The impact of delayed transfers of care on emergency departments: common sense arguments, evidence and confounding

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordData availability statement: All data and code required to reproduce this study are available at http://doi.org/10.5281/zenodo.3523179Objectives There have been claims that Delayed Transfers of Care (DTOCs) of inpatients to home or a less acute setting are related to Emergency Department (ED) crowding. In particular DTOCs were associated with breaches of the UK 4-hour waiting time target in a previously published analysis. However, the analysis has major limitations by not adjusting for the longitudinal trend of the data. The aim of this work is to investigate whether the proposition that DTOCs impact the 4-hour target requires further research. Method Estimation of an association between two or more variables that are measured over time requires specialised statistical methods. In this study, we performed two separate analyses. First, we created two sets of artificial data with no correlation. We then added an upward trend over time and again assessed for correlation. Second, we reproduced the simple linear regression of the original study using NHS England open data of English trusts between 2010 and 2016, assessing correlation of numbers of DTOCs and ED breaches of the 4-hour target. We then reanalysed the same data using standard time series methods to remove the trend before estimating an association. Results After introducing upward trends into the uncorrelated artificial data the correlation between the two data sets increased (R2=0.00 to 0.51 respectively). We found strong evidence of longitudinal trends within the NHS data of ED breaches and DTOCs. After removal of the trends the R2 reduced from 0.50 to 0.01. Conclusion Our reanalysis found weak correlation between numbers of DTOCs and ED 4-hour target breaches. Our study does not indicate that there is no relationship between 4-hour target and DTOCs, it highlights that statistically robust evidence for this relationship does not currently exist. Further work is required to understand the relationship between breaches of the 4-hour target and numbers of DTOCs.National Institute for Health Research (NIHR

Dialectic tensions in the financial markets: a longitudinal study of pre- and post-crisis regulatory technology

This article presents the findings from a longitudinal research study on regulatory technology in the UK financial services industry. The financial crisis with serious corporate and mutual fund scandals raised the profile of compliance as governmental bodies, institutional and private investors introduced a ‘tsunami’ of financial regulations. Adopting a multi-level analysis, this study examines how regulatory technology was used by financial firms to meet their compliance obligations, pre- and post-crisis. Empirical data collected over 12 years examine the deployment of an investment management system in eight financial firms. Interviews with public regulatory bodies, financial institutions and technology providers reveal a culture of compliance with increased transparency, surveillance and accountability. Findings show that dialectic tensions arise as the pursuit of transparency, surveillance and accountability in compliance mandates is simultaneously rationalized, facilitated and obscured by regulatory technology. Responding to these challenges, regulatory bodies continue to impose revised compliance mandates on financial firms to force them to adapt their financial technologies in an ever-changing multi-jurisdictional regulatory landscape

Scottish social survey data, past present and future:Does Scotland need its own data strategy?

The UK now has a National Data Strategy. In this paper we explore whether or not in addition Scotland needs its own specific data strategy. This paper is intended to be a ‘think piece’ or critical essay, the motivation being to encourage debate about Scottish social survey data. Post-devolution, with the emergence of new forms of governance and new institutional arrangements, the political desire to research Scotland in the 21st Century has been brought into sharper resolution. Social and economic life in Scotland shares both similarities and differences with life south of the border. It is important that these characteristics are correctly identified with empirical data rather than simply being assumed. Scotland is a small territory with a good social science tradition and a healthy research sector. There is an increasing amount of survey data collecting measures relating to social and economic life in Scotland. These include both United Kingdom or Great Britain based surveys with a Scottish component, and Scotland focussed surveys. In this paper we outline a number of key issues relating to Scottish social science data resources. We provide a number of critical recommendations for social science data collection in Scotland. Finally, we examine the potential benefits of a comprehensive data strategy

Ethical behaviors and wealth: generation Y’s experience

This research investigates if ethical behaviors and personal finances are related using a large scale U.S. random survey called the NLSY97. Fifteen indicators covering both ethical and unethical behaviors are compared to net worth for people in their 20s and 30s, who are called Generation Y. Breaking rules, stealing and being arrested are associated with less wealth in this generation. Results suggest that among people in their early 20s there is little or no relationship between ethical behaviors and wealth. However, as this cohort ages, a positive relationship between acting more ethically and wealth emerges.Accepted manuscrip