Evaluation Report: NH Multi-Stakeholder Medical Home Pilot

The New Hampshire Multi-Stakeholder Medical Home Pilot was initiated in 2008 by the New Hampshire Citizens Health Initiative as a collaborative effort of its Medical Home workgroup, the Center for Medical Home Improvement and the four private New Hampshire Health Plans: Harvard Pilgrim Health Care, CIGNA, Anthem, and MVP Healthcare, as well as NH Medicaid. The goal of the pilot was to value, prescribe, and reward medical care that is tightly coordinated and of superior quality and efficiency

Hot subdwarf stars in close-up view - II. Rotational properties of single and wide binary subdwarf B stars

Subluminous B stars (sdBs) form the extremely hot end of the horizontal branch and are therefore related to the blue horizontal branch (BHB) stars. While the rotational properties of BHB stars have been investigated extensively, studies of sdB stars have concentrated on close binaries that are influenced by tidal interactions between their components. Here we present a study of 105 sdB stars, which are either single stars or in wide binaries where tidal effects become negligible. The projected rotational velocities have been determined by measuring the broadening of metal lines using high-resolution optical spectra. All stars in our sample are slow rotators (${v_{\rm rot}\sin{i}}<10\,{\rm km\,s^{-1}}$). Furthermore, the $v_{\rm rot}\sin{i}$-distributions of single sdBs are similar to those of hot subdwarfs in wide binaries with main-sequence companions as well as close binary systems with unseen companions and periods exceeding $\simeq1.2\,{\rm d}$. We show that blue horizontal and extreme horizontal branch stars are also related in terms of surface rotation and angular momentum. Hot blue horizontal branch stars ($T_{\rm eff}>11\,500\,{\rm K}$) with diffusion-dominated atmospheres are slow rotators like the hot subdwarf stars located on the extreme horizontal branch, which lost more envelope and therefore angular momentum in the red-giant phase. The uniform rotation distributions of single and wide binary sdBs pose a challenge to our understanding of hot subdwarf formation. Especially the high fraction of helium white dwarf mergers predicted by theory seems to be inconsistent with the results presented here.Comment: 12 pages, 7 figures, A&A, in pres

Chemical and kinematical properties of BSSs and HB stars in NGC 6397

We used three sets of high-resolution spectra acquired with the multifiber facility FLAMES at the Very Large Telescope of the European Southern Observatory to investigate the chemical and kinematical properties of a sample of 42 horizontal branch (HB) stars, 18 Blue Straggler Stars (BSSs) and 86 main sequence turn-off and sub-giant branch stars in the nearby globular cluster NGC 6397. We measured rotational velocities and Fe, O and Mg abundances. All the unevolved stars in our sample turn out to have low rotational velocites (v sin i< 10\kms), while HB stars and BSSs show a broad distribution, with values ranging from 0 to 70 \kms. For HB stars with T<10500 K there is a clear temperature-oxygen anti-correlation, that can be understood if the star position along the HB is mainly determined by the He content. The hottest BSSs and HB stars (with temperatures T>8200 K and T> 10500 K, respectively) also show significant deviations in their iron abundance with respect to the cluster metallicity (as traced by the unevolved stars, [Fe/H]=-2.12). While similar chemical patterns have been already observed in other hot HB stars, this is the first evidence ever collected for BSSs. We interprete these abundance anomalies as due to the metal radiative levitation, occurring in stars with shallow or no convective envelopes

Electric Vehicles as a Mobile Storage Device

International audienceElectricity is a quite recent energy (150 years old) that has developed very much as it allows a flexible use through converters (electrical machines and power electronics). At the beginning, the main use was for lighting and metro. Now, electricity is a major energy for developed countries: 17.7% of the world final energy consumption and 22% for the ECD countries (IEA, 2013a; b, Figure 1), and an economic growth is always linked to an electric consumption growth. Electricity has improved our daily life: washer, dryer, dishwasher, microwaves, internet, TV, air-conditioning, and so on. Humans have become very dependent on electricity consumptions. Nevertheless, electricity is a specific product in the sense that it is a nonmaterial energy, and thus it can only be stored through a costly transformation. Electricity can be classified as a tertiary or secondary energy produced from thermal, potential, hydro (see Volume 5, Chapter XX), wind hces137, or solar energy. For a thermal plant, the primary energy (coal, gas, or uranium) is converted into mechanical energy (secondary energy) by a turbine and is transmitted to the generator to be converted into electricity (tertiary energy). As electricity is difficult to store, it needs an infrastructure to be delivered to consumers: the electrical grid that makes the link between power plants and the consumers through transformers and overhead or cabled lines. At the beginning of the twentieth century, all countries made the choice of the alternating current technology as it allowed—thanks to a key device (the transformer) transmission of high power at high voltages to reduce losses. In the context of emissions reduction (CO2, NOx, etc.), objectives have been given for cleaner energies and the use of more efficient ones. In Europe, there are the “20–20–20” targets: 20% reduction for CO2 emissions, 20% reduction in energy consumption, and 20% increase in efficiency by 2020 (see Volume 6, Chapter XX). To reach these policy goals, electricity is an appropriate vector: it is a flexible energy that can be produced from renewable or CO2-free sources, electrical converters have high efficiency (80–90% for an electric motor) and are bidirectional what makes energy recovery possible for applications such as breaking (trains, vehicles, etc.). Transportation (cars, autobuses, and trucks) is often considered a major contributor to local pollution. Then, constraints for CO2 emissions reduction are more and more severe, especially in Europe. Automakers and their suppliers have optimized their engines with innovations such as start&stop starter/generator, kinetic energy recovery ystems, hybrid systems, and full battery electric vehicles (EVs) and plugin hybrid vehicles. For the two last cases, the energy stored in the batteries will totally or partially come from the electric grid

GPs' attitudes, beliefs and behaviours regarding exercise for chronic knee pain: a questionnaire survey

OBJECTIVES: The aim of this study was to investigate general practitioners' (GPs) attitudes, beliefs and behaviours regarding the use of exercise for patients with chronic knee pain (CKP) attributable to osteoarthritis. SETTING: Primary care GPs in the UK. PARTICIPANTS: 5000 GPs, randomly selected from Binley's database, were mailed a cross-sectional questionnaire survey. OUTCOME MEASURES: GPs' attitudes and beliefs were investigated using attitude statements, and reported behaviours were identified using vignette-based questions. GPs were invited to report barriers experienced when initiating exercise with patients with CKP RESULTS: 835 (17%) GPs responded. Overall, GPs were positive about general exercise for CKP. 729 (87%) reported using exercise, of which, 538 (74%) reported that they would use both general and local (lower limb) exercises. However, only 92 (11% of all responding) GPs reported initiating exercise in ways aligning with best-evidence recommendations. 815 (98%) GPs reported barriers in using exercise for patients with CKP, most commonly, insufficient time in consultations (n=419; 51%) and insufficient expertise (n=337; 41%). CONCLUSIONS: While GPs' attitudes and beliefs regarding exercise for CKP were generally positive, initiation of exercise was often poorly aligned with current recommendations, and barriers and uncertainties were reported. GPs' use of exercise may be improved by addressing the key barriers of time and expertise, by developing a pragmatic approach that supports GPs to initiate individualised exercise, and/or by other professionals taking on this role

Can mimetics, a theatre based practice, open possibilities for young people with learning disabilities - a capability approach?

Whilst the significance of the social model of disability for articulating inclusive approaches in education is recognised, the application of capability theory to education is less developed. We consider how a particular theatre based practice, here described as ‘mimetics’, can alter and extend the aspirations and achievements of children and young people with learning disabilities, and might be understood as applied capability theory or ‘capability practice’. Mimetics has been crafted from experimental psycho-physical actor training processes by Open Theatre Company working in collaboration with actors with learning disabilities, and adapted to support the learning and development of young people with learning disabilities. We draw upon an action research project set up by Creative Partnerships with Open Theatre Company and a special school, where children demonstrated increased motivation and capacity for communication and socialisation, improved well-being, learning and wider achievement. To illustrate the process we offer the case of one child with an autistic spectrum disorder

Characterization of the seismic environment at the Sanford Underground Laboratory, South Dakota

An array of seismometers is being developed at the Sanford Underground Laboratory, the former Homestake mine, in South Dakota to study the properties of underground seismic fields and Newtonian noise, and to investigate the possible advantages of constructing a third-generation gravitational-wave detector underground. Seismic data were analyzed to characterize seismic noise and disturbances. External databases were used to identify sources of seismic waves: ocean-wave data to identify sources of oceanic microseisms, and surface wind-speed data to investigate correlations with seismic motion as a function of depth. In addition, sources of events contributing to the spectrum at higher frequencies are characterized by studying the variation of event rates over the course of a day. Long-term observations of spectral variations provide further insight into the nature of seismic sources. Seismic spectra at three different depths are compared, establishing the 4100-ft level as a world-class low seismic-noise environment.Comment: 29 pages, 16 figure

Building nurse education capacity in India: insights from a faculty development programme in Andhra Pradesh

Background: India faces an acute shortage of nurses. Strategies to tackle the human resource crisis depend upon scaling up nursing education provision in a context where the social status and working conditions of nurses are highly variable. Several national and regional situation assessments have revealed significant concerns about educational governance, institutional and educator capacity, quality and standards. Improving educational capacity through nursing faculty development has been proposed as one of several strategies to address a complex health human resource situation. This paper describes and critically reflects upon the experience of one such faculty development programme in the state of Andhra Pradesh. Discussion: The faculty development programme involved a 2 year partnership between a UK university and 7 universities in Andhra Pradesh. It adopted a participatory approach and covered training and support in 4 areas: teaching, research/scholarship, leadership/management and clinical education. Senior hospital nurses were also invited to participate. Summary: The programme was evaluated positively and some changes to educational practice were reported. However, several obstacles to wider change were identified. At the programme level, there was a need for more intensive individual and institutional mentorship as well as involvement of Indian Centres of Excellence in Nursing to provide local (as well as international) expertise. At the organisational level, the participating Colleges reported heavy workloads, lack of control over working conditions, lack of control over the curriculum and poor infra-structure/resources as ongoing challenges. In the absence of wider educational reform in nursing and government commitment to the profession, faculty development programmes alone will have limited impac

‘The only way is Essex’: Gender, union and mobilisation among fire service control room staff

This contribution to On the Front Line records a dialogue between two female Fire Brigades Union (FBU) representatives in the Essex Emergency Control Room who led industrial action over the imposition of a shift system that stretched their work–life balance to breaking point and constrained their ability to work full-time. Their testimony reveals how male members were mobilised in the interests of predominantly female control staff. Kate and Lynne’s discussion illuminates the interaction of gender and class interests and identities in the union and in the lives of its women members. It provides insight into the efficacy of trade unions for women’s collective action