Prediction of Driving Ability in People With Dementia- and Non- Dementia-Related Brain Disorders

Brain disorders can impair physical and cognitive functions necessary for safe driving. Two hundred people with brain disorders referred for a driving assessment were recruited and their performance on a computerized battery of sensory-motor and cognitive tests (SMCTests) and a blinded on-road assessment determined. Based on SMCTests performance, binary logistic regression (BLR) and nonlinear causal resource analysis (NCRA) models classified on-road pass or fail with 70% accuracy. Greater accuracy could be achieved by splitting referrals into two groups: (1) Dementia and (2) Non-dementia-related brain disorders. BLR models classified on-road driving outcome as pass or fail with accuracies of 76% (Dementia) and 75% (Non-dementia), while NCRA models had accuracies of 77% (Dementia) and 80% (Non-dementia). Measures of attention were most critical for predicting driving ability in the dementia group. In the non-dementia group, prediction of driving ability was most accurate with assessment of a broader range of sensory-motor and cognitive functions. Compared to BLR, NCRA was able to identify and use additional measures to improve accuracy. NCRA is also better able to accommodate outliers due to it being a non-linear modelling method based upon individual performance-limiting impairments. We propose three main factors underlying sub-optimal prediction of driving ability based on SMCTests performance: (1) there are one or more functions important for driving ability which are not currently assessed with SMCTests – these could be sensory-motor or cognitive or other (e.g., attitude, confidence, insight, road code knowledge); (2) suboptimal classification/prediction techniques or models; or (3) inaccuracies in the on-road driving assessments

Public involvement in research: Assessing impact through a realist evaluation

BackgroundThis study was concerned with developing the evidence base for public involvement in research in health and social care. There now is significant support for public involvement within the National Institute for Health Research, and researchers applying for National Institute for Health Research grants are expected to involve the public. Despite this policy commitment, evidence for the benefits of public involvement in research remains limited. This study addressed this need through a realist evaluation.Aim and objectivesThe aim was to identify the contextual factors and mechanisms that are regularly associated with effective public involvement in research. The objectives included identifying a sample of eight research projects and their desired outcomes of public involvement, tracking the impact of public involvement in these case studies, and comparing the associated contextual factors and mechanisms.DesignThe research design was based on the application of realist theory of evaluation, which argues that social programmes are driven by an underlying vision of change – a ‘programme theory’ of how the intervention is supposed to work. The role of the evaluator is to compare theory and practice. Impact can be understood by identifying regularities of context, mechanism and outcome. Thus the key question for the evaluator is ‘What works for whom in what circumstances . . . and why?’ (Pawson R. The Science of Evaluation. London: Sage; 2013). We therefore planned a realist evaluation based on qualitative case studies of public involvement in research.Setting and participantsEight diverse case studies of research projects in health and social care took place over the calendar year 2012 with 88 interviews from 42 participants across the eight studies: researchers, research managers, third-sector partners and research partners (members of the public involved in research).ResultsCase study data supported the importance of some aspects of our theory of public involvement in research and led us to amend other elements. Public involvement was associated with improvements in research design and delivery, particularly recruitment strategies and materials, and data collection tools. This study identified the previously unrecognised importance of principal investigator leadership as a key contextual factor leading to the impact of public involvement; alternatively, public involvement might still be effective without principal investigator leadership where there is a wider culture of involvement. In terms of the mechanisms of involvement, allocating staff time to facilitate involvement appeared more important than formal budgeting. Another important new finding was that many research proposals significantly undercosted public involvement. Nurturing good interpersonal relationships was crucial to effective involvement. Payment for research partner time and formal training appeared more significant for some types of public involvement than others. Feedback to research partners on the value of their contribution was important in maintaining motivation and confidence.ConclusionsA revised theory of public involvement in research was developed and tested, which identifies key regularities of context, mechanism and outcome in how public involvement in research works. Implications for future research include the need to further explore how leadership on public involvement might be facilitated, methodological work on assessing impact and the development of economic analysis of involvement.Funding detailsThe National Institute for Health Research Health Service and Delivery programme

‘IDEAS’ : Developing a ‘travelling companion’ model of inclusive curriculum development

Inclusive curriculum development in Higher Education is increasingly witnessing the development of institutional inclusive curriculum frameworks and toolkits. This short paper introduces one such framework recently developed at a modern university in the South East of England. The IDEAS model (Inclusive learning and teaching, Digital inclusion, Employability learning, assessment for learning, Sustainability mindset) involves a range of distinctive features in both design and scope, and was likewise co-created by colleagues working in the educational development and access and participation domains of academic practice. In a discussion structured by the stages of a traditional quest narrative, the paper relates the genesis, development and early implementation of the IDEAS model and draws attention to some of its distinctive emphases as well as its points of correspondence with wider sectoral initiatives on inclusive curriculum development

Alveolar macrophages of GM-CSF knockout mice exhibit mixed M1 and M2 phenotypes

Background Activin A is a pleiotrophic regulatory cytokine, the ablation of which is neonatal lethal. Healthy human alveolar macrophages (AMs) constitutively express activin A, but AMs of patients with pulmonary alveolar proteinosis (PAP) are deficient in activin A. PAP is an autoimmune lung disease characterized by neutralizing autoantibodies to Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF). Activin A can be stimulated, however, by GM-CSF treatment of AMs in vitro. To further explore pulmonary activin A regulation, we examined AMs in bronchoalveolar lavage (BAL) from wild-type C57BL/6 compared to GM-CSF knockout mice which exhibit a PAP-like histopathology. Both human PAP and mouse GM-CSF knockout AMs are deficient in the transcription factor, peroxisome proliferator activated receptor gamma (PPARγ). Results In sharp contrast to human PAP, activin A mRNA was elevated in mouse GM-CSF knockout AMs, and activin A protein was increased in BAL fluid. Investigation of potential causative factors for activin A upregulation revealed intrinsic overexpression of IFNγ, a potent inducer of the M1 macrophage phenotype, in GM-CSF knockout BAL cells. IFNγ mRNA was not elevated in PAP BAL cells. In vitro studies confirmed that IFNγ stimulated activin A in wild-type AMs while antibody to IFNγ reduced activin A in GM-CSF knockout AMs. Both IFNγ and Activin A were also reduced in GM-CSF knockout mice in vivo after intratracheal instillation of lentivirus-PPARγ compared to control lentivirus vector. Examination of other M1 markers in GM-CSF knockout mice indicated intrinsic elevation of the IFNγ-regulated gene, inducible Nitrogen Oxide Synthetase (iNOS), CCL5, and interleukin (IL)-6 compared to wild-type. The M2 markers, IL-10 and CCL2 were also intrinsically elevated. Conclusions Data point to IFNγ as the primary upregulator of activin A in GM-CSF knockout mice which in addition, exhibit a unique mix of M1-M2 macrophage phenotypes

The History of Makassan Trepang Fishing and Trade

The Malayan term trepang describes a variety of edible holothurians commonly known as sea cucumbers. Although found in temperate and tropical marine waters all over the world, the centre of species diversity and abundance are the shallow coastal waters of Island Southeast Asia. For at least 300 years, trepang has been a highly priced commodity in the Chinese market. Originally, its fishing and trade was a specialized business, centred on the town of Makassar in South Sulawesi (Indonesia). The rise of trepang fishing in the 17th century added valuable export merchandize to the rich shallow seas surrounding the islands of Southeast Asia. This enabled local communities to become part of large trading networks and greatly supported their economic development. In this article, we follow Makassan trepang fishing and trading from its beginning until the industrialization of the fishery and worldwide depletion of sea cucumbers in the 20th century. Thereby, we identify a number of characteristics which trepang fishing shares with the exploitation of other marine resources, including (1) a strong influence of international markets, (2) the role of patron-client relationships which heavily influence the resource selection, and (3) the roving-bandit-syndrome, where fishermen exploit local stocks of valuable resources until they are depleted, and then move to another area. We suggest that understanding the similarities and differences between historical and recent exploitation of marine resources is an important step towards effective management solutions

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Constructions of advocacy : an analysis of professional advocacy in work with children and young people

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Professional Advocacy as a Force for Resistance in Child Welfare

The development of child and youth advocacy is a relatively recent phenomenon, increasingly recognized by both practitioners and politicians as a way of establishing communication spaces for young people who are looked after in state care. Literature to date has focused on the development and underpinning principles of child and youth advocacy, which is a necessary starting point for establishing good practice. However, while policy and legislation promote the view that young people are actively involved in decision making, their advocates can be placed in a passive position, effectively denying young people a position as social actors. This paper argues that the problemitizing of independent advocacy as unprofessional can serve to further marginalize young people and render advocates impotent. It suggests that while it is structurally necessary for adults to take on the advocacy role, this must be undertaken in a way that actively resists the oppression of young people. Through consideration of accounts of advocacy activity, by way of illustration, the paper takes the debate beyond the principles of participation, empowerment and rights to a consideration of strategies that take into account the complexities of advocacy practice in child welfare

Developing the Concept of Professional Advocacy: An Examination of the Role of Child and Youth Advocates in England and Wales

• Summary: This article examines the development of child and youth advocacy through an analysis of the meaning of professionalization and argues that a culture of advocacy is needed to facilitate the development of professional advocacy expertise. • Findings: The fragmented development of child and youth advocacy in England and Wales has accelerated within the modernizing agenda of New Labour. While child and youth advocacy competes with other imperatives in the provision of health and social care services, advocates seek to develop professional status in order to ensure effectively the involvement of children and young people in decision making. The nature of advocacy practice creates resistance to traditional models of professionalization but a committed practitioner model, recognizing advocacy expertise, enables advocacy to develop in a way that does not compromise its role. • Applications: Debates about the professionalization of child and youth advocacy are ongoing, particularly with the publication of advocacy standards in England and Wales. This article contributes to the discussion and suggests a model for developing the theory and practice of child and youth advocacy. © 2004, Sage Publications. All rights reserved

What is confidentiality? Developing practice relating to young people

Sharing information needlessly is an invasion of privacy. Adults are justly indignant if something that they have talked about in confidence is passed on without their consent. However, information between professionals is often shared without the consent of the young people concerned. Many are already distrustful of adults when it comes to sharing confidential information and this is confirmed when something young people have expected to be treated confidentially is shared between adults without permission being sought For those working in agencies providing services for children and young people, attitudes to confidentiality can vary from those who have clear policies or codes of conduct to those who are totally unaware of the legal position. This then creates tensions between professionals and can often make working together difficult for many and impossible for some. In 1996 the Stratford District Children's Services Development group decided to consider issues of confidentiality as they affected different agencies working with young people. Two years on they launched 16 principles for sharing information that are acceptable to all the agencies and to the young people using them, based on shared good practice. This paper presents an account of the process of establishing those principles with particular reference to the part played by young people. © 1999, Taylor & Francis Group, LLC