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Lending standards collapsed to an almost unimaginable degree during the great bubble, to the point that in some areas if you had a pulse, you could get a mortgage. The collapse manifested itself in many ways. In 2001, the combined loan-to-value ratio for the average mortgage was 74 percent, meaning the buyer had put down 26 percent of the cost of the home (see Figure 1.7). When doing any kind of lending, it s critical that the borrower has meaningful skin in the game, so there is a strong incentive to repay the loan, even if the value of the asset falls. Over the next ve years, the average loan-to-value ratio rose to 84 percent, meaning that the average borrower was putting down only 16 percent, affording lenders much less protection in the event home prices tumbled. The situation was even more extreme for rst-time home buyers, who were putting down only 2 percent on average by early 2007. Not surprisingly, the percentage of mortgages for which the borrower put no money down and was effectively getting a free call

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More and more frequently, measuring equipment is connected with software which directly intervenes in the process of measurement. It stands to reason that the software, too, should be subjected to the same principles of control. Two levels have been defined by the standardization body: 1. You have to ensure that the software does not bias the final result provided by the equipment. The classical methods of validation of software that apply here are: measurement in parallel with other software that is certified to be fit for the purpose; non-automatic verification that the software is working correctly. 2. Periodically, or before each new use, a test should make it possible to ensure the software has not wandered. Such a verification is integrated in some software; it is called the check sum , and is invisible to the user and it makes the sum of the 0 or 1 of the program in binary. There is only one result and it is characteristic of the program; it is its genetic fingerprint . Any modification of only one of these bits results in a different sum and the user is alerted. If this verification is not integrated into the software (find out from the supplier or manufacturer), it is possible to have it installed later.

The potential for teleinedicine in primary care is yet to be realised [73]. Much of the GP's work is concerned with minor ailments and it seems likely that the majority of these will continue to be diagnosed by patients presenting themselves at the surgery or health centre. Increasingly. however, we shall see surgeries cropping up in public areas such as shopping malls. Does the physician need to be on the premises Dr Woodrow Kessler from Media, Pennsylvania thinks not [85]. Dr Kessler has a walk-in surgery in a mall in Philadelphia. Patients enter the surgery and register with a nurse, who asks a series of diagnostic questions prompted by a computer. The nurse reads the positive answers to Dr Kessler or one of his partners at the other end of a videoconferencing link and, with the nurse's help, the doctor examines the patient with simple tools such as a laryngoscope or otoscope. He then states his diagnosis and care plan. Cost $15 for five minutes! No insurance. cash on the nail! This is convenience medicine. Patients do not have to make a special appointment, take time off work, or take a detour to the surgery. They can pop in during their lunch break or after work. For the minor complaints it is meant to deal with it is ideal. In addition. it takes pressure off the mainstream health services and helps them to deal effectively with more serious conditions. We have not seen this approach in the UK yet but it is coming [151]. In a inore conventional vein we can distinguish three main ways in which GPs can use clinical telemedicine to benefit patients and themselves:

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HANDLE HeapCreate(DWORD flOptions, DWORD dwInitialSize, DWORD dwMaximumSize); LPVOID HeapAlloc(HANDLE hHeap, DWORD dwFlags, DWORD dwBytes); LPVOID HeapReAlloc(HANDLE hHeap, DWORD dwFlags, LPVOID lpMem, DWORD dwBytes); BOOL HeapFree(HANDLE hHeap, DWORD dwFlags, LPVOID lpMem); BOOL HeapDestroy(HANDLE hHeap);

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