Charles Galloway

UNF Oral History Project Interview of Charles Galloway by James B. Crooks on November 5, 200

O Heart Of Mine

https://digitalcommons.library.umaine.edu/mmb-vp/5792/thumbnail.jp

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

Calf pre-weaning traits and immunoglobulin response to bovine viral diarrhea virus vaccination

Calfhood vaccination for bovine viral diarrhea virus (BVDV) is a relatively new concept, and protocols are evolving. Our objective was to determine effects of BVDV type I vaccination protocol, calf behavior (chute score, and chute exit velocity), and gender on calf gain and immunoglobulin (Ig) response. Crossbred calves (n = 64) were randomly allotted to one of two vaccination protocols. In protocol 1, calves were vaccinated at 60 d of age (d 0) and at weaning (d 147). Calves assigned to protocol 2 were vaccinated against BVDV type I at 21 d prior to (d 126) and at weaning (d 147). Blood samples were collected from half of the calves in each protocol group on d 0 (60 days of age), d 21, d 126 (21 days prior to weaning), and d 147 (at weaning); serum was harvested and Ig titers were determined. Titers for BVDV type I were transformed (log base 2) and analyzed using a mixed model procedure. Calves vaccinated at d 0 and weaning had larger (P \u3c 0.0001) titers than calves vaccinated at d 126 and weaning (7.5 ± 0.36 and 5.1 ± 0.36, respectively). Mean BVDV titers were larger (P \u3c 0.0001) on d 147 when compared with d 126, d 21, and d 0 (8.3 ± 0.39, 5.1 ± 0.40, 5.9 ± 0.39 and 5.7 ± 0.39, respectively). A treatment × day interaction (P \u3c 0.0001) also affected BVDV titers. However, BVDV titers were not affected (P \u3e 0.05) by calf gender, chute score, or chute exit velocity. Weaning weight and pre-weaning average daily gain (ADG) were not related to BVDV type I titers. This study indicated that vaccinating beef calves against BVDV was effective in triggering an Ig response. Furthermore, our results suggest that calves should be vaccinated against BVDV type I at 60 d of age for greater disease resistance

Volume Comparison for Hypersurfaces in Lorentzian Manifolds and Singularity Theorems

We develop area and volume comparison theorems for the evolution of spacelike, acausal, causally complete hypersurfaces in Lorentzian manifolds, where one has a lower bound on the Ricci tensor along timelike curves, and an upper bound on the mean curvature of the hypersurface. Using these results, we give a new proof of Hawking's singularity theorem.Comment: 15 pages, LaTe

Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly

Objectives. To evaluate the risk of serious infections (SIs) in patients with RA treated with anti-TNF therapy with emphasis on the risk across different ages

Diagnostic delay is common for patients with axial spondyloarthritis: Results from the National Early Inflammatory Arthritis Audit

OBJECTIVES: Updated guidelines for patients with axial SpA (axSpA) have sought to reduce diagnostic delay by raising awareness among clinicians. We used the National Early Inflammatory Arthritis Audit (NEIAA) to describe baseline characteristics and time to diagnosis for newly referred patients with axSpA in England and Wales. METHODS: Analyses were performed on sociodemographic and clinical metrics, including time to referral and assessment, for axSpA patients (n = 784) recruited to the NEIAA between May 2018 and March 2020. Comparators were patients recruited to the NEIAA with RA (n = 9270) or mechanical back pain (MBP; n = 370) in the same period. RESULTS: Symptom duration prior to initial rheumatology assessment was longer in axSpA than RA patients (P 6 months, compared with 33.7% of RA patients and 76.0% of MBP patients. Following referral, the median time to initial rheumatology assessment was longer for axSpA than RA patients (36 vs 24 days; P < 0.001) and similar to MBP patients (39 days; P = 0.30). Of the subset of patients deemed eligible for early inflammatory arthritis pathway follow-up, fewer axSpA than RA patients had disease education provided (77.5% vs 97.8%) and RA patients reported a better understanding of their condition and treatment. CONCLUSION: Diagnostic delay in axSpA remains a major challenge despite improved disease understanding and updated referral guidelines. Disease education is provided to fewer axSpA than RA patients, highlighting the need for specialist clinics and support programmes for axSpA patients