MODELLING THE PREVALENCE OF DOWN SYNDROME WITH APPLICATIONS OF MARKOV CHAIN MONTE CARLO METHODS

This thesis was motivated by applications in the epidemiology of Down syndrome and prenatal screening for Down syndrome. Methodological problems arising in these applications include under-ascertainment of cases in livebirth studies, double-sampled data with missing observations and coarsening of data. These issues are considered from a classical perspective using maximum likelihood and from a Bayesian viewpoint employing Markov chain Monte Carlo (MCMC) techniques. Livebirth prevalence studies published in the literature used a variety of data collection methods and many are of uncertain completeness. In two of the nine studies an estimate of the level of under-reporting is available. We present a meta-analysis of these studies in which maternal age-related risks and the levels of under-ascertainment in individual studies are estimated simultaneously. A modified logistic model is used to describe the relationship between Down syndrome prevalence and maternal age. The model is then extended to include data from several studies of prevalence rates observed at times of chorionic villus sampling (CVS) and amniocentesis. New estimates for spontaneous loss rates between the times" of CVS, amniocentesis and live birth are presented. The classical analysis of live birth prevalence data is then compared with an MCMC analysis which allows prior information concerning ascertainment to be incorporated. This approach is particularly attractive since the double-sampled data structure includes missing observations. The MCMC algorithm, which uses single-component Metropolis-Hastings steps to simulate model parameters and missing data, is run under three alternative prior specifications. Several convergence diagnostics are also considered and compared. Finally, MCMC techniques are used to model the distribution of fetal nuchal translucency (NT), an ultrasound marker for Down syndrome. The data are a mixture of measurements rounded to whole millimetres and measurements more accurately recorded to one decimal place. An MCMC algorithm is applied to simulate the proportion of measurements rounded to whole millimetres and parameters to describe the distribution of NT in unaffected and Down syndrome pregnancies. Predictive probabilities of Down syndrome given NT and maternal age are then calculated

Building capacity to use and undertake applied health research: establishing a training programme for the health workforce in the West of England

ObjectivesIncreasing research capacity is important for health services as part of improving the conduct of high quality research which addresses the needs of patients and the public. It is a core function of the 13 Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) established in England between 2008 and 2013. This paper reports on the development of an innovative capacity building programme in CLAHRC West over an 18-month period (May 2015-December 2016). It aims to disseminate the learning from the initiative and share our experience with other CLAHRCs.Study DesignThe study design was an evaluation of a training programme to build research capacity.MethodsWe carried out a training needs assessment among local stakeholders and scoped existing provision of research-related training. This informed the development of a programme of free short courses which were targeted at health and social care professionals including those working in local authorities and the voluntary sector. We aimed to engage professionals working at all levels in these organisations and to promote interprofessional education, in order to build a research culture. We engaged a variety of educators to provide a range of one-day courses at an introductory level which were accessible to practitioners.ResultsDuring the first 18 months of the training programme we delivered 31 courses and trained 350 participants. Attendees came from secondary care (20%), voluntary sector (18%) and local authorities (18%). Professionals working in the mental health sector comprised 11% and commissioning 6%. Less well represented were primary care (3%) and community care (4%). The largest professional group was public health, followed by medical, nursing and allied health professionals in approximately equal proportions. Courses were evaluated on a scale of 1 (poor) to 4 (excellent) with the mean being 3.6 (range 3.3-4.0).ConclusionsThe training programme has been highly successful with many courses over-subscribed and all courses being well evaluated by participants. It has met the needs of local professionals for brief, applied training in research, as well as attracting those from other parts of the UK, suggesting the courses are both appropriate and helping to fill a gap in provision. We are building on this work to further engage audiences working in areas such as the wider determinants of health and commissioning, as well as primary and community sectors. CLAHRCs are uniquely placed to drive a culture change in the use, understanding and application of research across the healthcare community

Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988-2010

Introduction: Smoking prevalence has been declining in men all over Europe, while the trend varies in European regions among women. To study the impact of past smoking prevalence, we present a comprehensive overview of the most recent trends in incidence, during 1988-2010, in 26 countries, of four of the major cancers in the respiratory and upper gastro-intestinal tract associated with tobacco smoking. Methods: Data from 47 population-based cancer registries for lung, laryngeal, oral cavity and pharyngeal, and oesophageal cancer cases were obtained from the newly developed data repository within the European Cancer Observatory (http://eco.iarc.fr/). Truncated age-standardised incidence rates (35-74 years) by calendar year, average annual percentage change in incidence over 1998-2007 were calculated. Smoking prevalence in selected countries was extracted from the Organisation for Economic Co-operation and Development and the World Health Organization databases. Results:

FIREBall-2: advancing TRL while doing proof-of-concept astrophysics on a suborbital platform

Here we discuss advances in UV technology over the last decade, with an emphasis on photon counting, low noise, high efficiency detectors in sub-orbital programs. We focus on the use of innovative UV detectors in a NASA astrophysics balloon telescope, FIREBall-2, which successfully flew in the Fall of 2018. The FIREBall-2 telescope is designed to make observations of distant galaxies to understand more about how they evolve by looking for diffuse hydrogen in the galactic halo. The payload utilizes a 1.0-meter class telescope with an ultraviolet multi-object spectrograph and is a joint collaboration between Caltech, JPL, LAM, CNES, Columbia, the University of Arizona, and NASA. The improved detector technology that was tested on FIREBall-2 can be applied to any UV mission. We discuss the results of the flight and detector performance. We will also discuss the utility of sub-orbital platforms (both balloon payloads and rockets) for testing new technologies and proof-of-concept scientific ideasComment: Submitted to the Proceedings of SPIE, Defense + Commercial Sensing (SI19

Practice of Namaste Care for People Living with Dementia in the UK

Originating in the US, Namaste Care aims to improve quality of life for people with advanced dementia. However, recognition in the UK is sparse. This article reports on research that aims to create consistent understanding of the purpose, application and effect of Namaste Care. Using an online survey, telephone interviews and discussion group with UK practitioners we explored Namaste Care practice, its components and implementation challenges. Findings show that Namaste Care has potential to improve quality of life in advanced dementia and is held in high regard by practitioners. However, understanding is inconsistent and practical implementation highly varied

Prospective pathways to depressive symptoms and disordered eating in adolescence: A 7-year longitudinal cohort study

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8,915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls

Health inequalities, risky behaviours and protective factors in adolescents: An analysis of secondary survey data from the UK

Objective: Adolescents are at risk of developing detrimental health behaviours that will affect their adult health. The aim was to estimate prevalence of health risk behaviours (HRB), comparing young people (12–18 years old)in Wiltshire (UK)who are vulnerable (looked after children, special education needs and disabilities, young carers and military dependents)to those who are not vulnerable and assess whether these behaviours are associated with protective factors (e.g. friendship groups). Study design: Secondary analysis of cross-sectional survey data (n = 4129). Methods: In total, 900 vulnerable young people were compared with 3229 non-vulnerable young people. Differences between the two groups were assessed using Chi-squared tests, and associations with possible protective factors were assessed using logistic regression (adjusting for confounding factors). Results: Vulnerable young people have a higher prevalence of smoking tobacco (15% vs 9%, P < 0.001), using cannabis (7% vs 5%, P = 0.03)and self-harming (16% vs 9%, P < 0.001)monthly or more compared with the rest of the Wiltshire adolescent population. Whilst vulnerable young people have many shared protective factors with non-vulnerable young people, there are also differences between the two groups. Conclusions: There are shared protective factors across HRB that can build on the resilience of a young person, impacting their current and future health. Therefore, we should focus our attention on developing protective factors that promote health and well-being, not solely delivering specialist interventions targeted at specific risks. Further consideration should be given to identifying and promoting protective factors specifically for vulnerable people as they have higher levels of HRB and experience protective factors differently

A randomised controlled trial of student nurse performance of cardiopulmonary resuscitation in a simulated family-witnessed resuscitation scenario

© 2017 Elsevier Ltd This randomized controlled trial, conducted in a UK University nursing department, compared student nurses' performance during a simulated cardiac arrest. Eighteen teams of four students were randomly assigned to one of three scenarios: 1) no family witness; 2) a “quiet” family witness; and 3) a family witness displaying overt anxiety and distress. Each group was assessed by observers for a range of performance outcomes (e.g. calling for help, timing to starting cardiopulmonary resuscitation), and simulation manikin data on the depth and timing of three cycles of compressions. Groups without a distressed family member present performed better in the early part of the basic life support algorithm. Approximately a third of compressions assessed were of appropriate pressure. Groups with a distressed family member present were more likely to perform compressions with low pressure. Groups with no family member present were more likely to perform compressions with too much pressure. Timing of compressions was better when there was no family member present. Family presence appears to have an effect on subjectively and objectively measured performance. Further study is required to see how these findings translate into the registered nurse population, and how experience and education modify the impact of family member presence

Systematic Review of the Health and Equity Impacts of Remediation and Redevelopment of Contaminated Sites

(1) Background: Globally there is a vast legacy of contaminated sites from past industrial, commercial and military activity, waste disposal, and mineral extraction. This review examined the extent to which the remediation of contaminated sites reduces health risks to new and existing populations. (2) Methods: Standard academic databases were searched for papers that reported on health-related outcomes in humans following remediation and redevelopment of contaminated sites. Title/abstract screening, followed by full-text screening identified sixteen papers that met the eligibility criteria. (3) Results: Most studies were set in the United States of America and reported changes in blood lead concentrations in children, following soil remediation and, in some cases, public health campaigns to reduce exposure. Two further studies examined the impacts of remediation on soil contaminated with chromium and sediments contaminated with polychlorinated biphenyls (PCBs). (4) Conclusions: Overall, the evidence suggests that remediation via removal, capping, and replacing soil, and planting vegetation is effective at reducing concentrations of lead and chromium in blood and urine in children. There is also evidence that sediment dredging can reduce PCB concentrations in umbilical cords in infants. Study designs are relatively weak and some recommendations are provided for those wishing to examine the health impacts of remediation