Shaping the future for primary care education and training project. Best practise in education and training strategies for integrated health and social care: development of a benchmarking tool

Collaboration and partnership working between Higher Education and the NHS is an essential requirement for effective delivery of care (Universities UK 2003). The North West Universities Association (NWUA) and the North West Development Agency (NWDA) are two organisations at the forefront of creating such alliances. The research project, Shaping the Future for Primary Care Education and Training Project is a collaborative partnership between both these organisations and seven North West Higher Education Institutions. In addition, the project brings together for the first time all the key partners in the health, social care and education sectors who are involved in supporting the delivery of integrated health and social care in the North West Region

Studies in the Lake Ontario Basin using ERTS-1 and high altitude data

Studies in the Lake Ontario Basin are designed to provide input for models of river basin discharge and macro-scale features of lake circulation. Lake studies appear to require high altitude imagery to record the dynamic features of Lake Ontario so that ERTS-1 data may be interpreted. Land area studies require input of soil moisture, land use and soil-sediment-geomorphology measurements some of which appear to be available, on a regional scale from ERTS-1 products

FUSE Observations of a Full Orbit of Hercules X-1: Signatures of Disk, Star, and Wind

We observed an entire 1.7 day orbit of the X-ray binary Hercules X-1 with the Far Ultraviolet Spectroscopic Explorer (FUSE). Changes in the O VI 1032,1037 line profiles through eclipse ingress and egress indicate a Keplerian accretion disk spinning prograde with the orbit. These observations may show the first double-peaked accretion disk line profile to be seen in the Hercules X-1 system. Doppler tomograms of the emission lines show a bright spot offset from the Roche lobe of the companion star HZ Her, but no obvious signs of the accretion disk. Simulations show that the bright spot is too far offset from the Roche lobe to result from uneven X-ray heating of its surface. The absence of disk signatures in the tomogram can be reproduced in simulations which include absorption from a stellar wind. We attempt to diagnose the state of the emitting gas from the C III 977, C III 1175, and N III 991 emission lines. The latter may be enhanced through Bowen fluorescence.Comment: Accepted for publication in The Astrophysical Journa

The VLT-FLAMES Tarantula Survey XXII. Multiplicity properties of the B-type stars

We investigate the multiplicity properties of 408 B-type stars observed in the 30 Doradus region of the Large Magellanic Cloud with multi-epoch spectroscopy from the VLT-FLAMES Tarantula Survey (VFTS). We use a cross-correlation method to estimate relative radial velocities from the helium and metal absorption lines for each of our targets. Objects with significant radial-velocity variations (and with an amplitude larger than 16 km/s) are classified as spectroscopic binaries. We find an observed spectroscopic binary fraction (defined by periods of 0.1) for the B-type stars, f_B(obs) = 0.25 +/- 0.02, which appears constant across the field of view, except for the two older clusters (Hodge 301 and SL 639). These two clusters have significantly lower fractions of 0.08 +/- 0.08 and 0.10 +/- 0.09, respectively. Using synthetic populations and a model of our observed epochs and their potential biases, we constrain the intrinsic multiplicity properties of the dwarf and giant (i.e. relatively unevolved) B-type stars in 30 Dor. We obtain a present-day binary fraction f_B(true) = 0.58 +/- 0.11, with a flat period distribution. Within the uncertainties, the multiplicity properties of the B-type stars agree with those for the O stars in 30 Dor from the VFTS.Comment: Accepted by A&

The impact of changing provider remuneration on clinical activity and quality of care: evaluation of a pilot NHS contract in Northern Ireland

Objectives A pilot NHS dental contract was introduced in Northern Ireland between 2015 and 2016, which involved changing the method for paying general dental practitioners working in the NHS from Fee-For-Service (FFS) to capitation-based payments, providing an opportunity for a robust evaluation. We investigated the impact of a change in payment methods on clinical activity and the quality of care provided. Design A difference-in-difference (DiD) evaluation was applied to clinical activity data from pilot NHS dental practices in Northern Ireland compared to matched control NHS practices, and applied to a questionnaire survey of patient-rated outcomes of health outcomes and care quality. We estimated the impact on access to care, treatment activity levels, practice finances and patient-rated outcomes of care of a change from FFS to a capitation-based system for one year, as well as the impact of a reversion back to FFS at the end of the pilot period. Results The monthly number of registered patients in the pilot practices increased more than the control practices during the capitation period, by 1.5 registrations per 1,000 registered patients. The monthly reductions in the volumes of all treatments in the pilot practices during the capitation period was much larger than the control practices, with 175 fewer treatment items. All measures rapidly returned to baseline levels following reversion from capitation back to FFS. NHS income per month increased in pilot practices, by £5,920 per month (calculated on FFS item cost basis) more than controls in the capitation period. The analysis of patient questionnaires suggest found that patients notices differences only in waiting times, skill-mix and number of radiographs, but not on other measures of healthcare process and quality. Conclusion General dental practitioners working in the NHS respond rapidly and consistently to changes in provider payment methods. A move from FFS to a capitation-based system had little impact on access to care, but did produce large reductions in clinical activity and patient charge income. Patients noticed little change in the service they received. This shows that changes in remuneration contracts have the potential to meet policy goals, such as meeting the expectations of patients within a predictable cost envelope. However, it is unlikely that all policy goals can be met simply by changing payment methods. Therefore, work is also needed to identify and evaluate interventions that can complement changes in remuneration to achieve desirable outcomes

A dynamical magnetosphere model for periodic Halpha emission from the slowly rotating magnetic O star HD191612

The magnetic O-star HD191612 exhibits strongly variable, cyclic Balmer line emission on a 538-day period. We show here that its variable Halpha emission can be well reproduced by the rotational phase variation of synthetic spectra computed directly from full radiation magneto-hydrodynamical simulations of a magnetically confined wind. In slow rotators such as HD191612, wind material on closed magnetic field loops falls back to the star, but the transient suspension of material within the loops leads to a statistically overdense, low velocity region around the magnetic equator, causing the spectral variations. We contrast such "dynamical magnetospheres" (DMs) with the more steady-state "centrifugal magnetospheres" of stars with rapid rotation, and discuss the prospects of using this DM paradigm to explain periodic line emission from also other non-rapidly rotating magnetic massive stars.Comment: 5 pages, 5 figures, accepted for publication in MNRAS letter

The VLT-FLAMES Tarantula Survey XXIII. Two massive double-lined binaries in 30 Doradus

Aims. We investigate the characteristics of two newly discovered short-period, double-lined, massive binary systems in the Large Magellanic Cloud, VFTS 450 (O9.7 II–Ib + O7::) and VFTS 652 (B1 Ib + O9: III:). Methods. We perform model-atmosphere analyses to characterise the photospheric properties of both members of each binary (denoting the “primary” as the spectroscopically more conspicuous component). Radial velocities and optical photometry are used to estimate the binary-system parameters. Results. We estimate Teff = 27 kK, log g = 2.9 (cgs) for the VFTS 450 primary spectrum (34 kK, 3.6: for the secondary spectrum); and Teff = 22 kK, log g = 2.8 for the VFTS 652 primary spectrum (35 kK, 3.7: for the secondary spectrum). Both primaries show surface nitrogen enrichments (of more than 1 dex for VFTS 652), and probable moderate oxygen depletions relative to reference LMC abundances. We determine orbital periods of 6.89 d and 8.59 d for VFTS 450 and VFTS 652, respectively, and argue that the primaries must be close to filling their Roche lobes. Supposing this to be the case, we estimate component masses in the range ∼20–50 M⊙. Conclusions. The secondary spectra are associated with the more massive components, suggesting that both systems are high-mass analogues of classical Algol systems, undergoing case-A mass transfer. Difficulties in reconciling the spectroscopic analyses with the light-curves and with evolutionary considerations suggest that the secondary spectra are contaminated by (or arise in) accretion disks

The VLT-FLAMES Tarantula Survey X: Evidence for a bimodal distribution of rotational velocities for the single early B-type stars

Aims: Projected rotational velocities (\vsini) have been estimated for 334 targets in the VLT-FLAMES Tarantula survey that do not manifest significant radial velocity variations and are not supergiants. They have spectral types from approximately O9.5 to B3. The estimates have been analysed to infer the underlying rotational velocity distribution, which is critical for understanding the evolution of massive stars. Methods: Projected rotational velocities were deduced from the Fourier transforms of spectral lines, with upper limits also being obtained from profile fitting. For the narrower lined stars, metal and non-diffuse helium lines were adopted, and for the broader lined stars, both non-diffuse and diffuse helium lines; the estimates obtained using the different sets of lines are in good agreement. The uncertainty in the mean estimates is typically 4% for most targets. The iterative deconvolution procedure of Lucy has been used to deduce the probability density distribution of the rotational velocities. Results: Projected rotational velocities range up to approximately 450 \kms and show a bi-modal structure. This is also present in the inferred rotational velocity distribution with 25% of the sample having $0\leq$\ve$\leq$100\,\kms and the high velocity component having \ve$\sim 250$\,\kms. There is no evidence from the spatial and radial velocity distributions of the two components that they represent either field and cluster populations or different episodes of star formation. Be-type stars have also been identified. Conclusions: The bi-modal rotational velocity distribution in our sample resembles that found for late-B and early-A type stars. While magnetic braking appears to be a possible mechanism for producing the low-velocity component, we can not rule out alternative explanations.Comment: to be publisged in A&

A large scale system for searching and browsing images from the World Wide Web

This paper outlines the technical details of a prototype system for searching and browsing over a million images from the World Wide Web using their visual contents. The system relies on two modalities for accessing images — automated image annotation and NNk image network browsing. The user supplies the initial query in the form of one or more keywords and is then able to locate the desired images more precisely using a browsing interface