for the analysis of plan‐asymmetric buildings requiring a 3D structural model. In this paper, this simplified approach is summarized. Its application is demonstrated by means of an example of a three‐storey reinforced concrete frame (SPEAR) building. The results are compared with the results of a more accurate approach, based on IDA. The test example demonstrates the viability of the proposed approach. Copyright © 2007 John Wiley & Sons, Ltd.
Kinetic meshless method for compressible flows
Authors: Praveen C. , Deshpande S. M.
Published: May 2007

We present a grid‐free or meshless approximation called the kinetic meshless method (KMM), for the numerical solution of hyperbolic conservation laws that can be obtained by taking moments of a Boltzmann‐type transport equation. The meshless formulation requires the domain discretization to have very little topological information; a distribution of points in the domain together with local connectivity information is sufficient. For each node, the connectivity consists of a set of nearby nodes which are used to evaluate the spatial derivatives appearing in the conservation law. The derivatives are obtained using a modified form of the least‐squares approximation. The method is applied to the Euler equations for inviscid flow and results are presented for some 2‐D problems. The ability of the new scheme to accurately compute inviscid flows is clearly demonstrated, including good shock capturing ability. Comparisons with other grid‐free methods are made showing some advantages of the current approach. Copyright © 2007 John Wiley & Sons, Ltd.
Ascertainment correction for Markov chain Monte Carlo segregation and linkage analysis of a quantitative trait
Authors: Ma Jianzhong , Amos Christopher I. , Warwick Daw E.
Published: May 2007

Although extended pedigrees are often sampled through probands with extreme levels of a quantitative trait, Markov chain Monte Carlo (MCMC) methods for segregation and linkage analysis have not been able to perform ascertainment corrections. Further, the extent to which ascertainment of pedigrees leads to biases in the estimation of segregation and linkage parameters has not been previously studied for MCMC procedures. In this paper, we studied these issues with a Bayesian MCMC approach for joint segregation and linkage analysis, as implemented in the package Loki. We first simulated pedigrees ascertained through individuals with extreme values of a quantitative trait in spirit of the sequential sampling theory of Cannings and Thompson [Cannings and Thompson [1977] Clin. Genet. 12:208–212]. Using our simulated data, we detected no bias in estimates of the trait locus location. However, in addition to allele frequencies, when the ascertainment threshold was higher than or close to the true value of the highest genotypic mean, bias was also found in the estimation of this parameter. When there were multiple trait loci, this bias destroyed the additivity of the effects of the trait loci, and caused biases in the estimation all genotypic means when a purely additive model was used for analyzing the data. To account for pedigree ascertainment with sequential sampling, we developed a Bayesian ascertainment approach and implemented Metropolis‐Hastings updates in the MCMC samplers used in Loki. Ascertainment correction greatly reduced biases in parameter estimates. Our method is designed for multiple, but a fixed number of trait loci. Genet. Epidemiol. 2007. © 2007 Wiley‐Liss, Inc.
Incorporating covariates in mapping heterogeneous traits: a hierarchical model using empirical Bayes estimation
Authors: Biswas Swati , Lin Shili
Published: May 2007

Complex genetic traits are inherently heterogeneous, i.e., they may be caused by different genes, or non‐genetic factors, in different individuals. So, for mapping genes responsible for these diseases using linkage analysis, heterogeneity must be accounted for in the model. Heterogeneity across different families can be modeled using a mixture distribution by letting each family have its own heterogeneity parameter denoting the probability that its disease‐causing gene is linked to the marker map under consideration. A substantial gain in power is expected if covariates that can discriminate between the families of linked and unlinked types are incorporated in this modeling framework. To this end, we propose a hierarchical Bayesian model, in which the families are grouped according to various (categorized) levels of covariate(s). The heterogeneity parameters of families within each group are assigned a common prior, whose parameters are further assigned hyper‐priors. The hyper‐parameters are obtained by utilizing the empirical Bayes estimates. We also address related issues such as evaluating whether the covariate(s) under consideration are informative and grouping of families. We compare the proposed approach with one that does not utilize covariates and show that our approach leads to considerable gains in power to detect linkage and in precision of interval estimates through various simulation scenarios. An application to the asthma datasets of Genetic Analysis Workshop 12 also illustrates this gain in a real data analysis. Additionally, we compare the performances of microsatellite markers and single nucleotide polymorphisms for our approach and find that the latter clearly outperforms the former. Genet. Epidemiol. 2007. © 2007 Wiley‐Liss, Inc.
Cost analysis as a management tool for improving the efficiency of primary care: Some examples from Java
Authors: Berman Peter
Published: May 2007

Health programs in developing countries increasingly face limited or even reduced budgets. More and better services might be produced from these resources by improving efficiency through better management and program design. Cost analysis at individual health units can help identify sources of inefficiency, and provide guidance to managers as to where they can achieve important gains in productivity. This paper presents several examples from health centers and sub‐centers in rural Java, Indonesia, showing how inefficiencies in staffing patterns, personnel management, and drug management can affect cost‐efficiency. Routine analysis of cost data could provide the basis for management incentives to local health units to increase both outputs and quality of care.
The role of non‐governmental organizations and the private sector in the provision of health care in developing countries
Authors: Green Andrew
Published: May 2007

A major component of total hzalth care in many developing countries is that provided by organizations outside the state sector. Analysis of the relationships between the state and non‐state sectors and explicit government policies towards the non‐state sector have, however, often been neglected. Within many developing countries, there is heterogeneity rather than homogeneity within the non‐state sector, making the task of developing consistent and workable policies difficult. In order for such policies to be developed, a clear understanding of the characteristics and roles of the various non‐governmental and private health care providers is needed. This, in turn, requires the development of analytical tools and evaluative criteria. This article outlines and discusses issues requiring consideration in the formulation of policies, and sets a preliminary agenda for research action.
Consumer payment patterns for primary health care services in low‐income communities of Rio De Janeiro: Implications for designing service financing schemes
Authors: Lassner Karen Johnson , Parker Barnett R.
Published: May 2007

Primary health care (PHC) services are now recognized as a mainstay of development in low‐income regions of the world. Yet, in many of these areas, economic conditions that include a burgeoning international debt, precipitous drops in the prices of raw materials, expanding population bases, and faltering currency rates, make the effective financing of PHC services an issue requiring the most immediate attention.

A potentially valuable source of assistance in such endeavors is data on consumers' payment patterns for PHC services, and on socioeconomic conditions within their communities. The Centro de Pesquisas de Assistěncia Integrada à Mulher e à Criança (CPAIMC), the principal private source of PHC in Rio de Janeiro, has collected these type of data for nine low‐income communities (LICs) within the Greater Rio de Janeiro Metropolitan Region. The current paper interfaces these data with previously developed solutions to address the problem of financing PHC services within the nine LICs. The solutions were recommended by a methodology developed and implemented by two of the authors. Results indicate that the consumer payment pattern and socioeconomic data support the methodology's recommendations and, more importantly, may be used to improve the effectiveness of those recommendations. Examples are provided and implications discussed.
Equity in health care; Experiences from Sweden
Authors: Borcenhammer Edgar
Published: May 2007

Mortality figures for Sweden, and for expectation of life, match and in many cases better those of other developed countries of the world. At the same time, there is no doubt that there are many inequalities existing in Sweden which such figures disguise. The ideals of achieving good health, and care on equal terms, for the whole population are fine, but the realities are some distance from their achievement. Care on equal terms must be a urgent political goal: but, the contents of that goal must be specified more clearly. Despite all the good already achieved, the article suggests some of the key areas in which political action and rethinking are now necessary.
Selective intervention in primary health care: Planning and practical implications in Nigeria
Authors: Egwu Igb O. N.
Published: May 2007

The global goal of Health‐For‐All is an ideal: yet, its planning and implementation could be enhanced through the application of the concept of selective primary health care. The strategy advocates the selection of certain priority components of primary health care (PHC) as entry‐points. This would match with the sub‐objectives of removing technological, economic and developmental constraints. A model which illustrates the three levels of prevention — primary, secondary, and tertiary, is offered. The application of the model to Primary Health Care, coupled with practical examples in the field, and their relevance to health development in Nigeria, are examined.
Escaping from the dual organization: Physician self‐governance
Authors: Tap Henk J. , Schut Frederik T.
Published: May 2007

This article discusses a way of coping, in a time of limited resources, with the dual organization problem in hospitals. First, the historical roots of the dual organization problem are analysed. It is ascertained that the power structure within the hospital crucially depends on the socioeconomic circumstances and the state of medical knowledge. Since the health care systems of most industrialized countries are in transition from a stage of rapid expansion into a stage of consolidation, new problems arise which cannot be adequately handled within the context of the dual organization structure. The crux of the dual organization problem lies in the separation of the related responsibilities for resource allocation and patient care. Most proposals to solve this problem try to develop models of shared authority, which may be elegant in theory but often raise tremendous problems when implemented in practice. A straightforward solution would be the reunion of both responsibilities under one head, the physician‐executive. It is argued that in a situation of limited funds for medical care, patients, physicians as well as administrators will be best off when physicians become primarily responsible for the resource allocation within the hospital. Some empirical evidence for this supposition is discussed. Finally, attention is paid to the prerequisites for, and implementation of, physician self‐governance.
Primary health care is viable
Authors: Segall Malcolm
Published: May 2007

‘Selective primary health care’ and other recent vertical health strategies have been justified on the grounds that the broad primary health care (PHC) approach cannot be afforded by developing countries in the present constrained economic circumstances. This judgement is too sweeping. A simulated case example is presented, starting with baseline health expenditure data that are representative of the situation in many developing countries. It is assumed that real economic growth occurs and that government funding of health care is allowed to grow in parallel. Two annual growth rates are considered: 2 and 5 per cent. Two restrictive conditions are applied: none of the main health services is subjected to absolute cuts; and, additional funds from existing or new sources of finance are not considered. It is shown that, even with slow growth rates, substantial increases in the funding of priority (rural and PHC) services can be achieved if the growth in expenditures of lower‐priority services is curtailed. Also, savings from improved health service efficiency can be channelled to priority services.

The message is that the PHC approach is viable even with slow economic growth. What is required is the technical capacity to identify and plan resource flows in the health sector, and the political will to effect resource allocations according to PHC priorities. A strategic policy like PHC should not be ‘adjusted’ out of effective existence because of reversible economic problems. Rather, actions should be taken to reverse the adverse economic environment. International health‐related agencies should continue to support countries to develop national health systems based on PHC, and should campaign for reforms in the world economy to create at least the minimum economic conditions necessary for PHC implementation.
Government health insurance and privatization: An examination of the concept and of equity
Authors: Anderson Odin W.
Published: May 2007

After almost a century of the evolution of welfare capitalism in the liberal‐democratic countries, and the spread of government intervention in the financing and provision of health services, the debate is now whether or not government can, or should, be as all‐encompassing as it has clearly become. What is emerging with greater force is a pattern of private insurance and private provision, though its future is not easy to predict. What is clear, however, is that a modified version of a politically acceptable concept of equity will have to be formulated.
Scenarios for health planning and management: The dutch experience
Authors: Schreuder R. F.
Published: May 2007

The processes of health planning and management require a clear insight into: future developments in society at large; the magnitude of disease categories (mortality and morbidity patterns); the rapid developments in medical technology; and, changing concepts of ‘good’ health care delivery systems. In 1983, the Dutch Secretary of Welfare, Health and Cultural Affairs decided to establish a Steering Committee for Future Health Scenarios (STG). The chief task of this Committee is to create alternative pictures of possible futures in the field of public health and health care. These health scenarios are used to increase the anticipatory capability of policymakers and health managers. This paper evaluates the Dutch experience with scenario‐projects on ‘health and ageing’, ‘cardiovascular diseases’, and ‘cancer’.

After a short introduction on the structure of the STG, and the concept of scenarios, the scenario‐projects are described and analysed. The conclusions to date of the projects are mentioned briefly. This article ends with some recommendations, with respect to the methodology of scenarios in the field of health, the structural prerequisites for successful projects, and the communication aspects of these types of studies.
The metamorphosis of health planning in the Netherlands and the USA
Authors: Kirkman‐Liff Bradford L. , Lapre Ruud , Kirkman‐Liff Tracy L.
Published: May 2007

The United States and the Netherlands are the focus for this comparative analysis of the evolutionary interaction between health planning and the political system, seen in the context of change in social and economic ideologies. While health planning in the USA started in 1946, it was the comprehensive health planning program in 1966 that created the form to be followed by Health Systems Agency effort in 1974: local, voluntary planning, coordinated by state agencies, supported by federal funding. Health planning in the Netherlands has moved through four distinct periods: a hospital construction period, starting during the post‐war recovery; a hospital regionalization period, from 1971 through the late 1970s; a transition period from the late 1970s to 1982, during which several planning approaches were considered; and, the current comprehensive health and social services planning period. Today, federal support for health planning in the US has been eliminated as part of the current de‐regulatory, competitive health care strategy. Health planning in the US is now an institutional activity, with less focus on community needs. Advocated changes in the Dutch planning approach incorporate ideas similar to past approaches in the US; but, a failed approach in one nation may work in another, if the underlying cultural and organizational characteristics are sufficiently different.
Epidemiological measures in planning: Observations from Sweden
Authors: Rosén Måns
Published: May 2007

This article reviews how epidemiological measures can be used in health planning. Theoretical considerations are discussed together with empirical data from Sweden. Formulation of targets, priority settings, resource allocation and monitoring systems are some ways in which epidemiological data can improve health planning. One important lesson for planning is that problems related to health, inequalities in health, and access to care, must be made visible to politicians, health personnel and the public. Further, there is a need to complement a national health policy with a decentralized planning system that takes local conditions and needs into consideration.
Who gets what? utilization of health services in Indonesia
Authors: Gish Oscar , Malik Ridwan , Sudharto Paramita
Published: May 2007

An evaluation of health service utilization patterns was carried out in five rural districts and a number of urban areas in Indonesia. The study was part of a larger effort to develop economically‐related information about the health care services. Utilization levels were then related to such selected population variables as distance from health facilities, insurance status and income. The annual contact rate, curative plus preventive, with all public sector facilities was found to be 0.8 per capita. The geographic catchment areas of the facilities were also found to be very limited. The insured population (civil servants and their families) used services about four times more frequently, on average, than did the rest of the population. In one provincial study, the top 9 per cent of income earners made up one‐third of all hospital inpatients, one‐half of all hospital outpatients, and one‐quarter of all health centre visitors. The implications of these results for equity and efficiency are discussed.
Hospital utilization and reimbursement method in Brazil
Authors: Rodrigues Jose
Published: May 2007

Urban private hospital discharges in Brazil increased enormously during the last decade. Several measures were taken in an effort to slow the rate of increase in hospital admissions and the escalation of hospital costs, which were out of control by the end of the last decade. The introduction of a new case‐based reimbursement method, late in 1983, not only contributed to increased hospitalizations, but to changed hospital case mix, as private hospitals shifted from more costly to less costly patients. This occurred especially in the most developed areas of the country, where the concentration of profit‐making hospitals is very high. The case‐based prospective payment method can be seen as a good managerial tool for use in comparing hospital performance. However, it seems not to be a good mechanism for controlling health care expenditures, especially when profit‐making hospitals dominate the provision of hospital care. Any decrease in hospitalization by private hospitals in Brazil has been caused by the severe economic recession, which hit the Brazilian economy hard, and by the shift in hospital admissions from private to public hospitals, not by the introduction of the new reimbursement method which has changed the unit of payment from ‘patient day’ to case or procedure.
A ‘stethoscope’ for the physician manager—conditions for clinical accountability in the nordic setting
Authors: Brommels Mats
Published: May 2007

An increasing interest in requiring clinical accountability, i.e. direct economical and managerial involvement of physicians, can be witnessed in the US and the UK, representing two extremes on the axis of private versus public service provision. The development is also taking place in the Nordic countries alongside a ‘decentralisation’ of financial and managerial decision making to smaller units. The essay discusses possibilities to introduce clinical accountability on the Nordic scene. As a background to the anlaysis, clinical accountability is defined in terms of production targets, budget limits and preset standards of quality of care. Arguments for not using clinical outcome as result measure are presented. The product analogy is suggested as a means for the physician manager to control both clinical policies and resource management. The conclusion is that the possibilities to introduce clinical accountability in the Nordic countries probably are better than in the US or UK, for the following reasons: physician attitudes, interpreted indirectly by shown interest in management training are not unfavourable; the organisational structure with physicians in a line organisation gives the financially accountable Department Head professional as well as managerial authority; management policy stressing decentralisation increases autonomy and stimulates interest to involve in management; product control information is readily available through reliable information systems. Obstacles are also identified. Finally it is argued that the organisation structure found in Nordic countries enables clinical accountability still preserving clinical freedom in the singular doctor patient relation.
Invited review a measure of the effects of competition in the U.S. health care sector during the 1980s
Authors: Parker Barnett R.
Published: May 2007

For some years now, health planning and management efforts have been assigning greater importance to the values and preferences of patients as consumers of health care services. A key objective of this ‘marketing orientation’ has been to effect responsible change in the way health services are designed, priced, advertised, and delivered. Implementation of such a philosophy—inconceivable just a few years ago—was originally motivated by the emergence of competitive market forces in the hospital and health care sector. In the current paper, a perspective on the precursors and facilitating factors that gave rise to these forces is presented. With this perspective, the review of two relevant books, one published at the beginning of the 1980s and one towards the end of the decade, will serve as a measure of the large and increasing impact of competition in the U.S. health care sector during the 1980s.
Medical care and postmodern management
Authors: Huppes Wim , Van Bekkum Dirk W.
Published: May 2007

Because of the persistent influences of modern philosophies of management, health care has suffered from a monomania for economic thinking in a world thought of as a simple, unchanging machine. This form of management fails in the Netherlands, even in its own economic terms. We argue that best management is postmodern management and is inspired by postmodern thinking. It assumes that there is a non‐reducible plurality of forms of life in human society which mostly interact in a powerful and complex way. It, therefore, stresses simplicity and dynamics in structure making. It advocates the principle of freedom, within constraints, for the staff of the medical organization. As a paradigm of new management we suggest the deconstruction of the present piecework payment per activity of doctors: it is static, expensive and fails to control the quality of medical care. Instead, two dynamic structures are suggested consisting of a payment per treated patient, together with the creation of a limited number of teams of highly qualified medical controllers. Both of these measures should improve the quality of health care as well as its cost‐effectiveness.
Best medical practice: Viewpoint of a UK oncologist
Authors: Stoll Basil
Published: May 2007

In a clinician's view, best medical practice has two distinct meanings in a tax‐funded health system: optimal management as expected by the individual patient; or, the best possible within the economic limits dictated by the society. Based on this viewpoint, this article represents an oncologist's perspective on the meaning of best medical practice in the management of patients suffering from cancer, the extent to which it is achieved in the UK health system, and how far some of the present deficiencies may be overcome.

There is urgent need for medical audit in the management of cancer patients in the UK because the traditional clinical freedom of doctors can lead to wide variations in management without corresponding differences in outcome as measured by benefit to the patient. We need consensus by physicians on the guidelines for optimal management of different types of cancer at various stages, both to avoid overtreatment of the individual patient and also to direct scarce resources to their most effective use.

Physicians also need to agree on guidelines for giving priority to one patient over another when resources are limited, and such criteria need to be approved by society at large. The public must accept that in a non‐explicit rationing system, each individual competes with every other. In the case of even more difficult ethical choices, a multidiscip‐linary national committee is required to advise on decision‐making and its views need to be debated by the general public.
The political economy of decentralization of health and social services in Canada
Authors: Tsalikis George
Published: May 2007

A trend to decentralization in Canada's ‘welfare state’ has received support from the Left and from the Right. Some social critics of the Left expect decentralization to result in holistic services adjusted to local needs. Others, moreover, feel we are in the dawn of a new epoch in which major economic transformations are to bring about, through new class alliances and conflict, decentralization of power and a better quality of life in communities. These assumptions and their theoretical pitfalls are discussed here following an historical overview of the centralization/decentralization issue in Canadian social policy. It is argued that recent proposals of decentralization are a continuation of reactionary tendencies to constrain social expenditures, but not a path to better quality of life.
Short communication expenditures on health care in the last year of life
Authors: Nord Erik , Hjort Peter F. , Heiberg Astrid Nøklebye
Published: May 2007

18‐26% of public expenditure on health care is devoted to care of patients in their last year of life. 60% of this expenditure is on patients in somatic nursing homes. The figures do not tell directly whether too much or too little money in Norwegian health care is spent on people in the end stage of life. In order to answer this question, one must look at the quality of terminal care and assess the share of patients having a reasonable benefit of the care they receive.