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 $B_n(q,r)$ by lifting bases for cell modules of $B_{n-1}(q,r)$ 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 $q$ and $r$, 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 $M^{d_1+1}\times \mathcal{N}^n$, where $M^{d_1+1}$ is the $(d_1+1)$-dimensional Minkowski spacetime and $\mathcal{N}^n$ is an $n$-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

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

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

Stratigraphy of Lake Vida, Antarctica: hydrologic implications of 27 m of ice

Lake Vida, located in Victoria Valley, is one of the largest lakes in the McMurdo dry valleys and is known to contain hypersaline liquid brine sealed below 16 m of freshwater ice. For the first time, Lake Vida was drilled to a depth of 27 m. Below 21 m the ice is marked by well-sorted sand layers up to 20 cm thick within a matrix of salty ice. From ice chemistry, isotopic composition of δ18O and δ2H, and ground penetrating radar profiles, we conclude that the entire 27 m of ice formed from surface runoff and the sediment layers represent the accumulation of surface deposits. Radiocarbon and optically stimulated luminescence dating limit the maximum age of the lower ice to 6300 14C yr BP. As the ice cover ablated downwards during periods of low surface inflow, progressive accumulation of sediment layers insulated and preserved the ice and brine beneath, analogous to the processes that preserve shallow ground ice. The repetition of these sediment layers reveals hydrologic variability in Victoria Valley during the mid- to late Holocene. Lake Vida is an exemplar site for understanding the preservation of subsurface brine, ice, and sediment in a cold desert environment