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Resumo Os pilares Starfield são revistos assim como o sistema de saúde canadense. Avaliação objetiva e subjetiva são aplicadas ao sistema sob as lentes do acesso, longitudinalidade, integralidade e coordenação de cuidados. Discutem-se as vulnerabilidades do sistema e as ações e propostas que estão em curso para tentar melhorar esses aspectos, tanto nacionalmente como na província de Ontário. Destaque para a oportunidade de se criar um sistema gratuito de medicamentos e os diversos desafios para avançar a agenda de reformas. Abstract This paper reviews the Starfield pillars and the Canadian health system. An objective and subjective evaluation are applied to the system through the lenses of access, longitudinality, integrality, and coordination of care. System vulnerabilities, actions, and proposals that are underway to improve these aspects, both nationally and in the province of Ontario, are discussed. Worth highlighting is the opportunity to establish a national free drug system, and the several challenges to advance the agenda of reforms.

In this BJGP Open collection, we examine how international primary care systems have performed in response to COVID-19. The past few months have seen rapid change and adaption of primary care systems to meet unprecedented new challenges. The pandemic has also exposed critical weaknesses in systems all over the world.1 The World Health Organization (WHO) and the World Organization of Family Doctors (WONCA) contend that an ideal primary care system should fulfil the core characteristics laid out by Barbara Starfield:2 primary care should be accessible, affordable, available at the time of need, and represent the ‘front-door’ to the health system. It should provide ongoing care and coordination with other specialists and focus on individuals and their families beyond their biological disease.3,4 The Astana Declaration5 and the WHO Vision for Primary Health Care in the 21st Century 6 also make a case for empanelment (working for a listed or geographically defined population) and a model of primary care that is engaged with …

Human cognitive processes in wayfinding may differ depending on the time taken to accept visual information in environments. This study investigated users&rsquo, wayfinding processes using eye-tracking experiments, simulating a complex cultural space to analyze human visual movements in the perception and the cognitive processes through visual perception responses. The experiment set-up consisted of several paths in COEX Mall, Seoul&mdash, from the entrance of the shopping mall Starfield to the Star Hall Library to the COEX Exhibition Hall&mdash, using visual stimuli created by virtual reality (four stimuli and a total of 60 seconds stimulation time). The participants in the environment were 24 undergraduate or graduate students, with an average age of 24.8 years. Participants&rsquo, visual perception processes were analyzed in terms of the clarity and the recognition of spatial information and the activation of gaze fixation on spatial information. That is, the analysis of the visual perception process was performed by extracting &ldquo, conscious gaze perspective&rdquo, data comprising more than 50 consecutive 200 ms continuous gaze fixations, &ldquo, visual understanding perspective&rdquo, data were also extracted for more than 300 ms of continuous gaze fixation. The results show that the methods for analyzing the gaze data may vary in terms of processing, analysis, and scope of the data depending on the purpose of the virtual reality experiments. Further, they demonstrate the importance of what purpose statements are given to the subject during the experiment and the possibility of a technical approach being used for the interpretation of spatial information.

Resumo Este estudo propõe a realização de uma revisão integrativa da literatura a partir de artigos e publicações sobre o uso do “Primary Care Assessment Tool (PCAT)” como instrumento de avaliação desses serviços, discutindo os resultados encontrados no Brasil e em outros países do mundo, a partir da matriz inicial concebida pela equipe da Professora Bárbara Starfield e propor atualizações para a versão brasileira. Identificaram-se 124 trabalhos; porém, após a leitura dos mesmos, foram selecionados 42, de acordo com os critérios de inclusão estabelecidos. Deste subtotal, 17 (40,5%) foram estudos brasileiros. Sugere-se a necessidade da atualização de itens de cada atributo do instrumento, em particular do “acesso – primeiro contato”, incluindo novas formas de comunicação médico-paciente como: e-mail, mensagens por aplicativos em dispositivos móveis, uso de software de transmissão de vídeo para comunicação e mesmo utilização de telemedicina, entre outros. O PCAT apresenta simplicidade quanto ao uso, aplicação e cálculo dos escores, o que o torna útil e adequado para uso na gestão local dos serviços, especialmente em suas versões reduzidas em número de itens. Abstract This study proposes an integrative review of the literature based on articles and publications on the use of the Primary Care Assessment Tool (PCAT) as a tool for evaluating these services, discussing the results found in Brazil and in other countries of the world, from the initial matrix conceived by Professor Barbara Starfield’s team and proposing updates for the Brazilian version. We identified 124 studies, of which 42 were selected after full reading and according to the established inclusion criteria. Of this subtotal, 17 (40.5%) were Brazilian studies. There is a need to update items of each tool’s attribute, in particular “access – first contact”, including new forms of doctor-patient communication such as: email, mobile application messages, use of videoconference software for communication and even use of telemedicine, among others. PCAT’s use, application and calculation of scores is simple, which makes it useful and suitable for use in the local management of services, especially in its short version.

This article describes a large-scale analysis of dissertation macrostructures in the Faculties of Education at five major Canadian research universities. We draw on van Dijk (1980) and Paltridge (2002) in categorizing the global organizational patterns of 1,373 PhD dissertations and cross reference these patterns with each study’s research perspective. Although prior research has addressed thesis and dissertation writing by drawing on ESP and EAP perspectives, the majority of these studies have focused on individual sections within the larger dissertation text, while little work has considered the macrostructures of these texts, with some notable exceptions (e.g., Paltridge, 2002; Paltridge & Starfield, 2007, 2020; Paltridge, Starfield, Ravelli, & Tuckwell, 2012; Thompson, 1999). No study to date, however, has analyzed the breadth of dissertation macrostructures covered in this project. This research therefore occupies an important space in describing current trends in dissertation writing and research approaches in contemporary educational research from five large English-medium Canadian universities. In so doing, we highlight not only the variety in dissertation writing and doctoral research but, more specifically, the emergence of two new hybrid dissertation macrostructures.

The present article aims at discussing the singularities of primary health care (PHC) in contexts where violence, strongly supported by guns, is routinely, chronically, and systemically present, and to gauge the capacity of PHC as empowerment channel for communities where armed violence is an expressive vulnerability. Based on the Declaration of Alma-Ata and on the PHC principles described by Barbara Starfield, and focusing on community participation and social determinants of health, the discussion departs from the realities observed in Latin America and the commitment to access and universal coverage set forth in the third Sustainable Development Goal. The qualitative and quantitative characterization of armed violence and its consequences must be qualified using an intersectoral approach with heavy community participation in search of coherent and significant responses. The protection and safety of health care workers must be ensured to guarantee the continuous provision of health care services in contexts of violence.En el artículo se trata de abordar los aspectos singulares del trabajo de atención primaria de salud (APS) en los entornos donde la violencia, con el sólido apoyo del uso de armas de fuego, tiene una expresión habitual, crónica y generalizada, y de determinar la posibilidad que ofrece la APS de servir de canal de empoderamiento de la comunidad, donde la violencia armada representa una vulnerabilidad manifiesta. Con base en la Declaración de Alma-Ata y en los principios de la APS descritos por Bárbara Starfield, y con un enfoque en la participación comunitaria y en la perspectiva de los determinantes sociales de la salud, el debate tiene como punto de partida las realidades observadas en los países de América Latina y los compromisos orientados hacia el acceso universal a la salud y la cobertura universal de salud previstos en el tercero de los Objetivos de Desarrollo Sostenible. La caracterización cualitativa y cuantitativa de la violencia armada y de sus consecuencias debe hacerse a partir de un enfoque intersectorial con amplia participación comunitaria en la búsqueda de respuestas coherentes y significativas. También es preciso garantizar la protección y la seguridad de los profesionales para poder prestar servicios de salud de una manera continua en estos entornos.

Comprehensive primary care describes the long-term relationship between patient and provider in which medical services, support for self-care, and care coordination are the foundation. Research has associated comprehensive primary care with better system quality, equity, and efficiency. A performance measurement method is needed to enable teams delivering such care to optimize their performance and to evaluate the benefits over time. This article describes “The Starfield Model”—an approach to measuring quality, capacity, and total cost of care at this scope of service—and the results achieved by a small family health team in implementing this model. This experience suggests that real benefits arise from meaningful feedback to providers. The model has the potential to work in any payment system of primary care, thereby providing insight into all types of comprehensive primary care practices.

The analysis by Barbara Starfield and colleagues has serious methodological and conceptual shortcomings. Despite the reference to “evidence” in the title, there is little evidence to guide the health care community or policymakers. The paper faults specialists for most of the ailments of U.S. medicine and fails to recognize the critical role of specialists in improving Americans’ health status. A variety of factors, including organizational and financing systems, discourage effective use of both primary care and specialty physicians. The nation would be better served by developing an evidence base on the relationship between outcomes and education, training, and specialty.

Barbara Starfield and colleagues present evidence that having more primary care physicians and fewer specialists per capita is associated with lower mortality rates. These analyses stand ...

In the ICDM DMS (Display Metrology Standard), we introduce a method to help quantify contrast for displays which have backlight dimming for low-level drive levels — Starfield Contrast. LCD Displays with Dynamic Contrast (global/local dimming) reduce the output level of the backlights for display content with low average content. At the extreme (for all black or near black content) the backlight might be turned off, giving very high contrast values which might even be stated as infinite. Starfield Contrast determines the contrast of a display with global/local dimming at the threshold as the dimming circuitry begins operation. It controls the dimming to determine the real contrast of the display and provides the highest contrast before the display goes into its dynamic mode.

Clickstreams are visitors' paths through a Web site. Analysis of clickstreams shows how a Web site is navigated and used by its visitors. Clickstream data of online stores contains information useful for understanding the effectiveness of marketing and merchandising efforts, such as how customers find the store, what products they see, and what products they purchase. In this paper, we present an interactive visualization system that provides users with greater abilities to interpret and explore clickstream data of online stores. This system visualizes the effectiveness of Web merchandising from two different points of view by using two different visualization techniques: visualization of sessions by using parallel coordinates and visualization of product performance by using starfield graphs. Furthermore, this system provides facilities for zooming, filtering, color-coding, dynamic querying and data sampling. It also provides summary information along with visualizations, and by maintaining a connection between visualizations and the source database, it dynamically updates the summary information. To demonstrate how the presented visualization system provides capabilities for examining online store clickstreams, we present a series of parallel coordinates and starfield visualizations that display clickstream data from an operating online retail store. A framework for understanding Web merchandising is briefly explained. A set of metrics referred to as i>micro-conversion rates, which are defined for Web merchandising analysis in our previous work (Lee et al., Electronic Markets, 2000), is also explained and used for the visualizations of online store effectiveness.

The articles in this special issue were written for a symposium on the ethics of language testing held at the triennial congress of the Association Internationale de Linguistique Appliquée in August 1996 in Finland. This special issue addresses the role of ethics (and the limits of that role) in professional activities such as language testing. The nine articles that follow can be divided into four sections. The two articles in the first section (Spolsky and Hawthorne) consider language testing as a means of political control. The two in the second section (Elder, and Norton and Starfield) are concerned essentially with the definition of the test con struct — Elder considering whether the construct has the same meaning for differ ent groups and Norton and Starfield questioning whether it is form or content that is being assessed. The two articles in the third section (Hamp-Lyons and Rea- Dickins) consider the effects of language tests on the various stakeholders who are involved. In the fourth section, the three articles (Shohamy, Lynch and Davies) offer criteria for promoting ethicality in language testing, Lynch by an approach from principle (deontological), Davies through the professionalizing of the activity (teleological), and Shohamy through attention both to method and to consequence.

*School of Public and Environmental Affairs, Indiana University, Bloomington, IN 47405–1701, U.S.A., email meretsky@indiana.edu †P.O. Box 16426, Portal, AZ 85632, U.S.A. ‡Department of Environmental Science, Policy & Management, 151 Hilgard Hall, University of California, Berkeley, CA 94720–3114, U.S.A. §Wind Wolves Preserve, P.O. Box 189, Maricopa, CA 93252, U.S.A. **Grambling Cooperative Wildlife Project, Grambling State University, P.O. Box 841, Grambling, LA 71245, U.S.A.