Law, ethics and end-of-life care: the policy and practice interface in England

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Noninvasive Instrument-based Tests for Detecting and Measuring Vitreous Inflammation in Uveitis: A Systematic Review

PURPOSE: This systematic review aims to identify instrument-based tests for quantifying vitreous inflammation in uveitis, report the test reliability and the level of correlation with clinician grading. METHODS: Studies describing instrument-based tests for detecting vitreous inflammation were identified by searching bibliographic databases and trials registers. Test reliability measures and level of correlation with clinician vitreous haze grading are extracted. RESULTS: Twelve studies describing ultrasound, optical coherence tomography (OCT), and retinal photography for detecting vitreous inflammation were included: Ultrasound was used for detection of disease features, whereas OCT and retinal photography provided quantifiable measurements. Correlation with clinician grading for OCT was 0.53-0.60 (three studies) and for retinal photography was 0.51 (1 study). Both instruments showed high inter- and intra-observer reliability (>0.70 intraclass correlation and Cohen's kappa), where reported in four studies. CONCLUSION: Retinal photography and OCT are able to detect and measure vitreous inflammation. Both techniques are reliable, automatable, and warrant further evaluation

What is the current state of debate around the use of contextualised admissions for undergraduate admissions? A review of the current stakeholder perspective

This is the author accepted manuscript. The final version is available from Taylor & Francis (Routledge) via the DOI in this record.Higher Education Institutions in England are an integral part of the government’s social mobility strategy. Contextualisation of undergraduate admissions decisions has emerged as a key tool towards progressing social mobility objectives. The present paper builds on our previous 2013 research by describing findings from 15 qualitative interviews with stakeholders in contextualised admissions. Stakeholders were drawn from government, non-governmental and third sector bodies including those representing the voice of schools and young people. We find that data challenges continue to be a main barrier to the application of contextual admissions. Respondents thought that more consistency and transparency between universities would be helpful to assist applicants and those who support them to better understand contextual data use in undergraduate admissions. Views are divided about whether differential admissions offers represent the most important application of contextual data. Respondents saw potential for using contextual data beyond admissions for supporting students at university and into further study or employment.The Access Projec

Prioritized Sweeping Neural DynaQ with Multiple Predecessors, and Hippocampal Replays

During sleep and awake rest, the hippocampus replays sequences of place cells that have been activated during prior experiences. These have been interpreted as a memory consolidation process, but recent results suggest a possible interpretation in terms of reinforcement learning. The Dyna reinforcement learning algorithms use off-line replays to improve learning. Under limited replay budget, a prioritized sweeping approach, which requires a model of the transitions to the predecessors, can be used to improve performance. We investigate whether such algorithms can explain the experimentally observed replays. We propose a neural network version of prioritized sweeping Q-learning, for which we developed a growing multiple expert algorithm, able to cope with multiple predecessors. The resulting architecture is able to improve the learning of simulated agents confronted to a navigation task. We predict that, in animals, learning the world model should occur during rest periods, and that the corresponding replays should be shuffled.Comment: Living Machines 2018 (Paris, France

Functional Big-step Semantics

When doing an interactive proof about a piece of software, it is important that the underlying programming language’s semantics does not make the proof unnecessarily difficult or unwieldy. Both smallstep and big-step semantics are commonly used, and the latter is typically given by an inductively defined relation. In this paper, we consider an alternative: using a recursive function akin to an interpreter for the language. The advantages include a better induction theorem, less duplication, accessibility to ordinary functional programmers, and the ease of doing symbolic simulation in proofs via rewriting. We believe that this style of semantics is well suited for compiler verification, including proofs of divergence preservation. We do not claim the invention of this style of semantics: our contribution here is to clarify its value, and to explain how it supports several language features that might appear to require a relational or small-step approach. We illustrate the technique on a simple imperative language with C-like for-loops and a break statement, and compare it to a variety of other approaches. We also provide ML and lambda-calculus based examples to illustrate its generality

A comparative study of the factors shaping postsecondary aspirations for low-income students in greater Boston and greater London

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this recordThis project investigated the postsecondary education aspirations of 27 secondary schoolaged students living in greater London, England and greater Boston, Massachusetts, USA. An innovative research design was implemented to support a technology-facilitated international focus group allowing for exchanges between the U.S. and English students. Using human ecology theory, the findings show that differences in students’ exosystems, specifically the financial aid and loan repayment processes, influence student postsecondary education and career aspirations. U.S. student concerns about affordability and loan repayment made aspirations lower and more localized. In contrast, English participants felt comforted by their government’s deferred loan repayment process, so they did not express as strong constraints on aspirations based on financial considerations. Both English and U.S. students were influenced similarly by the mesosystem when making decisions about which postsecondary institution to attend. In conclusion, altering exosystem policy and influencing mesosystem relationships could impact postsecondary education aspirations for low-income students

Longitudinal Numbers-Needed-To-Treat (NNT) for Achieving Various Levels of Analgesic Response and Improvement with Etoricoxib, Naproxen, and Placebo in Ankylosing Spondylitis

<p>Abstract</p> <p>Background</p> <p>Clinical analgesic trials typically report response as group mean results. However, research has shown that few patients are average and most have responses at the extremes. Moreover, group mean results do not convey response levels and thus have limited value in representing the benefit-risk at an individual level. Responder analyses and numbers-needed-to-treat (NNT) are considered more relevant for evaluating treatment response. We evaluated levels of analgesic response and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score improvement and the associated NNTs.</p> <p>Methods</p> <p>This was a post-hoc analysis of a 6-week, randomized, double-blind study (N = 387) comparing etoricoxib 90 mg, etoricoxib 120 mg, naproxen 1000 mg, and placebo in AS. Spine pain and BASDAI were measured on a 100-mm visual analog scale. The number and percentage of patients achieving ≥30% and ≥50% improvement in both BASDAI and spine pain were calculated and used to determine the corresponding NNTs. Patients who discontinued from the study for any reason were assigned zero improvement beyond 7 days of the time of discontinuation.</p> <p>Results</p> <p>For etoricoxib 90 mg, etoricoxib 120 mg and naproxen 1000 mg, the NNTs at 6 weeks compared with placebo were 2.0, 2.0, and 2.7 respectively for BASDAI ≥30% improvement, and 3.2, 2.8, and 4.1 for ≥50% improvement. For spine pain, the NNTs were 1.9, 2.0, and 3.2, respectively, for ≥30% improvement, and 2.7, 2.5, and 3.7 for ≥50% improvement. The differences between etoricoxib and naproxen exceeded the limit of ±0.5 units described as a clinically meaningful difference for pain. Response rates and NNTs were generally similar and stable over 2, 4, and 6 weeks.</p> <p>Conclusions</p> <p>For every 2 patients treated with etoricoxib, 1 achieved a clinically meaningful (≥30%) improvement in spine pain and BASDAI beyond that expected from placebo, whereas the corresponding values were approximately 1 in every 3 patients treated with naproxen. Use of NNTs and responder analyses provide additional, complementary information beyond population mean responses when assessing efficacy compared to placebo and amongst active therapies.</p

Neuroma of a double gallbladder: a case report

We report a case of 55 year old male patient who presented with recurrent upper abdominal pain following a laparoscopic cholecystectomy. A subsequent diagnostic laparoscopy revealed the presence of a second gallbladder which was initially missed. The peculiarity of his symptoms can in part be explained by the presence of a traumatic neuroma in his second gallbladder. A subsequent cholecystectomy led to a complete resolution of this patient's signs and symptoms. As far as we know this is the first report in the literature of a traumatic neuroma in a second gallbladder

Population Selection and Sequencing of Caenorhabditis elegans Wild Isolates Identifies a Region on Chromosome III Affecting Starvation Resistance

To understand the genetic basis of complex traits, it is important to be able to efficiently phenotype many genetically distinct individuals. In the nematode Caenorhabditis elegans, individuals have been isolated from diverse populations around the globe and whole-genome sequenced. As a result, hundreds of wild strains with known genome sequences can be used for genome-wide association studies (GWAS). However, phenotypic analysis of these strains can be laborious, particularly for quantitative traits requiring multiple measurements per strain. Starvation resistance is likely a fitness-proximal trait for nematodes, and it is related to metabolic disease risk in humans. However, natural variation in C. elegans starvation resistance has not been systematically characterized, and precise measurement of the trait is time-intensive. Here, we developed a population-selection-and-sequencing-based approach to phenotype starvation resistance in a pool of 96 wild strains. We used restriction site-associated DNA sequencing (RAD-seq) to infer the frequency of each strain among survivors in a mixed culture over time during starvation. We used manual starvation survival assays to validate the trait data, confirming that strains that increased in frequency over time are starvation-resistant relative to strains that decreased in frequency. Further, we found that variation in starvation resistance is significantly associated with variation at a region on chromosome III. Using a near-isogenic line (NIL), we showed the importance of this genomic interval for starvation resistance. This study demonstrates the feasibility of using population selection and sequencing in an animal model for phenotypic analysis of quantitative traits, documents natural variation of starvation resistance in C. elegans, and identifies a genomic region that contributes to such variation