Empirical Bayes Methods for Discrete Event Simulation Performance Measure Estimation

Discrete event simulation (DES) is a widely-used operational research methodology facilitating the analysis of complex real-world systems. Although, generally speaking, simplicity is greatly desirable in DES modelling applications, in many cases the nature of the underlying system results in simulation models which are large in scale, complex, and expensive to run. As such, the careful design and analysis of simulation experiments is essential to ensure valid and efficient inference concerning DES model performance measures. It is envisaged that empirical Bayes (EB) methods, which enable data to be pooled across a set of populations to support inference of the parameters of a single population, may be of use within this context. Despite this potential, EB has so far been neglected within the DES literature. This paper presents a preliminary computational investigation into the efficacy of EB procedures in the estimation of DES performance measures. The results of this investigation, and their significance, are explored. Additionally, likely directions for future research are also addressed

The Human Cost of 'Caring' Care for Registered Nurses in Clinical Practice

This research utilised a focus group methodology to discover what nurses in clinical practice considered 'caring' care meant for them. Six registered nurses volunteered to participate in the project. They practised over a variety of clinical settings within a public hospital, which provided both acute and elective surgical and medical services to the community, including an extensive elderly population. Taking these important 'caring' care statements, I then explored with the group what factors in their work environment hindered or enhanced their identified 'caring' care. New Zealand nurses identified similar themes and concepts important to their 'caring' in clinical practice as did their overseas counterparts. This study also highlighted the impact the health reforms had on individual clinical practice at this hospital. The effects of the institutional changes in response to the health reforms were far reaching at both a personal and professional level. Caring is an important concept found in nursing practice. It has been widely documented by nurse scholars, researchers and nurse authors that care is at the core of nursing practice. Some have even referred to care as being the heart of nursing. The findings from the present research indicates the importance nurses place on caring in their day to day encounters with patients. It also demonstrates how nurses express their care and their perceptions of the importance care has in their clinical practice

Critical systems heuristics : a systematic review

Critical systems heuristics (CSH) has been influential in the development of critical systems thinking. However, it is a relatively underutilised method compared with soft systems approaches such as soft systems methodology (SSM) and cognitive mapping. This may be in part due to the complexity of ideas underpinning CSH. Core ideas with which users must feel confident include boundary critique, coercion, emancipation, and “is” vs “ought to be” framings. These ideas were the subject of the early discourse surrounding CSH, which considered the role of boundary critique in systems research, the extent to which CSH could meaningfully address coercion, and the claims of CSH as an emancipatory approach. The purpose of this review is to provide clarity on these key concepts by reflecting on how they have been addressed in the CSH literature to date. We find that CSH has been applied in a range of problem contexts and is most frequently applied to address coercion or power asymmetries. CSH research is frequently associated with advocacy for marginalised groups, and we believe this is a natural extension of the methodological emancipation to which CSH aspires. In providing an overview of the key ideas underpinning CSH, we hope to lower the barrier to application for systems researchers and practitioners

Combining Bayesianism and reflexivity in interpretivist research

A trio of researchers with very different backgrounds present an argument towards using a combination of qualitative and quantitative methods in Interpretivist research. Drawing upon an ongoing study where this approach has been put into practice, and continues to evolve, the advantages of remaining open-minded when choosing methods and resisting external pressure to be restricted by "boxes" of acceptable methods is illustrated using examples. The importance of conducting insider research is emphasised, and comparisons are drawn between reflexivity in management research, and the philosophy behind Bayesianism. Strong emphasis is placed upon the requirement for good research, rather than that which can be classified simply as either quantitative or qualitative

An evaluation framework study assessing the role, applicability, and adherence to good practice of planning support tools for allocation of development aid for health in low- and middle-income countries

Objectives: Allocation of Development Aid for Health (DAH) is controversial and challenging. In recent years, several planning-software tools have promised to help decision-makers align resource allocation with their objectives, more clearly connect prioritisation to evidence and local circumstances, and increase transparency and comparability. We aim to explore these tools to provide insight into their fitness for purpose and suggest future directions to fulfil that promise. Design: We identified seven tools that met the inclusion criteria and developed an evaluation framework to compare them along two dimensions for assessing fitness for pupose: ability to produce analyses adhering to principles laid out in the International Decisions Support Initiative (iDSI) Reference Case for health economic evaluations; and resources required, including expertise and time. We extracted information from documentation and tool use and sent this information to tool developers for confirmation. Results: We categorise the tools into evidence-generating ones, evidence-syntheses ones, and process support ones. Tools’ fitness for purpose varies by the context, technical capacity, and time limitation. The tools adhere to several Reference Case principles but often not to all of them. The source and underlying assumptions of pre-populated data are often opaque. Comparing vertical interventions across diseases and health system strengthening ones remains challenging. Conclusions: The plethora of tools that aid priority setting in different ways is encouraging. Developers and users should place further emphasis on their ability to produce analyses that adhere to prioritisation principles. Opportunities for further development include using evidence-generating tools and Multi-Criteria Decision Analysis approaches complimentarily. However, maintaining tool simplicity should also be considered to allow wider access

The Potential of Honey as a Prebiotic Food to Re-engineer the Gut Microbiome Toward a Healthy State

Honey has a long history of use for the treatment of digestive ailments. Certain honey types have well-established bioactive properties including antibacterial and anti-inflammatory activities. In addition, honey contains non-digestible carbohydrates in the form of oligosaccharides, and there is increasing evidence from in vitro, animal, and pilot human studies that some kinds of honey have prebiotic activity. Prebiotics are foods or compounds, such as non-digestible carbohydrates, that are used to promote specific, favorable changes in the composition and function of the gut microbiota. The gut microbiota plays a critical role in human health and well-being, with disturbances to the balance of these organisms linked to gut inflammation and the development and progression of numerous conditions, such as colon cancer, irritable bowel syndrome, obesity, and mental health issues. Consequently, there is increasing interest in manipulating the gut microbiota to a more favorable balance as a way of improving health by dietary means. Current research suggests that certain kinds of honey can reduce the presence of infection-causing bacteria in the gut including Salmonella, Escherichia coli, and Clostridiodes difficile, while simultaneously stimulating the growth of potentially beneficial species, such as Lactobacillus and Bifidobacteria. In this paper, we review the current and growing evidence that shows the prebiotic potential of honey to promote healthy gut function, regulate the microbial communities in the gut, and reduce infection and inflammation. We outline gaps in knowledge and explore the potential of honey as a viable option to promote or re-engineer a healthy gut microbiome

Targeted genetic testing for familial hypercholesterolaemia using next generation sequencing:a population-based study

Background<p></p> Familial hypercholesterolaemia (FH) is a common Mendelian condition which, untreated, results in premature coronary heart disease. An estimated 88% of FH cases are undiagnosed in the UK. We previously validated a method for FH mutation detection in a lipid clinic population using next generation sequencing (NGS), but this did not address the challenge of identifying index cases in primary care where most undiagnosed patients receive healthcare. Here, we evaluate the targeted use of NGS as a potential route to diagnosis of FH in a primary care population subset selected for hypercholesterolaemia.<p></p> Methods<p></p> We used microfluidics-based PCR amplification coupled with NGS and multiplex ligation-dependent probe amplification (MLPA) to detect mutations in LDLR, APOB and PCSK9 in three phenotypic groups within the Generation Scotland: Scottish Family Health Study including 193 individuals with high total cholesterol, 232 with moderately high total cholesterol despite cholesterol-lowering therapy, and 192 normocholesterolaemic controls.<p></p> Results<p></p> Pathogenic mutations were found in 2.1% of hypercholesterolaemic individuals, in 2.2% of subjects on cholesterol-lowering therapy and in 42% of their available first-degree relatives. In addition, variants of uncertain clinical significance (VUCS) were detected in 1.4% of the hypercholesterolaemic and cholesterol-lowering therapy groups. No pathogenic variants or VUCS were detected in controls.<p></p> Conclusions<p></p> We demonstrated that population-based genetic testing using these protocols is able to deliver definitive molecular diagnoses of FH in individuals with high cholesterol or on cholesterol-lowering therapy. The lower cost and labour associated with NGS-based testing may increase the attractiveness of a population-based approach to FH detection compared to genetic testing with conventional sequencing. This could provide one route to increasing the present low percentage of FH cases with a genetic diagnosis

The Antibacterial Activity of Honey Derived from Australian Flora

Chronic wound infections and antibiotic resistance are driving interest in antimicrobial treatments that have generally been considered complementary, including antimicrobially active honey. Australia has unique native flora and produces honey with a wide range of different physicochemical properties. In this study we surveyed 477 honey samples, derived from native and exotic plants from various regions of Australia, for their antibacterial activity using an established screening protocol. A level of activity considered potentially therapeutically useful was found in 274 (57%) of the honey samples, with exceptional activity seen in samples derived from marri (Corymbia calophylla), jarrah (Eucalyptus marginata) and jellybush (Leptospermum polygalifolium). In most cases the antibacterial activity was attributable to hydrogen peroxide produced by the bee-derived enzyme glucose oxidase. Non-hydrogen peroxide activity was detected in 80 (16.8%) samples, and was most consistently seen in honey produced from Leptospermum spp. Testing over time found the hydrogen peroxide-dependent activity in honey decreased, in some cases by 100%, and this activity was more stable at 4°C than at 25°C. In contrast, the non-hydrogen peroxide activity of Leptospermum honey samples increased, and this was greatest in samples stored at 25°C. The stability of non-peroxide activity from other honeys was more variable, suggesting this activity may have a different cause. We conclude that many Australian honeys have clinical potential, and that further studies into the composition and stability of their active constituents are warranted

Molecular genetic contributions to socioeconomic status and intelligence

Education, socioeconomic status, and intelligence are commonly used as predictors of health outcomes, social environment, and mortality. Education and socioeconomic status are typically viewed as environmental variables although both correlate with intelligence, which has a substantial genetic basis. Using data from 6815 unrelated subjects from the Generation Scotland study, we examined the genetic contributions to these variables and their genetic correlations. Subjects underwent genome-wide testing for common single nucleotide polymorphisms (SNPs). DNA-derived heritability estimates and genetic correlations were calculated using the ‘Genome-wide Complex Trait Analyses’ (GCTA) procedures. 21% of the variation in education, 18% of the variation in socioeconomic status, and 29% of the variation in general cognitive ability was explained by variation in common SNPs (SEs ~ 5%). The SNP-based genetic correlations of education and socioeconomic status with general intelligence were 0.95 (SE 0.13) and 0.26 (0.16), respectively. There are genetic contributions to intelligence and education with near-complete overlap between common additive SNP effects on these traits (genetic correlation ~ 1). Genetic influences on socioeconomic status are also associated with the genetic foundations of intelligence. The results are also compatible with substantial environmental contributions to socioeconomic status