Biomedical subjects

M R Smallman-Raynor

Publications and source records attributed to M R Smallman-Raynor.

4 recordsLinked to original sources

PubMed1998

The geographical assignment of cancer units: patient accessibility as an optimal allocation problem.

The seminal report A Policy Framework for Commissioning Cancer Services provides the foundation for a major reorganisation of cancer service provision in England and Wales. One central recommendation of the report, the establishment of a tier of specialised cancer units in each Health Authority Region has raised the fundamental question of where those units are to be located. In particular, a declared objective of the report is for services to be planned to maximise their accessibility to patients. This paper demonstrates a classical method (location-allocation modelling) by which the accessibility criterion can be used to determine the optimal number, location and capacity of units for a given cancer site. The method is illustrated with reference to cervical cancer in Trent Health Authority Region. The implications of the method for the guidance of access-related decisions on the placement of cancer services are considered, and the wider relevance of the method to the organisation of service provision in other branches of medicine is suggested.

Algorithms↗

PubMed1995

The application of multidimensional scaling methods to epidemiological data.

This paper illustrates the use of multidimensional scaling methods (MDS) to examine space-time patterns in epidemic data. The paper begins by outlining the principles of MDS. The model is then formally specified and illustrated by application to two data sets. The first is partly a tutorial example. It uses monthly reported measles morbidity data for the 31-year period from January 1960 to December 1990, collected for the 50 states of the USA, plus New York City and the District of Columbia. These data are used to explore the various ways in which MDS may be used to identify changing spatial patterns in geographically-coded data. In addition to their tutorial use, the data are also employed to search for any substantive changes in the geographical structure of measles epidemics in the USA that may have followed the introduction of mass vaccination in 1965. New England appears to have developed an epidemic profile distinct from the rest of the USA, and there is tentative evidence of an urban-rural split in epidemic characteristics. The second data set takes annual reported measles mortality data for New Zealand and the states of Australia from 1860 to 1949. MDS is used to show how the spatial relationships among these geographical units have changed over time in response to changes in the sizes of local susceptible populations.

Australia↗

PubMed1992

Seasonality in tropical AIDS: a geographical analysis.

This paper presents evidence that the growth rate of the AIDS epidemic at the district level in Uganda, Central Africa, displays a seasonally recurring geographical pattern, with epidemic acceleration in some areas of the country in the first 8 months of each year. The spatial and temporal variations in acceleration appear to be correlated with the predominant agricultural systems in different parts of Uganda. Based upon the frequently hypothesized relationship between malnourishment and the progression to clinical AIDS in HIV-infected people, it is suggested that the variations in epidemic speed reflect the seasonal patterns of nutritional deficiency which occur under some tropical agricultural systems. These preliminary findings require further verification since they have important implications for directing nutrition-related remedial responses to the AIDS epidemic in tropical countries where malnutrition and endemic HIV infection coincide.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Civil war and the spread of AIDS in Central Africa.

Using ordinary least squares regression techniques this paper demonstrates, for the first time, that the classic association of war and disease substantially accounts for the presently observed geographical distribution of reported clinical AIDS cases in Uganda. Both the spread of HIV 1 infection in the 1980s, and the subsequent development of AIDS to its 1990 spatial pattern, are shown to be significantly and positively correlated with ethnic patterns of recruitment into the Ugandan National Liberation Army (UNLA) after the overthrow of Idi Amin some 10 years earlier in 1979. This correlation reflects the estimated mean incubation period of 8-10 years for HIV 1 and underlines the need for cognizance of historical factors which may have influenced current patterns of AIDS seen in Central Africa. The findings may have important implications for AIDS forecasting and control in African countries which have recently experienced war. The results are compared with parallel analyses of other HIV hypotheses advanced to account for the reported geographical distribution of AIDS in Uganda.

Acquired Immunodeficiency Syndrome↗