An exploration of the involvement of people who have aphasia in service delivery

The researcher works in the voluntary sector and is aware that there appears to be little involvement of people who have aphasia in service delivery activity (paid or unpaid work that helps others in some way) other than that linked with aphasia or stroke specific organisations, or with speech and language therapists. The WHO acknowledges the importance of participation (WHO 2001) and current UK legislation (Health and Social care Act 2001) supports the increased involvement of patients and public in health and social care. The Disability Discrimination Act (2004) expects reasonable adjustments to be made to engage people with disabilities in activity. There are many challenges for people with a range of disabilities when they are involved in service delivery activity. Aphasia presents particular challenges; knowledge of its existence is low (Code 2001) and there is lack of knowledge of the nature of aphasia which prevents people from making the necessary adjustments required to facilitate engagement in service delivery activity. For many aspects of service delivery communication is at the core, it is the channel through which any recruitment, consultation or involvement takes place. In order to understand more about the issues for organisations and people who have aphasia when involved in service delivery activity this qualitative study explores the involvement • to identify the roles within the involvement • to identify the effects of this involvement • to identify barriers to effective engagement • to identify the requirements for effective engagement Involvement is explored in a variety of types of service delivery which include • policy making for local health, social and community services • service provision as volunteers or paid employees • training and education • researc

A proof of Bell's inequality in quantum mechanics using causal interactions

We give a simple proof of Bell's inequality in quantum mechanics which, in conjunction with experiments, demonstrates that the local hidden variables assumption is false. The proof sheds light on relationships between the notion of causal interaction and interference between particles.Comment: http://biostats.bepress.com/cobra/art8

Challenges in maximising recruitment to an RCT through working with a service user group

Low levels of recruitment into randomised controlled trials is a recurring difficulty and one that potentially threatens the validity of any RCT (Donovan et al, 2002a; 2002b). In cognate fields, research has been carried out with trial participants and other service users to understand the likely difficulties associated with recruitment from user perspectives and to modify recruitment materials and methods to maximise participation (Edwards et al, 1998; Featherstone and Donovan, 1999). However, the vast majority of this work has taken place with service users who would not experience communication challenges in participating in the research in the first place. By contrast, this paper concerns a study in which service users with aphasia and/or dysarthria worked alongside researchers, within a participatory action research framework, to design the recruitment materials that would be used in a large RCT (the ACTNoW trial)

Semiparametric theory and empirical processes in causal inference

In this paper we review important aspects of semiparametric theory and empirical processes that arise in causal inference problems. We begin with a brief introduction to the general problem of causal inference, and go on to discuss estimation and inference for causal effects under semiparametric models, which allow parts of the data-generating process to be unrestricted if they are not of particular interest (i.e., nuisance functions). These models are very useful in causal problems because the outcome process is often complex and difficult to model, and there may only be information available about the treatment process (at best). Semiparametric theory gives a framework for benchmarking efficiency and constructing estimators in such settings. In the second part of the paper we discuss empirical process theory, which provides powerful tools for understanding the asymptotic behavior of semiparametric estimators that depend on flexible nonparametric estimators of nuisance functions. These tools are crucial for incorporating machine learning and other modern methods into causal inference analyses. We conclude by examining related extensions and future directions for work in semiparametric causal inference

Causal inference based on counterfactuals

BACKGROUND: The counterfactual or potential outcome model has become increasingly standard for causal inference in epidemiological and medical studies. DISCUSSION: This paper provides an overview on the counterfactual and related approaches. A variety of conceptual as well as practical issues when estimating causal effects are reviewed. These include causal interactions, imperfect experiments, adjustment for confounding, time-varying exposures, competing risks and the probability of causation. It is argued that the counterfactual model of causal effects captures the main aspects of causality in health sciences and relates to many statistical procedures. SUMMARY: Counterfactuals are the basis of causal inference in medicine and epidemiology. Nevertheless, the estimation of counterfactual differences pose several difficulties, primarily in observational studies. These problems, however, reflect fundamental barriers only when learning from observations, and this does not invalidate the counterfactual concept

Childhood brain tumors: A review of strategies to translate CNS drug delivery to clinical trials

Brain tumors account for over 20% of childhood cancers and are the biggest cancer killer in children and young adults. Several initiatives over the past 40 years have tried to identify more effective drug treatments, but with very limited success. This is largely due to the bloodâ brain barrier, which restricts the entry of many drugs into the brain. In this review, we describe the main techniques that are being developed to enhance brain tumor drug delivery and explore the preclinical brain tumor models that are essential for translational development of these techniques. We also identify existing approved drugs that, if coupled with an efficient delivery method, could have potential as brain tumor treatments. Bringing this information together is part of a funded initiative to highlight drug delivery as a research strategy to overcome the current challenges for children diagnosed with brain tumors

Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

Background: There is growing interest in interventions that promote positive outcomes and well-being for people with aphasia (PWA) and their families, but provision is inconsistent. An asset-based approach, based on the theory of salutogenesis, focuses on what makes you well rather than ill. This approach has been used successfully across a variety of research fields, including health and social care research and practice, and has the potential to provide coherent strategies to support people living successfully with aphasia. Aim: To explore the relevance and potential of an asset-based approach to promoting and sustaining well-being for PWA and their families, across contexts and cultures. Methods & procedures: Exploratory case studies were carried out in the United Kingdom (UK), Norway, Israel, Ireland, and Denmark in a variety of settings. Following an interpretative paradigm, we used qualitative methods including: interviews; appreciative inquiry; group discussions; and participatory action research. 95 PWA and 25 family members were asked to identify assets within themselves and their communities that promote, sustain and maintain well-being, by responding to: “What makes you feel good/well/healthy?” Data were analysed using thematic analysis. Outcomes & results: An asset-based approach proved to be a powerful means for PWA and family members to explore what helps them live well with aphasia. Key themes were identified: (1) personal journey; (2) helping others; (3) connecting to self; (4) connecting to others; (5) recreation; and (6) personal attributes. Self-identification of assets, within the person and their community, and connections to these, helped PWA and their family members to maintain well-being, overcome barriers and regain confidence. Using this approach, focusing on the person’s recognition, activation and mobilisation of assets, could enhance the person’s understanding and restore meaning around the stroke and onset of aphasia. Conclusion: This novel exploratory research demonstrates the relevance and potential across diverse cultural contexts of taking an asset-based approach to promoting and sustaining well-being for PWA and their families. Focusing on maintaining connections to these assets and developing meaning around the event, could prevent some of the negative sequela of stroke. The “patient–professional” relationship must transform into a collaborative partnership, with time and flexibility needed to introduce this approach. Further research should examine how service providers and PWA could develop and operationalise an asset-based approach in clinical and community settings and identify if there is an optimum timing for introducing this approach along the stroke pathway

Finding Dynamic Treatment Effects under Anticipation: Spanking Effects on Behavior

The dynamic treatment effect literature considers multiple treatments administered over time, with some treatments affected by interim outcomes. But the literature overlooks the possibility of individuals acting in anticipation of future treatments. Thi

Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery

Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community