Recent Submissions

  • Gendered and classed performances of motherhood and good academic in Greece

    Tsouroufli, Maria (Sage, 2018)
    The enduring significance of gender and how it intersects with class in the organisation of parenting, domestic, and professional work has been obscured in contemporary neo-liberal contexts. This paper examines how Greek academic women conceptualize and enact motherhood and the classed and gendered strategies they adopt to reconcile ‘good’ motherhood with notions of the ‘good’ academic professional. It draws on semi-structured interviews about the career narratives of 15 women in Greek Medical Schools at the aftermath of the Greek recession. The analysis presented in this paper is informed by a feminist post-structuralist paradigm and an emic approach to intersectionality. Motherhood emerged in the data as a dynamic concept, and a network of practices both constrained and enabled by gendered and classed family and work cultures. Drawing on neo-liberal ‘DIY’ and ‘having it all’ discourse Greek mothers claimed that they could achieve almost anything professionally, if they organised their private lives sensibly. They drew on idealised discourses of motherhood, but they also contradicted these notions by doing non- traditional forms of motherhood, such as remote or transnational motherhood, afforded by their privileged social positioning and academic careers. Further research is required to investigate configurations of classed motherhood in less prestigious professions.
  • Lurking towards empowerment: Explaining propensity to engage with online health support groups and its association with positive outcomes

    Fullwood, Chris; Chadwick, Darren; Keep, Melanie; Attrill-Smith, Alison; Asbury, Titus; Kirwan, Grainne (Elsevier, 2018-08-22)
    Online health support groups (OHSGs) offer opportunities for people with various health conditions to gain support and associated physical and mental health benefits, however evidence suggests that those who choose to lurk in OHSGs may be less likely to accrue benefits (e.g. empowering outcomes) than those who actively contribute. Most research to date has focused on comparing the outcomes of OSHG engagement for lurkers and participators, yet there has been little research which has considered how the different reasons for lurking might be associated with levels of participation and empowering processes. In this investigation we used a survey to gather data from 237 participants to develop a new scale to measure factors influencing the Propensity for Online Community Contribution (POCCS), and to explore the relationship between these factors and OHSG engagement behaviour and empowering processes accrued from OHSG use. The POCCS comprised nine factors, 1) poor sense of community; 2) struggles with self-expression; 3) inhibited disclosure and privacy; 4) negative online interactions; 5) ease of access and use; 6) health preventing contribution; 7) delayed and selective contribution; 8) goals met without contribution; and 9) lack of time. Five of these factors (1, 3, 6, 7, and 8) significantly predicted OHSG contribution and positive experiences in the form of empowering processes. Findings advocate a more nuanced approach to OHSG engagement, rather than a simple lurking/engaging dichotomy, and may enhance understanding of the relationship between OHSG use and perceived benefits.
  • Correlates of sedentary behaviour and light physical activity in people living with rheumatoid arthritis: protocol for a longitudinal study

    O'Brien, Ciara M.; Duda, Joan L.; Kitas, George D.; Veldhuijzen Van Zanten, Jet J.C.S.; Metsios, George S.; Fenton, Sally A.M. (Mediterranean Journal of Rheumatology, 2018)
    Background: Sedentary behaviour (SB) is associated with adverse health outcomes in the general population. Replacing sedentary time with light intensity physical activity (LPA) has been linked with improvements in all-cause and cardiovascular disease mortality in adults. People with Rheumatoid Arthritis (RA) typically spend long periods of time sedentary, but the health consequences of ‘too much sitting’, and possible benefits of LPA, have not been fully explored in this population. Moreover, little is known regarding the determinants of these behaviours among people living with RA, and such knowledge is required for the development of effective behavioural interventions. Aims: To examine longitudinal relationships between:1) objectively-assessed SB/LPA with health outcomes in RA, 2) hypothesised determinants of SB/LPA with objectively-assessed SB/LPA in RA. Methods: This longitudinal study will secure assessments at baseline (Time 1) and 6-month follow-up (Time 2) from RA patients. At both time points, physical assessments will be undertaken, and questionnaires administered to measure physical (e.g., percentage body fat, disease activity, physical function, pain) and psychological (e.g., depression, anxiety, vitality) health outcomes. Additional questionnaires will be administered to establish hypothesised determinants (i.e., psychosocial, individual differences, and physical environmental). Participants will wear the ActiGraph GT3X accelerometer and activPAL3 for 7 days to objectively measure SB and LPA. Discussion: Findings will elucidate the health correlates of SB in RA, as well as the relevance of interventions targeting reductions in SB by promoting LPA. Results will also assist in identifying intervention targets (i.e., determinants), with the potential to encourage SB change in RA.
  • Online qualitative methods – challenges and opportunities

    Lloyd, Joanne (British Psychological Society, 2018)
    This is a prepublication version of the following article; Online qualitative methods – challenges and opportunities 2018, 26 Qualitative Methods in Psychology Bulletin A growing proportion of the population are spending an increasing amount of time online (Poushter, 2016) and engaging in a wide variety of online activities (Blank & Groselj, 2014). Communication is one of the most common, with email, for example, being used by over 90% of UK adults (Blank & Groselj, 2014), and other forms of ‘computer mediated discourse’ (Herring & Androutsopoulos, 2015) including private, ‘direct messages’ sent between individuals through applications such as Whatsapp or Facebook messenger, also being widely used (Oghuma, Libaque-Saenz, Wong & Chang, 2016). Thus, there are many efficient and convenient avenues of online communication via which primary qualitative data can be collected; such as online interviews through text-based or video-based chat, or online qualitative surveys.
  • Author accepted manuscript: Time-Dependent Forgetting and Retrieval Practice Effects in Detailed Visual Long-Term Memory.

    Mercer, Tom; Jones, Gemma (Sage, 2018-08-24)
    Memories – especially those containing fine details – are usually lost over time, but the present study assessed whether detailed visual memories can survive a one-week delay if retrieval practice is provided. In three experiments, participants viewed 300 objects and then completed recognition tests assessing memory for precise object exemplars and their state. The recognition tests occurred immediately after encoding and one week later, and required participants to distinguish between a previously seen target object and an incorrect foil. Whilst there was forgetting when participants were tested on different sets of stimuli across the delay, retrieval practice led to an advantage in recognition performance. This effect was not simply due to mere exposure, as retrieval practice boosted recognition beyond a restudy condition, which had a second encoding opportunity but no retrieval practice. Yet more detailed analyses revealed that the effect of retrieval practice was highly dependent upon the type of information being tested (exemplar or state) and the specific foil that was presented. In addition, state information was harder to retain over the delay than exemplar information, suggesting that memory for different properties is forgotten at different rates.
  • ‘We have to wait in a queue for our turn quite a bit’ Examining children’s physical activity during primary physical education lessons

    Powell, Emma; Woodfield, Lorayne; Nevill, Alan; Powell, Alexander J; Myers, Tony D (Sage, 2018-07-16)
    The overall purpose of this study was to examine children’s physical activity (PA) during primary physical education (PE). This was achieved through the following two research objectives: (1) to measure children’s PA, lesson context and teacher promotion of PA during PE lessons; and (2) to explore teachers’ and children’s perspectives on PA levels during PE lessons. Evidence suggests that children’s PA during PE is below recommended levels and further research is required to understand the reasons why. Through a mixed method design, 138 children were observed using the System for Observing Fitness and Instruction Time, 80 children participated in group interviews, and 13 teachers were interviewed, across three primary schools in England. Findings indicated that the mean percentage of lesson time allocated to moderate to vigorous PA (MVPA) was 42.4% and the average lesson length was 35.3 minutes. Qualitative themes identified were: ‘knowledge and beliefs’; ‘teacher pedagogy’; and ‘teacher development’. The findings indicate that a change in perspective is needed, which includes a focus on PA during primary PE lessons. Intervention work is required that targets teachers’ knowledge and beliefs towards PE along with the development of effective teaching strategies. However, this needs to be grounded in an ecological approach which will allow researchers and schools to target the various levels of influence. It is strongly recommended that interventions are grounded in behaviour change theory, as this study indicates that sharing knowledge about pedagogical strategies to increase children’s MVPA does not necessarily produce changes in teachers’ behaviours.
  • Rights management to enable a true Internet of Things

    Newman, Robert; Doody, Pat; Trebar, Mira; Okoke, Uchenna (IEEE, 2016)
    In this paper, we differentiate between a true ‘Internet of things’ and its component parts. We argue that the determining aspect of the ‘Internet of Things’ (IoT) is the accessibility of ‘things’ on the global Internet, as opposed to a simple interconnection of networked ‘things’. We observe that most reported applications of the ‘Internet of Things’ would be more accurately described as ‘Intranets of Things’. In large part, this is because the owners and operators of AIDC (Automatic identification and data capture) systems and sensor networks that in the main make up the IoT have understandable concerns about the security of their assets and therefore will limit access to that which serves their own purposes. In the wider field of the Internet ‘in the large’, the open mining of the Web for information has become the mainstay of many genres of research, allowing the assembly of huge corpora, enabling analytical techniques that can reveal far more information than previous limited studies. It is argued that part of the expected dividend for the IoT is to enable use on a similar scale of sensor and AIDC data, and that the results will be availability of information fusion on a huge scale, which will allow significant new knowledge to be generated. We give an example of how in one project, the RFID from Farm to Fork traceability project, this prospect has been validated to an extent on the basis that data owners voluntarily made their data available on the Web for specific purposes. Extrapolating to a more general case, we suggest that there are two services that need to be provided in order for the generalized information mining that occurs on the Internet-at-large to occur in the Internet of Things. The first is a means of cataloguing available data, which is already being addressed by services such as HyperCAT. The second is an automatic rights management service (IoT-RM), which would manage the rights and permissions and allow data owners to determine in advance to whom their data should be released, for what purposes, subject to which restrictions (such as, for instance, anonymisation) and whether any remuneration should be involved. We make some concrete proposals about the form that such an IoT-RM should take.
  • Gendered performances and identity construction among UK female soccer players and netballers: a comparative study

    Devonport, Tracey J.; Russell, Kate; Leflay, Kath; Conway, Jennifer (Taylor and Francis, 2018)
    This paper examines the gendered performances and identity construction of UK female University soccer players and netballers (n = 31). Focus group interviews explored their sporting experiences with reference to body perceptions, and perceptions of their sporting bodies outside sporting contexts. Three themes resulted from data analysis, these being; (1) UK culture, body performances and femininity, (2) sporting culture, body performances and femininity and (3) transiency of body satisfaction across sport and nonsport contexts. Findings suggest that sport may not always provide an opportunity to challenge and resist dominant discourses. In both netball and soccer, a range of surveillance and management practices were used that served to perpetuate the value of a ‘feminine’ and assumed heterosexual body, and legitimize their sport participation through an emphasis on a hyper-femininity. The influence of sport subcultures on gendered performances and identity construction, along with implications for marketing sports participation to women are discussed.
  • What have the changes made to primary and secondary assessment frameworks since 2014 done to the ‘London effect’ in school performance?

    Hayes, Sean; Jopling, Michael; Gul, Ruki (UCL IOE Press, 2018)
    This paper examines whether the so-called ‘London effect’, in which London’s schools improved rapidly and outperformed the rest of England on key performance measures between 2003 and 2013, has persisted through the high levels of change that have continued to characterise the school system in England since 2013. Using detailed analysis of educational attainment data, its primary focus is on determining whether the introduction in 2014 of significant changes to the primary curriculum and the national assessment frameworks in both primary and secondary phases affected the performance of London’s schools in 2016, when the first examinations were taken under the new assessment systems.
  • Active Students Are Healthier and Happier Than Their Inactive Peers: The Results of a Large Representative Cross-Sectional Study of University Students in Ireland.

    Murphy, Marie H; Carlin, Angela; Woods, Catherine; Nevill, Alan; MacDonncha, Ciaran; Ferguson, Kyle; Murphy, Niamh (Human Kinetics, 2018-08-17)
    Time spent in university represents a period of transition and may be an appropriate time to promote physical activity among young adults. The aim of this study was to assess participation of university students in sport and physical activity in Ireland and to explore the association between physical activity and perceptions of overall health, mental health, and happiness. The Student Activity and Sport Study Ireland was a cross-sectional online survey among a representative sample (n = 8122) of university students in Ireland. Binary logistic regressions were performed to examine associations between self-reported physical activity and gender (predictor variables) and individual perceptions of overall health, mental health, and happiness (binary outcomes). Only 64.3% of respondents met the recommended level of 150 minutes of moderate to vigorous physical activity per week with males significantly more active than females (72.1% vs 57.8% meeting guidelines). Those meeting physical activity guidelines were more likely to report greater overall health and higher mental health and happiness scores compared with their inactive peers. Active students enjoy better health (overall and mental) and are happier than their inactive peers. This provides a clear rationale for providing students with opportunities to be active at university. The data provide a baseline to monitor changes in physical activity patterns.
  • Seamlessly Transcending the Academic Bump to support the novice lecturer in higher education

    Bywater, Amy; Mander, Sarah (Taylor and Francis, 2018-05-08)
    This self-reflective article considers the support mechanisms from which new lecturers from a teaching background may benefit upon their entry to academia. The concept of academic identity is explored and the suggestion of a continually evolving professional identity is discussed. Emergent themes of reciprocity and critical friendship, team teaching and personal skills and qualities are examined. The framework for this article is the introduction of the Teaching Excellence Framework and recommendations for higher education practice are made in support of this.
  • Association of fat mass profile with natriuretic peptide receptor alpha in subcutaneous adipose tissue of medication-free healthy men: A cross-sectional study.

    Dinas, Petros C; Nintou, Eleni; Psychou, Dimitra; Granzotto, Marnie; Rossato, Marco; Vettor, Roberto; Jamurtas, Athanasios Z; Koutedakis, Yiannis; Metsios, George S; Flouris, Andreas D (F1000 Research, 2018-01-01)
    Atrial natriuretic peptide increases lipolysis in human adipocytes by binding to natriuretic peptide receptor-A (NPRA). The aim of the current study was to examine the associations of NPRA mRNA of subcutaneous adipose tissue with fat mass, fat-free mass, body mass index (BMI) and arterial blood pressure in medication-free healthy men.
  • Effects of situational variables on the physical activity profiles of elite soccer players in different score line states.

    Redwood-Brown, Athalie J; O'Donoghue, Peter G; Nevill, Alan M; Saward, Chris; Dyer, Nicholas; Sunderland, Caroline (Wiley, 2018-07-28)
    The aim of this study were to investigate the effects of playing position, pitch location, team ability and opposition ability on the physical activity profiles of English premier league soccer players in difference score line states. A validated automatic tracking system (Venatrack Ltd.) was used to track players in real time (at 25 Hz) for total distance covered, high speed running distance and sprint distance. This is the first study to include every team from an entire season in the English premier league, resulting in 376 games, 570 players and 35 000 rows of data from the 2011-12 season being analyzed using multi-level modelling. Multi-level regression revealed an inverted "u" shaped association between total distance covered and goal difference (GD), with greater distances covered when GD was zero and reduced distances when GD was either positive or negative. A similar "u" shaped association was found with high speed distance covered at home. In addition distance covered (both at home and away) were predicted by playing position. All activity profiles (with the exception of sprint distance at home) were predicted by pitch location and time scored. Lastly, distance away from home and high speed running at home were predicted by opposition ability. Score line appears to effect player activity profiles across a number of situational factors and thus should be considered by managers when preparing and selecting teams to maximize performance. The current study also highlighted the need for more sensitive score line definitions in which to consider score line effects.
  • Adult education for a change: Advocacy, learning festivals, migration, and the pursuit of equity and social justice

    Tuckett, Alan (Sage Publications, 2018-08-30)
    This paper explores the characteristics of learning festivals and Adult Learners’ Weeks and their use as tools of advocacy in seeking policy change on behalf of under-represented groups, and it considers their impact on public policy affecting adult learners. In addition, it reflects on the role of the week in celebrating a culture of adult learning. The paper includes analysis of the relationship between the development of festivals and policy change affecting adult learners through Adult Learners’ Weeks in the United Kingdom after 1992, exploring, in particular, the role of the Week in affecting policy, participation, and inter-communal understanding arising from increased migration. The paper explores the spread of learning festivals and the sequence of Presidency conferences in the European Union in the years leading up to the Lisbon Memorandum in 2000; the role of festivals in the aftermath of war in the Balkans; and the role of the World Social Forum as an antidote to neo-liberal orthodoxies in international policy discussions. It also considers the success and failure of learning weeks as a tool of advocacy and policy change.
  • Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis.

    Bakre, Aishat T; Chen, Ruoling; Khutan, Ranjit; Wei, Li; Smith, Tina; Qin, Gordon; Danat, Isaac M; Zhou, Weiju; Schofield, Peter; Clifford, Angela; Wang, Jiaji; Verma, Arpana; Zhang, Cuilin; Ni, Jindong (Cambridge Core, 2018-07-01)
    To assess the association of fish consumption with risk of dementia and its dose-response relationship, and investigate variations in the association among low-, middle- and high-income countries. A new community-based cross-sectional study and a systematic literature review.SettingsUrban and rural communities in China; population-based studies systematically searched from worldwide literature. Chinese adults aged ≥60 years in six provinces (n 6981) took part in a household health survey of dementia prevalence and risk factors. In addition, 33 964 participants from eleven published and eligible studies were included in the systematic review and meta-analysis. In the new study in China, 326 participants were diagnosed with dementia (4·7 %); those who consumed any amount of fish in the past two years v. those who consumed no fish had reduced risk of dementia (adjusted OR=0·73, 95 % CI 0·64, 0·99), but the dose-response relationship was not statistically significant. The meta-analysis of available data from the literature and the new study showed relative risk (RR) of dementia of 0·80 (95 % CI 0·74, 0·87) for people with fish consumption; the impact was similar among countries with different levels of income. Pooled dose-response data revealed RR (95 % CI) of 0·84 (0·72, 0·98), 0·78 (0·68, 0·90) and 0·77 (0·61, 0·98) in people with low, middle and high consumption of fish, respectively. Corresponding figures for Alzheimer's disease were 0·88 (0·74, 1·04), 0·79 (0·65, 0·96) and 0·67 (0·58, 0·78), respectively.
  • The effectiveness and cost-effectiveness of biomarkers for the prioritisation of patients awaiting coronary revascularisation: a systematic review and decision model.

    Hemingway, H; Henriksson, M; Chen, R; Damant, J; Fitzpatrick, N; Abrams, K; Hingorani, A; Janzon, M; Shipley, M; Feder, G; Keogh, B; Stenestrand, U; McAllister, K; Kaski, J-C; Timmis, A; Palmer, S; Sculpher, M (NIHR, 2010-02-01)
    To determine the effectiveness and cost-effectiveness of a range of strategies based on conventional clinical information and novel circulating biomarkers for prioritising patients with stable angina awaiting coronary artery bypass grafting (CABG). MEDLINE and EMBASE were searched from 1966 until 30 November 2008. We carried out systematic reviews and meta-analyses of literature-based estimates of the prognostic effects of circulating biomarkers in stable coronary disease. We assessed five routinely measured biomarkers and the eight emerging (i.e. not currently routinely measured) biomarkers recommended by the European Society of Cardiology Angina guidelines. The cost-effectiveness of prioritising patients on the waiting list for CABG using circulating biomarkers was compared against a range of alternative formal approaches to prioritisation as well as no formal prioritisation. A decision-analytic model was developed to synthesise data on a range of effectiveness, resource use and value parameters necessary to determine cost-effectiveness. A total of seven strategies was evaluated in the final model. We included 390 reports of biomarker effects in our review. The quality of individual study reports was variable, with evidence of small study (publication) bias and incomplete adjustment for simple clinical information such as age, sex, smoking, diabetes and obesity. The risk of cardiovascular events while on the waiting list for CABG was 3 per 10,000 patients per day within the first 90 days (184 events in 9935 patients with a mean of 59 days at risk). Risk factors associated with an increased risk, and included in the basic risk equation, were age, diabetes, heart failure, previous myocardial infarction and involvement of the left main coronary artery or three-vessel disease. The optimal strategy in terms of cost-effectiveness considerations was a prioritisation strategy employing biomarker information. Evaluating shorter maximum waiting times did not alter the conclusion that a prioritisation strategy with a risk score using estimated glomerular filtration rate (eGFR) was cost-effective. These results were robust to most alternative scenarios investigating other sources of uncertainty. However, the cost-effectiveness of the strategy using a risk score with both eGFR and C-reactive protein (CRP) was potentially sensitive to the cost of the CRP test itself (assumed to be 6 pounds in the base-case scenario).
  • Evaluating the quality of research into a single prognostic biomarker: a systematic review and meta-analysis of 83 studies of C-reactive protein in stable coronary artery disease.

    Hemingway, Harry; Philipson, Peter; Chen, Ruoling; Fitzpatrick, Natalie K; Damant, Jacqueline; Shipley, Martin; Abrams, Keith R; Moreno, Santiago; McAllister, Kate S L; Palmer, Stephen; Kaski, Juan Carlos; Timmis, Adam D; Hingorani, Aroon D (Public Library of Science, 2010-06-01)
    Systematic evaluations of the quality of research on a single prognostic biomarker are rare. We sought to evaluate the quality of prognostic research evidence for the association of C-reactive protein (CRP) with fatal and nonfatal events among patients with stable coronary disease. We searched MEDLINE (1966 to 2009) and EMBASE (1980 to 2009) and selected prospective studies of patients with stable coronary disease, reporting a relative risk for the association of CRP with death and nonfatal cardiovascular events. We included 83 studies, reporting 61,684 patients and 6,485 outcome events. No study reported a prespecified statistical analysis protocol; only two studies reported the time elapsed (in months or years) between initial presentation of symptomatic coronary disease and inclusion in the study. Studies reported a median of seven items (of 17) from the REMARK reporting guidelines, with no evidence of change over time. The pooled relative risk for the top versus bottom third of CRP distribution was 1.97 (95% confidence interval [CI] 1.78-2.17), with substantial heterogeneity (I(2) = 79.5). Only 13 studies adjusted for conventional risk factors (age, sex, smoking, obesity, diabetes, and low-density lipoprotein [LDL] cholesterol) and these had a relative risk of 1.65 (95% CI 1.39-1.96), I(2) = 33.7. Studies reported ten different ways of comparing CRP values, with weaker relative risks for those based on continuous measures. Adjusting for publication bias (for which there was strong evidence, Egger's p<0.001) using a validated method reduced the relative risk to 1.19 (95% CI 1.13-1.25). Only two studies reported a measure of discrimination (c-statistic). In 20 studies the detection rate for subsequent events could be calculated and was 31% for a 10% false positive rate, and the calculated pooled c-statistic was 0.61 (0.57-0.66). Multiple types of reporting bias, and publication bias, make the magnitude of any independent association between CRP and prognosis among patients with stable coronary disease sufficiently uncertain that no clinical practice recommendations can be made. Publication of prespecified statistical analytic protocols and prospective registration of studies, among other measures, might help improve the quality of prognostic biomarker research.
  • Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery.

    Henriksson, Martin; Palmer, Stephen; Chen, Ruoling; Damant, Jacqueline; Fitzpatrick, Natalie K; Abrams, Keith; Hingorani, Aroon D; Stenestrand, Ulf; Janzon, Magnus; Feder, Gene; Keogh, Bruce; Shipley, Martin J; Kaski, Juan-Carlos; Timmis, Adam; Sculpher, Mark; Hemingway, Harry (BMJ, 2010-01-20)
    To determine the effectiveness and cost effectiveness of using information from circulating biomarkers to inform the prioritisation process of patients with stable angina awaiting coronary artery bypass graft surgery. Decision analytical model comparing four prioritisation strategies without biomarkers (no formal prioritisation, two urgency scores, and a risk score) and three strategies based on a risk score using biomarkers: a routinely assessed biomarker (estimated glomerular filtration rate), a novel biomarker (C reactive protein), or both. The order in which to perform coronary artery bypass grafting in a cohort of patients was determined by each prioritisation strategy, and mean lifetime costs and quality adjusted life years (QALYs) were compared. Swedish Coronary Angiography and Angioplasty Registry (9935 patients with stable angina awaiting coronary artery bypass grafting and then followed up for cardiovascular events after the procedure for 3.8 years), and meta-analyses of prognostic effects (relative risks) of biomarkers. The observed risk of cardiovascular events while on the waiting list for coronary artery bypass grafting was 3 per 10,000 patients per day within the first 90 days (184 events in 9935 patients). Using a cost effectiveness threshold of pound20,000- pound30,000 (euro22,000-euro33,000; $32,000-$48,000) per additional QALY, a prioritisation strategy using a risk score with estimated glomerular filtration rate was the most cost effective strategy (cost per additional QALY was < pound410 compared with the Ontario urgency score). The impact on population health of implementing this strategy was 800 QALYs per 100,000 patients at an additional cost of pound 245,000 to the National Health Service. The prioritisation strategy using a risk score with C reactive protein was associated with lower QALYs and higher costs compared with a risk score using estimated glomerular filtration rate.

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