Non-stationary Gaussian models with physical barriers

The classical tools in spatial statistics are stationary models, like the Matern field. However, in some applications there are boundaries, holes, or physical barriers in the study area, e.g. a coastline, and stationary models will inappropriately smooth over these features, requiring the use of a non-stationary model. We propose a new model, the Barrier model, which is different from the established methods as it is not based on the shortest distance around the physical barrier, nor on boundary conditions. The Barrier model is based on viewing the Matern correlation, not as a correlation function on the shortest distance between two points, but as a collection of paths through a Simultaneous Autoregressive (SAR) model. We then manipulate these local dependencies to cut off paths that are crossing the physical barriers. To make the new SAR well behaved, we formulate it as a stochastic partial differential equation (SPDE) that can be discretised to represent the Gaussian field, with a sparse precision matrix that is automatically positive definite. The main advantage with the Barrier model is that the computational cost is the same as for the stationary model. The model is easy to use, and can deal with both sparse data and very complex barriers, as shown in an application in the Finnish Archipelago Sea. Additionally, the Barrier model is better at reconstructing the modified Horseshoe test function than the standard models used in R-INLA. (C) 2019 Elsevier B.V. All rights reserved.Peer reviewe

Evaluation of the Kent Serious Youth Violence Project

This report summarises the findings in relation to the effectiveness and cost-effectiveness over a period of two years and began in September 2020

The quality and effectiveness of interventions that target multiple risk factors among young people: a systematic review

Objective: To identify evaluations of interventions that target multiple risk factors in high-risk young people, describe their characteristics, critique their methodological quality and summarise their effectiveness. Methods: A search of the literature published between 2009 and 2014 identified 13 evaluations of interventions that targeted multiple risk factors, compared to 95 evaluations that targeted single risk factors. The methodological adequacy of the 13 evaluation studies was analysed using the Quality Assessment Tool for Quantitative Studies and information regarding characteristics and intervention effectiveness was extracted and summarised. Results: There were very few outcome evaluation studies of interventions that targeted multiple risk factors, relative to single risk factors, among high-risk young people. Of the identified studies, half were methodologically weak. Interventions delivered in community settings targeted a greater number of risk factors, while those delivered in a school or health setting reported a higher proportion of statistically significant outcomes. No economic analyses were conducted. Conclusions and Implications for Public Health: More methodologically rigorous evaluations of interventions targeting multiple risk factors among high-risk young people are required, especially for those delivered in community settings. Four key areas for improvement are: i) more precisely defining the risk factors experienced by high-risk young people; ii) achieving greater consistency across interventions; iii) standardising outcome measures; and iv) conducting economic analyses

Uptake of prescription smoking cessation pharmacotherapies after hospitalization for major cardiovascular disease

AIMS: We determined the prevalence of prescription smoking cessation pharmacotherapy (SCP) use after hospitalization for major cardiovascular disease (MCD) among people who smoke and whether this varies by sex. METHODS AND RESULTS: We conducted a population-based cohort study including all people hospitalized in New South Wales, Australia, between July 2013 and December 2018 (2017 for private hospitals) with an MCD diagnosis. For patients who also had a diagnosis of current tobacco use, we used linked pharmaceutical dispensing records to identify prescription SCP dispensings within 90 days post-discharge. We determined the proportion who were dispensed an SCP within 90 days, overall and by type of SCP. We used logistic regression to estimate the odds of females being dispensed an SCP relative to males. Of the 150 758 patients hospitalized for an MCD, 20 162 (13.4%) had a current tobacco use diagnosis, 31% of whom were female. Of these, 11.3% (12.4% of females, 10.9% of males) received prescription SCP within 90 days post-discharge; 3.0% were dispensed varenicline, and 8.3% were dispensed nicotine replacement therapy patches. Females were more likely than males to be dispensed a prescription SCP [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.06-1.27)]; however, this was not maintained after adjusting for potential confounders (adjusted OR 1.04, 95% CI 0.94-1.15). CONCLUSION: Very few females and males who smoke use prescription SCPs after hospitalization for an MCD. The use of varenicline, the SCP with the highest efficacy, was particularly low. This represents a missed opportunity to increase smoking cessation in this high-risk population, thereby reducing their risk of recurrent cardiovascular events

Validity of algorithms for identifying five chronic conditions in MedicineInsight, an Australian national general practice database.

Background MedicineInsight is a database containing de-identified electronic health records (EHRs) from over 700 Australian general practices. It is one of the largest and most widely used primary health care EHR databases in Australia. This study examined the validity of algorithms that use information from various fields in the MedicineInsight data to indicate whether patients have specific health conditions. This study examined the validity of MedicineInsight algorithms for five common chronic conditions: anxiety, asthma, depression, osteoporosis and type 2 diabetes. Methods Patients’ disease status according to MedicineInsight algorithms was benchmarked against the recording of diagnoses in the original EHRs. Fifty general practices contributing data to MedicineInsight met the eligibility criteria regarding patient load and location. Five were randomly selected and four agreed to participate. Within each practice, 250 patients aged ≥ 40 years were randomly selected from the MedicineInsight database. Trained staff reviewed the original EHR for as many of the selected patients as possible within the time available for data collection in each practice. Results A total of 475 patients were included in the analysis. All the evaluated MedicineInsight algorithms had excellent specificity, positive predictive value, and negative predictive value (above 0.9) when benchmarked against the recording of diagnoses in the original EHR. The asthma and osteoporosis algorithms also had excellent sensitivity, while the algorithms for anxiety, depression and type 2 diabetes yielded sensitivities of 0.85, 0.89 and 0.89 respectively. Conclusions The MedicineInsight algorithms for asthma and osteoporosis have excellent accuracy and the algorithms for anxiety, depression and type 2 diabetes have good accuracy. This study provides support for the use of these algorithms when using MedicineInsight data for primary health care quality improvement activities, research and health system policymaking and planning

Children's Relative Age and Medicine Treatment for Attention-Deficit/Hyperactivity Disorder Across Australian Jurisdictions with Different School Enrolment Policies

Background: Children who are relatively young for their school grade are more likely to receive treatment for attention-deficit/hyperactivity disorder (ADHD). It is unclear whether the phenomenon also exists across Australia or is impacted by the school enrolment policy in place. Objective: We evaluated the association between children's relative age and initiation of ADHD medicines across Australian jurisdictions with different school enrolment policies and rates of delayed school entry. Methods: We used Australia-wide dispensing data for a 15% random sample of children 4-9 years of age in 2013-2017 to create a nationwide cohort. Due to high rates of delayed school entry in New South Wales (NSW), we used linked prescribing and education data for a cohort of NSW residents starting school in 2009 and 2012. We estimated incidence rate ratios (IRRs) for ADHD medicine across children's birth month, sex, and jurisdiction. We used asthma medicines as a negative control. Results: For girls, we observed a relative age effect in three out of five jurisdictions, with an IRR ranging from 1.3 to 2.8, comparing the youngest versus oldest birth month thirds. We observed more modest effects among boys, ranging from null to 1.5-fold. In NSW, the relatively youngest boys were less likely to initiate stimulant medicines than the oldest (IRR = 0.5, 95% confidence interval 0.29-0.78). We did not observe a relative age effect for initiation of asthma medicines. Conclusions: In jurisdictions with low rates of delayed entry, relatively young children were more likely to initiate ADHD medicines than their older classmates. We observed the inverse association in NSW where delayed entry was highest, likely reflecting the characteristics and needs of children who delay school entry for 1 year and become the oldest children in the grade. Increased awareness around children's maturity differences and school readiness may enhance appropriate diagnosis and treatment of ADHD

Mars Science Helicopter Conceptual Design

Robotic planetary aerial vehicles increase the range of terrain that can be examined, compared to traditional landers and rovers, and have more near-surface capability than orbiters. Aerial mobility is a promising possibility for planetary exploration as it reduces the challenges that difficult obstacles pose to ground vehicles. The first use of a rotorcraft for a planetary mission will be in 2021, when the Mars Helicopter technology demonstrator will be deployed from the Mars 2020 rover. The Jet Propulsion Laboratory and NASA Ames Research Center are exploring possibilities for a Mars Science Helicopter, a second-generation Mars rotorcraft with the capability of conducting science investigations independently of a lander or rover (although this type of vehicle could also be used assist rovers or landers in future missions). This report describes the conceptual design of Mars Science Helicopters. The design process began with coaxial-helicopter and hexacopter configurations, with a payload in the range of two to three kilograms and an overall vehicle mass of approximately twenty kilograms. Initial estimates of weight and performance were based on the capabilities of the Mars Helicopter. Rotorcraft designs for Mars are constrained by the dimensions of the aeroshell for the trip to the planet, requiring attention to the aircraft packaging in order to maximize the rotor dimensions and hence overall performance potential. Aerodynamic performance optimization was conducted, particularly through airfoils designed specifically for the low Reynolds number and high Mach number inherent in operation on Mars. The final designs show a substantial capability for science operations on Mars: a 31 kg hexacopter that fits within a 2.5 m diameter aeroshell could carry a 5 kg payload for 10 min of hover time or over a range of 5 km

The perception and management of risk in UK office property development

Risk is an ever-present aspect of business, and risk taking is necessary for profit and economic progress. Speculative property development is popularly perceived as a 'risky business' yet, like other entrepreneurs, developers have opportunities to manage the risks they face; techniques include phasing and joint ventures. The associated areas of investment portfolio risk, development risk analysis and construction risk management have all been addressed by research. This article presents new knowledge about how developers perceive risks and the means they subsequently adopt to manage them. The developers of office projects across the UK were sent questionnaires by post. Respondents were asked about their perceptions of risks at the first appraisal stage and currently and about the risk management techniques that they had adopted. In-depth interviews with a selection of respondents were then used to discuss and augment the findings. Developers were most concerned about market-based risks at both stages. Concern about production-orientated risks was lower and fell significantly between the two stages. A fixed price contract was the most common risk management technique. Risk management techniques were used more often outside London and the South East. Developer type affects both the perception and management of risk. While developers do manage risk, decisions are made on the basis of professional and business experience. These findings should help development companies manage risk in a more objective and analytical way

Tobacco policy reform and population-wide antismoking activities in Australia: the impact on smoking during pregnancy

Publisher's version (útgefin grein)Introduction This study examined the impact of antismoking activities targeting the general population and an advertising campaign targeting smoking during pregnancy on the prevalence of smoking during pregnancy in New South Wales (NSW), Australia. Methods Monthly prevalence of smoking during pregnancy was calculated using linked health records for all pregnancies resulting in a birth (800 619) in NSW from 2003 to 2011. Segmented regression of interrupted time series data assessed the effects of the extension of the ban on smoking in enclosed public places to include licensed premises (evaluated in combination with the mandating of graphic warnings on cigarette packs), television advertisements targeting smoking in the general population, print and online magazine advertisements targeting smoking during pregnancy and increased tobacco tax. Analyses were conducted for all pregnancies, and for the population stratified by maternal age, parity and socioeconomic status. Further analyses adjusted for the effect of the Baby Bonus maternity payment. Results Prevalence of smoking during pregnancy decreased from 2003 to 2011 overall (0.39% per month), and for all strata examined. For pregnancies overall, none of the evaluated initiatives was associated with a change in the trend of smoking during pregnancy. Significant changes associated with increased tobacco tax and the extension of the smoking ban (in combination with graphic warnings) were found in some strata. Conclusions The declining prevalence of smoking during pregnancy between 2003 and 2011, while encouraging, does not appear to be directly related to general population antismoking activities or a pregnancy-specific campaign undertaken in this period.This research was supported by an Australian National Health and Medical Research Council Project Grant (#1028543) and AH is supported by a National Heart Foundation Future Leader Fellowship (#100411). The funders had no involvement in the study design; the collection, analysis or interpretation of the data; in the writing of the report or the decision to submit the report for publication.Peer Reviewe