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

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

'I just want a job' : what do we really know about young people in jobs without training?

Over recent years, a central concern of policy has been to drive up post-16 participation rates in full-time education and address the needs of young people not in education, employment or training (NEET). As a result, young people who enter work which is classified as 'without training' at 16/17 have largely been ignored. However, the decision to Raise the Participation Age (RPA) for continuing in learning for all 17-year olds from 2013 and for all 18-year olds from 2015 in England, together with a growing unease about the impact of the current recession on youth unemployment rates, have revived interest in the 'jobs without training' (JWT) group. This paper draws on the findings from two studies: first, a qualitative study in two contrasting local labour markets, of young people in JWT, together with their employers and parents; and second, an evaluation of the Learning Agreement Pilots (LAP), which was the first policy initiative in England targeted at the JWT group. Both studies reveal a dearth of understanding about early labour market entrants and a lack of policy intervention and infrastructure to support the needs of the JWT group throughout the UK. From this, it is concluded that questionable assumptions have been made about the composition and the aspirations of young people in JWT, and their employers, on the basis of little or no evidence. As a consequence, a policy 'quick fix' to satisfy the RPA agenda will not easily be achieved. If the decision to raise the participation age is adopted also by the Welsh and Scottish parliaments, similar challenges may have to be faced

Understanding the limits to ethnic change: lessons from Uganda's “lost counties”

The historically constructed nature of ethnicity has become a widely accepted paradigm in the social sciences. Scholars have especially have focused on the ways modern states have been able to create and change ethnic identities, with perhaps the strongest case studies coming from colonial Africa, where the gap between strong states and weak societies has been most apparent. I suggest, however, that in order to better understand how and when ethnic change occurs it is important to examine case studies where state-directed ethnic change has failed. To rectify this oversight I examine the case of the “lost counties” of Uganda, which were transferred from the Bunyoro kingdom to the Buganda kingdom at the onset of colonial rule. I show that British attempts to assimilate the Banyoro residents in two of the lost counties were an unmitigated failure, while attempts in the other five counties were successful. I claim that the reason for these differing outcomes lies in the status of the two lost counties as part of the historic Bunyoro homeland, whereas the other five counties were both geographically and symbolically peripheral to Bunyoro. The evidence here thus suggests that varying ethnic attachments to territory can lead to differing outcomes in situations of state-directed assimilation and ethnic change

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

The Probable Detection of SN 1923A: The Oldest Radio Supernova?

Based upon the results of VLA observations, we report the detection of two unresolved radio sources that are coincident with the reported optical position of SN 1923A in M83. For the source closest to the SN position, the flux density was determined to be 0.30 +/- 0.05 mJy at 20 cm and 0.093 +/- 0.028 mJy at 6 cm. The flux density of the second nearby source was determined to be 0.29 +/- 0.05 at 20 cm and 0.13 +/- 0.028 at 6 cm. Both sources are non-thermal with spectral indices of alpha = -1.0 +/- 0.30 and -0.69 +/- 0.24, respectively. SN 1923A has been designated as a Type II-P. No Type II-P (other than SN 1987A) has been detected previously in the radio. The radio emission from both sources appears to be fading with time. At an age of approximately 68 years when we observed it, this would be the oldest radio supernova (of known age) yet detected

Seasonal pattern of incidence and outcome of acute kidney injury: A national study of Welsh AKI electronic alerts

Objectives To identify any seasonal variation in the occurrence of, and outcome following Acute Kidney Injury. Methods The study utilised the biochemistry based AKI electronic (e)-alert system established across the Welsh National Health Service to collect data on all AKI episodes to identify changes in incidence and outcome over one calendar year (1st October 2015 and the 30th September 2016). Results There were total of 48 457 incident AKI alerts. The highest proportion of AKI episodes was seen in the quarter of January to March (26.2%), and the lowest in the quarter of October to December (23.3%, P < .001). The same trend was seen for both community-acquired and hospital-acquired AKI sub-sets. Overall 90 day mortality for all AKI was 27.3%. In contrast with the seasonal trend in AKI occurrence, 90 day mortality after the incident AKI alert was significantly higher in the quarters of January to March and October to December compared with the quarters of April to June and July to September (P < .001) consistent with excess winter mortality reported for likely underlying diseases which precipitate AKI. Conclusions In summary we report for the first time in a large national cohort, a seasonal variation in the incidence and outcomes of AKI. The results demonstrate distinct trends in the incidence and outcome of AKI

Gravitational Waves from Collapsing Vacuum Domains

The breaking of an approximate discrete symmetry, the final stages of a first order phase transition, or a post-inflationary biased probability distribution for scalar fields are possible cosmological scenarios characterized by the presence of unstable domain wall networks. Combining analytical and numerical techniques, we show that the non-spherical collapse of these domains can be a powerful source of gravitational waves. We compute their contribution to the stochastic background of gravitational radiation and explore their observability by present and future gravitational wave detectors.Comment: Revised version to appear in Physical Review Letters. Changes have been made which improve the presentation of the results. Figure 3 was modified, but conclusions remain the sam

Ultraviolet Imaging Observations of the cD Galaxy in Abell 1795: Further Evidence for Massive Star Formation in a Cooling Flow

We present images from the Ultraviolet Imaging Telescope of the Abell 1795 cluster of galaxies. We compare the cD galaxy morphology and photometry of these data with those from existing archival and published data. The addition of a far--UV color helps us to construct and test star formation model scenarios for the sources of UV emission. Models of star formation with rates in the range \sim5-20M_{\sun}yr$^{-1}$ indicate that the best fitting models are those with continuous star formation or a recent ($\sim4$ Myr old) burst superimposed on an old population. The presence of dust in the galaxy, dramatically revealed by HST images complicates the interpretation of UV data. However, we find that the broad--band UV/optical colors of this cD galaxy can be reasonably matched by models using a Galactic form for the extinction law with $E_{B-V}=0.14$. We also briefly discuss other objects in the large UIT field of view.Comment: To appear in the Astrophysical Journal. 14 AAS preprint style pages plus 7 figure