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Procurement's important role in healthcare decision making has encouraged criticism and calls for greater collaboration with health technology assessment (HTA), and necessitates detailed analysis of how procurement approaches the decision task.
We reviewed tender documents that solicit medical technologies for patient care in Canada, focusing on request for proposal (RFP) tenders that assess quality and cost, supplemented by a census of all tender types. We extracted data to assess (i) use of group purchasing organizations (GPOs) as buyers, (ii) evaluation criteria and rubrics, and (iii) contract terms, as indicators of supplier type and market conditions.
GPOs were dominant buyers for RFPs (54/97) and all tender types (120/226), and RFPs were the most common tender (92/226), with few price-only tenders (11/226). Evaluation criteria for quality were technical, including clinical or material specifications, as well as vendor experience and qualifications; “total cost” was frequently referenced (83/97), but inconsistently used. The most common (47/97) evaluative rubric was summed scores, or summed scores after excluding those below a mandatory minimum (22/97), with majority weight (64.1 percent, 62.9 percent) assigned to quality criteria. Where specified, expected contract lengths with successful suppliers were high (mean, 3.93 years; average renewal, 2.14 years), and most buyers (37/42) expected to award to a single supplier.
Procurement's evaluative approach is distinctive. While aiming to go beyond price in the acquisition of most medical technologies, it adopts a narrow approach to assessing quality and costs, but also attends to factors little considered by HTA, suggesting opportunities for mutual lesson learning.
Atomic mixing by replacement collision sequences and other cascade effects is well known to create chemical disorder in irradiated alloys. Most studies of irradiation-induced disordering have focused on ex situ analysis of irradiated samples; however, fast in situ techniques are necessary to measure disordering at elevated temperatures without significant interference from concurrent re-ordering processes. In the present work, we use in situ electron diffraction with high speed data collection to measure the initial change in the long-range order parameter S with ion dose ϕ during 500 keV Ne+ irradiation of Cu3Au foils. The data reveal an unexpected and dramatic increase in the disordering rate as the critical order–disorder transition temperature TC is approached. Molecular dynamics simulations show that this increase is not due to temperature-dependent cascade mixing. We attribute the enhanced disordering, instead, to coupling between point defect fluxes and the chemical state of order.
Ice cores provide a robust reconstruction of past climate. However, development of timescales by annual-layer counting, essential to detailed climate reconstruction and interpretation, on ice cores collected at low-accumulation sites or in regions of compressed ice, is problematic due to closely spaced layers. Ice-core analysis by laser ablation–inductively coupled plasma–mass spectrometry (LA-ICP-MS) provides sub-millimeter-scale sampling resolution (on the order of 100 μm in this study) and the low detection limits (ng L−1) necessary to measure the chemical constituents preserved in ice cores. We present a newly developed cryocell that can hold a 1 m long section of ice core, and an alternative strategy for calibration. Using ice-core samples from central Greenland, we demonstrate the repeatability of multiple ablation passes, highlight the improved sampling resolution, verify the calibration technique and identify annual layers in the chemical profile in a deep section of an ice core where annual layers have not previously been identified using chemistry. In addition, using sections of cores from the Swiss/Italian Alps we illustrate the relationship between Ca, Na and Fe and particle concentration and conductivity, and validate the LA-ICP-MS Ca profile through a direct comparison with continuous flow analysis results.
In the 1998-99 flight, BOOMERanG has produced maps of ∼4% of the sky at high Galactic latitudes, at frequencies of 90, 150, 240 and 410 GHz, with resolution ≳ 10'. The faint structure of the Cosmic Microwave Background at horizon and sub-horizon scales is evident in these maps. These maps compare well to the maps recently obtained at lower frequencies by the WMAP experiment. Here we compare the amplitude and morphology of the structures observed in the two sets of maps. We also outline the polarization sensitive version of BOOMERanG, which was flown early this year to measure the linear polarization of the microwave sky at 150, 240 and 350 GHz.
We show how estimates of parameters characterizing inflation-based theories of structure formation localized over the past year when large scale structure (LSS) information from galaxy and cluster surveys was combined with the rapidly developing cosmic microwave background (CMB) data, especially from the recent Boomerang and Maxima balloon experiments. All current CMB data plus a relatively weak prior probability on the Hubble constant, age and LSS points to little mean curvature (Ωtot = 1.08±0.06) and nearly scale invariant initial fluctuations (ns = 1.03±0.08), both predictions of (non-baroque) inflation theory. We emphasize the role that degeneracy among parameters in the Lpk = 212 ± 7 position of the (first acoustic) peak plays in defining the Ωtot range upon marginalization over other variables. Though the CDM density is in the expected range (Ωcdmh2 = 0.17 ± 0.02), the baryon density Ωbh2 = 0.030 ± 0.005 is somewhat above the independent 0.019 ± 0.002 nucleosynthesis estimates. CMB+LSS gives independent evidence for dark energy (ΩΛ = 0.66 ± 0.06) at the same level as from supernova (SN1) observations, with a phenomenological quintessence equation of state limited by SN1+CMB+LSS to wQ < −0.7 cf. the wQ=−1 cosmological constant case.
BOOMERanG has recently resolved structures on the last scattering surface at redshift ˜ 1100 with high signal to noise ratio. We review the technical advances which made this possible, and we focus on the current results for maps and power spectra, with special attention to the determination of the total mass-energy density in the Universe and of other cosmological parameters.
We offer the first sub-seasonal view of glacial age archives from the Siple Dome-A (SDMA) ice core using the ultra-high resolution capabilities of a newly developed laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS; 121 µm sampling resolution) system capable of conducting multi-element glaciochemical analysis. Our ultra-high resolution data demonstrates that: (1) the SDMA ice core record can be annually dated based on seasonality in chemical inputs at a depth not previously possible using previous glaciochemical sampling methods, (2) winter accumulation at the SD site was greater than summer accumulation during the three late glacial periods selected (~15.3, 17.3, 21.4 Ka ago) in this study and (3) resulting annual layer thicknesses results show greater variability than the current SD ice core depth/age model (Brook and others, 2005), possibly due to depositional effects such as wind scouring and/or decadal variability in snow accumulation that is not captured by the resolution of the current depth/age model.
Young children are slow to master conventional intonation patterns in their yes/no questions, which may stem from imperfect understanding of the links between terminal pitch contours and pragmatic intentions. In Experiment 1, five- to ten-year-old children and adults were required to judge utterances as questions or statements on the basis of intonation alone. Children eight years of age or younger performed above chance levels but less accurately than adult listeners. To ascertain whether the verbal content of utterances interfered with young children's attention to the relevant acoustic cues, low-pass filtered versions of the same utterances were presented to children and adults in Experiment 2. Low-pass filtering reduced performance comparably for all age groups, perhaps because such filtering reduced the salience of critical pitch cues. Young children's difficulty in differentiating declarative questions from statements is not attributable to basic perceptual difficulties but rather to absent or unstable intonation categories.
The behavior of the redox-based resistive switching memories is influenced by chemical interactions between the electrode and the solid electrolyte, as well as by local environment. The existence of different chemical potential gradients is resulting in nanobattery effect lowering the stability of the devices. In order to minimize these effects we introduce a graphene layer at the active electrode – solid electrolyte interface. We observe that graphene is acting as an effective diffusion barrier in the SiO2-based electrochemical metallization cells and acts catalytically on the electrochemical processes prior to resistive switching.
In this work we examine the electrical characteristics and the memory properties of metal-alumina-nitride-oxide-silicon (MANOS) devices as a function of the post deposition annealing conditions. Post deposition annealing of the samples was performed at 850 or 1050 °C in nitrogen ambient using two different processes: (1) Furnace annealing for 15 min and (2) rapid thermal annealing for 1 or 5 min. The capacitance equivalent thickness as extracted from the capacitance voltage characteristics depends strongly on the annealing process, being smallest for the furnace annealing. Furthermore, the experimental results indicate that the type of the annealing determines the defect state density of the Al2O3 layer, via which the undesired effect of gate electrode electron injection takes place in the negative voltage regime. For inert ambient annealing the furnace process appears more efficient as compared to RTA.
Studies on the role of diet in the development of chronic diseases often rely on self-report surveys of dietary intake. Unfortunately, many validity studies have demonstrated that self-reported dietary intake is subject to systematic under-reporting, although the vast majority of such studies have been conducted in industrialised countries. The aim of the present study was to investigate whether or not systematic reporting error exists among the individuals of African ancestry (n 324) in five countries distributed across the Human Development Index (HDI) scale, a UN statistic devised to rank countries on non-income factors plus economic indicators. Using two 24 h dietary recalls to assess energy intake and the doubly labelled water method to assess total energy expenditure, we calculated the difference between these two values ((self-report − expenditure/expenditure) × 100) to identify under-reporting of habitual energy intake in selected communities in Ghana, South Africa, Seychelles, Jamaica and the USA. Under-reporting of habitual energy intake was observed in all the five countries. The South African cohort exhibited the highest mean under-reporting ( − 52·1 % of energy) compared with the cohorts of Ghana ( − 22·5 %), Jamaica ( − 17·9 %), Seychelles ( − 25·0 %) and the USA ( − 18·5 %). BMI was the most consistent predictor of under-reporting compared with other predictors. In conclusion, there is substantial under-reporting of dietary energy intake in populations across the whole range of the HDI, and this systematic reporting error increases according to the BMI of an individual.