High Temporal Resolution XMM Monitoring of PKS 2155-304

The bright, strongly variable BL Lac object PKS 2155-304 was observed by XMM for two essentially uninterrupted periods of ~11 and 16 hr on 30-31 May 2000. The strongest variations occurred in the highest energy bands. After scaling for this effect, the three softest bands (0.1-1.7 keV) showed strong correlation with no measurable lag to reliable limits of \tau \ls 0.3 hr. However, the hardest band (~3 keV) was less well-correlated with the other three, especially on short time scales, showing deviations of ~10-20% in ~1 hr although, again, no significant interband lag was detected. This result and examination of previous ASCA and BeppoSAX cross-correlation functions suggest that previous claims of soft lags on time scales of 0.3-4 hr could well be an artifact of periodic interruptions due to Earth-occultation every 1.6 hr. Previous determinations of the magnetic field/bulk Lorentz factor were therefore premature, as these data provide only a lower limit of B \gamma^{1/3} \gs 2.5 G. The hardest band encompasses the spectral region above the high-energy break; its enhanced variability could be indicating that the break energy of the synchrotron spectrum, and therefore of the underlying electron energy distribution, changes independently of the lower energies.Comment: 13 pages, 3 figures, accepted by Ap

Concepts for a multi-criteria sustainability assessment of a new more biobased economy in rural production landscapes

This study presents a new approach to model the biophysical potentials for increased biomass harvest in Denmark, and a multi-criteria sustainability assessment of the socio-economic and environmental effects of different scenarios for such increased production and new biobased economy in rural landscapes. Thereby the results serve as input to the ongoing productivism – post-productivism debate related to rural spaces in Europe. Empirical results from a case study of large scale conversion to biorefenery technologies, aiming to increase the total Danish harvest of biomass by 10 million tonnes via the conversion to new types of crop production and land management, is used as an example, and will be related to the common conceptual model presented by the workshop convenors, and a so called “Traffic-light” multi-criteria sustainability assessment scheme introduced and exemplified in the present paper. The aim is to contextualize how the problems in relation to the concrete scenario results can be considered with the landscape as the meeting basis, and used as input for a discussion of innovative models for future farming systems, landscape research and management

X-ray Spectral Variability and Rapid Variability of the Soft X-ray Spectrum Seyfert 1 Galaxies Ark 564 and Ton S180

The bright, soft X-ray spectrum Seyfert 1 galaxies Ark 564 and Ton S180 were monitored for 35 days and 12 days with ASCA and RXTE (and EUVE for Ton S180). The short time scale (hours-days) variability patterns were very similar across energy bands, with no evidence of lags between any of the energy bands studied. The fractional variability amplitude was almost independent of energy band. It is difficult to simultaneously explain soft Seyferts stronger variability, softer spectra, and weaker energy-dependence of the variability relative to hard Seyferts. The soft and hard band light curves diverged on the longest time scales probed, consistent with the fluctuation power density spectra that showed relatively greater power on long time scales in the softest bands. The simplest explanation is that a relatively hard, rapidly-variable component dominates the total X-ray spectrum and a slowly-variable soft excess is present in the lowest energy channels of ASCA. Although it would be natural to identify the latter with an accretion disk and the former with a corona surrounding it, a standard thin disk could not get hot enough to radiate significantly in the ASCA band, and the observed variability time scales are much too short. The hard component may have a more complex shape than a pure power-law. The most rapid factor of 2 flares and dips occurred within ~1000 sec in Ark 564 and a bit more slowly in Ton S180. The speed of the luminosity changes rules out viscous or thermal processes and limits the size of the individual emission regions to <~15 Schwarzschild radii (and probably much less), that is, to either the inner disk or small regions in a corona

Post-discharge care following acute kidney injury: quality improvement in primary care

BACKGROUND: Over the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI. DESIGN: We conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI. RESULTS: AKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality. CONCLUSION: The findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI

Novel methods to deal with publication biases: secondary analysis of antidepressant trials in the FDA trial registry database and related journal publications

Objective To assess the performance of novel contour enhanced funnel plots and a regression based adjustment method to detect and adjust for publication biases

Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.

BackgroundThe incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.Methods/designThis will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.DiscussionThe results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.Trial registrationClinicalTrials.gov: NCT02034045. Date: 9 January 2014

Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: an open randomised trial

Objective To assess which of three triage strategies for women with borderline abnormal cervical smear results in the best psychosocial outcomes

Transporting comparative effectiveness evidence between countries : considerations for health technology assessments

Internal validity is often the primary concern for health technology assessment agencies when assessing comparative effectiveness evidence. However, the increasing use of real-world data from countries other than a health technology assessment agency's target population in effectiveness research has increased concerns over the external validity, or "transportability", of this evidence, and has led to a preference for local data. Methods have been developed to enable a lack of transportability to be addressed, for example by accounting for cross-country differences in disease characteristics, but their consideration in health technology assessments is limited. This may be because of limited knowledge of the methods and/or uncertainties in how best to utilise them within existing health technology assessment frameworks. This article aims to provide an introduction to transportability, including a summary of its assumptions and the methods available for identifying and adjusting for a lack of transportability, before discussing important considerations relating to their use in health technology assessment settings, including guidance on the identification of effect modifiers, guidance on the choice of target population, estimand, study sample and methods, and how evaluations of transportability can be integrated into health technology assessment submission and decision processes. [Abstract copyright: © 2023. The Author(s).

Cosmology with exponential potentials

We examine in the context of general relativity the dynamics of a spatially flat Robertson-Walker universe filled with a classical minimally coupled scalar field \phi of exponential potential ~ e^{-\mu\phi} plus pressureless baryonic matter. This system is reduced to a first-order ordinary differential equation, providing direct evidence on the acceleration/deceleration properties of the system. As a consequence, for positive potentials, passage into acceleration not at late times is generically a feature of the system, even when the late-times attractors are decelerating. Furthermore, the structure formation bound, together with the constraints on the present values of \Omega_{m}, w_{\phi} provide, independently of initial conditions and other parameters, necessary conditions on \mu. Special solutions are found to possess intervals of acceleration. For the almost cosmological constant case w_{\phi} ~ -1, as well as, for the generic late-times evolution, the general relation \Omega_{\phi}(w_{\phi}) is obtained.Comment: RevTex4, 9 pages, 2 figures, References adde

Human behaviour in emergency situations: comparisons between aviation and rail domains

This article presents a comparative review of the knowledge base regarding human behaviour in emergencies for both aviation and rail domains. Generic models of human behaviour in emergency situations are introduced and specific attention is then focussed on methods of behaviour prediction, exhibited behaviours in emergencies and methods of aiding evacuation across both modes of transport. Using established knowledge from the aviation domain, it has been possible to make observations and comparisons about the rail domain. Traditionally, the aviation domain has been a major focus of research attention and this is used to inform and interpret the rail domain. By drawing comparisons across these domains for human behaviour in emergency situations, the observations are discussed along with recommendations for future policies/planning for emergencies and future research areas