Mental health and primary care: An alternative policy agenda BUTLER, CAROLINE GLENDINNING, LINDA GASK, KIRSTEIN RUMMERY, ANNE ROGERS, JOHN LEE & PETER BOWER, TOM
Journal of mental health (Abingdon, England),
01/1997, Letnik:
6, Številka:
4
Journal Article
Recenzirano
Discusses flaws in the Green Paper on mental health published by the outgoing Conservative government. Suggests that an alternative agenda would be for mental health policy to work within a policy of ...developing a primary care led NHS.
Three additions of inorganic14Cwere made during midsummer to the mixed layers of two small lake basins in northwestern Ontario. The incorporation of this14Cinto organic matter was monitored, and the ...resulting rates of daily primary production measured in the open water were compared with those derived from bottles incubated both in the laboratory and in situ. Sedimentation of particulate14C, regeneration of inorganic14Cfrom organic14Cfixed on previous days, and time scale were examined as potentially important ways in which the whole-lake method differed from bottle incubations. Daily production estimates derived from laboratory incubations and a numerical model agreed well with whole-lake values. In situ bottle measurements that were analyzed in the standard way consistently underestimated whole-lake values, primarily because of the assumption that solar irradiance (I) is linearly related to integral production (P). Investigators without access to a controlled-light incubator could increase the accuracy of their daily production estimates by calculating P vs. I curves from their in situ production data and analyzing them with the numerical model.
This paper describes the discovery of, and subsequent investigations into, a previously unknown Michelangelo drawing found in an album at Castle Howard, Yorkshire, England. The probable origin of the ...drawing is discussed through comparison with other works by the young Michelangelo and his circle. The composite laminated structure of the drawing and its eighteenth-century collector's mount are described in detail, together with an analysis of the constituent papers. Conservation treatment, including temporary separation of the drawing from its mount, is covered. The great similarity in the manner of drawing between this and other works by Michelangelo, together with the provenance and the paper evidence have led to this work being accepted as an important new addition to Michelangelo's oeuvre. This investigation of a complex paper object is presented as an excellent illustration of the productive collaboration between specialists in three different disciplines: art history, paper history, and paper conservation.
Purpose of the study: to examine the costs and cost-effectiveness of 'second-generation' telecare, in addition to standard support and care that could include 'first-generation' forms of telecare, ...compared with standard support and care that could include 'first-generation' forms of telecare. Design and methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care. Primary outcome measure: incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective. Results: cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY. Implications: while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs. Trial registration number: ISRCTN 43002091.
PDF
