Why do folk clutch at straws when there is a lifeboat on hand?

The Mazankowski committee considered all too familiar problems with the Alberta healthcare system, in particular expenditure inflation and public "affordability," and the efficiency of the provision of care to the population. The remedies if offers are incomplete and unconvincing because of the failure to use rigorously the evidence base. Is the system unaffordable when the modest effects of the aging of the population and efficient health technology assessment could control inflation? Why advocate "competition" when it is not defined and managed care in the United States has failed? The Council's report glosses over the crucial issues of how physicians ration healthcare in Alberta and how the profession has failed to evaluate and manage major variations in medical activity and outcomes.

Dilemmas in regulation of the market for pharmaceuticals.

What can be learned from international experience of efforts to control spending and to improve efficiency and access in pharmaceutical markets? Policymakers tend to reinvent many policies to control the behavior of patients, doctors, and industry, despite a lack of evidence of those policies' cost-effectiveness. There is an emerging consensus that reimbursement in public and private health care systems should be informed by evidence of the cost-effectiveness of treatments and that utilization should be constrained by budget caps and information systems. Whatever the policy chosen, evaluation is as essential as it is rare.

Predicting within-family variability in juvenile height growth of Salix based upon similarity among parental AFLP fingerprints.

Willow is being developed as a crop for biomass plantations in the Northeast and North-central United States, but has only recently been the subject of controlled breeding to generate improved genotypes. Maximizing variability among progeny within full-sib families produced by controlled pollination may increase the probability of producing willow clones exhibiting desirable extreme phenotypes. Yet, predicting combinations of parents yielding highly variable progeny is not currently possible.

Estimating aerosol surface area from number and mass concentration measurements.

A number of toxicology studies have been published indicating that health effects associated with low-solubility inhaled particles may be more appropriately associated with particulate surface area than mass. While exposure data from the workplace is needed to further investigate the relevance of such an association, the means of measuring exposure to aerosol surface area are not readily available. A possible interim solution is to estimate surface area from measurements of particle number and mass concentration using readily available direct-reading instruments.

Evaluating health interventions: exploiting the potential.

The importance of the evaluation of health care interventions (EHI) including formal health technology assessment (HTA) cannot be over-emphasised, as its results can inform and improve resource allocation decisions in all parts of the health care system, public and private. At present, fragmented and inefficient resource allocation processes are a universal problem and, as a consequence, patients are deprived of care from which they could benefit. Such outcomes are not only inefficient but also unethical.

Cultural pathways through universal development.

We focus our review on three universal tasks of human development: relationship formation, knowledge acquisition, and the balance between autonomy and relatedness at adolescence. We present evidence that each task can be addressed through two deeply different cultural pathways through development: the pathways of independence and interdependence. Whereas core theories in developmental psychology are universalistic in their intentions, they in fact presuppose the independent pathway of development.

Investigation of the aerosols produced by a high-speed, hand-held grinder using various substrates.

Mechanical processes such as grinding are classically thought to form micrometer scale aerosols through abrasion and attrition. High-speed grinding has been used as the basis for testing the hypothesis that ultrafine particles do not form a substantial component of mechanically generated aerosols. A wide variety of grinding substrates were selected for evaluation to represent the broad spectrum of materials available.

Thoracic size-selection of fibres: dependence of penetration on fibre length for five thoracic sampler types.

It has been suggested that the non-size-selective sampling methods currently used for fibrous aerosols potentially lead to the presence of large compact particles, agglomerates and fibre clumps in samples, which in turn reduce the accuracy and precision of the manual fibre counting techniques employed to analyse samples. The use of thoracic size-selective samplers has been proposed as an alternative, leading to the prevention of large particles reaching the collection substrate while at the same time bringing fibre sampling into line with general occupational aerosol sampling methodologies. Thoracic samplers should give good agreement with current sampling methods under ideal conditions based on aerodynamic fibre properties.

Cultural teaching: the development of teaching skills in Maya sibling interactions.

Psychology has considered the development of learning, but the development of teaching in childhood has not been considered. The data presented in this article demonstrate that children develop teaching skills over the course of middle childhood. Seventy-two Maya children (25 boys, 47 girls) ranging in age from 3 to 11 years (M = 6.

Translating evidence into practice. The case of influenza vaccination.

A problem common to all health care systems remains the translation of robust evidence into effective practice. Influenza vaccination has been reported to be an effective public health care intervention, but guidelines on coverage and subsequent uptake rates for vaccination across European countries vary substantially. One challenge therefore is to evaluate how effective different implementation mechanisms may be in improving overall vaccination rates for target populations across Europe.

Management of multiple burn casualties in a high volume ED without a verified burn unit.

The objective of the study was to evaluate the effectiveness of triage, treatment, and transfer interventions on multiple burn casualties managed in a high volume ED that does not have a verified in-hospital burn unit. The charts of 11 male patients injured in a 1999 foundry explosion and brought to Baystate Medical Center (BMC), a level I trauma center, were reviewed. All patients sustained deep partial and full thickness burns.

Ethics and health care 'underfunding'.

There are continual "crises" in health care systems worldwide as producer and patient groups unify and decry the "underfunding" of health care. Sometimes this cacophony is the self interest of profit seeking producers and often it is advocacy of unproven therapies. Such pressure is to be expected and needs careful management by explicit rationing criteria which determine who gets access to what health care.

Money or your life? The health-wealth trade-off in pharmaceutical regulation.

For decades the development of pharmaceuticals has been regulated by safety, efficacy and quality rules for product registration. In public health care systems, these three 'hurdles' are increasingly being supplemented by a fourth: the mandatory requirement to demonstrate economic efficiency in order to obtain reimbursement. This requirement challenges the wealth creation ethic of industry (money) with the population health ethic of public health and health economics (your life).

Reactivity of zinc finger cores: analysis of protein packing and electrostatic screening.

The chemical stability of 207 zinc fingers, derived from 92 experimental protein structures, is evaluated according to the protein packing and electrostatic screening of their zinc cores. These properties are used as measures of the protein protection of zinc cores, to predictively rank relative zinc finger reactivities and assess differences in function. On average, there is a substantial and concomitant increase in the screening of increasingly anionic core motifs, suggesting zinc fingers have evolved in a manner that promotes shielding of their potentially reactive core thiolates.

Workforce productivity and incentive structures in the UK National Health Service.

The UK National Health Service (NHS) is a labour-intensive service, yet the productivity of one of the largest labour forces in the world has been relatively ignored over the last 50 years. The data available to measure productivity over time are limited and focus on inputs and activity, not outcome. However, what data there are indicate that, despite major increases in NHS funding and staffing, changes in technology and continuous reorganisation of structures, productivity tends to show little or no change over successive decades.