Venezuela: The failure of the fifth republic

The turmoil that has rocked Venezuela since early February has resulted in almost 30 deaths, hundreds of injuries, and 1,500 detentions (see timeline here). Although such protests were never likely to threaten the survival of the regime, their intensity, breadth, and duration have exposed the deep cleavages and polarization in Venezuelan society. The intent of many of the protesters is clear: to bring down a government elected less than a year ago

Development of a Fluorescence Imaging Photometer-Based Method for Characterization of Phytoplankton Communities

The development of methods for real-time characterization of phytoplankton community structure has important implications for environmental monitoring and the prediction of harmful algal blooms. Our research group has developed an instrument, the Fluorescence Imaging Photometer (FIP), which is capable of rapid classification of phytoplankton via imaging single-cell chlorophyll a fluorescence under different excitation conditions. Discrimination of cells from different taxonomic groups is achieved using optical bandpass filters that have been chosen to selectively excite pigments which occur in characteristic ratios that vary from one group to the next. The relative fluorescence intensity emitted by cells under these different excitation conditions can be used to distinguish between different species. Originally, the design of filters used to modulate excitation light was accomplished by generating filter designs with transmission profiles that mimicked linear discriminant (LD) vectors produced through analysis of single-cell fluorescence excitation spectra. Due to an unforeseen source of fluorescence yield variability, however, filters produced using this approach underperformed in real-world systems. We have recently developed a novel approach to filter design that remedies many of the shortcomings of the LD- based approach. In conjunction with the implementation of a new filter wheel design that offers improved fluorescence measurement precision, the use of these filters offers significantly improved discrimination of phytoplankton from different species. This work will detail the theoretical underpinnings of the new filter design approach, detail other instrumental improvements, and demonstrate methods for using FIP measurements to obtain information about the composition of phytoplankton communities

Peer Support and Recovery From Limb Loss in Post-conflict Settings

In this article, the authors describe an unprecedented study on peer support services for landmine survivors and victims of explosive remnants of war based on the strategic approach implemented by Survivor Corps, in which survivors were trained to provide psychosocial assistance to other survivors. The study’s methodology is thoroughly explained and analyzed by the authors

Medical graduate views on statistical learning needs for clinical practice: a comprehensive survey

BACKGROUND: This paper seeks to contribute to a reputable evidence base for required competencies across different topics in statistics and probability (statistical topics) in preparing medical graduates for clinical practice. This is in order to inform the prioritization of statistical topics within future undergraduate medical curricula, while exploring the need for preparing tomorrow's doctors to be producers, and not merely consumers, of statistics. METHODS: We conducted a comprehensive online survey from July 2013 to August 2014 for a target group of 462 medical graduates with current or prior experience of teaching undergraduate medical students of the University of Edinburgh of whom 278 (60.2%) responded. Statistical topics were ranked by proportion of respondents who identified the practice of statistics, performing statistical procedures or calculations using appropriate data, as a required competency for medical schools to provide in preparing undergraduate medical students for clinical practice. Mixed effects analyses were used to identify potential predictors for selection of the above competency and to compare the likelihood of this selection for a range of statistical topics versus critical appraisal. RESULTS: Evidence was gleaned from medical graduates' experiences of clinical practice for the need for, not only a theoretical understanding of statistics and probability but also, the ability to practice statistics. Nature of employment and statistical topic were highly significant predictors of choice of the practice of statistics as a required competency ((F = 3.777, p < 0.0005) and (F = 45.834, p < 0.0005), respectively). The most popular topic for this competency was graphical presentation of data (84.3% of respondents) in contrast to cross-over trials for the competency understanding the theory only (70.5% of respondents). Several topics were found to be more popular than critical appraisal for competency in the practice of statistics. CONCLUSIONS: The model of medical graduates as mere consumers of statistics is oversimplified. Contrary to what has been suggested elsewhere, statistical learning opportunities in undergraduate medicine should not be restricted to development of critical appraisal skills. Indeed, our findings support development of learning opportunities for undergraduate medical students as producers of statistics across a wide range of statistical topics

From Debate to Design: Issues in Clean Energy and Climate Change Law and Policy

A report on the work of the REIL Network 2007-200

The Patient Centered Assessment Method (PCAM): integrating the social dimensions of health into primary care

Background: Social dimensions of health are known to contribute to what is often termed “patient complex-ity,” which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs. Objectives: To examine: (i) the Patient Centered Assessment Method (PCAM), a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii) the impact of the PCAM on referral patterns and its perceived value; and (iii) the PCAM’s perceived applicability for use in a complex patient population. Design: Two studies are described: (i) a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii) a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population. Results: Use of the PCAM did not impact patient satisfaction or perception of practitioners’ empathy, but it did increase both the number of onward referrals per referred patient (9–12%) and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients’ lives, and found it to be highly relevant for use in populations with known high complexity. Conclusions: The PCAM represents a feasible approach for assessing patient needs with consider-ation to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity

Engaging the agricultural community in the development of mental health interventions: a qualitative research study

Background: Farmers and those involved in the wider agricultural industry have a high suicide rate. They are also a ‘hard to reach’ group who make less than average use of mental health services. There is therefore a need to understand how best to develop interventions that meet their needs. The aims of this study were to develop a deeper understanding of the farming context and target population and to engage farmers in the shaping of two potential mental health interventions that could be incorporated in a pilot RCT. Methods: The study was informed throughout by a reference group, who assisted in co-production of the research materials. A snowball approach was used to recruit interested individuals who had an association with farming. Twenty one telephone interviews were undertaken and analysed using the six phases of thematic analysis proposed by Braun and Clarke. Results: Key themes (and sub-themes shown in brackets) related to the study aims were: everyday life (work-life balance; isolation and loneliness); farm management (technology and social media; production, people management, learning and teaching; external pressures; livestock and farm production; financial aspects); demographics (effects of aging); engagement (appropriate wording when talking about mental health; recognising need for help; religion; normalising mental health issues; approaching the conversation); training (mental health training for supporters of the farming community; health &amp; safety and the inclusion of mental health training); and personal stories and experiences, which was an emerging theme. Conclusions: Recruiting farmers into research studies is best done by meeting farmers where they are found, for example, farmers marts. Accessibility of content, tailoring to the farming community, and guided support are key to effective recruitment and retention

Wearable activity technology and action-planning (WATAAP) to promote physical activity in cancer survivors: Randomised controlled trial protocol

Background/Objective: Colorectal and gynecologic cancer survivors are at cardiovascular risk due to comorbidities and sedentary behaviour, warranting a feasible intervention to increase physical activity. The Health Action Process Approach (HAPA) is a promising theoretical frame-work for health behaviour change, and wearable physical activity trackers offer a novel means of self-monitoring physical activity for cancer survivors. Method: Sixty-eight survivors of colorectal and gynecologic cancer will be randomised into 12- week intervention and control groups. Intervention group participants will receive: a Fitbit AltaTM to monitor physical activity, HAPA-based group sessions, booklet, and support phone-call. Participants in the control group will only receive the HAPA-based booklet. Physical activity (using accelerometers), blood pressure, BMI, and HAPA constructs will be assessed at baseline, 12-weeks (post-intervention) and 24-weeks (follow-up). Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis. Conclusions: Physical activity interventions that are acceptable and have robust theoretical underpinnings show promise for improving the health of cancer survivors

Large-Area, High Spatial Resolution Land Cover Mapping Using Random Forests, GEOBIA, and NAIP Orthophotography: Findings and Recommendations

Despite the need for quality land cover information, large-area, high spatial resolution land cover mapping has proven to be a difficult task for a variety of reasons including large data volumes, complexity of developing training and validation datasets, data availability, and heterogeneity in data and landscape conditions. We investigate the use of geographic object-based image analysis (GEOBIA), random forest (RF) machine learning, and National Agriculture Imagery Program (NAIP) orthophotography for mapping general land cover across the entire state of West Virginia, USA, an area of roughly 62,000 km2. We obtained an overall accuracy of 96.7% and a Kappa statistic of 0.886 using a combination of NAIP orthophotography and ancillary data. Despite the high overall classification accuracy, some classes were difficult to differentiate, as highlight by the low user’s and producer’s accuracies for the barren, impervious, and mixed developed classes. In contrast, forest, low vegetation, and water were generally mapped with accuracy. The inclusion of ancillary data and first- and second-order textural measures generally improved classification accuracy whereas band indices and object geometric measures were less valuable. Including super-object attributes improved the classification slightly; however, this increased the computational time and complexity. From the findings of this research and previous studies, recommendations are provided for mapping large spatial extents