Residual Correlation in Graph Neural Network Regression

A graph neural network transforms features in each vertex's neighborhood into a vector representation of the vertex. Afterward, each vertex's representation is used independently for predicting its label. This standard pipeline implicitly assumes that vertex labels are conditionally independent given their neighborhood features. However, this is a strong assumption, and we show that it is far from true on many real-world graph datasets. Focusing on regression tasks, we find that this conditional independence assumption severely limits predictive power. This should not be that surprising, given that traditional graph-based semi-supervised learning methods such as label propagation work in the opposite fashion by explicitly modeling the correlation in predicted outcomes. Here, we address this problem with an interpretable and efficient framework that can improve any graph neural network architecture simply by exploiting correlation structure in the regression residuals. In particular, we model the joint distribution of residuals on vertices with a parameterized multivariate Gaussian, and estimate the parameters by maximizing the marginal likelihood of the observed labels. Our framework achieves substantially higher accuracy than competing baselines, and the learned parameters can be interpreted as the strength of correlation among connected vertices. Furthermore, we develop linear time algorithms for low-variance, unbiased model parameter estimates, allowing us to scale to large networks. We also provide a basic version of our method that makes stronger assumptions on correlation structure but is painless to implement, often leading to great practical performance with minimal overhead

Resilience of New Zealand indigenous forest fragments to impacts of livestock and pest mammals

A number of factors have combined to diminish ecosystem integrity in New Zealand indigenous lowland forest fragments surrounded by intensively grazed pasture. Livestock grazing, mammalian pests, adventive weeds and altered nutrient input regimes are important drivers compounding the changes in fragment structure and function due to historical deforestation and fragmentation. We used qualitative systems modelling and empirical data from Beilschmiedia tawa dominated lowland forest fragments in the Waikato Region to explore the relevance of two common resilience paradigms – engineering resilience and ecological resilience – for addressing the conservation management of forest fragments into the future. Grazing by livestock and foraging/predation by introduced mammalian pests both have direct detrimental impacts on key structural and functional attributes of forest fragments. Release from these perturbations through fencing and pest control leads to partial or full recovery of some key indicators (i.e. increased indigenous plant regeneration and cover, increased invertebrate populations and litter mass, decreased soil fertility and increased nesting success) relative to levels seen in larger forest systems over a range of timescales. These changes indicate that forest fragments do show resilience consistent with adopting an engineering resilience paradigm for conservation management, in the landscape context studied. The relevance of the ecological resilience paradigm in these ecosystems is obscured by limited data. We characterise forest fragment dynamics in terms of changes in indigenous species occupancy and functional dominance, and present a conceptual model for the management of forest fragment ecosystems

Diagnostic thoracic ultrasound imaging – An exploration of respiratory physiotherapists' interest and use in clinical practice: A national survey

Introduction Physiotherapists are learning to perform diagnostic thoracic ultrasound but it is currently unknown how they are learning, how they are using thoracic ultrasound in their practice, or any factors affecting the implementation of thoracic ultrasound into practice. The aim of this survey was to explore the use of thoracic ultrasound by physiotherapists. This information could be used to aid training and implementation strategies to assist physiotherapists to integrate thoracic ultrasound safely into their practice. Methods A questionnaire comprising of open/closed questions was distributed to respiratory physiotherapist. Distribution was at three national study days and via a specialist newsletter containing a link to a SurveyMonkey™ questionnaire. Results A total of 133 questionnaires were returned with 31 reported that they used thoracic ultrasound imaging and 101 reporting they did not. The most common roles of thoracic ultrasound in practice were to: enhance the ability to differentially diagnose respiratory pathologies, aid respiratory assessment and support clinical reasoning. Of the 133 respondents, 58 reported that they had undertaken training in thoracic ultrasound imaging and 75 had not. The most common factors identified regarding thoracic ultrasound implementation were team support, ultrasound machine availability/cost, time pressures and mentor availability. Discussion This survey has provided an understanding of thoracic ultrasound practice amongst respiratory physiotherapists in the UK. The survey results demonstrated the barriers that inhibit current practice and highlighted the importance of mentor support. There was a good understanding by all respondents regarding the clinical application of thoracic ultrasound. These findings are being used to develop professional guidance and ensure safe practice of thoracic ultrasound

Challenges and opportunities in point-of-care ultrasound: A qualitative exploration of respiratory physiotherapists' experiences of lung ultrasound training and its adoption in critical care

Introduction Diagnostic lung ultrasound (LUS) is gaining popularity among respiratory physiotherapists as an imaging modality to aid pulmonary assessments, guide intervention selection, and monitor the efficacy of chosen interventions. The ability of respiratory physiotherapists to incorporate LUS into their clinical practice is influenced by multiple factors to adoption and implementation. The aim of this study was to explore the experiences of senior respiratory physiotherapists who have attempted to adopt and implement LUS into their clinical practice in critical care. It is hoped these experiences will inform the development of educational and adoption strategies for the future implementation of LUS. Methods Following a national call out, eight senior critical care respiratory physiotherapists were purposively selected to be interviewed using semi-structured questions exploring their varied experiences of LUS adoption into clinical practice in critical care. The transcribed data were thematically analysed. Results Five main themes emerged from the participants’ responses: (i) support for physiotherapists using LUS, (ii) knowledge and understanding of LUS evidence, (iii) governance, (iv) physiotherapists’ motivation to use LUS, and (v) resources. Quotes for each of the five themes are given as exemplars. Conclusion Participants reported a range of factors that influenced their ability to adopt and implement LUS into practice several were enabling, and others were barriers to progress. Online Appendix 1 contains recommendations from the authors to help guide managers and clinicians wishing to adopt LUS into respiratory physiotherapy services and patient pathways

A proposed framework for point of care lung ultrasound by respiratory physiotherapists: scope of practice, education and governance

Abstract: Background: Point of care ultrasound (PoCUS) has the potential to provide a step change in the management of patients across a range of healthcare settings. Increasingly, healthcare practitioners who are not medical doctors are incorporating PoCUS into their clinical practice. However, the professional, educational and regulatory environment in which this occurs is poorly developed, leaving clinicians, managers and patients at risk. Main body: Drawing upon existing medical and non-medical literature, the authors present a proposed framework for the use of PoCUS. Throughout, mechanisms for applying the principles to other professionals and healthcare settings are signposted. Application of the framework is illustrated via one such group of healthcare practitioners and in a particular healthcare setting: respiratory physiotherapists in the UK. In defining the point of care LUS scope of practice we detail what structures are imaged, differentials reported upon and clinical decisions informed by their imaging. This is used to outline the educational and competency requirements for respiratory physiotherapists to safely and effectively use the modality. Together, these are aligned with the regulatory (professional, legal and insurance) arrangements for this professional group in the UK. In so doing, a comprehensive approach for respiratory physiotherapists to consolidate and expand their use of point of care LUS is presented. This provides clarity for clinicians as to the boundaries of their practice and how to train in the modality; it supports educators with the design of courses and alignment of competency assessments; it supports managers with the staffing of existing and new care pathways. Ultimately it provides greater accessibility for patients to safe and effective point of care lung ultrasound. For clinicians who are not respiratory physiotherapists and/or are not based in the UK, the framework can be adapted to other professional groups using point of care LUS as well as other point of care ultrasound (PoCUS) applications, thereby providing a comprehensive and sustainable foundation for PoCUS consolidation and expansion. Conclusion: This paper presents a comprehensive framework to support the use of point of care LUS by respiratory physiotherapists in the UK. Mechanisms to adapt the model to support a wide range of other PoCUS users are outlined

A proposed framework for point of care musculoskeletal ultrasound and ultrasound image-guided interventions by physiotherapists: scope of practice, education and governance

Background: The use of point of care ultrasound (PoCUS) in the management of musculoskeletal (MSK) disorders is a diverse area of PoCUS practice. Its use by clinicians, such as physiotherapists, can occur across a wide range of roles and care pathway configurations; however, professional, educational and regulatory uncertainties can leave clinicians, managers and patients at risk. Main body: A PoCUS framework approach (previously applied to support PoCUS consolidation and expansion) is used to frame these proposals. Central to this is the defining of (clinical and sonographic) scope of practice (ScoP). A number of indicative ScoPs are described to both (i) illustrate application of the principles and (ii) provide templates for ScoP derivations for individual services or clinicians. Image-guided MSK interventions are increasingly an aspect of MSK physiotherapy PoCUS. Given the utility of physiotherapists drawing upon their imaging to fully inform the selection (and performance) of such techniques, we present a rationale for competency in undertaking sonographic differentials as a pre-cursor to performing ultrasound image-guided MSK interventions. Alignment of ScoP with the relevant education and formal competency assessments are a cornerstone of the PoCUS framework approach; as such, key aspects of MSK PoCUS education and competency assessment are outlined. Strategies for addressing such requirements in healthcare settings where formal provision is not accessible, are also presented. Governance considerations are aligned with the regulatory environment, including those pertaining to professional guidance and insurance considerations. In addition, generic quality assurance elements are emphasised, as core aspects of high-quality service provision. Whilst the paper clarifies the situation for MSK physiotherapists using PoCUS in the UK, prompts are provided to support other professional groups working in MSK services in the United Kingdom (UK) and MSK physiotherapists/physical therapists in other countries—to facilitate their application of the principles. Conclusion: Acknowledging the breadth of MSK physiotherapy PoCUS practice, this paper draws upon a framework approach to provide integrated ScoP, education/competency and governance solutions, along with mechanisms for other professions working with MSK PoCUS—and physiotherapists/physical therapists outside of the UK—to consolidate and expand their practice

Point of care ultrasound in pelvic health: scope of practice, education and governance for physiotherapists

Pelvic health and pelvic floor dysfunction have wide-reaching implications across a range of patient groups. Placing ultrasound imaging into the hands of assessing and treating clinicians (i.e. point of care ultrasound, PoCUS) can provide a step change in clinical effectiveness and efficiency. Pelvic floor dysfunction is managed by one or more members of a multi-disciplinary team that includes physiotherapists. Physiotherapists’ involvement includes diagnosis, patient education, identifying shared treatment goals, using rehabilitative strategies and empowering patients through self-management. Drawing upon existing publications in this area and applying framework principles, the authors propose a clinical and sonographic scope of practice for physiotherapists as part of supporting the consolidation and expansion of pelvic health PoCUS. Education and governance considerations are detailed to ensure the robust and safe use of this modality. Alongside empowering the use of ultrasound imaging by clinicians such as physiotherapists in the UK and internationally, we provide clarity to other members of the care pathway and ultrasound imaging professionals