Performance-based financing as a health system reform : mapping the key dimensions for monitoring and evaluation

Peer reviewedPublisher PD

A second glance at SN 2002ap and the M74 field with XMM-Newton

We have re-observed the field of M74 in January 2003 with XMM-Newton, 11 months after the X-ray detection of SN 2002ap. From a comparison of the two XMM-Newton observations we obtain more accurate values for the X-ray luminosity and colours of the source five days after the event, and a limit on its decline rate. We compare its X-ray behaviour (prompt soft X-ray emission, relatively low luminosity) with that of other Type Ic SNe, and speculate that SN 2002ap may share some physical properties (low mass-loss rate and high-velocity stellar wind from the progenitor star) with the candidate hypernova/GRB progenitor SN 1998bw, but with a lower (non-relativistic) speed of the ejecta. We suggest that the X-ray emission observed in 2002 is likely to come from the radiatively-cooling reverse shock, at a temperature kT ~ 0.8 keV, and that this soft component was already detected 5 d after the event because the absorbing column density of the cool shell between the forward and reverse shocks was only ~ 10^{20} cm^{-2}, ie, the shell was optically thin in the soft X-ray band. The new XMM-Newton data also allowed us to continue monitoring two bright variable sources in M74 that had reached peak luminosities > 10^{39} erg s^{-1} in previous XMM-Newton and Chandra observations. Finally, we used two Chandra observations from 2001 to investigate the luminosity and colour distribution of the X-ray source population of M74, typical of moderately-active late-type spirals.Comment: 13 pages, A&A, in press. Revised version with an expanded discussion of the X-ray behaviour of SN2002a

The employee as 'Dish of the Day’:human resource management and the ethics of consumption

This article examines the ethical implications of the growing integration of consumption into the heart of the employment relationship. Human resource management (HRM) practices increasingly draw upon the values and practices of consumption, constructing employees as the ‘consumers’ of ‘cafeteria-style’ benefits and development opportunities. However, at the same time employees are expected to market themselves as items to be consumed on a corporate menu. In relation to this simultaneous position of consumer/consumed, the employee is expected to actively engage in the commodification of themselves, performing an appropriate organizational identity as a necessary part of being a successful employee. This article argues that the relationship between HRM and the simultaneously consuming/consumed employee affects the conditions of possibility for ethical relations within organizational life. It is argued that the underlying ‘ethos’ for the integration of consumption values into HRM practices encourages a self-reflecting, self-absorbed subject, drawing upon a narrow view of individualised autonomy and choice. Referring to Levinas’ perspective that the primary ethical relation is that of responsibility and openness to the Other, it is concluded that these HRM practices affect the possibility for ethical being

Funnel plots, performance variation and the Myocardial Infarction National Audit Project 2003–2004

BACKGROUND: Clinical governance requires health care professionals to improve standards of care and has resulted in comparison of clinical performance data. The Myocardial Infarction National Audit Project (a UK cardiology dataset) tabulates its performance. However funnel plots are the display method of choice for institutional comparison. We aimed to demonstrate that funnel plots may be derived from MINAP data and allow more meaningful interpretation of data. METHODS: We examined the attainment of National Service Framework standards for all hospitals (n = 230) and all patients (n = 99,133) in the MINAP database between 1(st )April 2003 and 31(st )March 2004. We generated funnel plots (with control limits at 3 sigma) of Door to Needle and Call to Needle thrombolysis times, and the use of aspirin, beta-blockers and statins post myocardial infarction. RESULTS: Only 87,427 patients fulfilled criteria for analysis of the use of secondary prevention drugs and 15,111 patients for analysis by Door to Needle and Call to Needle times (163 hospitals achieved the standards for Door to Needle times and 215 were within or above their control limits). One hundred and sixteen hospitals fell outside the 'within 25%' and 'more than 25%' standards for Call to Needle times, but 28 were below the lower control limits. Sixteen hospitals failed to reach the standards for aspirin usage post AMI and 24 remained below the lower control limits. Thirty hospitals were below the lower CL for beta-blocker usage and 49 outside the standard. Statin use was comparable. CONCLUSION: Funnel plots may be applied to a complex dataset and allow visual comparison of data derived from multiple health-care units. Variation is readily identified permitting units to appraise their practices so that effective quality improvement may take place

Resolving and parameterising the ocean mesoscale in earth system models

Purpose of Review. Assessment of the impact of ocean resolution in Earth System models on the mean state, variability, and future projections and discussion of prospects for improved parameterisations to represent the ocean mesoscale. Recent Findings. The majority of centres participating in CMIP6 employ ocean components with resolutions of about 1 degree in their full Earth Systemmodels (eddy-parameterising models). In contrast, there are alsomodels submitted toCMIP6 (both DECK and HighResMIP) that employ ocean components of approximately 1/4 degree and 1/10 degree (eddy-present and eddy-rich models). Evidence to date suggests that whether the ocean mesoscale is explicitly represented or parameterised affects not only the mean state of the ocean but also the climate variability and the future climate response, particularly in terms of the Atlantic meridional overturning circulation (AMOC) and the Southern Ocean. Recent developments in scale-aware parameterisations of the mesoscale are being developed and will be included in future Earth System models. Summary. Although the choice of ocean resolution in Earth System models will always be limited by computational considerations, for the foreseeable future, this choice is likely to affect projections of climate variability and change as well as other aspects of the Earth System. Future Earth System models will be able to choose increased ocean resolution and/or improved parameterisation of processes to capture physical processes with greater fidelity

Species richness declines and biotic homogenization have slowed down for NW-European pollinators and plants

Concern about biodiversity loss has led to increased public investment in conservation. Whereas there is a widespread perception that such initiatives have been unsuccessful, there are few quantitative tests of this perception. Here, we evaluate whether rates of biodiversity change have altered in recent decades in three European countries (Great Britain, Netherlands and Belgium) for plants and flower visiting insects. We compared four 20-year periods, comparing periods of rapid land-use intensification and natural habitat loss (1930–1990) with a period of increased conservation investment (post-1990). We found that extensive species richness loss and biotic homogenisation occurred before 1990, whereas these negative trends became substantially less accentuated during recent decades, being partially reversed for certain taxa (e.g. bees in Great Britain and Netherlands). These results highlight the potential to maintain or even restore current species assemblages (which despite past extinctions are still of great conservation value), at least in regions where large-scale land-use intensification and natural habitat loss has ceased