The application of bayesian and frequentist regularization and variable selection methods for the prediction of asthma in later childhood

Asthma is a global health problem and among the most common chronic conditions in childhood. Several models were proposed to predict asthma in children, but their reproducibility in external populations was limited and none was developed to predict asthma in adolescence. I conducted a systematic review of asthma predictive models validated in external populations; validation studies showed poorer predictive performances than development studies. I developed predictive models for asthma between 15 and 20 years, using data from the Study Team for Early Life Asthma Research (STELAR) consortium of five UK asthma cohorts. For one of these cohorts, the Ashford study, I developed an questionnaire to collect follow-up information when study subjects were age 20 years. I harmonised 41 variables across the STELAR cohorts, 39 of which were used as candidate predictors to develop predictive models, while the others were used to define asthma at 15–20 years. Asthma at that age was defined as positive responses to ‘current wheezing’ and ‘asthma medications in the last year’.Two of the five STELAR cohorts (development data) were combined to develop predictive models using stepwise regression and frequentist, Bayesian and empirical Bayes regularization models. The remaining cohorts (validation data) were used to assess predictive performance using discrimination and accuracy measures. Analyses were performed in two populations - all children and a subgroup with reported wheezing between two and five years (high-risk population). Sex, eczema, sensitization to house dust mite and doctor’s diagnosis of asthma in early childhood (4-7 years) were identified as asthma predictors at 15-20 years in both populations. Additional predictors in the general population included early wheezing symptoms and parental allergies, while in the high-risk population maternal allergies and pet in the house at one year were important for asthma prediction in adolescence. Sensitivity was higher in the general population, whereas positive predictive value was higher in the high-risk population. Although accuracy was good in both populations, the predictive ability of the models developed was limited.Open Acces

A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study proto

© Article author(s). Introduction Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended-release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-Arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD. Methods and analysis The primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0-10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used. Ethics and dissemination Ethics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness. Trial registration number NCT02720822; Pre-results

Systematic review and conceptual framework for health literacy training in health professions education

Purpose: This review investigates health literacy education interventions for health professions students in higher education settings with the aim of identifying core elements for the first conceptual framework for a health literacy curriculum. Method: A systematic literature search based on pre-specified inclusion criteria was conducted across education and health peer-reviewed literature - Academic Search Complete; CINAHL; MEDLINE (OVID); ProQuest Health & Medicine; SCOPUS (Elsevier); Australian Education Index Plus Text (AEIPT); Education Research Complete; ERIC; ProQuest Education. Twenty-eight peer-reviewed primary studies were found to be eligible and were systemically examined. Data on intervention characteristics, evaluation methods and key outcomes were extracted and content analysed. Results: Numerous health professions were represented in the examined studies, with undergraduate students principally targeted. The large majority of interventions reported positive results. Significant heterogeneity was found in instructional methods, evaluation instruments and outcomes. Instructional approaches ranged from single didactic to clinical and community placement interventions. Less than 40% of interventions used a pre/post evaluation design and control groups were used in only 3 of the included studies. The most successful interventions were found to be those that offered numerous training sessions and integrated knowledge and skill acquisition particularly when patient communication and assessment skills were developed within real-world settings with patients or community members. Review findings informed a draft health literacy training framework for conceptualizing multiple dimensions of health literacy training structure, design and assessment. Discussion/conclusion: Core aspects and best practice teaching elements for health professions health literacy training were identified. It was found that overall, this is an underdeveloped domain in the health professions education field. Future research should focus on identifying an agreed definition of health literacy for this field and structure and process opportunities for health literacy inter-professional education. Also needed is a much better understanding of the impact of health literacy training on specific health profession students, and over what time period to enable targeted curriculum and workforce education planning

SafetyNet final activity report

SafetyNet final activity repor

Reasons for nonparticipation in the Valuing Active Life in Dementia randomised controlled trial of a dyadic occupational therapy intervention: An interview study

Objectives: There is currently little known about why people decline to participate in dyadic, psychosocial dementia research. This interview study aims to explore the reasons why people declined to participate in the Valuing Active Life in Dementia research trial. / Methods: Ten family carers of people with dementia, who were part of a dyad that had declined to take part in the randomised controlled trial, participated in qualitative telephone interviews to explore their reasons for declining. Inductive thematic analysis was used to identify themes. / Findings: Two themes with related sub-themes were identified: (1) Protectiveness – protecting the person with dementia, themselves as carers and their current lifestyle; (2) ‘It’s not for us’ – the time commitment, and the possible unsuitability of the intervention, was seen to outweigh the perceived benefit of taking part. People with dementia were not always involved in the decision-making process, with carers stating the decision not to participate was made in the usual way as all their decisions. No apparent differences between the spousal and the child carers were apparent in the small sample. / Conclusion: Recruitment to randomised controlled trials can be considered difficult or unfair because some participants will miss out on the desired intervention. However, this study shows that concern about the time and inconvenience of being involved in the trial can put people off research participation. Identifying possible reasons for declining research participation contributes to the design of future trials and recruitment strategies, so that the potential benefit is considered relative to the time and effort involved. Offering research opportunities to people with dementia and their families at the right stage of the dementia trajectory for their needs, facilitating personalised recruitment strategies with finely tailored researcher communication skills should help maximise recruitment, reduce attrition and deliver a more successful trial

Application of experimental design methodologies in the enantioseparation of pharmaceuticals by capillary electrophoresis: a review

Chirality is one of the major issues in pharmaceutical research and industry. Capillary electrophoresis (CE) is an interesting alternative to the more frequently used chromatographic techniques in the enantioseparation of pharmaceuticals, and is used for the determination of enantiomeric ratio, enantiomeric purity, and in pharmacokinetic studies. Traditionally, optimization of CE methods is performed using a univariate one factor at a time (OFAT) approach; however, this strategy does not allow for the evaluation of interactions between experimental factors, which may result in ineffective method development and optimization. In the last two decades, Design of Experiments (DoE) has been frequently employed to better understand the multidimensional effects and interactions of the input factors on the output responses of analytical CE methods. DoE can be divided into two types: screening and optimization designs. Furthermore, using Quality by Design (QbD) methodology to develop CE-based enantioselective techniques is becoming increasingly popular. The review presents the current use of DoE methodologies in CE-based enantioresolution method development and provides an overview of DoE applications in the optimization and validation of CE enantioselective procedures in the last 25 years. Moreover, a critical perspective on how different DoE strategies can aid in the optimization of enantioseparation procedures is presented

Mental Health and Wellbeing in England: the Adult Psychiatric Morbidity Survey 2014

This report presents findings of a survey of mental illness and wellbeing among people aged 16 and over living in private households in England. The survey was commissioned by NHS Digital and funded by the Department of Health, and is the fourth in a series of surveys of adult mental health

Reasons for non participation in the Valuing Active Life in Dementia (VALID) randomised controlled trial of a dyadic occupational therapy intervention: an interview study

Objectives There is currently little known about why people decline to participate in dyadic, psychosocial dementia research. This interview study aims to explore the reasons why people declined to participate in the Valuing Active Life in Dementia (VALID) research trial. Methods Ten family carers of people with dementia, who were part of a dyad that had declined to take part in the randomised controlled trial, participated in qualitative telephone interviews to explore their reasons for declining. Inductive thematic analysis was used to identify themes. Findings Two themes with related sub-themes were identified. 1) Protectiveness; protecting the person with dementia, themselves as carers, and their current lifestyle. 2) ‘It’s not for us’; the time commitment, and the possible unsuitability of the intervention, was seen to outweigh the perceived benefit of taking part. People with dementia were not always involved in the decision making process, with carers stating the decision not to participate was made in the usual way as all their decisions. No apparent differences between the spousal and child carers were apparent in the small sample. Conclusions Recruitment to randomised controlled trials can be considered difficult or unfair because some participants will miss out on the desired intervention. However, this study shows that concern about the time and inconvenience of being involved in the trial can put people off research participation. Identifying possible reasons for declining research participation contributes to the design of future trials and recruitment strategies, so that the potential benefit is considered relative to the time and effort involved. Offering research opportunities to people with dementia and their families at the right stage of the dementia trajectory for their needs, facilitating personalised recruitment strategies with finely tailored researcher communication skills should help maximise recruitment, reduce attrition and deliver a more successful trial