2,050 research outputs found
How to identify when a performance indicator has run its course
The official published version can be found at the link below.Increasing numbers of countries are using indicators to evaluate the quality of clinical care, with some linking payment to achievement. For performance frameworks to remain effective the indicators need to be regularly reviewed. The frameworks cannot cover all clinical areas, and achievement on chosen indicators will eventually reach a ceiling beyond which further improvement is not feasible. However, there has been little work on how to select indictors for replacement. The Department of Health decided in 2008 that it would regularly replace indicators in the national primary care pay for performance scheme, the Quality and Outcomes Framework, making a rigorous approach to removal a priority. We draw on our previous work on pay for performance and our current work advising the National Institute for Health and Clinical Excellence (NICE) on the Quality and Outcomes Framework to suggest what should be considered when planning to remove indicators from a clinical performance framework
Early Dark Energy Cosmologies
We propose a novel parameterization of the dark energy density. It is
particularly well suited to describe a non-negligible contribution of dark
energy at early times and contains only three parameters, which are all
physically meaningful: the fractional dark energy density today, the equation
of state today and the fractional dark energy density at early times. As we
parameterize Omega_d(a) directly instead of the equation of state, we can give
analytic expressions for the Hubble parameter, the conformal horizon today and
at last scattering, the sound horizon at last scattering, the acoustic scale as
well as the luminosity distance. For an equation of state today w_0 < -1, our
model crosses the cosmological constant boundary. We perform numerical studies
to constrain the parameters of our model by using Cosmic Microwave Background,
Large Scale Structure and Supernovae Ia data. At 95% confidence, we find that
the fractional dark energy density at early times Omega_early < 0.06. This
bound tightens considerably to Omega_early < 0.04 when the latest Boomerang
data is included. We find that both the gold sample of Riess et. al. and the
SNLS data by Astier et. al. when combined with CMB and LSS data mildly prefer
w_0 < -1, but are well compatible with a cosmological constant.Comment: 6 pages, 3 figures; references added, matches published versio
Specht modules and semisimplicity criteria for Brauer and Birman--Murakami--Wenzl Algebras
A construction of bases for cell modules of the Birman--Murakami--Wenzl (or
B--M--W) algebra by lifting bases for cell modules of
is given. By iterating this procedure, we produce cellular bases for B--M--W
algebras on which a large abelian subalgebra, generated by elements which
generalise the Jucys--Murphy elements from the representation theory of the
Iwahori--Hecke algebra of the symmetric group, acts triangularly. The
triangular action of this abelian subalgebra is used to provide explicit
criteria, in terms of the defining parameters and , for B--M--W algebras
to be semisimple. The aforementioned constructions provide generalisations, to
the algebras under consideration here, of certain results from the Specht
module theory of the Iwahori--Hecke algebra of the symmetric group
New Techniques for Analysing Axisymmetric Gravitational Systems. 1. Vacuum Fields
A new framework for analysing the gravitational fields in a stationary,
axisymmetric configuration is introduced. The method is used to construct a
complete set of field equations for the vacuum region outside a rotating
source. These equations are under-determined. Restricting the Weyl tensor to
type D produces a set of equations which can be solved, and a range of new
techniques are introduced to simplify the problem. Imposing the further
condition that the solution is asymptotically flat yields the Kerr solution
uniquely. The implications of this result for the no-hair theorem are
discussed. The techniques developed here have many other applications, which
are described in the conclusions.Comment: 30 pages, no figure
Finite temperature Casimir effect for massive scalar field in spacetime with extra dimensions
We compute the finite temperature Casimir energy for massive scalar field
with general curvature coupling subject to Dirichlet or Neumann boundary
conditions on the walls of a closed cylinder with arbitrary cross section,
located in a background spacetime of the form ,
where is the -dimensional Minkowski spacetime and
is an -dimensional internal manifold. The Casimir energy is
regularized using the criteria that it should vanish in the infinite mass
limit. The Casimir force acting on a piston moving freely inside the closed
cylinder is derived and it is shown that it is independent of the
regularization procedure. By letting one of the chambers of the cylinder
divided by the piston to be infinitely long, we obtain the Casimir force acting
on two parallel plates embedded in the cylinder. It is shown that if both the
plates assume Dirichlet or Neumann boundary conditions, the strength of the
Casimir force is reduced by the increase in mass. Under certain conditions, the
passage from massless to massive will change the nature of the force from long
range to short range. Other properties of the Casimir force such as its sign,
its behavior at low and high temperature, and its behavior at small and large
plate separations, are found to be similar to the massless case. Explicit exact
formulas and asymptotic behaviors of the Casimir force at different limits are
derived. The Casimir force when one plate assumes Dirichlet boundary condition
and one plate assumes Neumann boundary condition is also derived and shown to
be repulsive.Comment: 28 pages, 4 figure
Numerical Investigation of Slag Behavior for RSRM
It is known that the flow field of the redesigned solid rocket motor (RSRM) is very complicated due to the complex characteristics of turbulent multi-phase flow, chemical reaction, particle combustion, evaporation, breakup and agglomeration etc. It requires multi-phase calculations, chemical reaction simulation, and particle combustion, evaporation, and breakup models to obtain a better understanding of thermophysics for the RSRM design using numerical methods. Also, the slag buildup due to the molten particles is another factor affecting the performance of the RSRM. To achieve this goal, the volume of fluid (VOF) method is used to capture the free surface motion so as to simulate the accumulation of the molten particles (slag) of the RSRM. A finite rate chemistry model is used to simulate the chemical reaction effects. For multi-phase calculations, the Hermsen combustion model is used for the aluminum particle combustion analysis and the Taylor Analogy Breakup (TAB) model is used for the particle breakup analysis. An interphase mas-exchange model introduced by Spalding is used for the evaporation calculation. The particle trajectories are calculated using a one-step implicit method for several groups of particle sizes by which the drag forces and heat fluxes are then coupled with the gas phase equations. The preliminary results predicted a reasonable physical simulation of the particle effects using a simple two dimensional solid rocket motor configuration. It shows that the AL/AL2O3 particle sizes are reduced due to the combustion, evaporation, and breakup. The flow field is disturbed by the particles. Mach number distributions in the nozzle are deformed due to the effect of particle concentrations away from the center line
Baryon Acoustic Oscillations and Dynamical Dark Energy
We compute the impact of dark energy at last scattering on measurements of
baryon acoustic oscillations (BAOs). We show that an early dark energy
component can contribute a systematic uncertainty to BAO measurements of up to
2.5%. Whilst this effect turns out to only slightly affect current BAO surveys,
the results of future BAO surveys might become biased. We find that BAO surveys
alone appear unable to resolve this systematic uncertainty, so supplementary
measurements are necessary.Comment: 4 pages, added sections and references, matches published versio
Bose-Einstein condensate dark matter phase transition from finite temperature symmetry breaking of Klein-Gordon fields
In this paper the thermal evolution of scalar field dark matter particles at
finite cosmological temperatures is studied. Starting with a real scalar field
in a thermal bath and using the one loop quantum corrections potential, we
rewrite Klein-Gordon's (KG) equation in its hydrodynamical representation and
study the phase transition of this scalar field due to a Z_2 symmetry breaking
of its potential. A very general version of a nonlinear Schr\"odinger equation
is obtained. When introducing Madelung's representation, the continuity and
momentum equations for a non-ideal SFDM fluid are formulated, and the
cosmological scenario with the SFDM described in analogy to an imperfect fluid
is then considered where dissipative contributions are obtained in a natural
way.Additional terms appear compared to those obtained in the classical version
commonly used to describe the \LambdaCDM model, i.e., the ideal fluid. The
equations and parameters that characterize the physical properties of the
system such as its energy, momentum and viscous flow are related to the
temperature of the system, scale factor, Hubble's expansion parameter and the
matter energy density. Finally, some details on how galaxy halos and smaller
structures might be able to form by condensation of this SF are given.Comment: Substantial changes have been made to the paper, following the
referees recommendations. 16 pages. Published in Classical and Quantum
Gravit
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Membranous Glomerulonephritis With Crescents.
INTRODUCTION: Membranous glomerulonephritis (MGN) is rarely associated with necrotizing and crescentic glomerulonephritis (NCGN). METHODS: We report the clinical and pathologic findings in 15 patients with MGN and NCGN associated with anti-neutrophil cytoplasm antibodies (ANCAs), anti-glomerular basement membrane (GBM), or anti-phospholipase A2 receptor (PLA2R) antibodies. RESULTS: The cohort consisted of 15 patients: 7 males and 8 females with a median age of 63 years (range: 18-79). In 12 of 15 patients, MGN and NCGN were diagnosed at the time of the biopsy, and in 3 cases, MGN predated the NCGN. ANCA was positive in 7 cases (6 MPO myeloperoxidase (MPO)-ANCA and 1 PR3-ANCA), anti-GBM antibodies were detected in 5 cases, and anti-PLA2R antibodies were found in 2 cases. One case was negative for all antibodies. Microscopic hematuria was present in all but one patient who was anuric, and median urinary protein-to-creatinine ratio was 819.5 mg/mmol (range: 88-5600). Pathologic evaluation revealed MGN and NCGN with crescents involving 28% of glomeruli (median; range: 5%-100%). Follow-up was available for all 15 patients; all were treated with steroids; 10 with cyclophosphamide, and 6 also received rituximab. At a median follow-up of 72 months, 9 had stabilization or improvement of renal function, 6 had progressed to end-stage renal disease, and 4 died during the follow-up period. CONCLUSION: MGN with crescents associated with ANCAs or anti-GBM antibodies is a rare dual glomerulopathy. Patients present with heavy proteinuria, microscopic hematuria, and acute kidney injury and should be treated for a rapidly progressive glomerulonephritis. Prognosis is variable, and 40% of patients progress to end-stage renal disease
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