Data quality predicts care quality: findings from a national clinical audit

Background: Missing clinical outcome data are a common occurrence in longitudinal studies. Data quality in clinical audit is a particular cause for concern. The relationship between departmental levels of missing clinical outcome data and care quality is not known. We hypothesise that completeness of key outcome data in a national audit predicts departmental performance. Methods: The National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis (NCAREIA) collected data on care of patients with suspected rheumatoid arthritis (RA) from early 2014 to late 2015. This observational cohort study collected data on patient demographics, departmental variables, service quality measures including time to treatment, and the key RA clinical outcome measure, disease activity at baseline, and 3 months follow-up. A mixed effects model was conducted to identify departments with high/low proportions of missing baseline disease activity data with the results plotted on a caterpillar graph. A mixed effects model was conducted to assess if missing baseline disease activity predicted prompt treatment. Results: Six thousand two hundred five patients with complete treatment time data and a diagnosis of RA were recruited from 136 departments. 34.3% had missing disease activity at baseline. Mixed effects modelling identified 13 departments with high levels of missing disease activity, with a cluster observed in the Northwest of England. Missing baseline disease activity was associated with not commencing treatment promptly in an adjusted mix effects model, odds ratio 0.50 (95% CI 0.41 to 0.61, p < 0.0001). Conclusions: We have shown that poor engagement in a national audit program correlates with the quality of care provided. Our findings support the use of data completeness as an additional service quality indicator

Remote laboratory: using Internet-of-Things (IoT) for E-learning

In order to equip engineering E-learners with realistic hands-on laboratory experience, remote access to an operating lab may be provided. Such an access can be implemented using live video streaming from a physical lab coupled with IoT telemetry and telecontrol. The progress of an ongoing remote laboratory project is presented. Three different video streaming solutions were compared side-by-side, the back end electronic architecture was fully developed and the most notable observations are now reported

Safe and unsafe spaces? Using drawings and photos to explore children's sense of safety in domestic violence

Objectives: Dominant professional and academic discourses position children who have experienced domestic violence as passive observers of abuse, ‘wounded’ by the things they have seen (Øverlien 2013). Challenging this representation of children, this paper explores how children represent embodied and spatial experience of violence, including a consideration of how children use their material experiences to produce resistant embodied agency. Method This paper is based on interviews with 107 children, in 4 European countries (Italy, Greece, Spain and the UK), focused on their experiences of coping and of maintaining a sense of agency, in families where domestic violence occurs. These interviews included use of photo-elicitation, free drawing, and guided drawing - including family drawing and spatial mapping (Bridger, 2013; Gabb and Singh, 2014), to facilitate young people’s expression of difficult to articulate experiences. The interviews were analysed using Denzin’s Interpretive Interactionism. Results: Visual methods facilitated children’s critical reflections on their experiences of embodiment, and how they used spaces and places within and outside the violent home environment. Three themes are considered: children’s experiences of displacement and disruption (the un-homing of the home), their accounts of creating safe spaces within their home, and use of space as a form of escape and resistance to abuse and control. Conclusions and Implications Findings suggest that children are capable and active agents, resourceful and inventive in their capacity to use, produce and construct physical, embodied and relational spaces for security, comfort and healing during and after living within violent and volatile contexts. The practical applications of these findings are considered

Stabilization of the perovskite phase in the Y-Bi-O system by using a BaBiO3_{3} buffer layer

A topological insulating phase has theoretically been predicted for the thermodynamically unstable perovskite phase of YBiO$_{3}$. Here, it is shown that the crystal structure of the Y-Bi-O system can be controlled by using a BaBiO$_{3}$ buffer layer. The BaBiO$_{3}$ film overcomes the large lattice mismatch of 12% with the SrTiO$_{3}$ substrate by forming a rocksalt structure in between the two perovskite structures. Depositing an YBiO$_{3}$ film directly on a SrTiO$_{3}$ substrate gives a fluorite structure. However, when the Y-Bi-O system is deposited on top of the buffer layer with the correct crystal phase and comparable lattice constant, a single oriented perovskite structure with the expected lattice constants is observed.Comment: 8 pages, 7 figures + 4 pages supporting informatio

The valuation of European financial firms

We extend the recent literature concerning accounting based valuation models to investigate financial firms from six European countries with substantial financial sectors: France, Germany, Italy, Netherlands, Switzerland and the UK. Not only are these crucial industries worthy of study in their own right, but unusual accounting practices, and inter-country differences in those accounting practices, provide valuable insights into the accounting-value relationship. Our sample consists of 7,714 financial firm/years observations from 1,140 companies drawn from 1989-2000. Sub-samples include 1,309 firm/years for banks, 650 for insurance companies, 1,705 for real estate firms, and 3,239 for investment companies. In most countries we find that the valuation models work as well or better in explaining cross-sectional variations in the market-to-book ratio for financial firms as they do for industrial and commercial firms in the same countries, although Switzerland is an exception to this generalization. As expected, the results are sensitive to industrial differences, accounting regulation and accounting practices. In particular, marking assets to market value reduces the relevance of earnings figures and increases that of equity

Outcomes of Fusions From the Cervical Spine to the Pelvis.

Study designRetrospective cohort study.ObjectiveDetermine the indications, complications, and clinical outcomes in patients requiring fusions from the cervical spine to the pelvis. Several investigators have examined fusions from the thoracic spine to the sacrum, but no similar study has been performed for cervical-to-pelvis fusions.MethodsPatients from 2003 to 2014 with an upper instrumented vertebrae (UIV) in the cervical spine (any level) and a lower instrumented vertebrae (LIV) in the sacrum or pelvis were included in the study. Those with infectious or acute trauma-related deformities were excluded. Patient demographics, medical history, diagnosis, operative procedure, and health-related quality of life measures were analyzed. Student's t test, Kruskal-Wallis test, and χ2 test were used as appropriate; significance was set at P &lt; .05 for all tests.ResultsFifty-five patients met inclusion criteria for the study. Average follow-up was 2.8 years. Proximal junctional kyphosis was the most common indication for cervical-to-pelvis fusions (36%). The most common UIV was C2 (29%) followed by C7 (24%). There was an average 31° correction in maximum kyphosis and a 3.3 cm improvement in sagittal vertical axis. In adults, the rate of complication was 71.4%, with a major complication rate of 39.3% and reoperation rate of 53.6%. There was significant improvement in the Scoliosis Research Society (SRS-22r) score (3.0 to 3.5; P &lt; .01).ConclusionProximal junctional kyphosis is the most common indication for patients requiring fusion to the cervical spine. Adult patients incur a significant risk of major complications and reoperations. However, significant improvement in SRS-22r outcomes are noted in these patients