North Head Research Articles

The State of Health and Medicine Museums

144 EXHIBITION REVIEWS The State of Health and Medicine Museums Megan Hicks ‘Health and medicine museums’ is a broad term that covers a range of collecting organisations all of which have in common the aim of preserving the material heritage of some aspect of health care. The parent bodies and funding sources of these museums vary greatly, from state government departments to historical societies, from educational institutions to commercial and not-for-profit businesses. Many of them are volunteer-managed or have a single paid part-time staff member working with or without the assistance of volunteers. In New South Wales they include, for example, hospital museums run by trained nurses associations; archives and display rooms at professional associations, such as the Australian Society of Anaesthetists and the College of Nursing; and museums in historic buildings or sites, like the Quarantine Station at Sydney’s North Head and the Bush Nurse Cottage at Lightning Ridge. There is also medical material in large and small museums with wider collections—the Powerhouse being a notable example, the Army Museum at Victoria Barracks another. When a gathering of custodians from health and medicine museums met for a seminar in February 2014, many of them came away with renewed hope for the future of their collections. The initial mood had been gloomy and the title of the seminar, ‘Surviving in difficult times’, had been chosen to reflect the challenges that some museums in New South Wales are currently facing, including the imminent demise of several.1 But the theme on the day became ‘What makes a really good health and medicine museum?’ after two guests from New Zealand asked that this question be discussed. Margaret Horsburgh and Robin Norris are on a committee for the formation of a medical museum in Auckland and after listening to the afternoon’s speakers they – and other attendees—left with notebooks full of ideas to take home. To some extent the seminar was a reunion of the Health and Medicine Museums Special Interest Group (HMM).2 I organised it after one former member of HMM expressed an interest in catching up with colleagues. As a past secretary of the group I had access to the contact details of many relevant museums and collections, and the event was attended by over thirty people—representing at least sixteen collections—eight of whom gave presentations.3 A sad Health & History ● 16/2 ● 2014 145 absence on the day was Judith Cornell, who was too ill to attend. Judith had been president of HMM since 1998 and was intending to talk at the seminar on the status of collections in NSW and ACT hospitals, bringing up to date a survey she had undertaken for NSW Health several years ago.4 The problems faced by such museums come in various forms. ‘Inadequate funding’ may be the perennial cry of all museums but it is a very real concern nevertheless, with few museums of any sort in Australia having access to money from philanthropic foundations. So health and medicine museums often do not have the means to properly catalogue, preserve and store their collections or maintain their premises. They lack sufficient trained staff or do not have the resources to send volunteers on training programs. And despite the enthusiasm and dedication of paid and unpaid staff, some of them may not have the skills to mount polished displays, develop programs of events, or devise marketing strategies that will attract new visitors and supporters. Uncertainty about tenure in the buildings they occupy is another worry for health and medicine museums. As healthcare facilities grow, shrink, change their function, or get sold as valuable real estate, museums are often the last occupants to be considered. Kenmore Hospital Museum is a case in point. A vast psychiatric asylum built in 1895 on 75 hectares near Goulburn, Kenmore Hospital now exists as a small mental health facility in a corner of the original site. The Kenmore Hospital Museum was located in an old ward within the original complex of sandstone buildings. It was founded by a group of dedicated staff and ex-staff who ran tours, mounted a new exhibition each year, and were successful in gaining grants...

Treating Medical Professionals and Colleagues: The Duty to Disclose for Public Safety versus Patient Confidentiality

Dr. G is a 43-year-old practising family physician who lives alone in a condominium. He had been raised as Taoist but converted to Christianity after meeting his wife in medical school. He and his wife had no children together and they divorced amicably five years ago. She remarried and has moved to England with her husband. Dr. G also has a brother but lost contact with him many years ago and his parents are living abroad in residency home for the elderly. He did not mind being alone as he was committed to his practice. Dr. G was recently found walking barefoot along an expressway dressed in his office attire — long-sleeved shirt with tie and tailored pants — when a highway patrol car pulled up alongside him in the late afternoon. By then, he had been walking on the expressway that heads north towards Malaysia with its heavy flowing traffic for almost eight hours. The police brought him to the state mental institute where he revealed to the attending psychiatrist that he had been following God’s orders who had commanded him to walk along that stretch of the expressway as a trial for his eventual transformation into a saint. He was not agitated and calmly welcomed his staying in the hospital as it might be yet another trial arranged by God. It transpired that Dr. G had been having this conversation with God for a number of months but kept this to himself while he continued to work at his practice. He said that he could hear two male voices — one of which he attributed to God, and the other to the Devil. These voices were not his own thought but occurred outside his head. Of late, these voices had become more frequent and insistent. Dr. G did not think that he had any problem being a family physician as he believed that a higher calling awaited him and that among the various gifts that God had promised him, would be healing powers. He adamantly denied that he had a psychotic disorder — a condition that, as a doctor, he could describe with exact detail and see these manifestations in some of the other patients in the ward — and has refused all medication. He has indicated that he wishes to return to his practice where, guided by God’s voice, he thinks he will be able to perform miracles by “laying hands” on his patients and eschewing the use medication on them as they are the work of the Devil.

6월의 남극진동이 한국의 6월 강우량에 미치는 영향

이 연구는 6월 남극진동이 한국 6월 강우량에 영향을 주는지 알아보기 위해 두 변수 사이에 상관분석이 이루어졌고 높은 양의 상관관계가 있음이 밝혀졌다. 이는 한국 6월 강우량이 같은 시기에 남반구에서 강화되는 머스커렌 고기압과 호주 고기압의 영향을 받음을 의미하는 것이다. 이 두 고기압이 발달할 때 호주 주위지역으로부터 적도방향으로 적도 횡단류가 강화되며, 이 적도 횡단류의 강화는 북태평양고기압의 북쪽으로의 강화로 이어진다. 이는 결국 장마전선을 한국으로 북상시키는 역할을 한다. 더욱이 북태평양 고기압의 북쪽으로의 강화는 한국에 상륙하거나 영향을 주는 태풍의 빈도를 증가시켜 6월 강우량의 증가에 중요한 역할을 한다. This study examined the effect of the Antarctic Oscillation (AAO) in June on the June rainfall in Korea by using a correlational statistical analysis. Results showed that there is a highly positive correlation between the two variables. In other words, the June rainfall in Korea is influenced by the Mascarene High and Australian High that are strengthened in the Southern Hemisphere, which is a typical positive AAO pattern. When these two anomalous pressure systems strengthen, the cold cross-equatorial flows in the direction from the region around Australia to the equator are intensified, which in turn, force a western North Pacific subtropical high (WNPSH) to develop northward. This pressure development eventually drives the rain belt to head north. As a result, the Changma begins early in the positive AAO phase and the June rainfall increases in Korea. In addition, a WNPSH that develops more northward increases the landfall (or affecting) frequency of tropical cyclones in Korea, which plays an important role in increasing the June rainfall.

From Serra to Sancho: Music and Pageantry in the California Missions by Craig H. Russell (review)

Reviewed by: From Serra to Sancho: Music and Pageantry in the California Missions by Craig H. Russell Robert R. Grimes S.J. From Serra to Sancho: Music and Pageantry in the California Missions. By Craig H. Russell. New York: Oxford University Press, 2009. 480 pp. $65.00. In a 1970s liturgical magazine an article appeared entitled "Pocahontas Never Sang Gregorian Chant," never considering the fact that she was baptized in the Church of England. Over many years of research on American Catholic church music the title has amused me as I have come across example after example of Native American Catholics employing chant, from the Mohawk and Passamaquoddy tribes of the Northeast to the missions of California. Although there have been important studies of the music of the Franciscan missions of California before, Craig Russell has produced what must be called a library of materials concerning musical life in and around the missions. The work is extensively documented. For example, chapter one contains thirty-five pages of text followed by twenty pages of footnotes. In addition, Oxford University Press maintains on their website an extensive array of additional documentation and resources collected by the author. In spite of this, the author says that he chose to write "a human narrative" rather than an encyclopedia. He has, in my opinion, actually succeeded at both. The title of this book refers to two Franciscan missionaries, Blessed Junipero Serra, the friar who founded and oversaw the Catholic missions in what is today the state of California, and Juan Bautista Sancho, in the author's estimation one of the most important musicians working in the early nineteenth century missions. The Franciscans took over the missions in Baja California after King [End Page 75] Carlos III of Spain ordered the expulsion of the Jesuits in 1768. These missions were soon handed over to the Dominicans while the Franciscans headed north to Alta California. Serra worked in the missions from the foundation of San Diego in 1769 until his death in 1784 at the Carmel Mission. Sancho arrived in Mexico from Europe in 1803 and worked in the Mission of San Antonio de Padua from shortly thereafter until his death in 1830. It is entirely possible that no one reader would be interested in every aspect of Russell's work. Conversely most everyone would find something of interest within its vast range. The introduction is a fine overview of the historiography of the California missions and would be a useful reading in American history and American Catholic Studies courses. Music theorists would find the second chapter of particular interest with its discussion of notation and modes. Historical musicologists will be fascinated by the presence of orchestral masses in early European classical style and the extensive manuscript research the author presents. Ethnomusicologists will find the discussion of dance and pageantry enlightening as well as the discussion of Native American music in the missions. Performers and choir directors will benefit from the performing editions of a number of mission-related works contained on the website. Historians will benefit from seeing life in the California missions in a new light and continuing this research with the many original documents and photographs included in both the book and website. In a work of this impressive scope it is inevitable that some errors can be found, particularly in the case of Catholic theology and practice. For example, the author speaks of a mass setting used on Good Friday (311), a day when no mass in permitted in Catholic worship. In another place the author uses "adoration" and "veneration" interchangeably in regard to the Blessed Mother (303-304) when only the latter is allowed. These are, however, small errors in a generally magnificent piece of scholarship. Average readers should not be dissuaded from reading From Serra to Sancho. They might well want to skip over some of the more technical sections of the volume, but should not overlook the photographic section of the website. Readers will encounter scenes ranging from the comic (a friar in a shed celebrating mass atop a clavichord while he accompanied himself) to the sublime (Native American orchestras at mass). Most of all, they will find the author...

‘Rebecca will you marry me? Tim’: inscriptions as objects of biography at the North Head Quarantine Station, Manly, New South Wales

AbstractIn this paper we explore the historical inscriptions at the North Head Quarantine Station, Manly through the lens of biography to examine what the archaeological record can tell us about some of the people who found themselves in quarantine and who chose to mark their presence in the landscape. In particular we focus on two inscriptions located in the Wharf area of the Quarantine Station to illustrate how the archaeological record in this instance provides a mechanism for investigating and exploring the personal and social histories of migration and quarantine. Half of all the inscriptions at the Quarantine Station contain some biographical information about people, place and passage. They provide a material portal through which we can access something of the stories of the ordinary men, women and children who migrated to Australia. The archaeological record of names and lists of passengers and crew does not simply map onto the shipping registers in the archives, as the Samuel Plimsoll and John Howie examples illustrate. The material characteristics of the inscriptions set up a discursive interaction between the archaeological and historical records that allows us to interrogate them as objects with a biography and as objects as biography.

Now head north for a Summer Congress

Now head north for a Summer Congress

New mites Terraphagus antipodus gen. n., sp. n. and Neohyadesia minor sp. n. (Acarina: Astigmata: Algophagidae) from islands of the Southern Ocean

Mites are a diverse and important component in the soils of the Southern Ocean islands, but for many groups, their taxonomy and biogeography is little studied. This paper reports the Algophagidae, a poorly known family, from the New Zealand region for the first time. The study used soil samples from seabird burrows, brackish algal wrack samples and a museum collection to recover specimens. Terraphagus antipodus gen. n., sp. n. is described from grey petrel Procellaria cinerea burrow soil on the Antipodes Islands, New Zealand. The axillary organ is confined to the dorsum; the epigynal apodeme ends are fused with the ends of coxal apodeme II; seta 2a and ω2 are absent, and the famulus is bilobed. Males have the sternum fused to coxal apodemes II; the tarsal setae of legs I, III and IV of the male are modified for mate guarding. The short stout legs I and II end in huge spines in females as e, d, q, s, wa and hT. From brackish algal wrack, Lake Forsyth/Wairewa, Canterbury, New Zealand, another algophagid Neohyadesia minor sp. n. is described and illustrated. The new species is the smallest known algophagid. A neohyadesid collected in 1961 is newly reported here from Eudyptes sp. penguin rookery mud from North Head, Macquarie Island. These records further extend the known microhabitats of the family to the allochthonous marine seabird nutrient flow into islands in the New Zealand region and make Neohyadesia Hughes and Goodman, 1969 present in all Southern Ocean provinces.

D is for Denmark…

In the fourth of our series on exploring countries and customs, we head north to Scandinavia.

DIE DOOD VAN GENRAAL DE LA REY

When World War I broke out in Europe, South Africa was united in title only. The bitter memories of the Anglo-Boer War were now freshened by the Union Government's opinion that Britain's declaration of war automatically involved South Africa as a member of the British Empire. Certain leaders of the old republics had never reconciled themselves to the Imperial connexion however; among these was General J. H. de la Rey, one of the great republican heroes of the late war. In 1913 De la Rey, a serving Senator, had already begun to express publicly his desire for a resurrection of the republics. The outbreak of war in Europe was greeted by De la Rey as a heaven-sent opportunity for South Africa to divorce herself from the Empire. He was encouraged in this belief by the visions of the 'prophet' Nicolaas van Rensburg. Despite warnings from influential friends, De la Rey called a meeting of 800 burghers at Treurfontein in mid-August 1914. The result was anticlimactic, and De la Rey did not call for an armed protest against Botha's intention to collaborate with Britain. Yet by early September De la Rey was consorting with other dissident leaders and plans for a restoration of the republics continued. On 12 September he spoke in the Senate debate on the Union's projected action against the German colony of South West Africa. This speech was another anti-climax as the general maintained his equivocal public stance. Immediately after finishing his speech, De la Rey headed north, to meet Beyers in Pretoria on 15 September. Beyers and De la Rey left Pretoria by motor car that evening to talk with another republican sympathiser. Genl Kemp. On the same day the police along the Witwatersrand had mounted a large operation to capture the Foster gang, a group of three criminals wanted for the murder of three policemen. Road-blocks were set up to intercept the bandits' car. Already one tragedy had occurred when a certain Dr Grace had ignored a summons to halt at a road-block and had been shot dead. Unaware of the Foster-hunt, and evidently believing that the police were under orders to arrest them, Beyers and De la Rey failed to halt at three police blocks. At a fourth block, at Langlaagte, they again ignored a call to halt and shots were fired at the car's tyres. A richochet struck De la Rey and he died shortly afterwards, leaving unanswered the question of what role he had intended to play in the recent rebellion.

The Doctor Is in … Love

The Doctor Is in … Love

A dynamic ventilation model for gravity sewer networks

To implement any effective odour and corrosion control technology in the sewer network, it is imperative that the airflow through gravity sewer airspaces be quantified. This paper presents a full dynamic airflow model for gravity sewer systems. The model, which is developed using the finite element method, is a compressible air transport model. The model has been applied to the North Head Sewerage Ocean Outfall System (NSOOS) and calibrated using the air pressure and airflow data collected during October 2008. Although the calibration is focused on forced ventilation, the model can be applied to natural ventilation as well.

American Exodus

In the year or so before Woodrow Wilson's administration took the United States into the Great War raging in Europe, Americans recognized that something unusual was taking place in communities across the South: African Americans were departing in unprecedented numbers for the North. While black and white contemporaries might have differed on the particulars, the outline they saw was clear. With the European war dramatically reducing the number of immigrants, laborstarved industrialists were tapping a labor force they had previously ignored or rejected. And since the vast number of blacks lived in the South, labor recruiters logically turned their attention toward that region. Advertising good jobs, high wages, and a level of personal freedom unknown in the land of Jim Crow, recruiters, black newspapers, and earlier migrants spread the word that exclusionary employment barriers were falling and that a land of hope now beckoned. In the first wave of what was called the "Negro Exodus," a half million southern blacks headed North; in the decade after the war, another 700,000 followed. The Great Migration was on.

The Floating Life

The Floating Life Sarah Cornwell (bio) We cluster around the radio in the teachers' berth. I twist the dial to 16, the hailing and distress channel, and Dave holds a hand up for silence, even though nobody's talking. Most of the message is static, but it sounds bad. Ports are closed all along the northern coast of Puerto Rico, Haiti, the Virgin Islands. The throaty, Spanish-inflected voice of the Coast Guard broadcaster tells us to switch to 22A, and we do, straining for specifics of the attack, or whatever it is. I can make out snatches only: stay at sea . . . hazards . . . we don't know . . . repeat stay . . . as it comes in. The distant sound of hip-hop drifts from the dormitory berths; the students are enjoying a normal afternoon belowdecks, unaware. The satellites are down. The computers and the handheld devices search endlessly for signals. [End Page 11] Dave is trembling. He clamps one meaty hand over the other on the tabletop. "Do we tell the kids?" he asks. Dave is our history guy, but his graduate degree was in ethics. "Tell them what?" I ask. "That we don't know what's going on?" There are four of us down here, the core teachers: Dave, me and the two women, Beth and Audrey, who huddle together tearfully. Beth is a Catholic, and she stares out a porthole at the dark reddish line of the horizon, racked no doubt by fictional horrors—the four horsemen bearing down from the cloud cover. Captain Ho and the crew are above, engaged, I assume, in some immediately useful work. As a biologist, I can say that Captain Ho is a good example of evolved human behavior; he navigates, he adapts, he survives. His wife is the cook. He has everything he needs onboard the Demeter, our 140-foot steel-hull brigantine. We four are lesser examples, lonely men and women who for various reasons have chosen to live life afloat, teaching spoiled, wealthy children, none of whom we will know for more than one semester. This is our summer trip, a ninety-day southern odyssey. We leave in May from San Francisco straight for the Great Barrier Reef, head north to the Indian Ocean and then down the coast of East Africa, around the tip and across the South Atlantic to Argentina, then shoot back up toward home base in the Florida Keys in August. Most of us missed a mark somewhere: career, family, dream. The hatch opens with a wet squeak, and Captain Ho appears on the stairs—his sockless boat shoes and the cuffs of his jeans. He climbs down, looking tired already, a sheen of sweat on his forehead, ham radio clutched in his hand. "Nothing," he says. "Nothing on VHF, nothing on single sideband or satellite, and this thing—" He smacks the radio down with a force that speaks of tightly lidded pressure. "Even this fucking thing. Nothing." "So what do we do?" I ask him. "What can we do?" "Right." Our situation seems to me like an ethics test question, a hypothetical dilemma. If you were stranded on a boat full of high school students during some kind of catastrophe—say, terrorist attack, nuclear detonation, apocalypse—would you a, b, c or d? Would that Dave could offer us multiple choice. The unlimited field of options for response feels, right now, like no options at all. At dinner, I watch the kids—thirty of them—shoveling canned peas into their mouths, cutting fat off the thick steaks we've been eating ever since [End Page 12] Rio. I can see in their easy conversation that end-of-semester shipmate bond, a weathered good nature that will surprise their parents when they tramp down the gangway at Key West. If they tramp down the gangway at Key West. Stop it, I tell myself. This is dangerous and weak-minded thinking, and I should stop. But Jesus Christ, what if we have to start a new race on an island somewhere, out of view of the aliens or al-Qaeda or whoever? I can't help darting a glance at Lisa, who is demonstrating something for the boy...

Finding The Courage to Change the Things You Can

Finding The Courage to Change the Things You Can

Un Coeur rouge dans la glace by Robert Lalonde

LALONDE, ROBERT. Un Cœur rouge dans la glace. Montréal: Boréal, 2009. ISBN 978-27646 -0646-9. Pp. 240. $22,95 Can. Professor of dramatic arts, actor, and author Robert Lalonde draws the reader into a haunting and poetic world in his most recent collection of stories, Un Cœur rouge dans la glace. The book is composed of three stories, “Souvent je prononce un adieu”, “Un Cœur rouge dans la glace”, and “Traduire Alison”, which explore how human experience is recomposed through memory and reflection. Each story’s protagonist suffers emotional and creative sterility following the loss of a loved one. Lost in his solitude, the protagonist requires the intervention of another character, who invites him to leave his familiar surroundings and his spiritual stagnation. Through the exteriorization of his anguish and the revelation of painful secrets, he rediscovers joy in life and finds inspiration to create through writing and song. Lalonde explains that the title story’s name is a metaphor for any dangerous attraction that can drive one to madness, this “berlue qui vous prend comme si le soleil a chaviré” (115). In the three stories, romantic or brotherly love and their loss cause each protagonist to lose touch with reality. Each character’s heart is figuratively frozen until another person intervenes. “Un Cœur rouge dans la glace” tells of Antoine’s quest to find his brother, who has run away. As Antoine heads north, lost in his preoccupations, a chance meeting with a little girl, and his friendship with Nicolas, restore his faith in humanity. As Nicolas guides Antoine through snowy surroundings, he encourages Antoine to articulate his sadness. In this second story, Lalonde gives winter landscapes a ghostly quality through his poetic prose. The author juxtaposes their pallor with splotches of fiery color such as that of a blood red couch (106), the orange sun’s reflection in the snow (109), and the image of an Amerindian’s red heart encased in ice (115). In the first story, “Souvent je prononce un adieu”, a widower has lost the desire to live and write. Unable to extricate himself from memories of the past, the protagonist thinks he sees, one day, Virginia Woolf in his garden. The professor’s dialogues with Woolf are a prelude to his helping one of his students who is struggling with her own ghosts. She will reciprocate, drawing the narrator out of his self-imposed exile from humanity. As the narrator travels with her to the ocean, he regains a taste for life and literary creation. “Traduire Alison” continues the title story’s depiction of nature, whose grandeur and unpredictability remind the characters of their relative insignificance. When the disenchanted narrator sends an e-mail to Alison, a poet he admires, she invites him to visit her at the ocean shore. The ocean tides and sea life are awe-inspiring, but also mirror the character’s emotions. Alison lends the narrator her red quill pen, and he sets to work translating her poetry from English to French. Then he realizes that to translate others’ writings is a step towards translating oneself. Each story acknowledges the literature that inspired it, such as Melville, Woolf, and Nelligan. The stories in Lalonde’s collection illustrate how linguistic creation embraces one’s mortality while reaffirming the will to survive. Each protagonist moves beyond his past by inserting it into the present. Self-identity is a collage of experiences , and we have to recognize, as the narrator of “Traduire Alison” explains, that “le péché originel, c’est d’être incapable de vivre à fond l’instant” (228). Bloomsburg University (PA) Nathalie G. Cornelius 616 FRENCH REVIEW 84.3 ...

Spatial heterogeneities in aerosol properties over Bay of Bengal inferred from ship-borne and MODIS observations during ICARB-W cruise campaign: Implications to radiative forcing

Comprehensive investigations during the last decade have clearly established that aerosols have a significant impact on the climate. This paper reports the results of the spatial variations in aerosol optical depth (AOD) and fine mode fraction (FMF) characteristics as a function of latitude and longitude over the Bay of Bengal (BoB) and the Northern Indian Ocean (NIO) during ICARB-W cruise period of 27th December 2008–30th January 2009 from onboard Sunphotometer and MODIS (Terra, Aqua) satellite measurements. Very high AOD 500 (0.7–0.8) occurred over the north head BoB adjacent to the northeastern Indian coast and the lowest AOD 500 (0.1–0.2) occurred in central BoB far away from the coasts, and in a small area in the northeastern part close to Myanmar coast as well as over NIO. The highest values (as high as 1.2) of Ångström exponent, α occurring over northeast BoB (regions close to Bangladesh and Myanmar) indicate relative abundance of accumulation mode particles and very low values of α (below 0.7) over central part of BoB as well as southern BoB/NIO suggesting dominance of coarse-mode sea spray aerosols. Terra/Aqua MODIS AOD 550 and cruise measured AOD 500 using Sunphotometer showed good agreement ( R 2 = 0.92) over the BoB. The total mass concentrations over BoB during cruise period were remarkably high, with a mean value of 28.4 ± 5.7 μg m −3 . Aerosol FMF was higher than 0.7 over the BoB, while FMF over NIO was about 0.5. NCEP reanalysis data on winds at 850 hPa, along with 5-days airmass back trajectories via HYSPLIT model, suggested transport of continental aerosols from the central and northern India over the BoB by the strong westerly/northwesterly winds. Regionally averaged clear sky aerosol (net) forcing over BoB during the winter is −28.9 W m −2 at the surface and −10.4 W m −2 at the top of the atmosphere whereas, the ARF values estimated over NIO at TOA, surface and in the atmosphere are −6.4, −18.3 and +11.9 W m −2 , respectively. ► The spatial variation of columnar measurements of AOD 500 observed high values over northern/northwestern parts of the BoB in which AODs were as high as ∼0.7; while the low values of AOD 500 (<0.2) were observed in the northeastern regions of BoB (Myanmar/Bangladesh coast) and southern BoB which opens to the vast Indian Ocean. ► α showed highest values of ∼1.5, even though generally high values prevailed over the eastern as well as northern coastal regions of India and β followed the pattern similar to that of AOD with a mean value of 0.17 ± 0.09 over BoB. ► Total mass concentration showed low values over the central BoB and equatorial Indian Ocean with a mean value of 23.6 ± 4.3 μg m −3 , high values over northern BoB (mean 45.4 ± 10.2 μg m −3 ) and moderate mass concentrations with a mean value of 32.3 ± 7.1 μg m −3 , persisted along the east coast of India with higher values very near to the ports. ► FMF is found to be higher than 0.7 over BoB indicates the dominance of fine mode particles which were produced mainly due to manmade sources in the surrounding regions and got transported across the oceanic region. ► The diurnally averaged aerosol forcing over entire BoB at the surface is −28.9 W m −2 and at the TOA is −10.4 W m −2 . The difference between the TOA and the surface forcing is +18.5 W m −2 which is absorbed in the atmosphere. Similarly, the ARF values estimated over NIO at TOA, surface and in the atmosphere are −6.4, −18.3 and +11.9 W m −2 , respectively.

Lessons On Health Reform From Across The Waves

From the Editor-In-Chief Health AffairsVol. 29, No. 8: Lessons From Around The World Lessons On Health Reform From Across The WavesSusan DentzerPUBLISHED:August 2010Free Accesshttps://doi.org/10.1377/hlthaff.2010.0743AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSHealth reformSystems of carePrimary care The United States is among the world’s leading exporters in the brisk trade of ideas for financing and delivering health care. But in this issue of Health Affairs , insights from abroad flow our way, as several of our authors reflect on health reforms in other industrialized nations. Spain is in the spotlight for having won the World Cup, but its health system scores high as well, write Jeffrey Borkan and colleagues. The nation emerged from the Franco dictatorship in 1975 socially and economically behind much of the rest of Europe. But the demise of the old order cleared the deck for sweeping changes in health care, along with much else. Planners concentrated on building an infrastructure focused on primary care. A key goal was that no citizen in this nation roughly the size of Texas—and with a population today of forty-one million—was to be more than fifteen minutes away from a primary care site.‘Leadership And Commitment’ The results have been impressive, the authors report, contributing to longer life expectancy and lower infant mortality than in the United States. The lesson for America—now embarked on its own primary care reinvention effort (see Health Affairs , May 2010)—may simply be that a modern democracy truly can plan and implement system restructuring at both the national and local levels. Spain’s example shows that what it takes is “sustained, bipartisan leadership and commitment toward health care transformation,” Borkan and colleagues write. Thus apprised of what advanced nations can do, we then head north and east to Switzerland, where Tsung-Mei Cheng interviews the former Swiss health minister, Thomas Zeltner. Zeltner recently stepped down from his post after nineteen years, during which he helped implement major reforms in the 1990s and thereafter.Rediscovered Switzerland, Zeltner notes, had at the time imported the idea of “managed competition” among competing private health insurance plans pioneered by longtime Health Affairs contributor Alain Enthoven. Zeltner notes the irony that Switzerland, with its private health plans and individual mandate, has now been “rediscovered” as a source of inspiration for the U.S. health reform. But as the Cheng-Zeltner dialogue makes clear, it’s not sensible to reduce another country’s complicated health system to just one or two bullet points. As successful as the Swiss system has been, it’s been governed by laws and regulations that place the emphasis on “management” as much as on “competition.” Specifically, Zeltner points to his nation’s requirement that health plans and providers negotiate with each other over prices—with the Swiss government watching over the negotiators’ shoulders and determining prices if negotiations fail.So most health systems are complicated, and most also face problems common across many nations. Spain struggles with rapidly rising costs. The Swiss are shocked about how much they pay for health coverage, and health care providers aren’t sufficiently transparent about the health outcomes they produce for patients. And nobody, apparently anywhere, is content with the state of the health care workforce. Spain has one of the lowest ratios in the European Union of general practitioners to population. Switzerland wants its nurses to stay on the job longer, and thinks it will need a third more personnel to cover long-term care needs within about a decade.Reforms Without EndMost important, perhaps, is the lesson that health reforms, once enacted, are never truly finished. As Zeltner puts it: “You end one reform and you start the next one. It’s a never-ending task.” Perhaps there’s another lesson there for all of us—including politicians who preach either that the Affordable Care Act is an optimal fix or that repealing it will clear the way for more perfect reforms for all time.Lest we fool ourselves that even reformed health systems will automatically produce better health, David Williams, Mark McClellan, and Alice Rivlin address underlying social and economic determinants. Williams served as staff director, and McClellan and Rivlin as panel members, of the Robert Wood Johnson Foundation Commission to Build a Healthier America.Pointing to statistics showing that many Americans’ health is slipping relative to the health of people in other countries, the authors call for major changes in “where and how Americans live, learn, work, and play.” After all, better health is among those nonimportable commodities we’ll have to create right here at home. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 August 2010 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited byEl buen gobierno de los servicios de salud de producción pública: ideas para avanzarCiência & Saúde Coletiva, Vol. 16, No. 6

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