NHS research ethics committees : still need more common sense and less bureaucracy

National Health Service research ethics committees exist to ensure that research performed within the NHS complies with recognised ethical standards and to protect the rights, safety, and dignity of all actual or potential participants. In the past decade the operation of research ethics committees has come under, and continues to come under, close scrutiny. Researchers now consider the process of acquiring ethical approval to be so onerous that it is compromising clinical research. Medical educators also think that the process is too unwieldy to allow undergraduate students to acquire research experience, an essential learning outcome required by the General Medical Council

The application of games in higher education

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End-of-life care and dementia

In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care

How overconfident are current projections of anthropogenic carbon dioxide emissions?

Analyzing the risks of anthropogenic climate change requires sound probabilistic projections of CO2 emissions. Previous projections have broken important new ground, but many rely on out-of-range projections, are limited to the 21st century, or provide only implicit probabilistic information. Here we take a step towards resolving these problems by assimilating globally aggregated observations of population size, economic output, and CO2 emissions over the last three centuries into a simple economic model. We use this model to derive probabilistic projections of business-as-usual CO2 emissions to the year 2150. We demonstrate how the common practice to limit the calibration timescale to decades can result in biased and overconfident projections. The range of several CO2 emission scenarios (e.g., from the Special Report on Emission Scenarios) misses potentially important tails of our projected probability density function. Studies that have interpreted the range of CO2 emission scenarios as an approximation for the full forcing uncertainty may well be biased towards overconfident climate change projections.economics of climate change, scenarios, data assimilation

Human rights education:developing a theoretical understanding of teachers' responsibilities

The United Nations (UN) asserts that children and young people should have access to human rights education (HRE) and that schools are one of the key means through which HRE should be made available. However, there is currently limited knowledge about the presence and form of HRE in school contexts, and there is no established means through which HRE provision within schools is evaluated. This paper proposes a theoretical framework to support the classification of teachers’ responsibilities in relation to HRE and argues that systemic change is needed within education systems if HRE provision is to be realised in more extensive and consistent ways. The curriculum documents of three nations – Australia, England and Sweden – were analysed to determine teacher responsibilities for educating pupils about human rights. The viability of the developed framework was then tested through applying it to the outcomes of these analyses. The theoretical contribution made by the paper deepens knowledge and understandings about the nature of responsibilities placed on teachers to educate pupils about human rights, and provides a foundation from which to stimulate debate about what constitutes effective school-based HRE practices

Evaluating multiagency interventions for children living with intimate partner violence in Birmingham

This research endeavour was born out of the need for a systematic evaluation of the efficacy of the multiagency Domestic Abuse Risk Assessment tool, which necessitates that all incidents of ‘domestic abuse’ (any incident within the family domain) reported to West Midlands Police, where a child or unborn child resides within that home, are scrutinised by Police and Social Care (and partners from Health, Education and the voluntary sector where possible) using a joint protocol. The primary purpose of the protocol is to promote safeguarding and provide a timely and appropriate response to children at risk following domestic abuse. The protocol incorporates the Banardos’ Multiagency Domestic Violence Risk Identification Threshold Scales (MDVRITS), which aids decision making about appropriate interventions based on predicted risk to children using a four level scale

How Overconfident are Current Projections of Anthropogenic Carbon Dioxide Emissions?

Analyzing the risks of anthropogenic climate change requires sound probabilistic projections of CO2 emissions. Previous projections have broken important new ground, but many rely on out-of-range projections, are limited to the 21st century, or provide only implicit probabilistic information. Here we take a step towards resolving these problems by assimilating globally aggregated observations of population size, economic output, and CO2 emissions over the last three centuries into a simple economic model. We use this model to derive probabilistic projections of business-as-usual CO2 emissions to the year 2150. We demonstrate how the common practice to limit the calibration timescale to decades can result in biased and overconfident projections. The range of several CO2 emission scenarios (e.g., from the Special Report on Emission Scenarios) misses potentially important tails of our projected probability density function. Studies that have interpreted the range of CO2 emission scenarios as an approximation for the full forcing uncertainty may well be biased towards overconfident climate change projections.Carbon Dioxide, Emissions, Scenarios, Data Assimilation, Markov Chain Monte Carlo

A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia

© The Author(s) 2019Background: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. Aim: To identify and critically evaluate quality indicators for end-of-life care in dementia. Results: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review. Ultimately, 246 individual indicators were identified as being relevant to dementia end-of-life care and mapped against EAPC guidelines. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.Peer reviewedFinal Published versio

Planning for tomorrow whilst living for today: the views of people with dementia and their families on Advance Care Planning

Background: Advance care planning (ACP) is increasingly prominent in many countries; however, the evidence base for its acceptability and effectiveness is limited especially in conditions where cognition is impaired, as in dementia. Method: This qualitative study used semi-structured interviews with people with mild to moderate dementia (n = 17) and family carers (n = 29) to investigate their views about planning for their future generally and ACP specifically. Results: People with dementia and their families make a number of plans for the future. Most people undertook practical, personal, financial, and legal planning. However participants did not make formal advance care plans with the exception of appointing someone to manage their financial affairs. Five barriers to undertaking ACP were identified: lack of knowledge and awareness, difficulty in finding the right time, a preference for informal plans over written documentation, constraints on choice around future care, and lack of support to make choices about future healthcare. Conclusions: Health and social care professionals can build on people's preferences for informal planning by exploring the assumptions underlying them, providing information about the possible illness trajectory and discussing the options of care available. Health and social care professionals also have a role to play in highlighting the aspects of ACP which seem to be most relevant to the wishes and aspirations of people with dementia

High-level synthesis for medical image processing on Systems on Chip : a case study

Adaptive radiotherapy is a technique intended to increase the accuracy of radiotherapy. Currently, it is not clinically feasible due to the time required to process the images of patient anatomy. Hardware acceleration of image processing algorithms may allow them to be carried out in a clinically acceptable timeframe. This paper presents the experiences encountered using high-level synthesis tools to design an accelerated segmentation algorithm for computed tomography images targeted for implementation on a System on Chip. Hardware coprocessors and their interfaces for optimal threshold generation and 3D mean filter algorithms were synthesised from C++ functions. Hardware acceleration significantly outperformed the software only implementation. The high-level synthesis tools allowed the rapid exploration of different design options. However, hardware design knowledge was still necessary in order to interpret the results effectively