Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England

Background - Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Methods - Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. Results - The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners’ contracts in perpetuity, potentially constraining commissioners’ abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. Conclusions - NHS dental practitioners’ contracts resemble budget-silos which do not facilitate local resource reallocation. ‘Context-specific’ factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations

The Solar Radius in the EUV during the Cycle XXIII

Aims. To determine the solar transition region and coronal radius at EUV wavelengths and its time evolution during Solar Cycle XXIII. Methods. We use daily 30.4 and 17.1 nm images obtained by the Extreme Ultraviolet Imager (EIT) aboard the SoHO satellite and derive the solar radius by fitting a circle to the limb brightness ring. Results. The weighted mean of the temporal series gives (967''.56 +/- 0''.04) and (969''.54 +/- 0''.02) at 30.4 and 17.1 nm respectively. No significant correlation was found with the solar cycle at any of the two wavelengths. Conclusions. Since the temperature formation of the 30.4 nm line is between (60 - 80) 10^3 K (Transition Region), the obtained result is bigger than that derived from present atmospheric models. On the contrary this height is compatible with radio models.Comment: accepted for publication in Astronomy & Astrophysics minor changes introduced during review proces

Compositional characterisation of the Themis family

Context. It has recently been proposed that the surface composition of icy main-belt asteroids (B-,C-,Cb-,Cg-,P-,and D-types) may be consistent with that of chondritic porous interplanetary dust particles (CPIDPs). Aims. In the light of this new association, we re-examine the surface composition of a sample of asteroids belonging to the Themis family in order to place new constraints on the formation and evolution of its parent body. Methods. We acquired NIR spectral data for 15 members of the Themis family and complemented this dataset with existing spectra in the visible and mid-infrared ranges to perform a thorough analysis of the composition of the family. Assuming end-member minerals and particle sizes (<2\mum) similar to those found in CPIDPs, we used a radiative transfer code adapted for light scattering by small particles to model the spectral properties of these asteroids. Results. Our best-matching models indicate that most objects in our sample possess a surface composition that is consistent with the composition of CP IDPs.We find ultra-fine grained Fe-bearing olivine glasses to be among the dominant constituents. We further detect the presence of minor fractions of Mg-rich crystalline silicates. The few unsuccessfully matched asteroids may indicate the presence of interlopers in the family or objects sampling a distinct compositional layer of the parent body. Conclusions. The composition inferred for the Themis family members suggests that the parent body accreted from a mixture of ice and anhydrous silicates (mainly amorphous) and subsequently underwent limited heating. By comparison with existing thermal models that assume a 400km diameter progenitor, the accretion process of the Themis parent body must have occurred relatively late (>4Myr after CAIs) so that only moderate internal heating occurred in its interior, preventing aqueous alteration of the outer shell.Comment: 9 pages, 5 figures, accepted for publication in A&

The triaxial ellipsoid dimensions, rotational pole, and bulk density of ESA Rosetta target asteroid (21) Lutetia

We seek the best size estimates of the asteroid (21) Lutetia, the direction of its spin axis, and its bulk density, assuming its shape is well described by a smooth featureless triaxial ellipsoid, and to evaluate the deviations from this assumption. Methods. We derive these quantities from the outlines of the asteroid in 307 images of its resolved apparent disk obtained with adaptive optics (AO) at Keck II and VLT, and combine these with recent mass determinations to estimate a bulk density. Our best triaxial ellipsoid diameters for Lutetia, based on our AO images alone, are a x b x c = 132 x 101 x 93 km, with uncertainties of 4 x 3 x 13 km including estimated systematics, with a rotational pole within 5 deg. of ECJ2000 [long,lat] = [45, -7], or EQJ2000 [RA, DEC] = [44, +9]. The AO model fit itself has internal precisions of 1 x 1 x 8 km, but it is evident, both from this model derived from limited viewing aspects and the radius vector model given in a companion paper, that Lutetia has significant departures from an idealized ellipsoid. In particular, the long axis may be overestimated from the AO images alone by about 10 km. Therefore, we combine the best aspects of the radius vector and ellipsoid model into a hybrid ellipsoid model, as our final result, of 124 +/- 5 x 101 +/- 4 x 93 +/- 13 km that can be used to estimate volumes, sizes, and projected areas. The adopted pole position is within 5 deg. of [long, lat] = [52, -6] or[RA DEC] = [52, +12]. Using two separately determined masses and the volume of our hybrid model, we estimate a density of 3.5 +/- 1.1 or 4.3 +/- 0.8 g cm-3 . From the density evidence alone, we argue that this favors an enstatite-chondrite composition, although other compositions are formally allowed at the extremes (low-porosity CV/CO carbonaceous chondrite or high-porosity metallic). We discuss this in the context of other evidence.Comment: 9 pages, 8 figures, 5 tables, submitted to Astronomy and Astrophysic

Calculation of Spectral Darkening and Visibility Functions for Solar Oscillations

Calculations of spectral darkening and visibility functions for the brightness oscillations of the Sun resulting from global solar oscillations are presented. This has been done for a broad range of the visible and infrared continuum spectrum. The procedure for the calculations of these functions includes the numerical computation of depth-dependent derivatives of the opacity caused by p modes in the photosphere. A radiative-transport code was used for this purpose to get the disturbances of the opacities from temperature and density fluctuations. The visibility and darkening functions are obtained for adiabatic oscillations under the assumption that the temperature disturbances are proportional to the undisturbed temperature of the photosphere. The latter assumption is the only way to explore any opacity effects since the eigenfunctions of p-mode oscillations have not been obtained so far. This investigation reveals that opacity effects have to be taken into account because they dominate the violet and infrared part of the spectrum. Because of this dominance, the visibility functions are negative for those parts of the spectrum. Furthermore, the darkening functions show a wavelength-dependent change of sign for some wavelengths owing to these opacity effects. However, the visibility and darkening functions under the assumptions used contradict the observations of global p-mode oscillations, but it is beyond doubt that the opacity effects influence the brightness fluctuations of the Sun resulting from global oscillations

Ultraviolet and visible photometry of asteroid (21) Lutetia using the Hubble Space Telescope

The asteroid (21) Lutetia is the target of a planned close encounter by the Rosetta spacecraft in July 2010. To prepare for that flyby, Lutetia has been extensively observed by a variety of astronomical facilities. We used the Hubble Space Telescope (HST) to determine the albedo of Lutetia over a wide wavelength range, extending from ~150 nm to ~700 nm. Using data from a variety of HST filters and a ground-based visible light spectrum, we employed synthetic photometry techniques to derive absolute fluxes for Lutetia. New results from ground-based measurements of Lutetia's size and shape were used to convert the absolute fluxes into albedos. We present our best model for the spectral energy distribution of Lutetia over the wavelength range 120-800 nm. There appears to be a steep drop in the albedo (by a factor of ~2) for wavelengths shorter than ~300 nm. Nevertheless, the far ultraviolet albedo of Lutetia (~10%) is considerably larger than that of typical C-chondrite material (~4%). The geometric albedo at 550 nm is 16.5 +/- 1%. Lutetia's reflectivity is not consistent with a metal-dominated surface at infrared or radar wavelengths, and its albedo at all wavelengths (UV-visibile-IR-radar) is larger than observed for typical primitive, chondritic material. We derive a relatively high FUV albedo of ~10%, a result that will be tested by observations with the Alice spectrograph during the Rosetta flyby of Lutetia in July 2010.Comment: 14 pages, 2 tables, 8 figure