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Additional file 1. HEMS-level intervention/drug/diagnostic. A list of all HLIDDs used within this study.

Additional file 3. AMPDS codes with significantly high rates of patient contact and/or HLIDD. A table listing the p value for both HLIDD and patient contact for specific codes.

Additional file 2. Sensitivity analysis to explore impact of thresholds on estimated tasking numbers/24 h. Demonstration of the impact of specific thresholds for intervention and/or patient contact on code availability.

Four different label-free, minimally-invasive, live single cell analysis techniques were applied in a quantitative comparison, to characterize embryonic stem cells and the hepatocytes into which they were differentiated. Atomic Force Microscopy measures the cell’s mechanical properties, Raman spectroscopy measures its chemical properties, and dielectrophoresis measures the membrane’s capacitance. We were able to assign cell type of individual cells with accuracies of 91% (Atomic Force Microscopy), 95.5% (Raman spectroscopy), and 72% (Dielectrophoresis). In addition, Stimulated Raman Scattering (SRS) microscopy was able to easily identify hepatocytes in images by the presence of lipid droplets. These techniques, used either independently or in combination, offer label-free methods to study individual living cells. Although these minimally-invasive biomarkers can be applied to sense phenotypical or environmental changes to cells, these techniques have most potential in human stem cell therapies where the use of traditional biomarkers is best avoided. Destructive assays consume valuable stem cells and do not characterize the cells which go on to be used in therapies; whereas immuno-labelling risks altering cell behaviour. We suggest how these four minimally invasive methods can be applied to cell culture, and how they could in future be combined into one microfluidic chip for cell sorting.

The characterisation of stem cells is of vital importance to regenerative medicine. Failure to separate out all stem cells from differentiated cells before therapies can result in teratomas - tumours of multiple cell types. Typically, characterisation is performed in a destructive manner with fluorescent assays. A truly non-invasive method of characterisation would be a major breakthrough in stem cell-based therapies. Raman spectroscopy has revealed that DNA and RNA levels drop when a stem cell differentiates into other cell types, which we link to a change in the relative sizes of the nucleus and cytoplasm. We also used Raman spectroscopy to investigate the biochemistry within an early embryo, or blastocyst, which differs greatly from colonies of embryonic stem cells. Certain cell types that differentiate from stem cells can be identified by directly imaging the biochemistry with CARS microscopy; examples presented are hydroxyapatite - a precursor to bone, and lipids in adipocytes.

There is a requirement for a noninvasive technique to monitor stem cell differentiation. Several candidates based on optical spectroscopy are discussed in this review: Fourier transform infrared (FTIR) spectroscopy, Raman spectroscopy, and coherent anti-Stokes Raman scattering (CARS) microscopy. These techniques are briefly described, and the ability of each to distinguish undifferentiated from differentiated cells is discussed. FTIR spectroscopy has demonstrated its ability to distinguish between stem cells and their derivatives. Raman spectroscopy shows a clear reduction in DNA and RNA concentrations during embryonic stem cell differentiation (agreeing with the well-known reduction in the nucleus to cytoplasm ratio) and also shows clear increases in mineral content during differentiation of mesenchymal stem cells. CARS microscopy can map these DNA, RNA, and mineral concentrations at high speed, and Mutliplex CARS spectroscopy/microscopy is highlighted as the technique with most promise for future applications.

Unemployment is regarded as one of the most challenging economic problems facing the governments of the Caribbean. Although there are variations in the measurement of unemployment, official estimates obtained from labor force surveys indicate that in 1995 the unemployment rate ranged from 7. 8 percent in Antigua/Barbuda to 19. 7 percent in Barbados. This paper explores unemployment in Trinidad and Tobago.