Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study

Background the structure of care homes markets in England is changing with the emergence of for-profit homes organised in chains and financed by private equity. Previous literature shows for-profit homes were rated lower quality than not-for-profit homes when inspected by the national regulator, but has not considered new forms of financing. Objectives to examine whether financing and organisation of care homes is associated with regulator assessments of quality. Methods retrospective observational study of the Care Quality Commission’s ratings of 10,803 care homes providing services to older people as of January 2020. We used generalised ordered logistic models to assess whether ratings differed between not-for-profit and for-profit homes categorised into three groups: (i) chained ownership, financed by private equity; (ii) chained ownership, not financed by private equity and (iii) independent ownership. We compared Overall and domain (caring, effective, responsive, safe, well-led) ratings adjusted for care home size, age and location. Results all three for-profit ownership types had lower average overall ratings than not-for-profit homes, especially independent (6.8% points (p.p.) more likely rated as ‘Requires Improvement/Inadequate’, 95% CI: 4.7–8.9) and private equity chains (6.6 p.p. more likely rated as ‘Requires Improvement/Inadequate’, 95% CI: 2.9–10.2). Independent homes scored better than private equity chains in the safe, effective and responsive domains but worst in the well-led domain. Discussion private equity financing and independent for-profit ownership are associated with lower quality. The consequences of the changing care homes market structure for quality of services should be monitored

Effects of chain ownership and private equity financing on quality in the English care home sector:retrospective observational study

BACKGROUND: the structure of care homes markets in England is changing with the emergence of for-profit homes organised in chains and financed by private equity. Previous literature shows for-profit homes were rated lower quality than not-for-profit homes when inspected by the national regulator, but has not considered new forms of financing.OBJECTIVES: to examine whether financing and organisation of care homes is associated with regulator assessments of quality.METHODS: retrospective observational study of the Care Quality Commission's ratings of 10,803 care homes providing services to older people as of January 2020. We used generalised ordered logistic models to assess whether ratings differed between not-for-profit and for-profit homes categorised into three groups: (i) chained ownership, financed by private equity; (ii) chained ownership, not financed by private equity and (iii) independent ownership. We compared Overall and domain (caring, effective, responsive, safe, well-led) ratings adjusted for care home size, age and location.RESULTS: all three for-profit ownership types had lower average overall ratings than not-for-profit homes, especially independent (6.8% points (p.p.) more likely rated as 'Requires Improvement/Inadequate', 95% CI: 4.7-8.9) and private equity chains (6.6 p.p. more likely rated as 'Requires Improvement/Inadequate', 95% CI: 2.9-10.2). Independent homes scored better than private equity chains in the safe, effective and responsive domains but worst in the well-led domain.DISCUSSION: private equity financing and independent for-profit ownership are associated with lower quality. The consequences of the changing care homes market structure for quality of services should be monitored.</p

An Analytical Approach for Comparing Linearization Methods in EKF and UKF

The transformation of the mean and variance of a normally distributed random variable was considered through three different nonlinear functions: sin(x), cos(x), and xk, where k is a positive integer. The true mean and variance of the random variable after these transformations is theoretically derived within, and verified with respect to Monte Carlo experiments. These statistics are used as a reference in order to compare the accuracy of two different linearization techniques: analytical linearization used in the Extended Kalman Filter (EKF) and statistical linearization used in the Unscented Kalman Filter (UKF). This comparison demonstrated the advantage of using the unscented transformation in estimating the mean after transforming through each of the considered nonlinear functions. However, the variance estimation led to mixed results in terms of which linearization technique provided the best performance. As an additional analysis, the unscented transformation was evaluated with respect to its primary scaling parameter. A nonlinear filtering example is presented to demonstrate the usefulness of the theoretically derived results

An Analytical Approach for Comparing Linearization Methods in EKF and UKF

The transformation of the mean and variance of a normally distributed random variable was considered through three different nonlinear functions: sin(x), cos(x), and xk, where k is a positive integer. The true mean and variance of the random variable after these transformations is theoretically derived within, and verified with respect to Monte Carlo experiments. These statistics are used as a reference in order to compare the accuracy of two different linearization techniques: analytical linearization used in the Extended Kalman Filter (EKF) and statistical linearization used in the Unscented Kalman Filter (UKF). This comparison demonstrated the advantage of using the unscented transformation in estimating the mean after transforming through each of the considered nonlinear functions. However, the variance estimation led to mixed results in terms of which linearization technique provided the best performance. As an additional analysis, the unscented transformation was evaluated with respect to its primary scaling parameter. A nonlinear filtering example is presented to demonstrate the usefulness of the theoretically derived results

Molecular phylogenies map to biogeography better than morphological ones

Phylogenetic relationships are inferred principally from two classes of data: morphological and molecular. Most current phylogenies of extant taxa are inferred from molecules, and when morphological and molecular trees conflict the latter are often preferred. Although supported by simulations, the superiority of molecular trees has never been assessed empirically. Here we test phylogenetic accuracy using two independent data sources: biogeographical distributions and fossil first occurrences. For 48 pairs of morphological and molecular trees, we show that, on average, molecular trees provide a better fit to biogeographical data than their morphological counterparts, and that, biogeographical congruence increases over research time. We find no significant differences in stratigraphical congruence between morphological and molecular trees. These findings have implications for understanding homoplasy in morphological data sets, the utility of morphology as a test of molecular hypotheses, and the implications of analysing fossil groups for which molecular data are unavailable

The evolution of the tetrapod humerus: morphometrics, disparity, and evolutionary rates

The present study explores the macroevolutionary dynamics of shape changes in the humeri of all major grades and clades of early tetrapods and their fish-like forerunners. Coordinate point eigenshape analysis applied to humeral outlines in extensor view reveals that fish humeri are more disparate than those of most early tetrapod groups and significantly separate from the latter. Our findings indicate sustained changes in humeral shape in the deepest portions of the tetrapod stem group and certain portions of the crown. In the first half of sampled tetrapod history, subclades show larger than expected humeral disparity, suggesting rapid diffusion into morphospace. Later in tetrapod evolution, subclades occupy smaller and non-overlapping morphospace regions. This pattern may reflect in part increasing specialisations in later tetrapod lineages. Bayesian shifts in rates of evolutionary change are distributed discontinuously across the phylogeny, and most of them occur within rather than between major groups. Most shifts with the highest Bayesian posterior probabilities are observed in lepospondyls. Similarly, maximum likelihood analyses of shifts support marked rate accelerations in lepospondyls and in various subclades within that group. In other tetrapod groups, rates either tend to slow down or experience only small increases. Somewhat surprisingly, no shifts are concurrent with structural, functional, or ecological innovations in tetrapod evolution, including the origin of digits, the water-land transition and increasing terrestrialisation. Although counterintuitive, these results are consistent with a model of continual phenotypic innovation that, although decoupled from key evolutionary changes, is possibly triggered by niche segregation in divergent clades and grades of early tetrapods.</p

Elasticity-Dependent Self-assembly of Micro-Templated Chromonic Liquid Crystal Films

We explore micropatterned director structures of aqueous lyotropic chromonic liquid crystal (LCLC) films created on square lattice cylindrical-micropost substrates. The structures are manipulated by modulating the LCLC mesophases and their elastic properties via concentration through drying. Nematic LCLC films exhibit preferred bistable alignment along the diagonals of the micropost lattice. Columnar LCLC films, dried from nematics, form two distinct director and defect configurations: a diagonally aligned director pattern with local squares of defects, and an off-diagonal configuration with zig-zag defects. The formation of these states appears to be tied to the relative splay and bend free energy costs of the initial nematic films. The observed nematic and columnar configurations are understood numerically using a Landau-de Gennes free energy model. Among other attributes, the work provide first examples of quasi-2D micropatterning of LC films in the columnar phase and lyotropic LC films in general, and it demonstrates alignment and configuration switching of typically difficult-to-align LCLC films via bulk elastic properties.Comment: 9 pages; 9 figures; accepted for publication in Soft Matte

GORTS: genetic algorithm based on one-by-one revision of two sides for dynamic travelling salesman problems

The dynamic travelling salesman problem (DTSP) is a natural extension of the standard travelling salesman problem, and it has attracted significant interest in recent years due to is practical applications. In this article, we propose an efficient solution for DTSP, based on a genetic algorithm (GA), and on the one-by-one revision of two sides (GORTS). More specifically, GORTS combines the global search ability of GA with the fast convergence feature of the method of one-by-one revision of two sides, in order to find the optimal solution in a short time. An experimental platform was designed to evaluate the performance of GORTS with TSPLIB. The experimental results show that the efficiency of GORTS compares favourably against other popular heuristic algorithms for DTSP. In particular, a prototype logistics system based on GORTS for a supermarket with an online map was designed and implemented. It was shown that this can provide optimised goods distribution routes for delivery staff, while considering real-time traffic information.This work was jointly sponsored by the National Natural Science Foundation of China under Grants 61472192 and 91646116, the Scientific and Technological Support Project (Society) of Jiangsu Province under Grant BE2016776, the Talent Project in Six Fields of Jiangsu Province under Grant 2015-JNHB-012, the “333” Scientific Research program of Jiangsu Province under Grant BRA2017228, and the Jiangsu Key Laboratory of Big Data Security and Intelligent Processing at NJUPT

The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities

This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC

Craniodental and Postcranial Characters of Non-Avian Dinosauria Often Imply Different Trees

Despite the increasing importance of molecular sequence data, morphology still makes an important contribution to resolving the phylogeny of many groups, and is the only source of data for most fossils. Most systematists sample morphological characters as broadly as possible on the principle of total evidence. However, it is not uncommon for sampling to be focused on particular aspects of anatomy, either because characters therein are believed to be more informative, or because preservation biases restrict what is available. Empirically, the optimal trees from partitions of morphological data sets often represent significantly different hypotheses of relationships. Previous work on hard-part versus soft-part characters across animal phyla revealed significant differences in about a half of sampled studies. Similarly, studies of the craniodental versus postcranial characters of vertebrates revealed significantly different trees in about one-third of cases, with the highest rates observed in non-avian dinosaurs. We test whether this is a generality here with a much larger sample of 81 published data matrices across all major dinosaur groups. Using the incongruence length difference test and two variants of the incongruence relationship difference test, we found significant incongruence in about 50% of cases. Incongruence is not uniformly distributed across major dinosaur clades, being highest (63%) in Theropoda and lowest (25%) in Thyreophora. As in previous studies, our partition tests show some sensitivity to matrix dimensions and the amount and distribution of missing entries. Levels of homoplasy and retained synapomorphy are similar between partitions, such that incongruence must partly reflect differences in patterns of homoplasy between partitions, which may itself be a function of modularity and mosaic evolution. Finally, we implement new tests to determine which partition yields trees most similar to those from the entire matrix. Despite no bias across dinosaurs overall, there are striking differences between major groups. The craniodental characters of Ornithischia and the postcranial characters of Saurischia yield trees most similar to the “total evidence” trees derived from the entire matrix. Trees from these same character partitions also tend to be most stratigraphically congruent: a mutual consilience suggesting that those partitions yield more accurate trees