Derivation of the order parameter of the chiral Potts model.

We derive the order parameter of the chiral Potts model, using the method of Jimbo et al. The result agrees with previous conjectures.

Accountable communities: how norms and values affect health system change.

Economic forces, policy initiatives, and technological change push markets along what some hypothesize is a common evolutionary path. Observations from twelve sites, however, indicate that the pace and direction of change are highly variable across markets. Other forces, internal and unique to a community, help to explain this variation. These forces emanate from the underlying history, culture, and values of a community and in part dictate the response of various players to the more common forces. This paper explores the mechanisms through which these forces operate and their relationship to health system change.

The roles and responsibilities of local public health systems in urban health.

In recent years, policy analysts have paid much attention to the precarious state and uncertain future of local public health departments and so-called safety net providers, usually treating each separately. This paper explores the ways in which these systems are converging, are adapting to a changing health marketplace, and are interacting with new private sector competitors and partners. Although threatened by policy, competitive, and financial forces, many of these local organizations are adapting successfully. An agenda for transforming these entities is described; the agenda emphasizes leadership, democratization, and partnerships with communities.

The status of local health care safety nets.

This paper examines variations in the composition, concentration, financing, and community context of local health care "safety nets" and the market pressures that they face. It also reviews financing mechanisms that support these systems and strategies being undertaken to retain publicly insured patients. As safety-net providers compete more aggressively, the availability of the public health, behavioral health, and social services they provide may be affected. Communities may have to consider more explicit investments in these "public goods" if competitive markets remove existing cross-subsidies.

The public cost of expanding coverage.

The 103d Congress considered several health care reform bills that would encourage voluntary expansions of coverage through insurance market reforms, new tax deductions for premiums, and direct premium subsidies for low-income persons. We found that insurance reforms alone will do little to expand coverage. We also found that most of the proposed tax deductions would go to persons who already have insurance and would have little impact on coverage. Premium subsidies for low-income persons would greatly increase coverage. However, coverage would change little for those who would have to pay all or part of the premium.

Visual outcome of childhood anterior perforating eye injuries: prognostic indicators.

Ninety-six cases of anterior globe perforation in children less than 16 years old, requiring surgical repair, were reviewed. Seventy-three patients were male and 23 female, with a mean age of 9 years 4 months. Perforation involving just the cornea was associated with a good visual prognosis unless: it involved the visual axis, resulting in corneal scarring and/or significant astigmatism (> 3.0 DS); it involved greater than one-quarter of corneal diameter; or there was non-compliance with spectacles/patching in patients younger than 8 years old. Injuries involving the lens in those younger than 8 years were associated with a far worse prognosis due to the problems of correcting aphakia. Surgical delay and method of injury did not affect prognosis. Some patients fail to re-attend and greater patient/parent education prior to discharge is recommended.

Aetiology of perforating eye injury.

This study addresses the aetiology of perforating ocular injury in childhood and possible preventive measures. Data have been collected from the case notes of 143 patients presenting over a 10 year period to a single ophthalmic unit. Injuries occurred most often in a domestic setting (34%) or with a child at play (19%) and showed an overall four to one ratio of boys to girls. Sports injuries accounted for 15% and assault for 8% of all injuries. A changing pattern of ocular injury is evident: road traffic accidents constituted 6% of injuries, compared with 31% in a similar study published in 1976. The role of litigation is discussed, particularly with regard to firearms, which accounted for 8% of injuries. It is concluded that the most important factor in the prevention of perforating ocular trauma is parental awareness, 53% of injuries occurring with the child in a domestic setting or at play.

Changes in the auditory middle latency responses during all-night sleep recording.

The middle latency response (MLR) using wide band-pass filters shows marked changes in amplitude, latency and configuration in sleep. The components with latencies greater than 20 ms show the greatest variability. There is a significant increase in Pa latency in stages 2 and stages 3/4, and in some cases a disappearance of the Nb component with the development of a broad positivity of latency intermediate to Pa and Pb which dominates the response. The responses in REM are of similar latency and configuration as in wakefulness but of reduced amplitude. The 40 Hz response is markedly reduced in amplitude in all sleep stages reflecting a decrease in the contribution of the middle latency components to this composite response. This appears to arise through a loss of 40 Hz periodicity in slow wave sleep and an increase in the slow 10 Hz component. In REM sleep, there is an overall reduction in amplitude. Much of the reported variability of the MLR in the literature arises from the widely differing band-pass filters used and the inadequate control for level of arousal. Both these factors have been shown to produce significant changes in the response.

Targeting services to chronically disabled elderly: the preliminary experiences of the National Long Term Care Channeling Demonstration.

In response to concerns about the adequate provision of long term care, the National Long Term Care Channeling Demonstration has been funded by the Department of Health and Human Services. The project is designed to provide coordinated community services as an alternative to institutionalization to those elderly individuals at risk of placement. This preliminary work examines the demonstration's experience in its attempt to target services to these individuals. Although final research results are not yet available, the method, problems, and results of the initial case finding and screening approaches provide additional knowledge concerning the targeting experience.