An Empirical Analysis of the Effects of GP Competition

We analyse the relationship between the quality of a GP practice in England and the degree of competition that it faces (as indicated by the number of nearby rival GP practices). We find that those GP practices that are located close to other rival GP practices provide a higher quality of care than that provided by GP practices that lack competitors. This higher level of quality is observed firstly in an indicator of clinical quality (referrals to secondary care for conditions that are treatable within primary care), and secondly in an indicator of patient observed quality (patient satisfaction scores obtained from the national GP patient survey). The association between increased competition and higher quality is found for GP practices located within 500 metres of each other. However it would appear that the magnitude and geographic scope of the relationship are constrained by restrictions upon patient choice. As a result the findings presented here may only reflect a fraction of the potential benefits to patients from increased choice and competition.General Practice; Primary care; Competition; Quality

An Empirical Analysis of the Effects of GP Competition

We analyse the relationship between the quality of a GP practice in England and the degree of competition that it faces (as indicated by the number of nearby rival GP practices). We find that those GP practices that are located close to other rival GP practices provide a higher quality of care than that provided by GP practices that lack competitors. This higher level of quality is observed firstly in an indicator of clinical quality (referrals to secondary care for conditions that are treatable within primary care), and secondly in an indicator of patient observed quality (patient satisfaction scores obtained from the national GP patient survey). The association between increased competition and higher quality is found for GP practices located within 500 metres of each other. However it would appear that the magnitude and geographic scope of the relationship are constrained by restrictions upon patient choice. As a result the findings presented here may only reflect a fraction of the potential benefits to patients from increased choice and competition

An Empirical Analysis of the Effects of GP Competition

We analyse the relationship between the quality of a GP practice in England and the degree of competition that it faces (as indicated by the number of nearby rival GP practices). We find that those GP practices that are located close to other rival GP practices provide a higher quality of care than that provided by GP practices that lack competitors. This higher level of quality is observed firstly in an indicator of clinical quality (referrals to secondary care for conditions that are treatable within primary care), and secondly in an indicator of patient observed quality (patient satisfaction scores obtained from the national GP patient survey). The association between increased competition and higher quality is found for GP practices located within 500 metres of each other. However it would appear that the magnitude and geographic scope of the relationship are constrained by restrictions upon patient choice. As a result the findings presented here may only reflect a fraction of the potential benefits to patients from increased choice and competition

Acoustic Room Compensation Using Local PCA-based Room Average Power Response Estimation

Acoustic room compensation techniques, which allow a sound reproduction system to counteract undesired alteration to the sound scene due to excessive room resonances, have been widely studied. Extensive efforts have been reported to enlarge the region over which room equalization is effective and to contrast variations of room transfer functions in space. A speaker-tuning technology "Trueplay" allows users to compensate for undesired room effects over an extended listening area based on a spatially averaged power response of the room, which is conventionally measured using microphones on portable devices when users move around the room. In this work, we propose a novel system that leverages measured speaker echo path self-responses to predict the room average power responses using a local PCA based approach. Experimental results confirm the effectiveness of the proposed estimation method, which further leads to a room compensation filter design that achieves a good sound similarity compared to the reference system with the ground-truth room average power response while outperforming other systems that do not leverage the proposed estimator.Comment: 5 pages, 7 figures, to appear in IWAENC 202

Approaches to multiplicity in publicly funded pragmatic randomised controlled trials:a survey of clinical trials units and a rapid review of published trials

BACKGROUND: Opinions and practices vary around the issue of performing multiple statistical tests in randomised controlled trials (RCTs). We carried out a study to collate information about opinions and practices using a methodological rapid review and a survey, specifically of publicly funded pragmatic RCTs that are not seeking marketing authorisation. The aim was to identify the circumstances under which researchers would make a statistical adjustment for multiplicity. METHODS: A review was performed extracting information from articles reporting primary analyses of pragmatic RCTs in one of seven high quality medical journals, in January to June (inclusive) 2018. A survey (Survey Monkey) eliciting opinions and practices around multiplicity was distributed to the 47 registered clinical trials units (CTUs) in the UK. RESULTS: One hundred and thirty-eight RCTs were included in the review, and survey responses were received from 27/47 (57%) CTUs. Both the review and survey indicated that adjusting for multiplicity was considered most important for multiple treatment comparisons; adjustment was performed for 11/23 (48%) published trials, and 24/27 (89%) CTU statisticians reported they would consider adjustment. Opinions and practices varied around adjustment for multiplicity arising from multiple primary outcomes and interim analyses. Adjustment was considered less important for multiplicity due to multiple secondary outcomes (adjustment performed for 17/136 [13%] published trials and 3/27 [11%] CTU statisticians would consider adjustment) and subgroup analyses (8/85 [9%] published trials adjusted and 6/27 CTU [22%] statisticians would consider adjustment). CONCLUSIONS: There is variation in opinions about adjustment for multiplicity among both statisticians reporting RCTs and applied statisticians working in CTUs. Further guidance is needed on the circumstances in which adjustment should be considered in relation to primary trial hypotheses, and if there are any situations in which adjustment would be recommended in the context of secondary analyses. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-022-01525-9

Analytical challenges in estimating the effect of exposures that are bounded by follow-up time: experiences from the Blood Stream Infection—Focus on Outcomes study

Abstract Objective To illustrate the challenges of estimating the effect of an exposure that is bounded by duration of follow-up on all-cause 28-day mortality, whilst simultaneously addressing missing data and time-varying covariates. Study design and methods BSI-FOO is a multicentre cohort study with the primary aim of quantifying the effect of modifiable risk factors, including time to initiation of therapy, on all-cause 28-day mortality in patients with bloodstream infection. The primary analysis involved two Cox proportional hazard models, first one for non-modifiable risk factors and second one for modifiable risk factors, with a risk score calculated from the first model included as a covariate in the second model. Modifiable risk factors considered in this study were recorded daily for a maximum of 28 days after infection. Follow-up was split at daily intervals from day 0 to 28 with values of daily collected data updated at each interval (i.e., one row per patient per day). Analytical challenges Estimating the effect of time to initiation of treatment on survival is analytically challenging since only those who survive to time t can wait until time t to start treatment, introducing immortal time bias. Time-varying covariates representing cumulative counts were used for variables bounded by survival time e.g. the cumulative count of days before first receipt of treatment. Multiple imputation using chained equations was used to impute missing data, using conditional imputation to avoid imputing non-applicable data e.g. ward data after discharge. Conclusion Using time-varying covariates represented by cumulative counts within a one row per day per patient framework can reduce the risk of bias in effect estimates. The approach followed uses established methodology and is easily implemented in standard statistical packages

Spatial Audio Production for Immersive Media Experiences: Perspectives on practice-led approaches to designing immersive audio content

Sound design with the goal of immersion is not new, however, sound design for Immersive Media Experiences (IMEs) utilizing spatial audio can still be considered a relatively new area of practice with less well-defined methods requiring a new and still emerging set of skills and tools. There is, at present, a lack of formal literature around the challenges introduced by this relatively new content form and the tools used to create it, and how these may differ from audio production for traditional media. This article, through the use of semi-structured interviews and an online questionnaire, looks to explore what audio practitioners view as defining features of IMEs, the challenges in creating audio content for IMEs, and how current practices for traditional stereo productions are being adapted for use within 360 interactive soundfields. It also highlights potential direction for future research and technological development and the importance of practitioner involvement in research and development in ensuring future tools and technologies satisfy the current needs