65 research outputs found
Competences for democratic culture: An empirical study of an intercultural citizenship project in language pedagogy
Get PDFThis article reports on a pedagogical intervention in foreign language teaching in higher education. It analizes the competences developed by Argentinian and UK-based students as they used Skype to design a leaflet that addressed a real world issue: the Argentinian military dictatorship and its manipulation of the 1978 Football World Cup. The data consists of students’ discussions of this highly disturbing human rights issue. A first level of analysis focused on identifying evidence of competences using the Council of Europe’s conceptual model of ‘competences for democratic culture’ (2016). In a second level of analysis, the data was categorized within the framework of Article 2.2 of the United Nations Declaration on Human Rights Education and Training (2011). This research study provides an empirical test of these two frameworks in the field of language education, an aspect that has not been investigated before. It also contributes to our understanding of the potential of intercultural citizenship projects in achieving the goals of human rights education in foreign language teaching. Results indicate the development of substantial competences for democratic culture defined in the Council of Europe’s model
Competences for democratic culture: An empirical study of an intercultural citizenship project in language pedagogy
Get PDFThis article reports on a pedagogical intervention in foreign language teaching in higher education. It analizes the competences developed by Argentinian and UK-based students as they used Skype to design a leaflet that addressed a real world issue: the Argentinian military dictatorship and its manipulation of the 1978 Football World Cup. The data consists of students’ discussions of this highly disturbing human rights issue. A first level of analysis focused on identifying evidence of competences using the Council of Europe’s conceptual model of ‘competences for democratic culture’ (2016). In a second level of analysis, the data was categorized within the framework of Article 2.2 of the United Nations Declaration on Human Rights Education and Training (2011). This research study provides an empirical test of these two frameworks in the field of language education, an aspect that has not been investigated before. It also contributes to our understanding of the potential of intercultural citizenship projects in achieving the goals of human rights education in foreign language teaching. Results indicate the development of substantial competences for democratic culture defined in the Council of Europe’s model
The LeVe CPAP System for Oxygen-Efficient CPAP Respiratory Support: Development and Pilot Evaluation
Get PDFBackground: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed a significant demand on healthcare providers (HCPs) to provide respiratory support for patients with moderate to severe symptoms. Continuous Positive Airway Pressure (CPAP) non-invasive ventilation can help patients with moderate symptoms to avoid the need for invasive ventilation in intensive care. However, existing CPAP systems can be complex (and thus expensive) or require high levels of oxygen, limiting their use in resource-stretched environments.
Technical Development + Testing: The LeVe (“Light”) CPAP system was developed using principles of frugal innovation to produce a solution of low complexity and high resource efficiency. The LeVe system exploits the air flow dynamics of electric fan blowers which are inherently suited to delivery of positive pressure at appropriate flow rates for CPAP. Laboratory evaluation demonstrated that performance of the LeVe system was equivalent to other commercially available systems used to deliver CPAP, achieving a 10 cm H2O target pressure within 2.4% RMS error and 50–70% FiO2 dependent with 10 L/min oxygen from a commercial concentrator.
Pilot Evaluation: The LeVe CPAP system was tested to evaluate safety and acceptability in a group of ten healthy volunteers at Mengo Hospital in Kampala, Uganda. The study demonstrated that the system can be used safely without inducing hypoxia or hypercapnia and that its use was well-tolerated by users, with no adverse events reported.
Conclusions: To provide respiratory support for the high patient numbers associated with the COVID-19 pandemic, healthcare providers require resource efficient solutions. We have shown that this can be achieved through frugal engineering of a CPAP ventilation system, in a system which is safe for use and well-tolerated in healthy volunteers. This approach may also benefit other respiratory conditions which often go unaddressed in Low and Middle Income Countries (LMICs) for want of context-appropriate technology designed for the limited oxygen resources available
Genome-wide association studies in oesophageal adenocarcinoma and Barrett's oesophagus: a large-scale meta-analysis.
Get PDFBACKGROUND: Oesophageal adenocarcinoma represents one of the fastest rising cancers in high-income countries. Barrett's oesophagus is the premalignant precursor of oesophageal adenocarcinoma. However, only a few patients with Barrett's oesophagus develop adenocarcinoma, which complicates clinical management in the absence of valid predictors. Within an international consortium investigating the genetics of Barrett's oesophagus and oesophageal adenocarcinoma, we aimed to identify novel genetic risk variants for the development of Barrett's oesophagus and oesophageal adenocarcinoma. METHODS: We did a meta-analysis of all genome-wide association studies of Barrett's oesophagus and oesophageal adenocarcinoma available in PubMed up to Feb 29, 2016; all patients were of European ancestry and disease was confirmed histopathologically. All participants were from four separate studies within Europe, North America, and Australia and were genotyped on high-density single nucleotide polymorphism (SNP) arrays. Meta-analysis was done with a fixed-effects inverse variance-weighting approach and with a standard genome-wide significance threshold (p<5 × 10-8). We also did an association analysis after reweighting of loci with an approach that investigates annotation enrichment among genome-wide significant loci. Furthermore, the entire dataset was analysed with bioinformatics approaches-including functional annotation databases and gene-based and pathway-based methods-to identify pathophysiologically relevant cellular mechanisms. FINDINGS: Our sample comprised 6167 patients with Barrett's oesophagus and 4112 individuals with oesophageal adenocarcinoma, in addition to 17 159 representative controls from four genome-wide association studies in Europe, North America, and Australia. We identified eight new risk loci associated with either Barrett's oesophagus or oesophageal adenocarcinoma, within or near the genes CFTR (rs17451754; p=4·8 × 10-10), MSRA (rs17749155; p=5·2 × 10-10), LINC00208 and BLK (rs10108511; p=2·1 × 10-9), KHDRBS2 (rs62423175; p=3·0 × 10-9), TPPP and CEP72 (rs9918259; p=3·2 × 10-9), TMOD1 (rs7852462; p=1·5 × 10-8), SATB2 (rs139606545; p=2·0 × 10-8), and HTR3C and ABCC5 (rs9823696; p=1·6 × 10-8). The locus identified near HTR3C and ABCC5 (rs9823696) was associated specifically with oesophageal adenocarcinoma (p=1·6 × 10-8) and was independent of Barrett's oesophagus development (p=0·45). A ninth novel risk locus was identified within the gene LPA (rs12207195; posterior probability 0·925) after reweighting with significantly enriched annotations. The strongest disease pathways identified (p<10-6) belonged to muscle cell differentiation and to mesenchyme development and differentiation. INTERPRETATION: Our meta-analysis of genome-wide association studies doubled the number of known risk loci for Barrett's oesophagus and oesophageal adenocarcinoma and revealed new insights into causes of these diseases. Furthermore, the specific association between oesophageal adenocarcinoma and the locus near HTR3C and ABCC5 might constitute a novel genetic marker for prediction of the transition from Barrett's oesophagus to oesophageal adenocarcinoma. Fine-mapping and functional studies of new risk loci could lead to identification of key molecules in the development of Barrett's oesophagus and oesophageal adenocarcinoma, which might encourage development of advanced prevention and intervention strategies. FUNDING: US National Cancer Institute, US National Institutes of Health, National Health and Medical Research Council of Australia, Swedish Cancer Society, Medical Research Council UK, Cambridge NIHR Biomedical Research Centre, Cambridge Experimental Cancer Medicine Centre, Else Kröner Fresenius Stiftung, Wellcome Trust, Cancer Research UK, AstraZeneca UK, University Hospitals of Leicester, University of Oxford, Australian Research Council
The effects of integrated care: a systematic review of UK and international evidence
Get PDFBACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725
Assessment of polygenic architecture and risk prediction based on common variants across fourteen cancers
Get PDFAbstract: Genome-wide association studies (GWAS) have led to the identification of hundreds of susceptibility loci across cancers, but the impact of further studies remains uncertain. Here we analyse summary-level data from GWAS of European ancestry across fourteen cancer sites to estimate the number of common susceptibility variants (polygenicity) and underlying effect-size distribution. All cancers show a high degree of polygenicity, involving at a minimum of thousands of loci. We project that sample sizes required to explain 80% of GWAS heritability vary from 60,000 cases for testicular to over 1,000,000 cases for lung cancer. The maximum relative risk achievable for subjects at the 99th risk percentile of underlying polygenic risk scores (PRS), compared to average risk, ranges from 12 for testicular to 2.5 for ovarian cancer. We show that PRS have potential for risk stratification for cancers of breast, colon and prostate, but less so for others because of modest heritability and lower incidence
Statistical analysis of self-assessed quality of life in cancer clinical trials
Get PDFThe assessment of quality of life as a primary outcome
in
cancer
clinical trials
is
now almost
universal. Such data are necessarily longitudinal and multidimensional, and
are often severely
unbalanced by missing values or early patient death. However, to
date, their
reporting
in the
applied literature has generally used simple descriptive summaries
that
ignore
many
of these
complexities. Not only can these be misleading,
but they
generally
do
not
allow
firm
conclusions to be drawn about a major endpoint.
The
aim
of this thesis
is to
assess the
practical
application of recent developments in statistical methodology
for the
analysis of quality
of
life
data collected using self assessment questionnaires within
cancer clinical trials. Its
emphasis
is on the use of relatively simple and flexible tools that
will
allow more reliable
and powerful
inferences to be drawn from the data than is done at present.
The principal statistical tools considered are random
coefficient and
marginal models.
It
is shown that these can be successfully used for the
analysis
of continuous,
binary
and
ordinal
responses. In particular, they offer a simple approach to the
analysis of repeated
multivariate
outcomes and can be very easily extended to model the
complex patterns
of response that
are
often seen in following cancer treatment.
In relation to the problem of censored quality
of
life
as a result of patient
death,
analyses
that attempt to combine the survival and quality
of
life
endpoints
in
a single variable are
contrasted with those that consider the two endpoints
as a multivariate
problem.
It is
shown
how this latter model can provide a summary of the
quality
of
life
response
conditional on patient survival that with further work should
have
great application to
such quality of
life data.
Finally, the problem of intermittent missing
data is
reviewed.
The implications
of missing
data for some of the analyses presented
in the thesis
are
assessed,
and two
models
that
attempt
to determine the nature of intermittent missing
data
are
developed. It is
concluded that the
problem of non-ignorable intermittent missing
data
presents
a very
challenging
area of
further
research
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