Quality and Outcomes Framework: what have we learnt?

Martin Roland and Bruce Guthrie assess the successes and failures of the pay-for-performance scheme and what its future should beThis is the final version of the article. It first appeared from BMJ Publishing Group via http://dx.doi.org/10.1136/bmj.i406

Striatal Function Explored Through a Biophysical Model of a Medium Spiny Neuron

Institute for Adaptive and Neural ComputationThe basal ganglia are a dynamic neural network of telencephalic subcortical nuclei, involved in adaptive control of behaviour. There has been much experimental evidence on the anatomy and physiology of the basal ganglia published over the last 25 years showing that the basal ganglia are involved in the learning of many adaptive behaviours, including motor planning, working memory and cognitive functions. Current qualitative basal ganglia models of the box and arrow type, whilst explaining much of the anatomical data, do not give enough insight into the mechanisms involved in basal ganglia function either in health or in disease states. The striatum is the main input nucleus of the basal ganglia, integrating widespread cortical and thalamic inputs to perform behaviour selection. Convergent data from control theory learning models and experimental data have shown that the phasic dopamine signal in the striatum could be performing a similar function to a scalar teaching signal in reinforcement learning models, both signals indicating the occurrence of reward. Similarly, both models and electrophysiological data have shown how the timing of this reward signal can be changed during learning so as to occur at the point in time of the earliest predictor of forthcoming reward. These models do not, however, show how this teaching signal is used in the striatum to learn to select the action most likely to lead to reward. Computational models have been produced to investigate the circuitry involved in striatal action selection. These models have tended to be of winner-takes-all networks, using a mechanism of recurrent lateral inhibition between the medium spiny cells of the striatum to select the winner and thus releasing the behavioural action judged to be correct in the current environmental context. However, the necessary biological circuitry to implement a winner-takes-all network is absent in the striatum. This leads to a requirement for new models of striatal function incorporating current biological data to provide a more realistic mechanism for behavioural selection. This thesis develops a biophysically inspired, minimal current model of a striatal medium spiny neuron which utilises transitions between two membrane potential states, both below firing threshold, to filter excitatory input. The behaviour of the model is first validated against experimental electrophysiological data and then used to demonstrate how the striatum could perform two of the tasks required for behaviour selection; accurately timed release of behaviours and learning a sequence of action selections to obtain reward. In the first series of simulations timed release of behaviours is demonstrated to be linearly related to the timing of firing of feed forward inhibitory interneurons. In a second set of simulations learned sequences of action selection, using a simulated dopamine reward signal, are shown in a reward location task performed by a small network of model medium spiny striatal neurons. Taken together these studies show that this simple model of a striatal medium spiny neuron is capable of simulating the basic functionality required for behaviour selection in a manner which has greater biological plausibility than previously published models

Etudes Pour Piano - Premier Livre , by Gyorgy Ligeti, And, The Song of Glory , an Original Opera in One Act.

This dissertation consists of two parts. Part I is an analytical survey of a composition entitled Etudes pour piano - premier livre, (1985) by Gyorgy Ligeti. Part II is an original composition entitled The Song of Glory, An Original Opera in One Act. Etudes pour piano - premier livre, by Gyorgy Ligeti is a collection of six pieces for piano. The etudes won the 1986 University of Louisville Grawemeyer Award--the largest cash award for composition. The etudes feature continuous motion and cross-accentuation which creates polyrhythmic effects. The purpose of part I is to survey the compositional techniques and materials used in the music. The survey will illustrate the interrelationships among the pieces by comparing the elements and procedures of composition. The analysis is descriptive in nature dealing objectively with the elements of melody, harmony, rhythm, form, and counterpoint. The structures employed in the etudes are often of such a nature as to elude the terminology and concepts of a singular common practice period. Therefore, the methods of analysis incorporate a diversity of heuristic procedures. The analysis is not intended to present an exhaustive investigation of the music, but an overview of the compositional techniques. The Song of Glory, An Original Opera in One Act, is scored for chamber orchestra and soloists. The libretto, written by the composer, depicts the pathos of Scott\u27s South Polar Party of 1912. The instrumentation calls for woodwinds, horn, trombone, one percussionist, and strings. The vocal requirements are two tenors, two baritones, and one bass. The instrumentation reflects a concern for economy. It is calculated to be effective, offering timbral variety and strength, yet economical enough for typical university new-music performance resources. The action takes place in three scenes separated by orchestral interludes. In scene I, the scenario is established as the characters reflect on their situation. In scene II, the ghost of a former sojourner who died earlier in the expedition appears to all but the captain. One character dies after leaving the tent to meet the specter. In scene III, the captain continues journal entries while the remaining characters perish

Basal Ganglia Preferentially Encode Context Dependent Choice in a Two-Armed Bandit Task

Decision is a self-generated phenomenon, which is hard to track with standard time averaging methods, such as peri-event time histograms (PETHs), used in behaving animals. Reasons include variability in duration of events within a task and uneven reaction time of animals. We have developed a temporal normalization method where PETHs were juxtaposed all along task events and compared between neurons. We applied this method to neurons recorded in striatum and GPi of behaving monkeys involved in a choice task. We observed a significantly higher homogeneity of neuron activity profile distributions in GPi than in striatum. Focusing on the period of the task during which the decision was taken, we showed that approximately one quarter of all recorded neurons exhibited tuning functions. These so-called coding neurons had average firing rates that varied as a function of the value of both presented cues, a combination here referred to as context, and/or value of the chosen cue. The tuning functions were used to build a simple maximum likelihood estimation model, which revealed that (i) GPi neurons are more efficient at encoding both choice and context than striatal neurons and (ii) context prediction rates were higher than those for choice. Furthermore, the mutual information between choice or context values and decision period average firing rate was higher in GPi than in striatum. Considered together, these results suggest a convergence process of the global information flow between striatum and GPi, preferentially involving context encoding, which could be used by the network to perform decision-making

Quality of Care in the United Kingdom after Removal of Financial Incentives.

BACKGROUND: The benefits of pay-for-performance schemes in improving the quality of care remain uncertain. There is little information on the effect of removing incentives from existing pay-for-performance schemes. METHODS: We conducted interrupted time-series analyses of electronic medical record (EMR) data from 2010 to 2017 for 12 quality-of-care indicators in the United Kingdom's Quality and Outcomes Framework for which financial incentives were removed in 2014 and 6 indicators for which incentives were maintained. We estimated the effects of removing incentives on changes in performance on quality-of-care measures. RESULTS: Complete longitudinal data were available for 2819 English primary care practices with more than 20 million registered patients. There were immediate reductions in documented quality of care for all 12 indicators in the first year after the removal of financial incentives. Reductions were greatest for indicators related to health advice, with a reduction of 62.3 percentage points (95% confidence interval [CI], -65.6 to -59.0) in EMR documentation of lifestyle counseling for patients with hypertension. Changes were smaller for indicators involving clinical actions that automatically update the EMR, such as laboratory testing, with a reduction of 10.7 percentage points (95% CI, -13.6 to -7.8) in control of cholesterol in patients with coronary heart disease and 12.1 percentage points (95% CI, -13.6 to -10.6) for thyroid-function testing in patients with hypothyroidism. There was little change in performance on the 6 quality measures for which incentives were maintained. CONCLUSIONS: Removal of financial incentives was associated with an immediate decline in performance on quality measures. In part, the decline probably reflected changes in EMR documentation, but declines on measures involving laboratory testing suggest that incentive removal also changed the care delivered

The neoliberal reality of higher education in Australia: how accountingisation is corporatising knowledge

Purpose: As accounting academics, the authors know that performance measurement is well-trodden ground in the literature. Yet rarely have they turned their gaze inwards to examine the performance controls which they are subject to in the own everyday working life. Over the past 40 years, the rise of the New Public Management paradigm and neoliberalism has intensified changes in the way universities, disciplines and individual academics justify the quality of their work. This paper aims to explore the impact of accountingisation on the field and the Australian public sector higher education sector. Design/methodology/approach: The perceptions of accounting academics in Australia’s 37 business faculties and schools were collected via an online survey. Additionally, a document analysis of annual reports, internal reports, strategy documents and other confidential material were also used. Findings: The changes have included the use of corporate and individual research metrics aimed at increasing institutional status, brand reputation and revenue generation. These changes have transformed business schools and universities into commercial enterprises and commoditised education. What this analysis demonstrates is the apparent relationship between various government agendas, the commercialisation of universities and the distortion of the research activities by individual academics. For increased profits and efficiencies, individual scholars have paid the highest price. Practical implications: If the accounting discipline is to be sustainable in the long term, business schools in Australia must reconfigure their performance measurement systems. Originality/value: To date, research on “accountingisation” has previously been primarily conducted in the health and social services sectors. This research raises rarely heard voices to expose the actual social and human costs of accountingisation in Australia’s higher education sector

Origami constraints on the initial-conditions arrangement of dark-matter caustics and streams

In a cold-dark-matter universe, cosmological structure formation proceeds in rough analogy to origami folding. Dark matter occupies a three-dimensional 'sheet' of free- fall observers, non-intersecting in six-dimensional velocity-position phase space. At early times, the sheet was flat like an origami sheet, i.e. velocities were essentially zero, but as time passes, the sheet folds up to form cosmic structure. The present paper further illustrates this analogy, and clarifies a Lagrangian definition of caustics and streams: caustics are two-dimensional surfaces in this initial sheet along which it folds, tessellating Lagrangian space into a set of three-dimensional regions, i.e. streams. The main scientific result of the paper is that streams may be colored by only two colors, with no two neighbouring streams (i.e. streams on either side of a caustic surface) colored the same. The two colors correspond to positive and negative parities of local Lagrangian volumes. This is a severe restriction on the connectivity and therefore arrangement of streams in Lagrangian space, since arbitrarily many colors can be necessary to color a general arrangement of three-dimensional regions. This stream two-colorability has consequences from graph theory, which we explain. Then, using N-body simulations, we test how these caustics correspond in Lagrangian space to the boundaries of haloes, filaments and walls. We also test how well outer caustics correspond to a Zel'dovich-approximation prediction.Comment: Clarifications and slight changes to match version accepted to MNRAS. 9 pages, 5 figure

Projected Rotational Velocities and Stellar Characterization of 350 B Stars in the Nearby Galactic Disk

Projected rotational velocities (vsini) are presented for a sample of 350 early B-type main sequence stars in the nearby Galactic disk. The stars are located within ~1.5 kpc from the Sun, and the great majority within 700 pc. The analysis is based on high-resolution spectra obtained with the MIKE spectrograph on the Magellan Clay 6.5-m telescope at the Las Campanas Observatory in Chile.Spectral types were estimated based on relative intensities of some key line absorption ratios and comparisons to synthetic spectra. Effective temperatures were estimated from the reddening-free Q index, and projected rotational velocities were then determined via interpolation on a published grid that correlates the synthetic full width at half maximum of the He I lines at 4026, 4388 and 4471 A with vsini. As the sample has been selected solely on the basis of spectral types it contains an selection of B stars in the field, in clusters, and in OB associations. The vsini distribution obtained for the entire sample is found to be essentially flat for vsini values between 0-150 km/s, with only a modest peak at low projected rotational velocities. Considering subsamples of stars, there appears to be a gradation in the vsini distribution with the field stars presenting a larger fraction of the slow rotators and the cluster stars distribution showing an excess of stars with vsini between 70 and 130 km/s. Furthermore, for a subsample of potential runaway stars we find that the vsini distribution resembles the distribution seen in denser environments, which could suggest that these runaway stars have been subject to dynamical ejection mechanisms.Comment: 38 pages, 11 figures. Complete sample table. AJ accepte

“Yes, and …” Exploring the Future of Learning Analytics in Medical Education

This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Northeastern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. Commentators brainstormed “what\u27s next” with learning analytics in medical education, including advancements in interaction metrics and the use of interactivity analysis to deepen understanding of perceptual, cognitive, and social learning and transfer processes