Characterising population variability in brain structure through models of whole-brain structural connectivity

Models of whole-brain connectivity are valuable for understanding neurological function. This thesis seeks to develop an optimal framework for extracting models of whole-brain connectivity from clinically acquired diffusion data. We propose new approaches for studying these models. The aim is to develop techniques which can take models of brain connectivity and use them to identify biomarkers or phenotypes of disease. The models of connectivity are extracted using a standard probabilistic tractography algorithm, modified to assess the structural integrity of tracts, through estimates of white matter anisotropy. Connections are traced between 77 regions of interest, automatically extracted by label propagation from multiple brain atlases followed by classifier fusion. The estimates of tissue integrity for each tract are input as indices in 77x77 ”connectivity” matrices, extracted for large populations of clinical data. These are compared in subsequent studies. To date, most whole-brain connectivity studies have characterised population differences using graph theory techniques. However these can be limited in their ability to pinpoint the locations of differences in the underlying neural anatomy. Therefore, this thesis proposes new techniques. These include a spectral clustering approach for comparing population differences in the clustering properties of weighted brain networks. In addition, machine learning approaches are suggested for the first time. These are particularly advantageous as they allow classification of subjects and extraction of features which best represent the differences between groups. One limitation of the proposed approach is that errors propagate from segmentation and registration steps prior to tractography. This can cumulate in the assignment of false positive connections, where the contribution of these factors may vary across populations, causing the appearance of population differences where there are none. The final contribution of this thesis is therefore to develop a common co-ordinate space approach. This combines probabilistic models of voxel-wise diffusion for each subject into a single probabilistic model of diffusion for the population. This allows tractography to be performed only once, ensuring that there is one model of connectivity. Cross-subject differences can then be identified by mapping individual subjects’ anisotropy data to this model. The approach is used to compare populations separated by age and gender

Canine-centered interface design: supporting the work of diabetes alert dogs

Many people with Diabetes live with the continuous threat of hypoglycaemic attacks and the danger of going into coma. Diabetic Alert Dogs are trained to detect the onset of an attack before the human handler they are paired with deteriorates, giving them time to take action. We investigated requirements for designing an alert system allowing dogs to remotely call for help when their human falls unconscious before being able to react to an alert. Through a multispecies ethnographic approach we focus on teasing out the requirements for a physical canine user interface, involving both dogs, their handlers and trainers in the design. We discuss tensions between the requirements for the canine and the human users, argue the need for increased sensitivity towards the needs of individual dogs that goes beyond breed specific physical characteristics and reflect on how we can move from designing for dogs to designing with dogs

Assessing the evidence: Student response system versus computer based testing for undertaking multiple choice question assessment in undergraduate nursing education

There is a dearth of evidence focusing on student preferences for computer-based testing versustesting via student response systems for summative assessment in undergraduate education.This quantitative study compared the preference and acceptability of computer-based testingand a student response system for completing multiple choice questions in undergraduatenursing education. After using both computer-based testing and a student response system tocomplete multiple choice questions, 192 first year undergraduate nursing students rated theirpreferences and attitudes towards using computer-based testing and a student response system.Results indicated that seventy four percent felt the student response system was easy to use.Fifty six percent felt the student response system took more time than the computer-based testingto become familiar with. Sixty Percent felt computer-based testing was more users friendly.Seventy Percent of students would prefer to take a multiple choice question summative examvia computer-based testing, although Fifty percent would be happy to take using student responsesystem. Results are useful for undergraduate educators in relation to student’s preferencefor using computer-based testing or student response system to undertake a summativemultiple choice question exa

Planning for tomorrow whilst living for today: the views of people with dementia and their families on Advance Care Planning

Background: Advance care planning (ACP) is increasingly prominent in many countries; however, the evidence base for its acceptability and effectiveness is limited especially in conditions where cognition is impaired, as in dementia. Method: This qualitative study used semi-structured interviews with people with mild to moderate dementia (n = 17) and family carers (n = 29) to investigate their views about planning for their future generally and ACP specifically. Results: People with dementia and their families make a number of plans for the future. Most people undertook practical, personal, financial, and legal planning. However participants did not make formal advance care plans with the exception of appointing someone to manage their financial affairs. Five barriers to undertaking ACP were identified: lack of knowledge and awareness, difficulty in finding the right time, a preference for informal plans over written documentation, constraints on choice around future care, and lack of support to make choices about future healthcare. Conclusions: Health and social care professionals can build on people's preferences for informal planning by exploring the assumptions underlying them, providing information about the possible illness trajectory and discussing the options of care available. Health and social care professionals also have a role to play in highlighting the aspects of ACP which seem to be most relevant to the wishes and aspirations of people with dementia

The Controversies and Difficulties of Diagnosing Primary Ciliary Dyskinesia

We welcome the correspondence from Lavie and Amirav (1), highlighting the difficulties diagnosing primary ciliary dyskinesia (PCD) and the role of high-speed video analysis (HSVA). As members of the European Respiratory Society (ERS) PCD Diagnostic Task Force (2) and/or large PCD Centres, we agree that HSVA has an important role that is not recognized by the American Thoracic Society (ATS) PCD Diagnostic Guideline (3). This risks a large proportion of false-negative “missed” diagnoses and a sizable number of false-positive cases; we make additional important observations.</div

Student use of whiteboards in the classroom

This paper discusses the use of whiteboards – both small, individual boards and larger, wall-mounted ones – within a variety of classes within our undergraduate mathematics degree. Details of those classes, and how students use whiteboards within them are presented. There is a focus on practicalities, particularly regarding the formation of student groups for whiteboard activities and the role of the member of staff in such classes. Issues which should be considered if introducing these to the classroom are discussed

A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia

© The Author(s) 2019Background: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. Aim: To identify and critically evaluate quality indicators for end-of-life care in dementia. Results: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review. Ultimately, 246 individual indicators were identified as being relevant to dementia end-of-life care and mapped against EAPC guidelines. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.Peer reviewedFinal Published versio

The impact of leadership on student outcomes: An analysis of the differential effects of leadership types

El propósito de este estudio fue examinar el impacto relativo de los diferentes tipos de liderazgo en los resultados académicos y no académicos de los estudiantes. La metodología consistió en el análisis de los resultados de 27 estudios publicados sobre la relación entre liderazgo y resultados de los estudiantes. El primer meta-análisis, que incluyó 22 de los 27 estudios, implicó una comparación de los efectos de la transformación y liderazgo instructivo en los resultados de los estudiantes. Con el segundo meta-análisis se realizó una comparación de los efectos de cinco conjuntos derivados inductivamente de prácticas de liderazgo en los resultados de los estudiantes. Doce de los estudios contribuyeron a este segundo análisis. El primer meta-análisis indicó que el efecto promedio de liderazgo instructivo en los resultados de los estudiantes fue de tres a cuatro veces la de liderazgo transformacional. La inspección de los elementos de la encuesta que se utilizaron para medir el liderazgo escolar reveló cinco conjuntos de prácticas de liderazgo o dimensiones: el establecimiento de metas y expectativas; dotación de recursos estratégicos, la planificación, coordinación y evaluación de la enseñanza y el currículo; promoción y participan en el aprendizaje y desarrollo de los profesores, y la garantía de un ambiente ordenado y de apoyo. El segundo meta- análisis reveló fuertes efectos promedio para la dimensión de liderazgo que implica promover y participar en el aprendizaje docente, el desarrollo y efectos moderados de las dimensiones relacionadas con la fijación de objetivos y la planificación, coordinación y evaluación de la enseñanza y el currículo. Las comparaciones entre el liderazgo transformacional y el instructivo y entre las cinco dimensiones de liderazgo sugirieron que los líderes que focalizan sus relaciones, su trabajo y su aprendizaje en el asunto clave de la enseñanza y el aprendizaje, tendrán una mayor influencia en los resultados de los estudiantiles. El artículo concluye con una discusión sobre la necesidad de que liderazgo, investigación y práctica estén más estrechamente vinculados a la evidencia sobre la enseñanza eficaz y el aprendizaje efectivo del profesorado. Dicha alineación podría aumentar aún más el impacto del liderazgo escolar en los resultados de los estudiantesThe purpose of this study was to examine the relative impact of different types of leadership on students’ academic and nonacademic outcomes. The methodology involved an analysis of findings from 27 published studies of the relationship between leadership and student outcomes. The first meta-analysis, including 22 of the 7 studies, involved a comparison of the effects of transformational and instructional leadership on student outcomes. The second meta-analysis involved a comparison of the effects of five inductively derived sets of leadership practices on student outcomes. Twelve of the studies contributed to this second analysis. The first meta-analysis indicated that the average effect of instructional leadership on student outcomes was three to four times that of transformational leadership. Inspection of the survey items used to measure school leadership revealed five sets of leadership practices or dimensions: establishing goals and expectations; resourcing strategically; planning, coordinating, and evaluating teaching and the curriculum; promoting and participating in teacher learning and development, and ensuring an orderly and supportive environment. The second meta-analysis revealed strong average effects for the leadership dimension involving promoting and participating in teacher learning and development and moderate effects for the dimensions concerned with goal setting and planning, coordinating, and evaluating teaching and the curriculum. The comparisons between transformational and instructional leadership and between the five leadership dimensions suggested that the more leaders focus their relationships, their work, and their learning on the core business of teaching and learning, the greater their influence on student outcomes. The article concludes with a discussion of the need for leadership research and practice to be more closely linked to the evidence on effective teaching and effective teacher learning. Such alignment could increase the impact of school leadership on student outcomes even furthe