Queen's University Belfast

About: Queen's University Belfast is a education organization based out in Belfast, United Kingdom. It is known for research contribution in the topics: Population & Context (language use). The organization has 25457 authors who have published 55463 publications receiving 1751346 citations. The organization is also known as: Queen's College, Belfast & Queen's College.

Reviewing audit: barriers and facilitating factors for effective clinical audit

Abstract: Objective—To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. Design—A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of “audit”, “audit of audits”, and “evaluation of audits” and a handsearch of the indexes of relevant journals for key papers. Results—Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation.The main barriers to clinical audit can be classified under five main headings.These are lack of resources, lack of expertise or advice in project design and analysis,problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, eVective training, dedicated staV, protected time, structured programmes, and a shared dialogue between purchasers and providers. Conclusions—Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing eVective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.

Archaeology: sharp shift in diet at onset of Neolithic.

Abstract: The introduction of domesticated plants and animals into Britain during the Neolithic cultural period between 5,200 and 4,500 years ago is viewed either as a rapid event1 or as a gradual process that lasted for more than a millennium2. Here we measure stable carbon isotopes present in bone to investigate the dietary habits of Britons over the Neolithic period and the preceding 3,800 years (the Mesolithic period). We find that there was a rapid and complete change from a marine- to a terrestrial-based diet among both coastal and inland dwellers at the onset of the Neolithic period, which coincided with the first appearance of domesticates. As well as arguing against a slow, gradual adoption of agriculture and animal husbandry by Mesolithic societies, our results indicate that the attraction of the new farming lifestyle must have been strong enough to persuade even coastal dwellers to abandon their successful fishing practices.

Exhaled nitric oxide correlates with airway eosinophils in childhood asthma

Abstract: Background: Exhaled nitric oxide has been proposed as a marker for airway inflammation in asthma. The aim of this study was to compare exhaled nitric oxide levels with inflammatory cells and mediators in bronchoalveolar lavage fluid from asthmatic and normal children. Methods: Children were recruited from elective surgical lists and a non-bronchoscopic bronchoalveolar lavage (BAL) was performed after induction of anaesthesia. Exhaled nitric oxide (parts per billion) was measured by two techniques: tidal breathing and restricted breath. Results: Median (interquartile range) exhaled nitric oxide measured by restricted breath was increased in asthmatics compared with normal children (24.3 (10.5–66.5) v 9.7 (6.5–16.5), difference between medians 14.6 (95% CI 5.1 to 29.9), p=0.001). In asthmatic children exhaled nitric oxide correlated significantly with percentage eosinophils ( r =0.78, p<0.001 (tidal breathing) and r =0.78, p<0.001 (restricted breath)) and with eosinophilic cationic protein ( r =0.53, p<0.01 (restricted breath)), but not with other inflammatory cells in the BAL fluid. The area under the receiver operator characteristic curves for the prediction of the presence of eosinophilic airways inflammation by exhaled nitric oxide (tidal and restricted) was 0.80 and 0.87, respectively. Conclusions: Exhaled nitric oxide correlates closely with percentage eosinophils in BAL fluid in asthmatic children and is therefore likely to be a useful non-invasive marker of airway inflammation.

On the dimensionality of ecological stability

Abstract: Ecological stability is touted as a complex and multifaceted concept, including components such as variability, resistance, resilience, persistence and robustness. Even though a complete appreciation of the effects of perturbations on ecosystems requires the simultaneous measurement of these multiple components of stability, most ecological research has focused on one or a few of those components analysed in isolation. Here, we present a new view of ecological stability that recognises explicitly the non-independence of components of stability. This provides an approach for simplifying the concept of stability. We illustrate the concept and approach using results from a field experiment, and show that the effective dimensionality of ecological stability is considerably lower than if the various components of stability were unrelated. However, strong perturbations can modify, and even decouple, relationships among individual components of stability. Thus, perturbations not only increase the dimensionality of stability but they can also alter the relationships among components of stability in different ways. Studies that focus on single forms of stability in isolation therefore risk underestimating significantly the potential of perturbations to destabilise ecosystems. In contrast, application of the multidimensional stability framework that we propose gives a far richer understanding of how communities respond to perturbations.