Do the UK government's new Quality and Outcomes Framework (QOF) scores adequately measure primary care performance? A cross-sectional survey of routine healthcare data

BACKGROUND General practitioners' remuneration is now linked directly to the scores attained in the Quality and Outcomes Framework (QOF). The success of this approach depends in part on designing a robust and clinically meaningful set of indicators. The aim of this study was to assess the extent to which measures of health observed in practice populations are correlated with their QOF scores, after accounting for the established associations between health outcomes and socio-demographics. METHODS QOF data for the period April 2004 to March 2005 were obtained for all general practices in two English Primary Care Trusts. These data were linked to data for emergency hospital admissions (for asthma, cancer, chronic obstructive pulmonary disease, coronary hear disease, diabetes, stroke and all other conditions) and all cause mortality for the period September 2004 to August 2005. Multilevel logistic regression models explored the association between health outcomes (hospital admission and death) and practice QOF scores (clinical, additional services and organisational domains), age, sex and socio-economic deprivation. RESULTS Higher clinical domain scores were generally associated with lower admission rates and this was significant for cancer and other conditions in PCT 2. Higher scores in the additional services domain were associated with higher admission rates, significantly so for asthma, CHD, stroke and other conditions in PCT 1 and cancer in PCT 2. Little association was observed between the organisational domain scores and admissions. The relationship between the QOF variables and mortality was less clear. Being female was associated with fewer admissions for cancer and CHD and lower mortality rates. Increasing age was mainly associated with an increased number of events. Increasing deprivation was associated with higher admission rates for all conditions and with higher mortality rates. CONCLUSION The associations between QOF scores and emergency admissions and mortality were small and inconsistent, whilst the impact of socio-economic deprivation on the outcomes was much stronger. These results have implications for the use of target-based remuneration of general practitioners and emphasise the need to tackle inequalities and improve the health of disadvantaged groups and the population as a whole

Circulating human leucine-rich a-2-glycoprotein 1 mRNA and protein levels to detect acute appendicitis in patients with acute abdominal pain

Background Elevated levels of circulating plasma and urine leucine-rich-2-glycoprotein-1 (LRG1) protein has been found in patients with acute appendicitis (AA) and may be useful for diagnosis. This study aimed to investigate whether combined tests including circulating LRG1 mRNA levels improve the early diagnosis of AA. Methods Between December 2011 and October 2012, a prospective study was conducted on patients aged 18 years or older presenting to the ED with acute abdominal pain (< 7 days of symptom onset). Levels of whole blood LRG1 mRNA and plasma LRG1 protein taken from these patients within 24 h of arrival (mean 12.4 h) were analyzed. The primary outcome was AA. Results Eighty-four patients (40 (47.6%) with AA and 44 (52.4%) without AA; mean age 35 years; 41.6% males) were recruited. Median whole blood LRG1 mRNA and plasma LRG1 levels were higher in AA patients than in non-AA. Of 40 AA patients, 13 (32.5%) were diagnosed as complicated AA. In ROC analysis of LRG1 mRNA (normalized to GAPDH), LRG1 protein and Alvarado score for discriminating AA and non-AA, the areas under the curve (AUC) were 0.723, 0.742 and 0.805 respectively. The AUC of combination of normalized LRG1 mRNA, LRG1 protein and Alvarado score was 0.845. Conclusion A combination of modified whole blood LRG1 mRNA levels, plasma LRG1 protein and Alvarado score at the ED may be useful to diagnose simple and complicated AA from other causes of abdominal pain

A clustering based transfer function for volume rendering using gray-gradient mode histogram

Volume rendering is an emerging technique widely used in the medical field to visualize human organs using tomography image slices. In volume rendering, sliced medical images are transformed into attributes, such as color and opacity through transfer function. Thus, the design of the transfer function directly affects the result of medical images visualization. A well-designed transfer function can improve both the image quality and visualization speed. In one of our previous paper, we designed a multi-dimensional transfer function based on region growth to determine the transparency of a voxel, where both gray threshold and gray change threshold are used to calculate the transparency. In this paper, a new approach of the transfer function is proposed based on clustering analysis of gray-gradient mode histogram, where volume data is represented in a two-dimensional histogram. Clustering analysis is carried out based on the spatial information of volume data in the histogram, and the transfer function is automatically generated by means of clustering analysis of the spatial information. The dataset of human thoracic is used in our experiment to evaluate the performance of volume rendering using the proposed transfer function. By comparing with the original transfer function implemented in two popularly used volume rendering systems, visualization toolkit (VTK) and RadiAnt DICOM Viewer, the effectiveness and performance of the proposed transfer function are demonstrated in terms of the rendering efficiency and image quality, where more accurate and clearer features are presented rather than a blur red area. Furthermore, the complex operations on the two-dimensional histogram are avoided in our proposed approach and more detailed information can be seen from our final visualized image

Semileptonic B−→ppˉℓ−νˉℓB-\to p\bar{p} \ell-\bar{\nu}_\ell decays

We study the four-body exclusive semileptonic baryonic $\bar B$ decays of $B^-\to p\bar p \ell^- \bar\nu_{\ell}$ ($\ell=e,\mu,\tau$) in the standard model. We find that their decay branching ratios are about $(1.0, 1.0,0.5)\times 10^{-4}$, respectively. In particular, the electron mode is close to the corresponding CLEO's upper limit of $5.2\times 10^{-3}$, while all results are about one or two orders of magnitude larger than the previous estimated values for the inclusive modes of $\bar B\to {\bf B\bar B'}\ell \bar \nu$. Clearly, both B-factories of Belle and BaBar should be able to observe these exclusive four-body modes.Comment: 10 pages, 3 figures, published versio

Observations of Coronal Mass Ejections with the Coronal Multichannel Polarimeter

The Coronal Multichannel Polarimeter (CoMP) measures not only the polarization of coronal emission, but also the full radiance profiles of coronal emission lines. For the first time, CoMP observations provide high-cadence image sequences of the coronal line intensity, Doppler shift and line width simultaneously in a large field of view. By studying the Doppler shift and line width we may explore more of the physical processes of CME initiation and propagation. Here we identify a list of CMEs observed by CoMP and present the first results of these observations. Our preliminary analysis shows that CMEs are usually associated with greatly increased Doppler shift and enhanced line width. These new observations provide not only valuable information to constrain CME models and probe various processes during the initial propagation of CMEs in the low corona, but also offer a possible cost-effective and low-risk means of space weather monitoring.Comment: 6 figures. Will appear in the special issue of Coronal Magnetism, Sol. Phy

Partial Wave Analysis of J/ψ→γ(K+K−π+π−)J/\psi \to \gamma (K^+K^-\pi^+\pi^-)

BES data on $J/\psi \to \gamma (K^+K^-\pi^+\pi^-)$ are presented. The $K^*\bar K^*$ contribution peaks strongly near threshold. It is fitted with a broad $0^{-+}$ resonance with mass $M = 1800 \pm 100$ MeV, width $\Gamma = 500 \pm 200$ MeV. A broad $2^{++}$ resonance peaking at 2020 MeV is also required with width $\sim 500$ MeV. There is further evidence for a $2^{-+}$ component peaking at 2.55 GeV. The non-$K^*\bar K^*$ contribution is close to phase space; it peaks at 2.6 GeV and is very different from $K^{*}\bar{K^{*}}$.Comment: 15 pages, 6 figures, 1 table, Submitted to PL

Moisture damage assessment using surface energy, bitumen stripping and the SATS moisture conditioning procedure

Durability is one of the most important properties of an asphalt mixture. A key factor affecting the durability of asphalt pavements is moisture damage. Moisture damage generally results in the loss of strength of the mixture due to two main mechanisms; the loss of adhesion between bitumen and aggregate and the loss of cohesion within the mixture. Conventional test methods for evaluating moisture damage include tests conducted on loose bitumen-coated aggregates and those conducted on compacted asphalt mixtures. The former test methods are simpler and less expensive to conduct but are qualitative/subjective in nature and do not consider cohesive failure while the latter, though more quantitative, are based on bulky mechanical test set-ups and therefore require expensive equipment. Both test methods are, however, empirical in nature thus requiring extensive experience to interpret/use their results. The rolling bottle test (RBT) (EN 12697-11) for loose aggregate mixtures and the saturation ageing tensile stiffness (SATS) test (EN 12697-45) for compacted asphalt mixtures are two such methods, which experience suggests, could clearly discriminate between ‘good’ and ‘poor’ performing mixtures in the laboratory. A more fundamental approach based on surface energy (SE) measurements offers promise to better understand moisture damage. This article looks at results from the rolling bottle and the SATS tests in an attempt to better understand the underlying processes and mechanisms of moisture damage with the help of SE measurements on the constituent bitumen and aggregates. For this work, a set of bitumens and typical acidic and basic aggregate types (granite and limestone) were selected. Combinations of these materials were assessed using both the rolling bottle and SATS tests. The SE properties of the binders were measured using a dynamic contact angle Analyser and those of the aggregates using a dynamic vapour sorption device. From these SE measurements it was possible to predict the relative performance of both the simple RBT and the more complicated SATS test. Mineralogical composition of the aggregates determined using a mineral liberation analyser was used to explain the differences in performance of the mixtures considered

BESII Detector Simulation

A Monte Carlo program based on Geant3 has been developed for BESII detector simulation. The organization of the program is outlined, and the digitization procedure for simulating the response of various sub-detectors is described. Comparisons with data show that the performance of the program is generally satisfactory.Comment: 17 pages, 14 figures, uses elsart.cls, to be submitted to NIM