With large funding increases planned for the next five years, England's National Health Service (NHS) has embarked on an ambitious program of system reform. This paper considers the main reform strategies now being deployed and assesses three potentially competing assumptions underpinning them. The first implies that improvement mainly requires a sufficient supply of health professionals, properly supported. The second advocates more hierarchical control to offset self-interested provider behavior, and the third stresses the role of local incentives and accountability. How these reforms play out over the next five years will determine the future shape of English health care.
The applicability of laparoscopic donor nephrectomy (LDN) has not been assessed in the obese donor. We hypothesized that obesity is not a technical contraindication to LDN. From May 1998 to February 1999, 40 patients underwent LDN at the Georgetown Transplant Institute with the transperitoneal technique. Prophylaxis against deep venous thrombosis consisted of venous compression stockings, low-molecular weight heparin in obese patients, and early ambulation. The following variables were examined: donor sex, age, weight, height, related versus nonrelated donation, body mass index (BMI; wt/ht2), operating room time, estimated blood loss, length of stay, time out of work, and complications. BMI>31 indicates morbid obesity, BMI>27 indicates >20% over ideal body weight, and normal BMI is 25. The patients were divided into nonobese (BMI< or =31) and obese groups (BMI>31). The two groups do not differ in outcome after LDN. Our data indicate that obesity is not associated with increased morbidity or mortality after LDN.
The cristobalite or-13 inversion has been studied using DSC on cristobalites produced by firing high purity quartz with and without addition of a mineraliser. If no mineraliser was used, the inversion temperatures and hysteresis on heating and cooling increased with firing temperature. Firing time had little or no effect on inversion temperature. When a mineraliser was used, the same general trend was observed with increases in firing time at low temperatures leading to splitting of the inversion peak. The amount of mineraliser added had little effect. Tridymite inversions were also observed. The results are explained in terms of the degree of order of the cristobalite structure.
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