The purchaser-provider split in NHS care in the United Kingdom and the role of the community dental service in planning

The former purchaser-provider split underwent an important change during the last years in UK. Especially since the new government came into office in 1997 the approach to equity and equality in dental health care has been characterised by two decisions. Firstly, the level of commissioning services was shifted from the centre to so-called natural communities of about 100,000 people. Secondly, the groups responsible for planning and providing care are constituted from local medical practitioners, community nurses and social services representatives, in line with the Regional Health Authority and the national framework "Our Healthier Nation". The new community dental service is expected to be in a better position to improve the situation in areas of social exclusion.     

HLA-DRB1 genes and disease severity in rheumatoid arthritis. The MIRA Trial Group. Minocycline in Rheumatoid Arthritis

OBJECTIVE: To examine the effect of alleles encoding the "shared"/"rheumatoid" epitope on rheumatoid arthritis (RA) disease severity in patients who participated in the minocycline in RA (MIRA) trial. METHODS: Of 205 patients with a week-48 visit, blood was available for typing of HLA-DRB1 and HLA-DQB1 in 174 (85%) and successfully completed in 169 (82%). Baseline erosions were used to assess disease severity and new erosions at the last visit served as a proxy for progression. RESULTS: At baseline, there was no association between the presence of erosive disease or rheumatoid factor status and the dose of rheumatoid epitope (homozygous, heterozygous, none) or the specific alleles identified. At the final visit, a gradient was observed for the 3 allelic subgroups (and their gene doses) in the occurrence of new erosions among the Caucasian placebo-treated, but not the minocycline-treated, patients. A treatment group/HLA-DR4 epitope interaction was demonstrated in multivariate analyses. Approximately two-thirds of African-American patients did not have the rheumatoid epitope. CONCLUSION: HLA-DRB1 oligotyping may be useful in predicting the progression of disease in some Caucasian patients. Our study corroborates the infrequency of the epitope among African-American patients with RA.     

Community resources for clients with mobility problems

Clients are leaving the hospital "quicker and sicker," and they frequently have acute care needs that must be met by resources outside the hospital setting. Community resources are diverse, vary widely from place to place, and have no central administration. Thus, using them can be challenging for both the nurse, client, and family. Reimbursement mechanisms underlie a person's ability to use resources and receive health care. By presenting two actual case scenarios where clients have mobility problems commonly seen by orthopaedic nurses, the authors discuss the community resources available, avenues of access to them, and their reimbursement mechanisms.     

基于MPLS的IPTV QoS研究

MPLS(Multi-Protocol Label Switch)和服务质量(QoS)是与下一代网络相关的重要技术.作者首先介绍了QoS的两种模型:综合服务(IntServ)和区分服务(DiffServ)模型,然后描述了基于MPLS网络的DiffServ模型的实现.文中介绍了网络电视(IPTV)系统的组成和存在的问题,并提出了一个基于MPLS的QoS区分服务模型改进方案.     

The removal of arsenic from （ground）-water by adsorbent loaded in polymeric microspheres

Arsenic is a natural tasteless and odourless element,existing in the earth’s crust at average levels of between two and five thousands micrograms per liter (parts per million) . Arsenic is highly toxic to humans, who are exposed to it primarily from air,food and water. The occurrence of arsenic in groundwater is due to geological composition of soil. High concentrations of arsenic in water are the result of dissolution or desorption of ferric oxides and the oxidation of mineral arsenopyrites. Arsenic in drinking water has an important impact on the human health,especially in the less developed countries. Different methods exist to remove arsenic from aquatic media,and one of them is by adsorption. In this work,the adsorption of both As(III) and As(V) by means of novel microspheres has been investigated. In particular,TiO2 has been embedded into polymeric microspheres PES (PolyEtherSulphone) and PEEK-WC (PolyEtherEther-Ketone) . The main advantages of this encapsulation adsorption material are: no loss of adsorbents into the water stream,easy to be used and scaled-up.     

Enteropathogenic, enterotoxigenic and enteroinvasive Escherichia coli isolated from acute gastroenteritis patients in Lagos, Nigeria

Enteropathogenic, enterotoxigenic and enteroinvasive Escherichia coli were isolated from 52 (4.8%) of 1,082 patients with acute gastroenteritis reporting at the Lagos University Teaching Hospital, Lagos, Nigeria between October 1979 and March, 1981. Of the 52 strains of E. coli isolated, 35 (67.3%) were enteropathogenic, 12 (23.1%) were enterotoxigenic and five (9.6%) were enteroinvasive. E. coli 0111 (25.7%) was the most predominant among the serotypes of the "classical" enteropathogenic strains found in this study. Diarrhoea associated with enteropathogenic E. coli occurred only in children aged less than five years, whereas enterotoxigenic and enteroinvasive E. coli were found primarily in adults. The study has highlighted for the first time the important role that enterotoxigenic and enteroinvasive E. coli strains could play in acute diarrhoeal diseases in Lagos, Nigeria.     

Histopathologic spectrum of vaginal adenosis and related changes in stilbestrol-exposed females

A total of 98 colposcopically directed biopsies were obtained from the vagina, cervix, and cervicovaginal ridge (hood) of 80 young women believed to have had intrauterine exposure to stilbestrol (DES). Specific investigation of the patient's medical records corroborated the history of maternal stilbestrol administration in 36 patients (45%), while in the remainder the drug history was regarded as presumptive since medical records were unavailable for review. The findings did not differ significantly in those biopsies taken from patients with confirmed or presumptive drug histories. Histologic evidence of vaginal adenosis was detected in vaginal biopsies from 43 patients. In 30 cases (70%) benign Müllerian-type glandular epithelium was in the superficial vaginal wall, residing on the mucosal surface and/or in the lamina propria. The glandular epithelium predominantly was of endocervical type, but in six instances it resembled endometrial or fallopian tubal epithelium. The glands were accompanied by varying degrees of squamous metaplasia in 22 cases. When extensive the metaplasia produced transformation zones similar to those seen in the normal cervix. Vaginal biopsies of adenosis from the other 13 patients (30%) revealed squamous metaplasia without demonstrable glands due to complete transformation of all antecedent glandular epithelium by squamous metaplasia. Our studies indicate that squamous metaplasia is a component of major importance in the natural history of adenosis and that the concept of adenosis should be broadened to include those examples comprised exclusively of metaplastic epithelium. In such examples metaplasia is identified by the immaturity and poor glycogenation of the squamous cells and their accompanying squamous pegs which often contain residual gland openings or squamous "eddies." Similar findings were present in biopsies of seven cervicovaginal ridges and in cervical biopsies from 37 patients, except for the absence of endometrial or tubal type glands in the latter site. Although no adenocarcinomas were detected, six patients had squamous dysplasia of the vagina and/or cervix. In no case were premalignant or dysplastic changes of glandular cells found. Our findings support the thesis that stilbestrol-associated adenosis represents anomalous embryologic localization of the original squamocolumnar junction in the vagina rather than in the cervix. It is closely related to so-called cervical "erosions." The development of squamous metaplasia accounts for modifications in the clinical and histologic appearances by producing transformation zones which then may be subject to the same oncogenic stimuli for squamous neoplasia as are their counterparts in the cervix.     

高速铁路铰接式列车车桥系统动力响应分析

根据铰接式车辆结构和悬挂形式的特点,建立了铰接车辆单元模型,以现有通用软件为基础直接生成桥梁模型的质量、刚度矩阵,并以实测轨道不平顺为系统激励,求解车桥耦合动力相互作用问题;以欧洲布鲁塞尔-巴黎高速铁路线上的Thalys铰接式列车通过Antoing桥为例,分析了桥梁的动挠度、竖向和横向加速度等动力响应及运行车辆的振动加速度响应,并对铰接式列车的振动特性进行了初步的探讨;最后通过现场试验对分析模型和计算结果进行了验证。