Public contracts as accountability mechanisms: assuring quality in public healthcare in England and Wales

Contracting in the public sector is designed to enhance the accountability of service providers to their funders. The idea is that quality is improved by the use of service specifications, monitoring of performance and imposition of contractual sanctions. Socio-legal and economic theories of contract indicate that it will be difficult to make and enforce contracts to achieve this. The results of a study of National Health Services contracting in England and Wales are reported. We conclude that contracts alone are not sufficient to improve accountability – collibration of various regulatory measures (including more hierarchical mechanisms such as performance targets) is required

Static Torsion Testing and Modeling of a Variable Thickness Hybrid Composite Bull Gear

Torsional strength of a variable thickness hybrid gear web was measured by performing static testing on the part in a large torsion test frame. The outer rim of the hybrid gear web was fixed to the bottom of the test frame and loading was applied to the web through a shaft. The test setup included the installation of digital image correlation (DIC) systems to obtain deformation and strain measurements from the surfaces of the hybrid gear web and the mechanical test equipment to ensure reliability of the test. The results indicated that the variable thickness hybrid gear web achieved approximately twice the torsional strength compared to that of previous hybrid gear designs. The DIC analysis showed significantly more straining of the loading shaft than the actual test article. Additionally, the results demonstrated the importance and affect that the metallic, lobed interlock features had on the principal strain and out-of-plane displacement fields. The analysis revealed that the fixed outer rim was in fact rotating and a rigid body motion compensation (RBMC) function was computed to determine the actual rotation of the hub and composite web relative to the outer rim. Modeling simulations were performed for the variable thickness hybrid gear web and correlated well with the RBMC rotational deformation seen in the DIC analysis. In addition to benchmarking the load capacity of the hybrid gear web, measuring its strength is useful information to define the parameters needed for dynamic, endurance, and other testing of the part

The impact of artificial fragrances on the assessment of mate quality cues in body odor

We investigated the impact of artificial fragrances on the accurate detection of biologically relevant information in human body odor. To do this, we examined cross-sensory consistency (across faces and odors) in the perception of masculinity and femininity in men and women, and how consistency is influenced by the use of artificial fragrance. Independent sets of same and opposite-sex participants rated odor samples (with and without a fragrance, N = 239 raters), and photographs (N = 130) of 20 men and 20 women. In female, but not male raters, judgments of masculinity/femininity of non-fragranced odor and faces were correlated. However, the correlation between female ratings of male facial and odor masculinity was not evident when assessing a body odor and fragrance blend. Further analysis also indicated that differences in ratings of male odor masculinity between men with very masculine or high and low levels of facial masculinity were removed by the addition of fragrance. This effect was absent in ratings of female odors by both female and male raters, suggesting sex-specificity in the effects of fragrance on odor perception. The widespread use of artificial fragrance in many modern populations raises questions about how this cultural practice influences ability to detect and utilize mate-choice relevant cues. Our findings suggest that women may be more sensitive to these cues, and therefore also to disruption of this information through fragrance use. We discuss our results using the framework of culture-gene coevolution

The analytic structure of heavy quark propagators

The renormalised quark Dyson-Schwinger equation is studied in the limit of the renormalised current heavy quark mass m_R --> infinity. We are particularly interested in the analytic pole structure of the heavy quark propagator in the complex momentum plane. Approximations in which the quark-gluon vertex is modelled by either the bare vertex or the Ball-Chiu Ansatz, and the Landau gauge gluon propagator takes either a gaussian form or a gaussian form with an ultraviolet asymptotic tail are used.Comment: 21 pages Latex and 5 postscript figures. The original version of this paper has been considerably extended to include a formalism dealing with the renormalised heavy quark Dyson-Schwinger equation and uses a more realistic Ansatz for the gluon propagator

Acute kidney injury: electronic alerts in primary care - findings from a large population cohort

Background: Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described. Aims: We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts. Design: A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI. Method: The study utilised the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service. Results: 28.8% of the 22,723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalisation was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within seven days, 42.5% between seven and ninety days, and 8.4% was not repeated within ninety days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function. Conclusion: The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within seven days should be considered an appropriate response to AKI e-alerts in primary care

Frictional cooling of positively charged particles

One of the focuses of research and development towards the construction of a muon collider is muon beam preparation. Simulation of frictional cooling shows that it can achieve the desired emittance reduction to produce high-luminosity muon beams. We show that for positively charged particles, charge exchange interactions necessitate significant changes to schemes previously developed for negatively charged particles. We also demonstrate that foil-based schemes are not viable for positive particles.Comment: 15 pages, 6 figure

Hydrothermal sensitivities of seed populations underlie fluctuations of dormancy states in an annual plant community

Plant germination ecology involves continuous interactions between changing environmental conditions and the sensitivity of seed populations to respond to those conditions at a given time. Ecologically meaningful parameters characterizing germination capacity (or dormancy) are needed to advance our understanding of the evolution of germination strategies within plant communities. The germination traits commonly examined (e.g., maximum germination percentage under optimal conditions) may not adequately reflect the critical ecological differences in germination behavior across species, communities, and seasons. In particular, most seeds exhibit primary dormancy at dispersal that is alleviated by exposure to dry after-ripening or to hydrated chilling to enable germination in a subsequent favorable season. Population-based threshold (PBT) models of seed germination enable quantification of patterns of germination timing using parameters based on mechanistic assumptions about the underlying germination physiology. We applied the hydrothermal time (HTT) model, a type of PBT model that integrates environmental temperature and water availability, to study germination physiology in a guild of coexisting desert annual species whose seeds were after-ripened by dry storage under different conditions. We show that HTT assumptions are valid for describing germination physiology in these species, including loss of dormancy during after-ripening. Key HTT parameters, the hydrothermal time constant (θHT ) and base water potential distribution among seeds (Ψb (g)), were effective in describing changes in dormancy states and in clustering species exhibiting similar germination syndromes. θHT is an inherent species-specific trait relating to timing of germination that correlates well with long-term field germination fraction, while Ψb (g) shifts with depth of dormancy in response to after-ripening and seasonal environmental variation. Predictions based on variation among coexisting species in θHT and Ψb (g) in laboratory germination tests matched well with 25-yr observations of germination dates and fractions for the same species in natural field conditions. Seed dormancy and germination strategies, which are significant contributors to long-term species demographics under natural conditions, can be represented by readily measurable functional traits underlying variation in germination phenologies.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Driving Simulator Performance Across the Lifespan: A Preliminary Study

OBJECTIVES Normal aging is associated with decline in abilities that may put an individual at increased riskfor a crash. Older individuals may have slowed processing speed and motor responses, a reduceduseful field of view (Ball et al., 1988), and greater difficulty with mental rotation (Armstrong etal., 1998). Although collision rates increase with age (Transportation Research Board, 1988), ithas been argued that specific age-related functional impairments, and not age itself, put one atrisk (Ball & Owsley, 2003). The goal of this study was to examine the relationship betweenaging and performance on driving simulations assessing specific components of driving—accident avoidance, divided attention, and navigation—and the degree to which they predict onroaddriving performance.METHODSForty control drivers (age 22 to 84; \u3c 50 yo, n = 14; 50-70 yo, n = 13; and \u3e 70 yo, n = 13)completed 3 simulations and an on-road driving evaluation. Exclusion criteria includedneurologic confounds, substance use and psychiatric disorders, as well as abnormalneuropsychological performance (based upon demographically-corrected norms). Thesimulations were presented on a Pentium III PC computer using a 17” monitor at 1280 x 1024resolution, and running STISIM Drive version 2.0 software (Systems Technology, Inc.;Hawthorne, CA). Hardware included a steering wheel, turn signal, and brake/accelerator pedals.The simulations consisted of 1) Advanced Routine and Emergency Driving (ARED), a 15-minute route simulating city/country driving, in which drivers must obey traffic signs, pass cars,and respond to high-risk crash scenarios; 2) Virtual City (VC), in which drivers must navigate toand from a location in a 5 x 5 block simulated city, and 3) Divided Attention, in which driversare to maintain a constant speed and lane position while responding to divided attention tasks inthe corner of the monitor. Participants also completed a 35-minute on-road assessment. Lastly,participants were assessed on a battery of neuropsychological tests. Earlier versions of thesimulations were predictive of on-road driving performance in an HIV-infected cohort (Marcotteet al., 2004). RESULTSThe three groups performed similarly on ARED (crashes, speeding tickets), as well as on the VCtask when the map was oriented to the same direction as the participant. On the other hand, olderparticipants had significantly more difficulty navigating when their orientation on the map wasreversed (e.g., the \u3c 50 group took 1.2 blocks beyond optimum to return from the destination; the50-70 and \u3e 70 years old groups took approximately 7.5 blocks). The three groups performedsimilarly with respect to lane deviation on the Divided Attention task, but the older groups hadincreased variability in speed maintenance, and the oldest group failed to respond to a greaternumber of divided attention stimuli (\u3c 50 yo = .3 (.83), 50-70 yo = 1.0 (1.3), \u3e 70 yo = 3.6 (2.7)).Although only one participant failed the on-road drive (50-70 yo), the percent of driversconsidered marginal or worse increased with age (7% vs. 25% vs. 55%). In a logistic regression,the simulator variables that best discriminated safe vs. marginal on-road came from the DividedAttention task: the number of missed stimuli and speed deviation, both of which require an intactuseful field of view and the shifting of gaze away from the roadway. Age did not enter into amodel that included these variables.CONCLUSIONSIn this study of normal, healthy controls, older participants drove similarly to young-to-middleaged participants on a simulation that most closely approximated real driving. Consistent withcognitive declines seen in normal aging, older participants had greater difficulty on a taskrequiring navigating when map orientation was reversed (perhaps indicative of impairedegocentric spatial abilities), as well as on a measure of driving-related divided attention, witholder participants appearing to allocate more attention to the roadway at the cost of attending andresponding to peripheral cues. Although older drivers had more difficulty during the on-road test,these difficulties were a function of deficits in the ability to divide attention efficiently, ratherthan aging per se.REFERENCESArmstrong, C.L., & Cloud, B. (1998). The emergence of spatial rotation deficits in dementia andnormal aging. Neuropsychology, 12(2), 208-217.Ball, K.K., Beard, B.L., Roenker, D.L., Miller, R.L., & Griggs, D.S. (1988). Age and visualsearch: Expanding the useful field of view. J Opt Soc Am A, 5(12), 2210-2219.Ball, K., & Owsley, C. (2003). Driving competence: It\u27s not a matter of age. J Am Geriatr Soc,51(10), 1499-1501.Marcotte, T.D., Wolfson, T., Rosenthal, T.J., Heaton, R.K., Gonzalez, R., Ellis, R.J., et al.(2004). A multimodal assessment of driving performance in HIV infection. Neurology, 63(8),1417-1422.Transportation Research Board. (1988). Transportation in an Aging Society, Vol 1. Washington,D.C.: National Research Council