Intentionality versus Constructive Empiricism

By focussing on the intentional character of observation in science, we argue that Constructive Empiricism – B.C. van Fraassen’s much debated and explored view of science – is inconsistent. We then argue there are at least two ways out of our Inconsistency Argument, one of which is more easily to square with Constructive Empiricism than the other

Star Formation in Violent and Normal Evolutionary Phases

Mergers of massive gas-rich galaxies trigger violent starbursts that - over timescales of $> 100$ Myr and regions $> 10$ kpc - form massive and compact star clusters comparable in mass and radii to Galactic globular clusters. The star formation efficiency is higher by 1 - 2 orders of magnitude in these bursts than in undisturbed spirals, irregulars or even BCDs. We ask the question if star formation in these extreme regimes is just a scaled-up version of the normal star formation mode of if the formation of globular clusters reveals fundamentally different conditions.Comment: 4 pages To appear in The Evolution of Galaxies. II. Basic building blocks, eds. M. Sauvage, G. Stasinska, L. Vigroux, D. Schaerer, S. Madde

Thoracoscopy and talc poudrage compared with intercostal drainage and talc slurry infusion to manage malignant pleural effusion: the TAPPS RCT

Background: There are around 40,000 new cases of malignant pleural effusion in the UK each year. Insertion of talc slurry via a chest tube is the current standard treatment in the UK. However, some centres prefer local anaesthetic thoracoscopy and talc poudrage. There is no consensus as to which approach is most effective. Objective: This trial tested the hypothesis that thoracoscopy and talc poudrage increases the proportion of patients with successful pleurodesis at 3 months post procedure, compared with chest drain insertion and talc slurry. Design: This was a multicentre, open-label, randomised controlled trial with embedded economic evaluation. Follow-up took place at 1, 3 and 6 months. Setting: This trial was set in 17 NHS hospitals in the UK. Participants: A total of 330 adults with a confirmed diagnosis of malignant pleural effusion needing pleurodesis and fit to undergo thoracoscopy under local anaesthetic were included. Those adults needing a tissue diagnosis or with evidence of lung entrapment were excluded. Interventions: Allocation took place following minimisation with a random component, performed by a web-based, centralised computer system. Participants in the control arm were treated with a bedside chest drain insertion and 4 g of talc slurry. In the intervention arm, participants underwent local anaesthetic thoracoscopy with 4 g of talc poudrage. Main outcome measures: The primary outcome measure was pleurodesis failure at 90 days post randomisation. Secondary outcome measures included mortality and patient-reported symptoms. A cost–utility analysis was also performed. Results: A total of 166 and 164 patients were allocated to poudrage and slurry, respectively. Participants were well matched at baseline. For the primary outcome, no significant difference in pleurodesis failure was observed between the treatment groups at 90 days, with rates of 36 out of 161 (22%) and 38 out of 159 (24%) noted in the poudrage and slurry groups, respectively (odds ratio 0.91, 95% confidence interval 0.54 to 1.55; p = 0.74). No differences (or trends towards difference) were noted in adverse events or any of the secondary outcomes at any time point, including pleurodesis failure at 180 days [poudrage 46/161 (29%), slurry 44/159 (28%), odds ratio 1.05, 95% confidence interval 0.63 to 1.73; p = 0.86], mean number of nights in hospital over 90 days [poudrage 12 nights (standard deviation 13 nights), slurry 11 nights (standard deviation 10 nights); p = 0.35] and all-cause mortality at 180 days [poudrage 66/166 (40%), slurry 68/164 (42%); p = 0.70]. At £20,000 per quality-adjusted life-year gained, poudrage would have a 0.36 probability of being cost-effective compared with slurry. Limitations: Entry criteria specified that patients must be sufficiently fit to undergo thoracoscopy, which may make the results less applicable to those patients presenting with a greater degree of frailty. Furthermore, the trial was conducted on an open-label basis, which may have influenced the results of patient-reported measures. Conclusions: The TAPPS (evaluating the efficacy of Thoracoscopy And talc Poudrage versus Pleurodesis using talc Slurry) trial has robustly demonstrated that there is no additional clinical effectiveness or cost-effectiveness benefit in performing talc poudrage at thoracoscopy over bedside chest drain and talc slurry for the management of malignant pleural effusion. Trial registration: Current Controlled Trials ISRCTN47845793. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 26. See the NIHR Journals Library website for further project information

The Big Opportunity: Advancing a Culture of Interprofessionalism

Historically, education has been siloed by disciplines leaving little room for interprofessional education to take place. Culture within an academic organization determines the strategies, modes of operation, goals, values, and terminal student learning outcomes. Using Kotter’s accelerated change management model, as a worksheet for educational cultural change, is an effective method to break complacency, generate ideas, align people, and overcome resistance to change

Interprofessional Education: A Curricular Gap Analysis

The goal of Interprofessional education (IPE) is to create a new health care workforce that is prepared to function as a deliberative culturally competent team, providing patient centered care that optimizes health and quality of life for individuals with multiple chronic conditions. The purpose of an IPE curricular gap analysis is to determine if IPE and key concepts related to chronic disease self-management are integrated into course descriptions, objectives, didactic, activities and evaluated. The baseline results can be an effective tool to initiate an institutional cultural change promoting curricular revision. Key concept terminology, interprofessional, chronic disease self-management, motivational interviewing, and culture and diversity were reviewed in graduate syllabi from the Colleges of Nursing, Medicine, and Allied Health Sciences. The terms were tallied in course content areas (course descriptions, objectives, content didactic, learning activities, and evaluation). Exemplary syllabi included 4 out of the 5 key concept terms listed above. Courses with key concepts in 3 out of 5 content areas were defined as meeting minimum expectations. A total of 457 courses were reviewed across the three graduate colleges. Ten exemplary courses were found with key term concepts threaded throughout the syllabi: 4 with motivational interviewing (MI), 3 with culture and diversity (C&D) and 3 with interprofessional (IP) concepts. Eighteen courses met minimum expectations: 7 courses with MI, 6 with IP and 5 with C&D. The other key concept, chronic disease self-management (CDSM) was notably lacking in all courses from all colleges. A curricular gap analysis is an effective tool to initiate an institutional cultural change to include IPE and related concepts. It can create awareness and commitment from administration, deans, faculty, and students. Champions can be identified from each college, spearheading action plans for changes in syllabi, there by promoting curricular revision in key content areas. Objectives: 1. Discuss the common definition of interprofessional education, chronic disease self-management, motivational interviewing, culture and diversity. 2. Identify a method to examine one’s own curriculum for a gap in IPE. 3. Discuss the use of a curricular gap analysis to create awareness, commitment to facilitate cultural and curricular change within a University

A Pilot Study Investigating the Utilization of Crest Pads for Treatment of Toe Callus and Ulceration (Presentation)

Patients with lesser-toe deformities are at increased risk of developing calluses and ulcers on the distal ends of the affected digits because of the increased pressures applied to these areas. The number of diabetic patients in the United States continues to increase, along with associated comorbidities such as peripheral vascular disease and peripheral neuropathy. These conditions predispose patients to developing foot ulcerations, especially if foot deformities are present. Crest pads are a simple-to-make, inexpensive option to treat calluses and ulcerations on the distal ends of digits; however, there is no research available that support their use. Crest pads consist of rolled gauze covered in moleskin, with a large opening that fits over several toes and lies on the dorsal aspect of the foot, with the padded portion resting under the toes. Over several days of use, the pad molds to the plantar aspect of the toes, offloading pressure from the distal end of the affected digit(s). The sample was obtained through a retrospective chart review of patients identified as having had at least one nail care visit and at least one follow-up visit at a vascular surgery practice between August 2011 and December 2014. Potential subjects with toe deformities who presented with callus or ulcer on the distal end of a digit were considered for inclusion, if they received a crest pad as part of their treatment plan. The scholarly project was a preintervention or postintervention design with subjects acting as their own controls. McNemar\u27s test was used to analyze the results which were statistically significant (P \u3c .0001 at first callus follow-up and P = .0002 at second callus follow-up) for callus, hemorrhagic callus, and/or ulcer improvement following the crest pad intervention. The results of this scholarly project support the use of crest pads in patients with lesser-toe deformities to treat distal toe calluses and/or ulcerations

Evaluating the efficacy of thoracoscopy and talc poudrage versus pleurodesis using talc slurry (TAPPS trial): protocol of an open-label randomised controlled trial

INTRODUCTION: The management of recurrent malignant pleural effusions (MPE) can be challenging. Various options are available, with the most efficacious and widely used being talc pleurodesis. Talc can either be applied via a chest drain in the form of slurry, or at medical thoracoscopy using poudrage. Current evidence regarding which method is most effective is conflicting and often methodologically flawed. The TAPPS trial is a suitably powered, multicentre, open-label, randomised controlled trial designed to compare the pleurodesis success rate of medical thoracoscopy and talc poudrage with chest drain insertion and talc slurry. METHODS AND ANALYSIS: 330 patients with a confirmed MPE requiring intervention will be recruited from UK hospitals. Patients will be randomised (1:1) to undergo either small bore (<14 Fr) Seldinger chest drain insertion followed by instillation of sterile talc (4 g), or to undergo medical thoracoscopy and simultaneous poudrage (4 g). The allocated procedure will be performed as an inpatient within 3 days of randomisation taking place. Following discharge, patients will be followed up at regular intervals for 6 months. The primary outcome measure is pleurodesis failure rates at 3 months. Pleurodesis failure is defined as the need for further pleural intervention for fluid management on the side of the trial intervention. ETHICS AND DISSEMINATION: The trial has received ethical approval from the National Research Ethics Service Committee North West-Preston (12/NW/0467). There is a trial steering committee which includes independent members and a patient and public representative. The trial results will be published in a peer-reviewed journal and presented at international conferences, as well as being disseminated via local and national charities and patient groups. All participants who wish to know the study results will also be contacted directly on their publication. TRIAL REGISTRATION NUMBER: ISRCTN47845793

A Profile Likelihood Analysis of the Constrained MSSM with Genetic Algorithms

The Constrained Minimal Supersymmetric Standard Model (CMSSM) is one of the simplest and most widely-studied supersymmetric extensions to the standard model of particle physics. Nevertheless, current data do not sufficiently constrain the model parameters in a way completely independent of priors, statistical measures and scanning techniques. We present a new technique for scanning supersymmetric parameter spaces, optimised for frequentist profile likelihood analyses and based on Genetic Algorithms. We apply this technique to the CMSSM, taking into account existing collider and cosmological data in our global fit. We compare our method to the MultiNest algorithm, an efficient Bayesian technique, paying particular attention to the best-fit points and implications for particle masses at the LHC and dark matter searches. Our global best-fit point lies in the focus point region. We find many high-likelihood points in both the stau co-annihilation and focus point regions, including a previously neglected section of the co-annihilation region at large m_0. We show that there are many high-likelihood points in the CMSSM parameter space commonly missed by existing scanning techniques, especially at high masses. This has a significant influence on the derived confidence regions for parameters and observables, and can dramatically change the entire statistical inference of such scans.Comment: 47 pages, 8 figures; Fig. 8, Table 7 and more discussions added to Sec. 3.4.2 in response to referee's comments; accepted for publication in JHE