Selecting tuning parameters in minimum distance estimators

Many minimum distance estimators have the potential to provide parameter estimates which are both robust and efficient and yet, despite these highly desirable theoretical properties, they are rarely used in practice. This is because the performance of these estimators is rarely guaranteed per se but obtained by placing a suitable value on some tuning parameter. Hence there is a risk involved in implementing these methods because if the value chosen for the tuning parameter is inappropriate for the data to which the method is applied, the resulting estimators may not have the desired theoretical properties and could even perform less well than one of the simpler, more widely used alternatives. There are currently no data-based methods available for deciding what value one should place on these tuning parameters hence the primary aim of this research is to develop an objective way of selecting values for the tuning parameters in minimum distance estimators so that the full potential of these estimators might be realised. This new method was initially developed to optimise the performance of the density power divergence estimator, which was proposed by Basu, Harris, Hjort and Jones [3]. The results were very promising so the method was then applied to two other minimum distance estimators and the results compared

Protocol for a randomised control trial of methylnaltrexone for the treatment of opioid-induced constipation and gastrointestinal stasis in intensive care patients (MOTION)

Gastrointestinal dysmotility and constipation are common problems in intensive care patients. The majority of critical care patients are sedated with opioids to facilitate tolerance of endotracheal tubes and mechanical ventilation, which inhibit gastrointestinal motility and lead to adverse outcomes. Methylnaltrexone is a peripheral opioid antagonist that does not cross the blood-brain barrier and can reverse the peripheral side effects of opioids without affecting the desired central properties. This trial will investigate whether methylnaltrexone can reverse opioid-induced constipation and gastrointestinal dysmotility.This is a single-centre, multisite, double-blind, randomised, placebo-controlled trial. 84 patients will be recruited from 4 intensive care units (ICUs) within Imperial College Healthcare NHS Trust. Patients will receive intravenous methylnaltrexone or placebo on a daily basis if they are receiving opioid infusion to facilitate mechanical ventilation and have not opened their bowels for 48 hours. All patients will receive standard laxatives as per the clinical ICU bowel protocol prior to randomisation. The primary outcome of the trial will be time to significant rescue-free laxation following randomisation. Secondary outcomes will include tolerance of enteral feed, gastric residual volumes, incidence of pneumonia, blood stream and Clostridium difficile infection, and any reversal of central opioid effects.The trial protocol, the patient/legal representative information sheets and consent forms have been reviewed and approved by the Harrow Research Ethics Committee (REC Reference 14/LO/2004). An independent Trial Steering Committee and Data Monitoring Committee are in place, with patient representation. On completion, the trial results will be published in peer-reviewed journals and presented at national and international scientific meetings.2014-004687-37; Pre-results

Developing a Proof-of-Concept Selection Test for Entry into Primary Teacher Education Programs

The purpose of this article is to report on the development of a proof-of-concept situational judgment test (SJT) to assist in the selection of candidates for primary teacher education (ITE) programs. Nine development steps involving practising teachers, teacher educators, and applicants to ITE programs were carried out to establish target attributes and to develop content for the test. The results from administering the test to 124 primary ITE candidates showed a near-normal distribution, high levels of reliability, and significant positive correlations with a range of concurrently administered interview scores. We conclude with a description of the necessary next steps needed to implement evidence-supported teacher education selection processes in a range of international settings

A cross-sectional survey of general practice health workers' perceptions of their provision of culturally competent services to ethnic minority people with diabetes

Aims To explore General Practice teams cultural-competence, in particular, ethnicity, linguistic skillset and cultural awareness. The practice teams’ access to diabetes-training, and overall perception of cultural-competence were also assessed. Methods A cross-sectional single-city-survey with one in three people with diabetes from an ethnic minority group, using 35 semi-structured questions was completed. Self-reported data analysed using descriptive statistics, interpreted with reference to the Culturally-Competent-Assessment-Tool. Results Thirty-four (52%) of all 66 practices in Coventry responded between November 2011 and January 2012. Key findings: (1) One in five practice staff was from a minority group in contrast with one in ten of Coventry’s population, (2) 164 practice staff (32%) spoke a second language relevant to the practice's minority population, (3) 56% of practices were highly culturally-competent at providing diabetes services for minority populations, (4) 94% of practices reported the ethnicity of their populations, and (5) the most frequently stated barriers to culturally-competent service delivery were language and knowledge of nutritional habits. Conclusions Culturally-competent diabetes care is widespread across the city. Language barriers are being addressed, cultural knowledge of diabetes-related-nutrition requires further improvement. Further studies should investigate if structured cultural-competence training for diabetes service providers produces positive effects in diabetes-related outcome-measures in minority populations

Immunological basis of genesis of hepatocellular carcinoma : unique challenges and potential opportunities through immunomodulation

A majority of hepatocellular carcinoma (HCC) develops in the setting of persistent chronic inflammation as immunological mechanisms have been shown to play a vital role in the initiation, growth and progression of tumours. The index review has been intended to highlight ongoing immunological changes in the hepatic parenchyma responsible for the genesis and progression of HCC. The in-situ vaccine effect of radiofrequency (RF) is through generation tumour-associated antigens (TAAs), following necrosis and apoptosis of tumour cells, which not only re-activates the antitumour immune response but can also act in synergism with checkpoint inhibitors to generate a superlative effect with intent to treat primary cancer and distant metastasis. An improved understanding of oncogenic responses of immune cells and their integration into signaling pathways of the tumour microenvironment will help in modulating the antitumour immune response. Finally, we analyzed contemporary literature and summarised the recent advances made in the field of targeted immunotherapy involving checkpoint inhibitors along with RF application with the intent to reinstate antitumour immunity and outline future directives in very early and early stages of HCC

Young children are human beings

11th September 2017 was a big day for Tommy, my four-year-old nephew in England: it was the day he started school. Tommy is the middle child of three in his immediate family; he is an active, inquiring little boy, disposed to becoming deeply involved in activities that interest him. He likes playing outside, he loves playing with his toy cars and he enjoys baking cakes. But at 4.5 years old, Tommy’s opportunities to engage in activities that he values have already diminished. Now, he must focus on another agenda: learning to use phonic knowledge to decode and read words, on spelling correctly and on counting and ordering numbers to 20. These are examples of the ‘schoolified’ knowledge that Tommy must acquire in preparation for the English National Curriculum which he will follow from next September when he reaches 5.5 years old. Tommy has entered a space where he is viewed, measured and valued according to what he will become, rather than the human being he is now (Qvortrup, 1994)

Genomics in cardiac metabolism

Cell biology is in transition from reductionism to a more integrated science. Large-scale analysis of genome structure, gene expression, and metabolites are new technologies available for studying cardiac metabolism in diseases known to modify cardiac function. These technologies have several limitations and this review aims both to assess and take a critical look at some important results obtained in genomics restricted to molecular genetics, transcriptomics and metabolomics of cardiac metabolism in pathophysiological processes known to alter myocardial function. Therefore, our goal was to delineate new signalling pathways and new areas of research from the vast amount of data already published on genomics as applied to cardiac metabolism in diseases such as coronary heart disease, heart failure, and ischaemic reperfusio

A deep wound under my heart”: Constructions of complex trauma and implications for women’s wellbeing and safety from violence

This project sought to develop a comprehensive picture of how complex trauma is being constructed in public policy and practice, and how it is viewed by women with experiences of complex trauma. The research took the form of a multi-method study that combined policy and service analysis with qualitative research with women with experiences of complex trauma and the professionals who work with them, via: a policy audit of approaches to complex trauma service documentary analysis and qualitative interviews with professionals in Queensland and New South Wales qualitative interviews with women with experiences of complex trauma in Queensland and New South Wales online workshops in which professional stakeholders and women with experiences of complex trauma provided feedback on the findings of the study. The research found that at the policy level, complex trauma overlaps with frameworks on violence against women and mental health. However, the impact of complex trauma is not comprehensively addressed by these frameworks, which contributes to the fragmented response to women in distress. It demonstrated that there is a strong need for a whole-of-government commitment to the implementation and coordination of trauma-informed practice across sectors. The report includes recommendations for policy and practice