How to identify when a performance indicator has run its course

The official published version can be found at the link below.Increasing numbers of countries are using indicators to evaluate the quality of clinical care, with some linking payment to achievement. For performance frameworks to remain effective the indicators need to be regularly reviewed. The frameworks cannot cover all clinical areas, and achievement on chosen indicators will eventually reach a ceiling beyond which further improvement is not feasible. However, there has been little work on how to select indictors for replacement. The Department of Health decided in 2008 that it would regularly replace indicators in the national primary care pay for performance scheme, the Quality and Outcomes Framework, making a rigorous approach to removal a priority. We draw on our previous work on pay for performance and our current work advising the National Institute for Health and Clinical Excellence (NICE) on the Quality and Outcomes Framework to suggest what should be considered when planning to remove indicators from a clinical performance framework

Van Allen Probes show that the inner radiation zone contains no MeV electrons: ECT/MagEIS data

Abstract We present Van Allen Probe observations of electrons in the inner radiation zone. The measurements were made by the Energetic Particle, Composition, and Thermal Plasma/Magnetic Electron Ion Spectrometer (MagEIS) sensors that were designed to measure electrons with the ability to remove unwanted signals from penetrating protons, providing clean measurements. No electrons \u3e900 keV were observed with equatorial fluxes above background (i.e., \u3e0.1 el/(cm2 s sr keV)) in the inner zone. The observed fluxes are compared to the AE9 model and CRRES observations. Electron fluxes \u3c200 keV exceeded the AE9 model 50% fluxes and were lower than the higher-energy model fluxes. Phase space density radial profiles for 1.3 ≤ L* \u3c 2.5 had mostly positive gradients except near L*~2.1, where the profiles for μ = 20–30 MeV/G were flat or slightly peaked. The major result is that MagEIS data do not show the presence of significant fluxes of MeV electrons in the inner zone while current radiation belt models and previous publications do

The dawn and dusk electrojet response to substorm onset

International audienceWe have investigated the time delay between substorm onset and related reactions in the dawn and dusk ionospheric electrojets, clearly separated from the nightside located substorm current wedge by several hours in MLT. We looked for substorm onsets occurring over Greenland, where the onset was identified by a LANL satellite and DMI magnetometers located on Greenland. With this setup the MARIA magnetometer network was located at dusk, monitoring the eastward electrojet, and the IMAGE chain at dawn, for the westward jet. In the first few minutes following substorm onset, sudden enhancements of the electrojets were identified by looking for rapid changes in magnetograms. These results show that the speed of information transfer between the region of onset and the dawn and dusk ionosphere is very high. A number of events where the reaction seemed to preceed the onset were explained by either unfavorable instrument locations, preventing proper onset timing, or by the inner magnetosphere's reaction to the Earthward fast flows from the near-Earth neutral line model. Case studies with ionospheric coherent (SuperDARN) and incoherent (EISCAT) radars have been performed to see whether a convection-induced electric field or enhanced conductivity is the main agent for the reactions in the electrojets. The results indicate an imposed electric field enhancement.Key words: Ionosphere (auroral ionosphere; electric fields and currents) - Magnetospheric physics (storms and substorms

Addemdum to: ''The Mathematical Structure of Quantum Superspace as a Consequence of Time Asymmetry''

In this paper we improve the results of sec. VI of paper [M. Castagnino, Phys. Rev. D 57, 750 (1998)] by considering that the main source of entropy production are the photospheres of the stars

The Suzaku Observation of NGC 3516: Complex Absorption and the Broad and Narrow Fe K Lines

We present results from a 150 ksec Suzaku observation of the Seyfert 1.5 NGC 3516 in October 2005. The source was in a relatively highly absorbed state. Our best-fit model is consistent with the presence of a low-ionization absorber which has a column density near 5 * 10^{22} cm^{-2} and covers most of the X-ray continuum source (covering fraction 96-100%). A high-ionization absorbing component, which yields a narrow absorption feature consistent with Fe K XXVI, is confirmed. A relativistically broadened Fe K alpha line is required in all fits, even after the complex absorption is taken into account; an additional partial-covering component is an inadequate substitute for the continuum curvature associated with the broad Fe line. A narrow Fe K alpha emission line has a velocity width consistent with the Broad Line Region. The low-ionization absorber may be responsible for producing the narrow Fe K alpha line, though a contribution from additional material out of the line of sight is possible. We include in our model soft band emission lines from He- and H-like ions of N, O, Ne and Mg, consistent with photo-ionization, though a small contribution from collisionally-ionized emission is possible.Comment: Accepted for publication in PASJ (Suzaku second special issue). 36 pages, 10 figure

An empirically observed pitch-angle diffusion eigenmode in the Earth\u27s electron belt near L* = 5.0

Abstract Using data from NASA\u27s Van Allen Probes, we have identified a synchronized exponential decay of electron flux in the outer zone, near L* = 5.0. Exponential decays strongly indicate the presence of a pure eigenmode of a diffusion operator acting in the synchronized dimension(s). The decay has a time scale of about 4 days with no dependence on pitch angle. While flux at nearby energies and L* is also decaying exponentially, the decay time varies in those dimensions. This suggests the primary decay mechanism is elastic pitch angle scattering, which itself depends on energy and L *. We invert the shape of the observed eigenmode to obtain an approximate shape of the pitch angle diffusion coefficient and show excellent agreement with diffusion by plasmaspheric hiss. Our results suggest that empirically derived eigenmodes provide a powerful diagnostic of the dynamic processes behind exponential decays

Classical and quantum regimes of two-dimensional turbulence in trapped Bose-Einstein condensates

We investigate two-dimensional turbulence in finite-temperature trapped Bose-Einstein condensates within damped Gross-Pitaevskii theory. Turbulence is produced via circular motion of a Gaussian potential barrier stirring the condensate. We systematically explore a range of stirring parameters and identify three regimes, characterized by the injection of distinct quantum vortex structures into the condensate: (A) periodic vortex dipole injection, (B) irregular injection of a mixture of vortex dipoles and co-rotating vortex clusters, and (C) continuous injection of oblique solitons that decay into vortex dipoles. Spectral analysis of the kinetic energy associated with vortices reveals that regime (B) can intermittently exhibit a Kolmogorov $k^{-5/3}$ power law over almost a decade of length or wavenumber ($k$) scales. The kinetic energy spectrum of regime (C) exhibits a clear $k^{-3/2}$ power law associated with an inertial range for weak-wave turbulence, and a $k^{-7/2}$ power law for high wavenumbers. We thus identify distinct regimes of forcing for generating either two-dimensional quantum turbulence or classical weak-wave turbulence that may be realizable experimentally.Comment: 11 pages, 10 figures. Minor updates to text and figures 1, 2 and

System Tests of the ATLAS Pixel Detector

The innermost part of the ATLAS (A Toroidal LHC ApparatuS) experiment at the LHC (Large Hadron Collider) will be a pixel detector, which is presently under construction. Once installed into the experimental area, access will be extremely limited. To ensure that the integrated detector assembly operates as expected, a fraction of the detector which includes the power supplies and monitoring system, the optical readout, and the pixel modules themselves, has been assembled and operated in a laboratory setting for what we refer to as system tests. Results from these tests are presented.Comment: 5 Pages, 9 Figures, to appear in Proceedings of the Eleventh Workshop on Electronics for LHC and Future Experiment