The early presentation and management of rheumatoid arthritis cases in primary care

Recent NICE guidance has emphasised the importance of early recognition and referral of patients with inflammatory arthritis so that disease modifying treatment can be promptly initiated. The timely identification of such patients, given the large numbers consulting with musculoskeletal complaints, is a considerable challenge and descriptive data from primary care are sparse. Our objective was to examine GP records from three years before to 14 days after the first coded diagnosis of rheumatoid arthritis in order to describe the early course and management of the diseas

Information literacy in the law curriculum: experiences from Cardiff

It is often said that the library is to a law student what the laboratory is to the scientist. Are we teaching students not only to find their way around this laboratory, both physical and virtual, but to evaluate what they find and use it effectively? Skills of research, analysis, synthesis and presentation are fundamental to the successful study of law and beyond. How can we ensure that students develop these skills without sacrificing substantive content in an already crowded curriculum? This paper discusses the concept of "information literacy" and how Cardiff Law School used the concept to integrate legal research, IT and other legal skills training into a coherent module with an English Legal System focus

L1 and off Sun-Earth line visible-light imaging of Earth-directed CMEs: An analysis of inconsistent observations

The efficacy of coronal mass ejection (CME) observations as a key input to space weather forecasting is explored by comparing on and off Sun-Earth line observations from the ESA/NASA SOHO and NASA STEREO spacecraft. A comparison is made of CME catalogues based on L1 coronagraph imagery and off Sun-Earth line coronagraph and heliospheric imager (HI) observations, for the year 2011. Analysis reveals inconsistencies in the identification of a number of potentially Earth-directed CMEs. The catalogues reflect our ability to identify and characterise CMEs, so any discrepancies can impact our prediction of Earth-directed CMEs. We show that 15 CMEs, which were observed by STEREO, that had estimated directions compatible with Earth-directed events, had no identified halo/partial halo counterpart listed in the L1 coronagraph CME catalogue. In-situ data confirms that for 9 of these there was a consistent L1 Interplanetary CME (ICME). The number of such "discrepant" events is significant compared to the number of ICMEs recorded at L1 in 2011, stressing the need to address space weather monitoring capabilities, particularly with the inclusion of off Sun-Earth line observation. While the study provides evidence that some halo CMEs are simply not visible in near-Earth coronagraph imagery, there is evidence that some halo CMEs viewed from L1 are compromised by preceding CME remnants or the presence of multiple-CMEs. This underlines (1) the value of multiple vantage point CME observation, and (2) the benefit of off Sun-Earth line platform heliospheric imaging, and coronagraph imaging, for the efficient identification and tracking of Earth-directed events.Comment: 36 pages, 6 figures, in press at AGU Space Weather, 202

Re-grounding the city with Polanyi: From urban entrepreneurialism to entrepreneurial municipalism

Conventional approaches to local economic development are failing to address deepening polarisation both within and between city regions across advanced capitalist economies. At the same time, austerity urbanism, particularly in the UK, presents challenges for urban authorities facing reduced budgets to meet increased demands on public services. Municipalities are beginning to experiment with creative responses to these crises, such as taking more interventionist and entrepreneurial roles in developing local economies, generating alternative sources of revenue or financialising existing assets. Rooted in a Polanyian perspective and building on the concepts of the entrepreneurial state and grounded city, we identify an embryonic alternative approach – what we call ‘entrepreneurial municipalism’ – as a policy pathway towards resolving enduring socioeconomic problems where neoliberal urban-entrepreneurial strategies have failed. We situate entrepreneurial municipalism as one strand in an assemblage of new municipalist interventions, between radical urban social movements and more neoliberal strategies such as financialised municipal entrepreneurialism. Drawing on original research on the Liverpool City Region, we explore how local authorities are working with social enterprises to harness placebased assets in ways which de-commodify land, labour and capital and re-embed markets back into society. Finally, we draw upon Polanyi as our guide to disentangle differences in approach amongst divergent forms of municipalist statecraft and to critically evaluate entrepreneurial municipalism as a possible trajectory towards the grounded city

Systematic review of comprehensive primary health care models

Many countries are investing in primary health care (PHC) reform, with particular attention being paid to establishing local or regional organisational structures; implementing new funding arrangements and changing the PHC workforce skills mix. This review examines what is known about the implementation and effectiveness of the different system-wide models being developed in Australia, United Kingdom and New Zealand to achieveThe research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

What evidence is there for a delay in diagnostic coding of rheumatoid arthritis in UK general practice records? An observational study of free text

Objectives: Much research with electronic health records uses coded or structured data only; important information captured in the free text remains unused. One dimension of EHR data quality assessment is “currency” or timeliness, i.e. that data are representative of the patient state at the time of measurement. We explored the utility of free text in UK general practice patient records to evaluate delays in recording of rheumatoid arthritis (RA) diagnosis. We also aimed to locate and quantify disease and diagnostic information recorded only in text Setting: UK general practice patient records from the Clinical Practice Research Datalink. Participants: 294 individuals with incident diagnosis of RA between 2005 and 2008; 204 women and 85 men, median age 63 years. Primary and Secondary Outcome Measures: Assessment of 1) quantity and timing of text entries for disease modifying anti-rheumatic drugs (DMARDs) as a proxy for the RA disease code, and 2) quantity, location and timing of free text information relating to RA onset and diagnosis. Results: Inflammatory markers, pain and DMARDs were the most common categories of disease information in text prior to RA diagnostic code; 10-37% of patients had such information only in text. Read codes associated with RA-related text included correspondence, general consultation, and arthritis codes. 64 patients (22%) had DMARD text entries >14 days prior to RA code; these patients had more and earlier referrals to rheumatology, tests, swelling, pain, and DMARD prescriptions, suggestive of an earlier implicit diagnosis than was recorded by the diagnostic code. Conclusions: RA-related symptoms, tests, referrals and prescriptions were recorded in free text with 22% of patients showing strong evidence of delay in coding of diagnosis. Researchers using EHRs may need to mitigate for delayed codes by incorporating text into their case-ascertainment strategies. Natural language processing techniques have the capability to do this at scale

The Evolving Role of Liaison Librarians: Supporting Researchers in the Systematic Review Process

From the summer of 2013 to early 2014, four University of Waterloo librarians surveyed Health Sciences faculty and PhD students to gather data on their current and future systematic review work. Data provided insight into expectations of librarian support, and identified multiple ways to meet the needs of the surveyed population. Findings also identified how librarian expertise can be used towards knowledge creation and synthesis, confirming that librarian work will continue to move from an advising, supportive role to being an integral part of the research process and a member of the research team

Testing the current paradigm for space weather prediction with heliospheric imagers

Predictions of the arrival of four coronal mass ejections (CMEs) in geospace are produced through use of three CME geometric models combined with CME drag modeling, constraining these models with the available Coronagraph and Heliospheric Imager data. The efficacy of these predications is assessed by comparison with the Space Weather Prediction Center (SWPC) numerical MHD forecasts of these same events. It is found that such a prediction technique cannot outperform the standard SWPC forecast at a statistically meaningful level. We test the Harmonic Mean, Self-Similar Expansion, and Ellipse Evolution geometric models, and find that, for these events at least, the differences between the models are smaller than the observational errors. We present a new method of characterizing CME fronts in the Heliospheric Imager field of view, utilizing the analysis of citizen scientists working with the Solar Stormwatch project, and we demonstrate that this provides a more accurate representation of the CME front than is obtained by experts analyzing elongation time maps for the studied events. Comparison of the CME kinematics estimated independently from the STEREO-A and STEREO-B Heliospheric Imager data reveals inconsistencies that cannot be explained within the observational errors and model assumptions. We argue that these observations imply that the assumptions of the CME geometric models are routinely invalidated and question their utility in a space weather forecasting context. These results argue for the continuing development of more advanced techniques to better exploit the Heliospheric Imager observations for space weather forecasting