A work force model to support the adoption of best practice care in chronic diseases – a missing piece in clinical guideline implementation

The development and implementation of an evidence-based approach to health workforce planning is a necessary step to achieve access to best practice chronic disease management. In its absence, the widely reported failure in implementation of clinical best practice guidelines is almost certain to continue. This paper describes a demand model to estimate the community-based primary care health workforce consistent with the delivery of best practice chronic disease management and prevention. The model takes a geographic region as the planning frame and combines data about the health status of the regional population by disease category and stage, with best practice guidelines to estimate the clinical skill requirement or competencies for the region. The translation of the skill requirement into a service requirement can then be modelled, incorporating various assumptions about the occupation group to deliver nominated competencies. The service requirement, when compared with current service delivery, defines the gap or surplus in services. The results of the model could be used to inform service delivery as well as a workforce supply strategy

PrivExtractor:Towards Redressing the Imbalance of Understanding Between Virtual Assistant Users and Vendors

The use of voice-controlled virtual assistants (VAs) is significant, and user numbers increase every year. Extensive use of VAs has provided the large, cash-rich technology companies who sell them with another way of consuming users' data, providing a lucrative revenue stream. Whilst these companies are legally obliged to treat users' information "fairly and responsibly,"artificial intelligence techniques used to process data have become incredibly sophisticated, leading to users' concerns that a lack of clarity is making it hard to understand the nature and scope of data collection and use.There has been little work undertaken on a self-contained user awareness tool targeting VAs. PrivExtractor, a novel web-based awareness dashboard for VA users, intends to redress this imbalance of understanding between the data "processors"and the user. It aims to achieve this using the four largest VA vendors as a case study and providing a comparison function that examines the four companies' privacy practices and their compliance with data protection law.As a result of this research, we conclude that the companies studied are largely compliant with the law, as expected. However, the user remains disadvantaged due to the ineffectiveness of current data regulation that does not oblige the companies to fully and transparently disclose how and when they use, share, or profit from the data. Furthermore, the software tool developed during the research is, we believe, the first that is capable of a comparative analysis of VA privacy with a visual demonstration to increase ease of understanding for the user

Metapopulation dynamics of roseate terns: Sources, sinks and implications for conservation management decisions

Habitat management to restore or create breeding sites may allow metapopulations to increase in size and reduce the risk of demographic stochasticity or disasters causing metapopulation extinction. However, if newly restored or created sites are of low quality, they may act as sinks that draw individuals away from better quality sites to the detriment of metapopulation size. Following intensive conservation effort, the metapopulation of roseate tern (Sterna dougallii) in NW Europe is recovering from a large crash in numbers, but most former colonies remain unoccupied and hence are potential targets for restoration. To inform conservation efforts, we studied the dynamics of this metapopulation with a multistate integrated population model to assess each of the three main colonies for important demographic contributors to population growth rate, source/sink status and possible density dependence. All three study colonies are managed for roseate terns (and other tern species) in similar ways, but the demographic processes vary considerably between colonies. The largest colony is a source involved in almost all dispersal, and its growth is determined by survival rates and productivity. Productivity and juvenile apparent survival at the largest colony appear to be density-dependent. Although the mechanisms are unclear, this may provide an increasing impetus for emigration of recruits to other colonies in future. The smallest of the three colonies is a sink, relying on immigration for its growth. Simulation models suggest the metapopulation would be c. 10% larger in the absence of dispersal to the sink colony. This work indicates that, due to variable site quality, aims to enhance both distribution and size of metapopulations may be mutually exclusive. In this case, before future attempts to encourage recolonisation of former sites, assessments of site suitability should be undertaken, focusing on food availability and isolation from predators to maximise the likelihood of attaining levels of productivity and survival that avoid creation of a sink population to the detriment of the overall metapopulation size

Exile Vol. XLV No. 2

43rd Year Title Page 3 Epigraph by Ezra Pound 5 Table of Contents 7 Contributors Notes 74-75 Editorial Board 76 INTERVIEWS The Art of Hearing: Interview with Stanley Plumly by Alison Stine \u2700 23-27 ART Self-Portrait by Angela Bliss \u2799 8 For a Living by Angela Bliss \u2799 12 Untitled by Frazier Taylor \u2702 22 Untitled by Amy Deaner \u2799 29 Perfect Knee by David Tulkin \u2701 34 Untitled by Amy Deaner \u2799 43 Still Light by Angela Bliss \u2799 62 Hiding Nature by Amy Deaner \u2799 64 Self-Portrait A by Sarah Leyrer \u2701 73 POETRY Bolted Back by Michelle Grindstaff \u2702 9 Squall by Georgia Riepe \u2702 10 Loaves and Fishes by Maeghan Demmons \u2701 11 World Cafe by Katie Kroner \u2701 28 Gurney Surfer by Tom Hankinson \u2702 31 Japanese Beetles by Alison Stine \u2700 32-33 Shoveling by Bekah Taylor \u2700 40 Tobacco Country by K. Moore \u2701 41 Winton Place by Rachel Colina \u2702 42 Bottom of the Ninth by Michelle Grindstaff \u2702 61 Fall Burning by Alison Stine \u2700 63 rocking by Bekah Taylor \u2700 71 The Armor of the Beach by Georgia Riepe \u2702 72 PROSE In the Aisles of the Night by Tom Dussel \u2701 13-21 From Those Uninvolved by Justin Walker \u2799 30 Frame by Paul Durica \u2700 35-39 The Rose by Rachel Bolton \u2799 44-60 Stop at the Soldier by Hillary Campbell \u2700 65-70 All submissions are reviewed on an anonymous basis, and all editorial decisions are shared equally among the members of the Editorial Board. -76 Cover Art Untitled by Kris Lewis \u2799 / Back Cover Art Figure 25 by Todd Gys \u2799 -76 Printed by Printing Arts Press -7

Consistent concentrations of critically endangered Balearic shearwaters in UK waters revealed by at-sea surveys

Aim: Europe’s only globally critically endangered seabird, the Balearic shearwater (Puffinus mauretanicus), is thought to have expanded its post-breeding range northwards into UK waters, though its distribution there is not yet well understood. This study aims to identify environmental factors associated with the species’ presence, and map the probability of presence of the species across the western English Channel and southern Celtic Sea, and estimate the number of individuals in this area. Location: The western English Channel and southern Celtic Sea. Methods: This study analyses strip transect data collected from vessel-based surveys in the western English Channel and southern Celtic Sea during the shearwater’s post-breeding period between 2013 and 2017. Using environmental data collected directly and from remote sensors both Generalized Additive Models (GAMs) and the Random Forest (RF) machine learning model were used to determine shearwater presence at different locations. Results: Both models indicated that oceanographic features were better predictors of shearwater presence than fish abundance. Seafloor aspect, sea surface temperature, depth, salinity, and maximum current speed were the most important predictors. Based on the timing of the surveys (mainly in October) it is probable that most of the sighted shearwaters were immatures. Main conclusions: Areas with consistently high probabilities of shearwater presence were identified at the Celtic Sea front. Our estimates suggest that the study area in southwest Britain supports between 2% and 23% of the global population of Balearic shearwaters. This study provides the most complete understanding of Balearic shearwater distribution in UK waters available to date, information that will help inform any future UK conservation actions concerning this endangered 38 species

On lions, impala, and bigraphs: modelling interactions in physical/virtual spaces

While HCI has a long tradition of formally modelling task-based interactions with graphical user interfaces, there has been less progress in modelling emerging ubiquitous computing systems due in large part to their highly contextual nature and dependence on unreliable sensing systems. We present an exploration of modelling an example ubiquitous system, the Savannah game, using the mathematical formalism of bigraphs, which are based on a universal process algebra that encapsulates both dynamic and spatial behaviour of autonomous agents that interact and move among each other, or within each other. We establish a modelling approach based on four perspectives on ubiquitous systems—Computational, Physical, Human, and Technology—and explore how these interact with one another. We show how our model explains observed inconsistencies in user trials of Savannah, and then, how formal analysis reveals an incompleteness in design and guides extensions of the model and/or possible system re-design to resolve this

Histological and Somatic Mutational Profiles of Mismatch Repair Deficient Endometrial Tumours of Different Aetiologies

SIMPLE SUMMARY: Endometrial cancers can arise due to an error in DNA mending known as mismatch repair. This can happen because of an error in the cancer itself (somatic) or due to an inherited error (Lynch syndrome). Treatment trials have considered endometrial cancers caused by either of these errors as identical. As it is easier to recruit people with Lynch syndrome, they may be overrepresented in this group despite being less numerous in clinical practice. This would not be an issue if somatic and Lynch syndrome-related endometrial cancers were similar at a molecular level. The data presented herein, however, indicates that these two routes to mismatch repair, although sharing many similarities, lead to endometrial cancers with distinct molecular and pathological features. This may explain the range of outcomes observed in clinical trials of endometrial cancers with mismatch repair errors. ABSTRACT: Background: Mismatch repair deficient (MMRd) tumours may arise from somatic events acquired during carcinogenesis or in the context of Lynch syndrome (LS), an inherited cancer predisposition condition caused by germline MMR pathogenic variants. Our aim was to explore whether sporadic and hereditary MMRd endometrial cancers (EC) display distinctive tumour biology. Methods: Clinically annotated LS-EC were collected. Histological slide review was performed centrally by two specialist gynaecological pathologists. Mutational analysis was by a bespoke 75- gene next-generation sequencing panel. Comparisons were made with sporadic MMRd EC. Multiple correspondence analysis was used to explore similarities and differences between the cohorts. Results: After exclusions, 135 LS-EC underwent independent histological review, and 64 underwent mutational analysis. Comparisons were made with 59 sporadic MMRd EC. Most tumours were of endometrioid histological subtype (92% LS-EC and 100% sporadic MMRd EC, respectively, p = NS). Sporadic MMRd tumours had significantly fewer tumour infiltrating lymphocytes (p ≤ 0.0001) and showed more squamous/mucinous differentiation than LS-EC (p = 0.04/p = 0.05). PTEN mutations were found in 88% sporadic MMRd and 61% LS-EC, respectively (p < 0.001). Sporadic MMRd tumours had significantly more mutations in PDGFRA, ALK, IDH1, CARD11, CIC, MED12, CCND1, PTPN11, RB1 and KRAS, while LS-EC showed more mutations affecting SMAD4 and ARAF. LS-EC showed a propensity for TGF-β signalling disruption. Cluster analysis found that wild type PTEN associates predominantly with LS-EC, whilst co-occurring mutations in PTEN, PIK3CA and KRAS predict sporadic MMRd EC. Conclusions: Whilst MMRd EC of hereditary and sporadic aetiology may be difficult to distinguish by histology alone, differences in infiltrating immune cell counts and mutational profile may predict heterogenous responses to novel targeted therapies and warrant further study