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

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

Proposed Regulation of Gene Expression by Glucose in Rodent Heart

Background: During pressure overload-induced hypertrophy, unloading-induced atrophy, and diabetes mellitus, the heart induces ‘fetal’ genes (e.g. myosin heavy chain β; mhcβ). Hypothesis: We propose that altered glucose homeostasis within the cardiomyocyte acts as a central mechanism for the regulation of gene expression in response to environmental stresses. The evidence is as follows. Methods and Results: Forced glucose uptake both ex vivo and in vivo results in mhc isoform switching. Restricting dietary glucose prevents mhc isoform switching in hearts of both GLUT1-Tg mice and rats subjected to pressure overload-induced hypertrophy. Thus, glucose availability correlates with mhc isoform switching under all conditions investigated. A potential mechanism by which glucose affects gene expression is through O-linked glycosylation of specific transcription factors. Glutamine:fructose-6-phosphate amidotransferase (GFAT) catalyzes the flux generating step in UDP-N-acetylglucosamine biosynthesis, the rate determining metabolite in protein glycosylation. Ascending aortic constriction increased intracellular levels of UDP-N-acetylglucosamine, and the expression of gfat2, but not gfat1, in the rat heart. Conclusions: Collectively, the results strongly suggest glucose-regulated gene expression in the heart, and the involvement of glucose metabolites in isoform switching of sarcomeric proteins characteristic for the fetal gene program

Cities’ role in mitigating United States food system greenhouse gas emissions

Current trends of urbanization, population growth, and economic development have made cities a focal point for mitigating global greenhouse gas (GHG) emissions. The substantial contribution of food consumption to climate change necessitates urban action to reduce the carbon intensity of the food system. While food system GHG mitigation strategies often focus on production, we argue that urban influence dominates this sector’s emissions and that consumers in cities must be the primary drivers of mitigation. We quantify life cycle GHG emissions of the United States food system through data collected from literature and government sources producing an estimated total of 3800 kg CO2e/capita in 2010, with cities directly influencing approximately two-thirds of food sector GHG emissions. We then assess the potential for cities to reduce emissions through selected measures; examples include up-scaling urban agriculture and home delivery of grocery options, which each may achieve emissions reductions on the order of 0.4 and ∼1% of this total, respectively. Meanwhile, changes in waste management practices and reduction of postdistribution food waste by 50% reduce total food sector emissions by 5 and 11%, respectively. Consideration of the scale of benefits achievable through policy goals can enable cities to formulate strategies that will assist in achieving deep long-term GHG emissions targets