The Empirical Properties of Some Popular Estimators of Long Memory Processes

We present the results of a simulation study into the properties of 12 different estimators of the Hurst parameter, H, or the fractional integration parameter, d, in long memory time series. We compare and contrast their performance on simulated Fractional Gaussian Noises and fractionally integrated series with lengths between 100 and 10,000 data points and H values between 0.55 and 0.90 or d values between 0.05 and 0.40. We apply all 12 estimators to the Campito Mountain data and estimate the accuracy of their estimates using the Beran goodness of t test for long memory time series.Strong dependence; global dependence; long range dependence; Hurst parameter estimators

The case of child abuse and neglect: identification of non-accidental injuries by medical professionals at the emergency and trauma department

It is well established that accidental and non-accidental injuries/child abuse and neglect (CAN) are a major public health problem globally. Not only do they affect individuals, injuries affect families, the community, government and internationally as well. Injuries span throughout childhood and into adulthood. Purpose of this study is to identify what are the difficulties and challenges in identifying and reporting CAN cases at the emergency (ED) department in Malaysian hospitals. Thirty in-depth interviews were conducted at the ED in three major hospitals in the Klang Valley, Malaysia which consists of specialists, medical officers, nurses and medical assistants. The study found that there is a significant gap identified in medical professionals’ knowledge and skills related to understanding, identifying and detecting CAN, particularly among medical officers who are in charge of diagnosis and reports in the hospital. Those who had previous experience or encounters in dealing with CAN cases would have higher suspicion index compared to those who haven’t. Other medical professionals such as nurses and medical assistants although do not have the mandate to diagnose or report of CAN cases, needed to have the basic knowledge and awareness and play more active role in their respective settings

Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis

Background: frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes. Methods: paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models. Results: we included 14 studies (n = 27,210 participants). Seven studies (n = 8,840) used a frailty index approach, four studies (n = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2–33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9–83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41–5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies). Conclusions: despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways

Resetting transcription factor control circuitry toward ground-state pluripotency in human.

Current human pluripotent stem cells lack the transcription factor circuitry that governs the ground state of mouse embryonic stem cells (ESC). Here, we report that short-term expression of two components, NANOG and KLF2, is sufficient to ignite other elements of the network and reset the human pluripotent state. Inhibition of ERK and protein kinase C sustains a transgene-independent rewired state. Reset cells self-renew continuously without ERK signaling, are phenotypically stable, and are karyotypically intact. They differentiate in vitro and form teratomas in vivo. Metabolism is reprogrammed with activation of mitochondrial respiration as in ESC. DNA methylation is dramatically reduced and transcriptome state is globally realigned across multiple cell lines. Depletion of ground-state transcription factors, TFCP2L1 or KLF4, has marginal impact on conventional human pluripotent stem cells but collapses the reset state. These findings demonstrate feasibility of installing and propagating functional control circuitry for ground-state pluripotency in human cells.This research was supported by the UK Medical Research Council, the Japan Science and Technology agency (JST, PRESTO), the Genome Biology Unit of the European Molecular Biology Laboratory, European Commission projects PluriMes, BetaCellTherapy, EpiGeneSys, and Blueprint, and the Wellcome Trust. Y.T. was a University of Cambridge Herchel Smith Fellow. A.S. is a Medical Research Council Professor

Measurement scale development for mobility-related quality of life among older Malaysian drivers

Quality of Life (QoL) is frequently understood as subjective well-being at both individual and population levels and specific to a country or context. For individuals, mobility afforded by transport is an important predictor of QoL. This paper aims to provide an overview of theoretical approaches, particularly the selection, optimization, compensation (SOC) model, the scales used to measure quality of life, and the scale development of Mobility-related Quality of Life (M-QoL) among older drivers. A pool of items was developed from three sources: i) literature review, ii) Instrumental Activities of Daily Living (IADL) scale and iii) focus group discussion with older drivers. A survey amongst 498 older Malaysian drivers was administered to confirm internal consistency of the scale. Exploratory factor analysis revealed that the developed M-QoL scale consists of 12 items with good internal consistency (α = 0.90), and consists of two subfactors addressing functions of driving and accessibility for independent living. Implications of the findings are discussed, including encouraging continuation of driving for those who are able to drive safely, and provision and use of alternatives to driving to help them achieve maximum mobility. Suggestions for future research are also recommended

Development of a valid measurement instrument to understand self-regulatory driving practices among older drivers in Malaysia

Self-regulatory driving is a term used to describe a strategy used by older drivers to preserve mobility and safety, through the adjustment of driving behaviors to match declining physical functions. It can be regarded as a way to prolong driving, or as a process leading to the cessation of driving. Previous studies have striven to explore and understand how older drivers self-regulate their driving. This paper aims to provide an overview of the relevant theories, to explicate the factors that contribute to the adoption of self-regulated driving and the scales used to measure self-regulatory behaviors. This paper also reports on the development and psychometric testing of a Self-Regulatory Driving Practices (SRDP) scale in the Malaysian context. Based on the reviewed theories, adoption of self-regulatory driving practices is a process and involves cognitive thinking that reflects a set of actions. Existing instruments to measure self-regulatory driving practices have been developed and used to identify the behavioral components of self-regulation. Based on literature reviews and a thematic analysis from focus group discussions, a SRDP scale was developed, accommodating the Malaysian context. There were 498 surveys completed by older drivers for further psychometric testing purposes. Results revealed that the final 12-item SRDP scale (α = 0.81) consists of four subscales that are planning, avoidance, reduction and alternatives. Suggestions for future research are also recommended

Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group

Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care.Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives.Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided.Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD

Disordered Microbial Communities in the Upper Respiratory Tract of Cigarette Smokers

Cigarette smokers have an increased risk of infectious diseases involving the respiratory tract. Some effects of smoking on specific respiratory tract bacteria have been described, but the consequences for global airway microbial community composition have not been determined. Here, we used culture-independent high-density sequencing to analyze the microbiota from the right and left nasopharynx and oropharynx of 29 smoking and 33 nonsmoking healthy asymptomatic adults to assess microbial composition and effects of cigarette smoking. Bacterial communities were profiled using 454 pyrosequencing of 16S sequence tags (803,391 total reads), aligned to 16S rRNA databases, and communities compared using the UniFrac distance metric. A Random Forest machine-learning algorithm was used to predict smoking status and identify taxa that best distinguished between smokers and nonsmokers. Community composition was primarily determined by airway site, with individuals exhibiting minimal side-of-body or temporal variation. Within airway habitats, microbiota from smokers were significantly more diverse than nonsmokers and clustered separately. The distributions of several genera were systematically altered by smoking in both the oro- and nasopharynx, and there was an enrichment of anaerobic lineages associated with periodontal disease in the oropharynx. These results indicate that distinct regions of the human upper respiratory tract contain characteristic microbial communities that exhibit disordered patterns in cigarette smokers, both in individual components and global structure, which may contribute to the prevalence of respiratory tract complications in this population