Can pay for performance improve the quality of primary care?

Martin Roland and Frede Olesen explore what other countries can learn from the UK’s experience with the Quality and Outcomes FrameworkThis is the final version of the article. It first appeared from BMJ Publishing Group via http://dx.doi.org/10.1136/bmj.i405

Are collagenous and lymphocytic colitis different aspects of the same disease?

Objective. Collagenous colitis (CC) and lymphocytic colitis (LC) are two subtypes of microscopic colitis (MC). Even though they most often are described as different entities they share many clinical and histological features. The aim of this study was to investigate the occurrence of conversion between CC and LC in a larger cohort of patients. Materials and methods. All 664 patients in our Pathology register with a diagnosis of CC and LC were scrutinized and those where additional endoscopies had been carried out were included, and their biopsies were re-examined. Results. Sixty-five patients (55 women, 10 men, median age 58 years; range 29-86) fulfilled our criteria for inclusion. The primary diagnosis was CC in 47 patients (39 women, 8 men, median age 58 years; range 29-86) and LC in 18 patients (16 women, 2 men, median age 58 years; range 33-74). Conversion occurred in nine of the 65 patients (14%, all women, median age 59 years; range 41-72), three from CC to LC and six from LC to CC. Conclusion. This study has found that patients can show histological features consistent with both CC and LC over time. These patients could represent a subgroup with a true conversion between two separate entities. Alternatively, MC could be a spectral disease where the varying histological features are manifestations of the natural fluctuation. A third possibility could be that the histological changes reflect different manifestations during the disease course and consequently, the diagnostic criteria could be too vague

An ecosystem-wide reproductive failure with more snow in the Arctic

In summer 2018, many arctic regions experienced unprecedented large amounts of snow. This Perspective article reports the ecological impacts of this extreme event, and shows that the severe snow conditions resulted in an almost complete reproductive failure across the entire ecosystem. The 2018 may be a rare event, but it also offers a gloomy peep into the future.Peer reviewe

METAMOC: Modular Execution Time Analysis using Model Checking

Safe and tight worst-case execution times (WCETs) are important when scheduling hard real-time systems. This paper presents METAMOC, a path-based, modular method, based on model checking and static analysis, that determines safe and tight WCETs for programs running on platforms fea-turing caching and pipelining. The method works by constructing a UPPAAL model of the program being analysed and annotating the model with information from an inter-procedural value analysis. The program model is then combined with a model of the hardware platform, and model checked for the WCET. Through support for the platforms ARM7, ARM9 and ATMEL AVR 8-bit the modularity and retargetability of the method is demonstrated, as only the pipeline needs to be remodelled. Mod-elling the hardware is performed in a state-of-the-art graphical modeling environment. Experiments on the Mälardalen WCET benchmark programs show that taking caching into account yields much tighter WCETs, and that METAMOC is a fast and versatile approach for WCET analysis. 1

DMI Report 21-17 Including a dynamic Greenland Ice Sheet in the EC-Earth global climate model

Recent observations have indicated rapidly increasing mass loss from the Greenland Ice Sheet. To explore the interactions and feedbacks of the ice sheets in the climate system, it is important to develop coupled climate-ice sheet models. The integration of an ice sheet model in a global model is challenging, and, currently, relatively few climate models include a two-way coupling to a dynamical ice sheet model. In this work package, we have continued developing the coupled ice sheet-climate model system comprising the global climate model EC-Earth and the Parallel Ice Sheet Model (PISM) for Greenland. The new model system, EC-Earth3-GrIS, is upgraded to include the recent model versions, EC-Earth3 and PISM version 1.2. In addition, a new module has been developed to handle the exchange of information between the ice sheet model and EC-Earth using the OASIS3- MCT software interface. The new module reads output from the ice sheet model and exchanges the fields with the relevant EC-Earth components. The ice sheet mask and topography are provided to the atmosphere and land surface components. The heat and freshwater fluxes from basal melt and ice discharge are provided to the ocean module via the runoff-mapper that routes surface runoff into the ocean. The new module also prepares the forcing fields for the ice sheet model, i.e., subsurface temperature and surface mass balance. These fields are calculated in EC- Earth3 using a land ice surface parameterization, developed explicitly for the Greenland ice sheet. The parameterization contains a responsive snow and ice albedo scheme and includes land ice characteristics in the calculation of heat and energy transfer at the surface. Experiments with and without the land ice surface parameterization have been carried out for preindustrial and present-day conditions to assess the influence of the surface parameterization on the calculated surface mass balance. The results show that the ice sheet responds stronger and more realistically to forcing changes when the new surface parameterization is used. Besides the model development, the results from experiments with the first model version, EC- Earth-PISM, have been analyzed. These results stress that a decent surface scheme with a responsive snow albedo scheme is necessary for investigating mass balance changes of the Greenland Ice Sheet. Overall, our results indicate that the feedbacks induced by the interactive ice sheet have a significant influence on Arctic climate change under warming conditions. In warm scenarios where the CO2 level is raised to four times the preindustrial level, the coupled model has a colder Arctic surface, a fresher ocean, and more sea-ice in winter