Electronic Healthcare Data Collection and Pay-for-Performance: Translating Theory into Practice

With insight grounded in his work for a national data collection consortium and as Vice President of Quality and Outcomes at the Children\u27s Hospital of Wisconsin, the author connects the theory of pay-for-performance to the realities of its implementation. The author expands the Diagnosing the Data conversation by describing the challenges of collecting meaningful data and by addressing the potential legal issues that data use raises. Drawing on his national and local experience, the author concludes with suggestions for adopting data collection programs that are both clinically relevant and scientifically reliable

Excessive use of reminders: Metacognition and effort-minimisation in cognitive offloading

People often use external reminders to help remember delayed intentions. This is a form of "cognitive offloading". Individuals sometimes offload more often than would be optimal (Gilbert et al., 2020). This bias has been linked to participants' erroneous metacognitive underconfidence in their memory abilities. However, underconfidence is unlikely to fully explain the bias. An additional, previously-untested factor that may contribute to the offloading bias is a preference to avoid cognitive effort associated with remembering internally. The present Registered Report examined evidence for this hypothesis. One group of participants received payment contingent on their performance of the task (hypothesised to increase cognitive effort, and therefore reduce the bias towards offloading); another group received a flat payment for taking part, as in the earlier experiment. The offloading bias was significantly reduced (but not eliminated) in the rewarded group, suggesting that a preference to avoid cognitive effort influences cognitive offloading

Adapting the queen square guided self help (QGSH) for functional neurological disorders as a stand-alone intervention: an exonian pilot study

Aim: Functional neurological disorders (FND) are one of the most common presentation in neurology clinics, causing a significant disability and economic burden. Cognitive behavioural therapy (CBT) has one of the best available evidence in managing FND, although access remains limited. Queen Square, London neuropsychiatry experts have established an excellent model for a CBT based, Guided Self Help (GSH) programme, which is preparatory to a multidisciplinary inpatient treatment. It has been shown to have good outcomes. This study was designed to ascertain the feasibility and acceptance of this QGSH model, in an Exonian cohort of FND patients, whilst piloting its stand-alone version, without the inpatient component. Additionally, the study explores the need and types of modifications required for the stand-alone adaptation of QGSH. Method: Consecutive patients referred to Exeter FND Service, between February to June 2020, who had internet access, were offered the QGSH pilot. Patients with a primary mental disorder concurrent drug/alcohol misuse or risk of self-harm or suicide were excluded. Ethics approval was not required. The QGSH intervention constitutes of 11 modules focussing on specific elements crucial to FND management along with homework tasks, delivered by the author, under supervision by QGSH experts. Patients completed Pre and Post-intervention questionnaires as well as structured feedback. Results: Three successive patients with varied FND symptoms were recruited to the pilot between February and June 2020. The baseline health status of these patients was worse as compared to EQ-5D-5L population norms with significant baseline psychiatric comorbidity. Outcome measures used before and after QGSH intervention included PHQ 9, GAD 7, EQ-5D-5L and a locally devised symptom severity questionnaire. Necessary modifications were made to the program based on the patients informal feedback and structured formal feedback was sought in the end. Conclusion: All patients derived some benefit from QGSH and certain modifications were suggested in patient feedback to improve engagement. Despite study limitations, especially small size and the impact of Covid 19 pandemic during the intervention; QGSH model appears acceptable and feasible in an Exonian cohort, however, some modifications are recommended for the stand-alone version to succeed. The recommendations will be presented

Factors Associated with Tuberculosis and Rifampicin-Resistant Tuberculosis amongst Symptomatic Patients in India: A Retrospective Analysis

Background Tuberculosis remains a major public health challenge for India. Various studies have documented different levels of TB and multi-drug resistant (MDR) TB among diverse groups of the population. In view of renewed targets set under the End TB strategy by 2035, there is an urgent need for TB diagnosis to be strengthened. Drawing on data from a recent, multisite study, we address key questions for TB diagnosis amongst symptomatics presenting for care: are there subgroups of patients that are more likely than others, to be positive for TB? In turn, amongst these positive cases, are there factors—apart from treatment history—that may be predictive for multi-drug resistance? Methods We used data from a multi-centric prospective demonstration study, conducted from March 2012 to December 2013 in 18 sub-district level TB programme units (TUs) in India and covering a population of 8.8 million. In place of standard diagnostic tests, upfront Xpert MTB/RIF testing was offered to all presumptive TB symptomatics. Here, using data from this study, we used logistic regression to identify association between risk factors and TB and Rifampicin-Resistant TB among symptomatics enrolled in the study. Results We find that male gender; history of TB treatment; and adult age compared with either children or the elderly are risk factors associated with high TB detection amongst symptomatics, across the TUs. While treatment history is found be a significant risk factor for rifampicin-resistant TB, elderly (65+ yrs) people have significantly lower risk than other age groups. However, pediatric TB cases have no less risk of rifampicin resistance as compared with adults (OR 1.23 (95% C.I. 0.85–1.76)). Similarly, risk of rifampicin resistance among both the genders was the same. These patterns applied across the study sites involved. Notably in Mumbai, amongst those patients with microbiological confirmation of TB, female patients showed a higher risk of having MDR-TB than male patients. Conclusion Our results cast fresh light on the characteristics of symptomatics presenting for care who are most likely to be microbiologically positive for TB, and for rifampicin resistance. The challenges posed by TB control are complex and multifactorial: evidence from diverse sources, including retrospective studies such as that addressed here, can be invaluable in informing future strategies to accelerate declines in TB burden

Design of an indentor viscometer for determining the viscosity of a fluid

Call number: LD2668 .T4 1969 M3Master of Scienc

Correlation of structure and stellar properties of galaxies in Stripe 82

Establishing a correlation (or lack thereof) between the bimodal colour distribution of galaxies and their structural parameters is crucial to understand the origin of bimodality. To achieve that, we have performed 2D mass-based structural decomposition (bulge+disc) of all disc galaxies (total$=$1263) in the Herschel imaging area of the Stripe 82 region using $K_s$ band images from the VICS82 survey. The scaling relations thus derived are found to reflect the internal kinematics and are employed in combination to select an indubitable set of classical and pseudo bulge hosting disc galaxies. The rest of the galaxies ($<20\%$) are marked as discs with "ambiguous" bulges. Pseudo and classical bulge disc galaxies exhibit clear bimodality in terms of all stellar parameters ($M_*$, sSFR, $r-K_s$). All pseudo bulge disc galaxies are blue and star-forming and all classical bulge disc galaxies are red and quiescent with less than $5\%$ digressions. Ambiguous bulge disc galaxies are intermittent to pseudo and classical bulge disc galaxies in the distribution of all structural and stellar parameters. $\Delta$$\langle\mu_{eb}\rangle$ - based on the placement of bulges on the Kormendy relation - is found to be the most efficient single structural indicator of both bulge type and stellar activity. The placement of ambiguous bulge disc galaxies on scaling relations and fundamental plane, in addition to their peculiar stellar properties suggest that they are dominantly a part of the green valley.Comment: Accepted for publication in ApJ, 16 pages, 10 figure