Bayes and health care research.

Bayes’ rule shows how one might rationally change one’s beliefs in the light of evidence. It is the foundation of a statistical method called Bayesianism. In health care research, Bayesianism has its advocates but the dominant statistical method is frequentism. There are at least two important philosophical differences between these methods. First, Bayesianism takes a subjectivist view of probability (i.e. that probability scores are statements of subjective belief, not objective fact) whilst frequentism takes an objectivist view. Second, Bayesianism is explicitly inductive (i.e. it shows how we may induce views about the world based on partial data from it) whereas frequentism is at least compatible with non-inductive views of scientific method, particularly the critical realism of Popper. Popper and others detail significant problems with induction. Frequentism’s apparent ability to avoid these, plus its ability to give a seemingly more scientific and objective take on probability, lies behind its philosophical appeal to health care researchers. However, there are also significant problems with frequentism, particularly its inability to assign probability scores to single events. Popper thus proposed an alternative objectivist view of probability, called propensity theory, which he allies to a theory of corroboration; but this too has significant problems, in particular, it may not successfully avoid induction. If this is so then Bayesianism might be philosophically the strongest of the statistical approaches. The article sets out a number of its philosophical and methodological attractions. Finally, it outlines a way in which critical realism and Bayesianism might work together. </p

Community Policing: Broken Windows, Community Building, and Satisfaction with the Police

The concept of community policing dominates the law enforcement profession today. One would be hard pressed to find an advertisement for a police chief’s position that does not require a thorough understanding of this method of policing. Like the Kansas City preventive patrol experiment and the Rand report on the criminal investigation process, the call for community policing has led to dramatic changes in the way that police carry out their responsibilities. In spite of its popularity, there have been a number of challenges to community policing from social scientists who are particularly concerned about the ‘broken windows’ model of policing. These challenges have not been received well by the law enforcement community, which argues that sociologists are wedded to the idea that crime is caused by the structural features of capitalist society, including economic injustice, racism, and poverty. The purpose of this article is to bridge the gap between these two positions. Yes, there is a place for community policing, and, yes, social problems do contribute to crime. The article starts by reviewing the development of community policing in the United States. An analysis of the theoretical constructs that support community policing then follows. Finally, we argue that there is sound theoretical evidence to support community policing, particularly those programmes that improve citizen satisfaction with the manner in which police carry out their responsibilities

Discoverer - Making commercial satellite operations in very low earth orbit a reality

DISCOVERER is a €5.7M European Commission funded Horizon 2020 project developing technologies to enable commercially-viable sustained-operation of satellites in very low Earth orbits. Why operate closer to the Earth? For communications applications latency is significantly reduced and link budgets improved, and for remote sensing improved link budgets allow higher resolution or smaller instruments, all providing cost benefits. In addition, all applications benefit from increased launch mass to lower altitudes, whilst end-of-life removal is ensured due to the increased atmospheric drag. However, this drag must also be minimised and compensated for. One of the key technologies being developed by DISCOVERER are materials that encourage specular reflection of the residual atmosphere at these altitudes. Combined with appropriate geometric designs these can significantly reduce drag, provide usable lift for aerodynamic attitude and orbit control, and improve the collection efficiency of aerodynamic intakes for atmosphere breathing electric propulsion systems, all of which are being developed as part of DISCOVERER. The paper provides highlights from the developments to date, and the potential for a new class of aerodynamic commercial satellites operating at altitudes below the International Space Station

Cascade testing in Familial Hypercholesterolaemia: how should family members be contacted?

Cascade testing or screening provides an important mechanism for identifying people at risk of a genetic condition. For some autosomal dominant conditions, such as Familial Hpercholesterolaemia (FH), identifying relatives allows for significant health-affecting interventions to be administered, which can extend a person’s life expectancy significantly. However, cascade screening is not without ethical implications. In this paper, we examine one ethically contentious aspect of cascade screening programmes, namely the alternative methods by which relatives of a proband can be contacted. Should the proband be responsible for contacting his or her family members, or should the screening programme contact family members directly? We argue that direct contact is an ethically justifiable method of contact tracing in cascade screening for FH. Not only has this method of contact already been utilised without adverse effects, an examination of the ethical arguments against it shows these are unsubstantiated. We describe several criteria which, if met, will allow an appropriate balance to be struck between maximising the efficiency of family tracing and respecting the interests of probands and their relatives. Keywords Cascade genetic screening; cascade testing; confidentiality; autonomy; genetics; ethics; guidelines; familial hypercholesterolaemi

Concepts and Applications of Aerodynamic Attitude and Orbital Control for Spacecraft in Very Low Earth Orbit

Spacecraft operations below 450km, namely Very Low Earth Orbit (VLEO), can offer significant advantages over traditional low Earth orbits, for example enhanced ground resolution for Earth observation, improved communications latency and link budget, or improved signal-to-noise ratio. Recently, these lower orbits have begun to be exploited as a result of technology development, particularly component miniaturisation and cost-reduction, and concerns over the increasing debris population in commercially exploited orbits. However, the high cost of orbital launch and challenges associated with atmospheric drag, causing orbital decay and eventually re-entry are still a key barrier to their wider use for large commercial and civil spacecraft. Efforts to address the impact of aerodynamic drag are being sought through the development of novel drag-compensation propulsion systems and identification of materials which can reduce aerodynamic drag by specularly reflecting the incident gas. However, the presence of aerodynamic forces can also be utilised to augment or improve spacecraft operations at these very low altitudes by providing the capability to perform coarse pointing control and trim or internal momentum management for example. This paper presents concepts for the advantageous use of spacecraft aerodynamics developed as part of DISCOVERER, a Horizon 2020 funded project with the aim to revolutionise Earth observation satellite operations in VLEO. The combination of novel spacecraft geometries and use of aerodynamic control methods are explored, demonstrating the potential for a new generation of Earth observation satellites operating at lower altitudes

The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study

Objectives: There are several reports of the association between SARS-CoV-2 infection (COVID-19) and cerebral venous sinus thrombosis (CVST). In this study, we aimed to compare the hospitalization rate of CVST before and during the COVID-19 pandemic (before vaccination program). Materials and methods: In this retrospective cohort study, the hospitalization rate of adult CVST patients in Namazi hospital, a tertiary referral center in the south of Iran, was compared in two periods of time. We defined March 2018 to March 2019 as the pre-COVID-19 period and March 2020 to March 2021 as the COVID-19 period. Results: 50 and 77 adult CVST patients were hospitalized in the pre-COVID-19 and COVID-19 periods, respectively. The crude CVST hospitalization rate increased from 14.33 in the pre-COVID-19 period to 21.7 per million in the COVID-19 era (P = 0.021). However, after age and sex adjustment, the incremental trend in hospitalization rate was not significant (95% CrI: -2.2, 5.14). Patients \u3e 50-year-old were more often hospitalized in the COVID-19 period (P = 0.042). SARS-CoV-2 PCR test was done in 49.3% out of all COVID-19 period patients, which were positive in 6.5%. Modified Rankin Scale (mRS) score ≥3 at three-month follow-up was associated with age (P = 0.015) and malignancy (P = 0.014) in pre-COVID period; and was associated with age (P = 0.025), altered mental status on admission time (P\u3c0.001), malignancy (P = 0.041) and COVID-19 infection (P = 0.008) in COVID-19 period. Conclusion: Since there was a more dismal outcome in COVID-19 associated CVST, a high index of suspicion for CVST among COVID-19 positive is recommended

The characteristics and activities of child and adolescent mental health services in Italy: a regional survey

<p>Abstract</p> <p>Background</p> <p>To date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence.</p> <p>The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years.</p> <p>Methods</p> <p>Unit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail.</p> <p>Results</p> <p>Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years.</p> <p>Conclusion</p> <p>The percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays).</p