Data-efficient Neuroevolution with Kernel-Based Surrogate Models

Surrogate-assistance approaches have long been used in computationally expensive domains to improve the data-efficiency of optimization algorithms. Neuroevolution, however, has so far resisted the application of these techniques because it requires the surrogate model to make fitness predictions based on variable topologies, instead of a vector of parameters. Our main insight is that we can sidestep this problem by using kernel-based surrogate models, which require only the definition of a distance measure between individuals. Our second insight is that the well-established Neuroevolution of Augmenting Topologies (NEAT) algorithm provides a computationally efficient distance measure between dissimilar networks in the form of "compatibility distance", initially designed to maintain topological diversity. Combining these two ideas, we introduce a surrogate-assisted neuroevolution algorithm that combines NEAT and a surrogate model built using a compatibility distance kernel. We demonstrate the data-efficiency of this new algorithm on the low dimensional cart-pole swing-up problem, as well as the higher dimensional half-cheetah running task. In both tasks the surrogate-assisted variant achieves the same or better results with several times fewer function evaluations as the original NEAT.Comment: In GECCO 201

Modern slavery in the UK: how should the health sector be responding?

Modern slavery is crime of extreme exploitation. It includes the use of coercion, force, deception and abuse of vulnerability for such purposes as trafficking, labour, sexual exploitation, forced criminal activity and domestic servitude. It is a topic of growing interest in the UK and beyond as it has emerged as an issue of considerable scale and consequence. To date, debates have been dominated by a law enforcement perspective. Less apparent has been an articulation of the implications of modern slavery for the health sector. This is despite growing evidence of the dire physical and mental health consequences for survivors. This paper addresses this gap by confronting a series of issues relevant to UK health systems. After describing what is modern slavery and the nature of the problem, we identify how the health sector has responded to date. We then articulate how health services and public health can more coherently and systematically meet the challenges of modern slavery through policy and practice. Finally, we present a call for the health sector to position itself as a central to the wellbeing of survivors and as a fundamental ally in modern slavery prevention

International migrants’ use of emergency departments in Europe compared with non-migrants’ use: a systematic review

Background: International migration across Europe is increasing. High rates of net migration may be expected to increase pressure on healthcare services, including emergency services. However, the extent to which immigration creates additional pressure on emergency departments (EDs) is widely debated. This review synthesizes the evidence relating to international migrants’ use of EDs in European Economic Area (EEA) countries as compared with that of non-migrants. Methods: MEDLINE, EMBASE, CINAHL, The Cochrane Library and The Web of Science were searched for the years 2000–16. Studies reporting on ED service utilization by international immigrants, as compared with non-migrants, were eligible for inclusion. Included studies were restricted to those conducted in EEA countries and English language publications only. Results: Twenty-two articles (from six host countries) were included. Thirteen of 18 articles reported higher volume of ED service use by immigrants, or some immigrant sub-groups. Migrants were seen to be significantly more likely to present to the ED during unsocial hours and more likely than non-migrants to use the ED for low-acuity presentations. Differences in presenting conditions were seen in 4/7 articles; notably a higher rate of obstetric and gynaecology presentations among migrant women. Conclusions: The principal finding of this review is that migrants utilize the ED more, and differently, to the native populations in EEA countries. The higher use of the ED for low-acuity presentations and the use of the ED during unsocial hours suggest that barriers to primary healthcare may be driving the higher use of these emergency services although further research is needed

International migrants’ use of emergency departments in Europe compared with non-migrants’ use: a systematic review

Background: International migration across Europe is increasing. High rates of net migration may be expected to increase pressure on healthcare services, including emergency services. However, the extent to which immigration creates additional pressure on emergency departments (EDs) is widely debated. This review synthesizes the evidence relating to international migrants’ use of EDs in European Economic Area (EEA) countries as compared with that of non-migrants. Methods: MEDLINE, EMBASE, CINAHL, The Cochrane Library and The Web of Science were searched for the years 2000–16. Studies reporting on ED service utilization by international immigrants, as compared with non-migrants, were eligible for inclusion. Included studies were restricted to those conducted in EEA countries and English language publications only. Results: Twenty-two articles (from six host countries) were included. Thirteen of 18 articles reported higher volume of ED service use by immigrants, or some immigrant sub-groups. Migrants were seen to be significantly more likely to present to the ED during unsocial hours and more likely than non-migrants to use the ED for low-acuity presentations. Differences in presenting conditions were seen in 4/7 articles; notably a higher rate of obstetric and gynaecology presentations among migrant women. Conclusions: The principal finding of this review is that migrants utilize the ED more, and differently, to the native populations in EEA countries. The higher use of the ED for low-acuity presentations and the use of the ED during unsocial hours suggest that barriers to primary healthcare may be driving the higher use of these emergency services although further research is needed

A formative review of physical activity interventions for minority ethnic populations in England

Background: Physical activity (PA) levels are lower among some UK minority ethnic groups than the majority White British population. Barriers to participation have been examined and a variety of tailored interventions have emerged. This study documents the characteristics and logic of local adaptations; a vital first step in evaluating such innovations. Methods: 58 PA interventions from an English PA dataset were examined to establish the characteristics of programmes focussed on minority ethnic populations. From these 58, three case studies were examined to reveal the nature of tailoring and the logic underpinning it; employing documentary analysis and qualitative interviews. Results: Interventions typically aimed to improve both health and social outcomes, were largely publically and charitably funded and sought to engage the most inactive groups. Tailoring was based on six principles including using community resources to promote the intervention and accommodating varying degrees of cultural identification. Additionally, tailoring interventions were intended to build capacity for sustainability. Conclusions: PA interventions tailored to the needs of minority ethnic groups reflect their largely disadvantaged position in society and focus on addressing inactivity. Tailoring PA with the six principles in mind could be used as a useful framework for developing, designing and evaluating interventions for minority ethnic populations

Paediatric emergency department utilisation rates and maternal migration status in the Born in Bradford cohort: A cross-sectional study

Background Globally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study. Methods and findings We analysed linked data from the BiB study—an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother’s migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between April 2007 and June 2011, of whom 35.6% were born to migrant mothers. Foreign-born mothers originated from South Asia (28.6%), Europe/Central Asia (3.2%), Africa (2.1%), East Asia/Pacific (1.1%), and the Middle East (0.6%). At recruitment the mothers ranged in age from 15 to 49 years old. Overall, 3,104 (30.5%) children had at least 1 ED visit in the first 5 years of life, with the highest proportion of visits being in the first year of life (36.7%). The proportion of children who visited the ED at least once was lower for children of migrant mothers as compared to children of non-migrant mothers (29.4% versus 31.2%). Children of migrant mothers were found to be less likely to visit the ED (odds ratio 0.88 [95% CI 0.80 to 0.97], p = 0.012). However, among children who visited the ED, the utilisation rate was significantly higher for children of migrant mothers (incidence rate ratio [IRR] 1.19 [95% CI 1.01 to 1.40], p = 0.040). Utilisation rates were higher for children born to mothers from Europe (IRR 1.71 [95% CI 1.07 to 2.71], p = 0.024) and established migrants (≥5 years living in UK) (IRR 1.24 [95% CI 1.02 to 1.51], p = 0.032) compared to UK/Irish-born mothers. Important limitations include being unable to measure children’s underlying health status and the urgency of ED attendance, as well as the analysis being limited by missing data. Conclusions In this study we observed that there is no higher likelihood of first paediatric ED attendance in the first 5 years of life for children in the BiB cohort for migrant mothers. However, among ED users, children of migrant mothers attend the service more frequently than children of UK/Irish-born mothers. Our findings show that patterns of ED utilisation differ by mother’s region of origin and time since arrival in the UK

Smart Home Personal Assistants: A Security and Privacy Review

Smart Home Personal Assistants (SPA) are an emerging innovation that is changing the way in which home users interact with the technology. However, there are a number of elements that expose these systems to various risks: i) the open nature of the voice channel they use, ii) the complexity of their architecture, iii) the AI features they rely on, and iv) their use of a wide-range of underlying technologies. This paper presents an in-depth review of the security and privacy issues in SPA, categorizing the most important attack vectors and their countermeasures. Based on this, we discuss open research challenges that can help steer the community to tackle and address current security and privacy issues in SPA. One of our key findings is that even though the attack surface of SPA is conspicuously broad and there has been a significant amount of recent research efforts in this area, research has so far focused on a small part of the attack surface, particularly on issues related to the interaction between the user and the SPA devices. We also point out that further research is needed to tackle issues related to authorization, speech recognition or profiling, to name a few. To the best of our knowledge, this is the first article to conduct such a comprehensive review and characterization of the security and privacy issues and countermeasures of SPA.Comment: Accepted for publication in ACM Computing Survey

Adapting primary care for new migrants: a formative assessment

Background: Immigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands. Aim: To formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need. Design & setting: Online survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector. Method: Non-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care. Results: Survey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care. Conclusion: Despite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented

Migrating learning management systems: A case of a large public university

In the past 20 years, institutions of higher education have made major investments in Learning Management Systems (LMSs). As institutions have integrated the LMS into campus culture, the potential of migrating to not only an upgraded version of the LMS, but also an entirely different LMS, has become a reality. This qualitative research study examines the perspectives of five stakeholders involved with the migration of an LMS at a major research institution in the southeastern United States. Using Lewin’s (1947) Change Management Model and Enterprise Resource Planning (ERP) Model as analogies, this research seeks to understand the role and responsibilities of the various stakeholders, their decision-making, and the implications of the decisions on the migration process. Using Glaser and Strauss’s (1967) constant comparative method and Charmaz’s (2006) work related to grounded theory, four major categories emerged from our data: time as a catalyst for change, power of communication, compatibility of technologies, and faith in the system. The categories contribute to a preliminary model that may assist other institutions as they consider whether to migrate LMSs