Evaluation of observed blast loading effects on NIF x-ray diagnostic collimators.

We present the "debris wind" models used to estimate the impulsive load to which x-ray diagnostics and other structures are subject during National Ignition Facility experiments. These models are used as part of the engineering design process. Isotropic models, based on simulations or simplified "expanding shell" models, are augmented by debris wind multipliers to account for directional anisotropy. We present improvements to these multipliers based on measurements of the permanent deflections of diagnostic components: 4× for the polar direction and 2× within the equatorial plane-the latter relaxing the previous heuristic debris wind multiplier.

Poland: health system review

The Health Systems in Transition (HiT) country profiles provide an analytical description of each health system and of policy initiatives in progress or under development. They aim to provide relevant comparative information to support policy-makers and analysts in the development of health systems and reforms in the countries of the WHO European Region and beyond. The HiT profiles are building blocks that can be used: to learn in detail about different approaches to the financing, organization and delivery of health services; to describe accurately the process, content and implementation of health reform programmes; to highlight common challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in countries of the WHO European Region. This series is an ongoing initiative and material is updated at regular intervals.

Regional integration of health services in Poland--an ambitious pilot project.

A new and very important feature of the health care reform in Poland is a set of initiatives emerging locally and striving for decentralisation of the management structure. The most promising manifestation of this process consists in the ambition to set up regional systems of integrated health services, guaranteeing provision of comprehensive care and run efficiently by competent managers. The direction of reform has been strongly encouraged by the Ministry of Health and Social Welfare, but still faces many barriers, mainly because of the misuse of the concept of integration by former health politicians. In the seventies and eighties integration was implemented in a very formal way, neglecting both medical professional attitudes and managerial abilities of decision makers. A major mistake was the resignation of inclusion of the rich 'parallel systems' within the services available to the general public. In the new political circumstances regionalised services, or health consortia as they are called, are a deliberate response to the need for decentralisation and efficient use of scarce resources. Three regions which volunteered to start an extensive experiment were selected through a formal competitive process. They include more than six million inhabitants and almost one quarter of the territory of the country. New organisational arrangements, networks of contracts and agreements, channels of financing and quality control programmes will be monitored in pilot areas to make them applicable all over the country.

[Necessity of changes and trends in the health care system for the workers in Poland]. / O potrzebie i kierunkach zmian w systemie opieki nad zdrowiem populacji pracujacej w polsce.

Authors define current organizing conditions and work effects of the industrial health service in Poland. They indicate these elements of diagnosis which effect the poor effectiveness of this health care unit. They also discuss the tasks assigned for health service in plants which were imposed by the ILO compact No 161 in 1985, and declare prompt implementation of the tasks in Poland. Suggestions concerning health insurance operative for all economic subjects are presented. The implementation of this kind of insurance would be one of indispensable modifications in the health care system of the working population. The range of free medical services available within this insurance would include a complex of preventive measures and medical assistance in case of disasters and life-threatening circumstances.

[Various problems in the utilization of resources of occupational health services]. / Niektóre problemy wykorzystania zasobów przemyslowych zespolów opieki zdrowotnej.

A theoretical starting point of the analysis is a hypothesis of the decreased use of OIHS's resources. This hypothesis is being verified in relation to 39 OIHCSes. The data specyifying the magnitude of resources-confined to the paid time of physicians' work--and their use comes from Lp-8 cards collected and processed at the Institute of Occupational Medicine, Lódz. The results confirmed the hypothesis in relation to all forms of services except those rendered by specialist physicians and--preventive examinations rendered by physicians of gynaecological dispensaries and industrial physicians of local out-patient departments. The least effective use of resources is that of the dental care and--of therapeutic activities carried on by other physicians. The conclusions emphasize the tentative nature of analysis, resulting from the confinement of the notion of effective use of resources to that related to the physicians' working time.

[Health resources and utilization of occupational health services]. / Wielkosc zasobów a korzystanie ze swiadczén przemyslowej sluzby zdrowia.

In literature on health care organization a hypothesis has been formulated on the relations between resources and health care use. The very development of resources, and not populations health condition deterioration has been emphasized as a stimulating factor. Attempts have been made in the paper to partially verify this hypothesis in relation to occupational health service. The results have confirmed the adopted hypothesis. Almost all the relationships concerned were statistically significant. Particularly strong dependences of the use of benefits have been found in the specialist care, for consultations rendered due to a disease (not prevention) and at the territorial (provincial) level--not at the level of integrated occupational health service authorities.

Selected organizational features of certain Polish health care institutions.

A special feature of the Polish health care system in the 70s was the process toward organizational centralization. This consisted in integrating independent organizational units into larger, more complex ones, and transferring the processes of decision-making to higher management levels. This transition was introduced in 1975. One of its effects was incorporating into one organization all health care systems in a given area, primary care hospitals, specialist care units, laboratory bases, emergency and social welfare agencies and subsuming all these institutions under one management. The ensuing organization was named the Health Care Complex (HCC). It is interesting that in the HCC area other organizations were founded to cover industrial workers. These were called Occupational Health Care Complexes (OHCC). This paper deals with a description of a variety of OHCC organizational structures, an analysis of the relationships between different parameters of organizational structures (leaving aside, however, their casual interpretation), and an examination of the possibilities for applying empirical data to OHCC organizational structural analysis.

[Organizational characteristics of health care and the problems of occupational health services. Part II. Problems of management organization]. / Organizacyjne cechy zespolu opieki zdrowotnej a problemy przemyslowej sluuby zdrowia. Czesc II: Problemy organizacji zarzadzania.

Efficient activity of industrial health service within health care complex (ZOZ) is fundamentally and directly determined by the form of ZOZ's management organization system. In this part the author analyses the following problems: 1) management levels, 2) management organization system and "morphology", 3) system of supervising the middle and lower personnel, 4) functional links structure. The author concludes that general rules are not sufficient for setting up the management structure of occupational health service. These questions should be solved by local ZOZ's legislation.

[Organizational characteristics of health care problems and the problems of industrial health services. I. Problems of organizational "morphology"]. / Organizacyjne cechy zespolu opieki zdrowotnej a problemy przemyslowej sluzby zdrowia. Czesc I: problemy morfologii organizacyjnej.

The major part of industrial health care facilities act in frames of territorial health care complexes (ZOZ). It is unquestionable that ZOZ's organizational features influence fundamentally the efficiency of industrial health care activity. It is assumed that an analysis of these characteristics enables formulation of hypotheses regarding organizational conditions of effective activity of industrial health care. In part I the author analyses two ZOZ's features: 1) organizational components 2) flexibility of organizational structure. The author comes to the conclusion that the flexible structure enables composition of health care facilities network which fit the existing needs. If any needs remain unsatisfied it is a result of either shortage in resources or mismanagement.

[Problems of formal organizational structure of industrial health care complexes]. / Problemy formalnej struktury organizacyjnej przemyslowego zespolu opieki zdrowotnej.

The author formulates the thesis that the description of organizational structure of industrial health care complex calls for isolation of the following aspects:--structure of territorial links--systemof organizational units and divisions--organization of basic functions--structure of management--structure of supervision of middle and lowe-level personnel--composition of health care complex council--system of accessibility ranges. Each of the above aspects has been considered on the basis of operative rules of law, using organizational analysis methods.