Detection of primary Sjögren's syndrome in primary care: developing a classification model with the use of routine healthcare data and machine learning

Background: Primary Sjögren's Syndrome (pSS) is a rare autoimmune disease that is difficult to diagnose due to a variety of clinical presentations, resulting in misdiagnosis and late referral to specialists. To improve early-stage disease recognition, this study aimed to develop an algorithm to identify possible pSS patients in primary care. We built a machine learning algorithm which was based on combined healthcare data as a first step towards a clinical decision support system. Method: Routine healthcare data, consisting of primary care electronic health records (EHRs) data and hospital claims data (HCD), were linked on patient level and consisted of 1411 pSS and 929,179 non-pSS patients. Logistic regression (LR) and random forest (RF) models were used to classify patients using age, gender, diseases and symptoms, prescriptions and GP visits. Results: The LR and RF models had an AUC of 0.82 and 0.84, respectively. Many actual pSS patients were found (sensitivity LR = 72.3%, RF = 70.1%), specificity was 74.0% (LR) and 77.9% (RF) and the negative predictive value was 99.9% for both models. However, most patients classified as pSS patients did not have a diagnosis of pSS in secondary care (positive predictive value LR = 0.4%, RF = 0.5%). Conclusion: This is the first study to use machine learning to classify patients with pSS in primary care using GP EHR data. Our algorithm has the potential to support the early recognition of pSS in primary care and should be validated and optimized in clinical practice. To further enhance the algorithm in detecting pSS in primary care, we suggest it is improved by working with experienced clinicians

The reflective learning continuum: reflecting on reflection

The importance of reflection to marketing educators is increasingly recognized. However, there is a lack of empirical research which considers reflection within the context of both the marketing and general business education literature. This paper describes the use of an instrument which can be used to measure four identified levels of a reflection hierarchy: habitual action, understanding, reflection and intensive reflection and two conditions for reflection: instructor to student interaction and student to student interaction. Further we demonstrate the importance of reflective learning in predicting graduates’ perception of program quality. Although the focus was on assessment of MBA level curricula, the findings have great importance to marketing education and educators

Challenges of Early Years leadership preparation: a comparison between early and experienced Early Years practitioners in England

Leadership has been under-researched in the Early Years (EY) sector of primary schools in England, especially in leading change for professional development. The aim of this paper is to theorise what the leadership culture for EY practitioners looks like, and how Initial Teacher Training providers and schools are preparing practitioners for leadership. Using case studies of EY practitioners in different stages of their career in primary schools, we offer an insight into their preparedness for leadership in EY, the implication being that leadership training requires an understanding and embedding of the EY culture and context. Interviews with both sample groups allowed for deeper insight into the lived world. Interviews were also conducted with the head teachers to gain an overview of the leadership preparation they provided. The main findings suggest that newer EY practitioners are better prepared for leadership from their university training in comparison to more experienced EY practitioners

Horses for courses: exploring the limits of leadership development through equine-assisted learning

YesThis essay draws on insights taken from Lacanian psychoanalysis to rethink and resituate notions of the self and subjectivity within the theory and practice of experiential leadership development. Adopting an auto-ethnographic approach, it describes the author’s own experience as a participant in a programme of equine assisted learning or ‘horse whispering’ and considers the consequences of human-animal interactions as a tool for self-development and improvement. Through an analysis of this human/animal interaction, the essay presents and applies three Lacanian concepts of subjectivity, desire and fantasy and considers their form and function in determining the often fractured relationship between self and other that characterises leader-follower relations

Expression of Protease-Activated Receptor 1 and 2 and Anti-Tubulogenic Activity of Protease-Activated Receptor 1 in Human Endothelial Colony-Forming Cells

Endothelial colony-forming cells (ECFCs) are obtained from the culture of human peripheral blood mononuclear cell (hPBMNC) fractions and are characterised by high proliferative and pro-vasculogenic potential, which makes them of great interest for cell therapy. Here, we describe the detection of protease-activated receptor (PAR) 1 and 2 amongst the surface proteins expressed in ECFCs. Both receptors are functionally coupled to extracellular signal-regulated kinase (ERK) 1 and 2, which become activated and phosphorylated in response to selective PAR1- or PAR2-activating peptides. Specific stimulation of PAR1, but not PAR2, significantly inhibits capillary-like tube formation by ECFCs in vitro, suggesting that tubulogenesis is negatively regulated by proteases able to stimulate PAR1 (e.g. thrombin). The activation of ERKs is not involved in the regulation of tubulogenesis in vitro, as suggested by use of the MEK inhibitor PD98059 and by the fact that PAR2 stimulation activates ERKs without affecting capillary tube formation. Both qPCR and immunoblotting showed a significant downregulation of vascular endothelial growth factor 2 (VEGFR2) in response to PAR1 stimulation. Moreover, the addition of VEGF (50–100 ng/ml) but not basic Fibroblast Growth Factor (FGF) (25–100 ng/ml) rescued tube formation by ECFCs treated with PAR1-activating peptide. Therefore, we propose that reduction of VEGF responsiveness resulting from down-regulation of VEGFR2 is underlying the anti-tubulogenic effect of PAR1 activation. Although the role of PAR2 remains elusive, this study sheds new light on the regulation of the vasculogenic activity of ECFCs and suggests a potential link between adult vasculogenesis and the coagulation cascade

A comparative thematic review of vocational leadership literature from the USA, Great Britain and Australia

Vocational education and its leadership is an important sphere of economic activity worldwide and is being impacted by several trends including: the increasing significance and centrality of skills development in today’s economies; economic trends associated with globalisation (internationalisation of education and emergence of global labour markets); and demographic trends resulting in ageing populations and workforces. Leadership in vocational education contexts is crucial to the economic success of this sector. The aim of this paper is to provide a comparative thematic review of the research and literature on leadership in vocational education between the USA, Great Britain and Australia posed by the research question, ‘What are the key leadership issues facing vocational education and training sectors in the USA, Great Britain and Australia?’ This study contributes to the research and literature by identifying key impact factors for vocational education leadership in these nations over the last 13 years. Results from the comparative review established the following three key issues: a concern over equity and diversity; the importance of change management; and leadership skills and their development. Although leadership competencies are the subject of some debate there appears to be a broad consensus that leaders are developed not only by formal courses, but more importantly by on-the-job experiential learning. The future development of leaders within vocational education is discussed in relation to the implications for policy and practice, and suggestions for future research are provided

Improving Prediction of Favourable Outcome After 6 Months in Patients with Severe Traumatic Brain Injury Using Physiological Cerebral Parameters in a Multivariable Logistic Regression Model.

BACKGROUND/OBJECTIVE: Current severe traumatic brain injury (TBI) outcome prediction models calculate the chance of unfavourable outcome after 6 months based on parameters measured at admission. We aimed to improve current models with the addition of continuously measured neuromonitoring data within the first 24 h after intensive care unit neuromonitoring. METHODS: Forty-five severe TBI patients with intracranial pressure/cerebral perfusion pressure monitoring from two teaching hospitals covering the period May 2012 to January 2019 were analysed. Fourteen high-frequency physiological parameters were selected over multiple time periods after the start of neuromonitoring (0-6 h, 0-12 h, 0-18 h, 0-24 h). Besides systemic physiological parameters and extended Corticosteroid Randomisation after Significant Head Injury (CRASH) score, we added estimates of (dynamic) cerebral volume, cerebral compliance and cerebrovascular pressure reactivity indices to the model. A logistic regression model was trained for each time period on selected parameters to predict outcome after 6 months. The parameters were selected using forward feature selection. Each model was validated by leave-one-out cross-validation. RESULTS: A logistic regression model using CRASH as the sole parameter resulted in an area under the curve (AUC) of 0.76. For each time period, an increased AUC was found using up to 5 additional parameters. The highest AUC (0.90) was found for the 0-6 h period using 5 parameters that describe mean arterial blood pressure and physiological cerebral indices. CONCLUSIONS: Current TBI outcome prediction models can be improved by the addition of neuromonitoring bedside parameters measured continuously within the first 24 h after the start of neuromonitoring. As these factors might be modifiable by treatment during the admission, testing in a larger (multicenter) data set is warranted