The Integrating Theory, Evidence and Action (ITEA) method: a procedure for helping practitioners translate theory and research into action

Introduction: The aim of this article is to describe and explain a new method for integrating theory and evidence that enables practitioners to translate evidence into action applied in their practice. Method: A new multiple methods procedure called the Integrating Theory, Evidence and Action method is described. It is a mixed method that progresses through seven distinct steps: clinical question, framework, identification, deconstruction, analysis, reconstruction, and transfer/utilization. An example of using this method to review evidence around occupational therapy with people recovering from alcohol misuse and/or abuse is provided. Findings: This method highlights the importance of theory, tests the empirical strength of theories, includes diverse forms of evidence, and encourages the integration of knowledge within clinical practice. Conclusion: The Integrating Theory, Evidence and Action method is accessible and useful to practitioners and will support their efforts to make their practice evidence based. Current methods of evidence-based practice focus mostly on research evidence (particularly quantitative evidence); however, research is only one of the ways of knowing that practitioners draw upon to guide their practice. This method enables occupational therapists to integrate theory, evidence, and practice in a coherent and translatable way.

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation.

DNA transfer by examination tools--a risk for forensic casework?

The introduction of profiling systems with increased sensitivity has led to a concurrent increase in the risk of detecting contaminating DNA in forensic casework. To evaluate the contamination risk of tools used during exhibit examination we have assessed the occurrence and level of DNA transferred between mock casework exhibits, comprised of cotton or glass substrates, and high-risk vectors (scissors, forceps, and gloves). The subsequent impact of such transfer in the profiling of a target sample was also investigated. Dried blood or touch DNA, deposited on the primary substrate, was transferred via the vector to the secondary substrate, which was either DNA-free or contained a target sample (dried blood or touch DNA). Pairwise combinations of both heavy and light contact were applied by each vector in order to simulate various levels of contamination. The transfer of dried blood to DNA-free cotton was observed for all vectors and transfer scenarios, with transfer substantially lower when glass was the substrate. Overall touch DNA transferred less efficiently, with significantly lower transfer rates than blood when transferred to DNA-free cotton; the greatest transfer of touch DNA occurred between cotton and glass substrates. In the presence of a target sample, the detectability of transferred DNA decreased due to the presence of background DNA. Transfer had no impact on the detectability of the target profile, however, in casework scenarios where the suspect profiles are not known, profile interpretation becomes complicated by the addition of contaminating alleles and the probative value of the evidence may be affected. The results of this study reiterate the need for examiners to adhere to stringent laboratory cleaning protocols, particularly in the interest of contamination minimisation, and to reduce the handling of items to prevent intra-item transfer.

Multiple task transfer learning with small sample sizes

Prognosis, such as predicting mortality, is common in medicine. When confronted with small numbers of samples, as in rare medical conditions, the task is challenging. We propose a framework for classification with data with small numbers of samples. Conceptually, our solution is a hybrid of multi-task and transfer learning, employing data samples from source tasks as in transfer learning, but considering all tasks together as in multi-task learning. Each task is modelled jointly with other related tasks by directly augmenting the data from other tasks. The degree of augmentation depends on the task relatedness and is estimated directly from the data. We apply the model on three diverse real-world data sets (healthcare data, handwritten digit data and face data) and show that our method outperforms several state-of-the-art multi-task learning baselines. We extend the model for online multi-task learning where the model parameters are incrementally updated given new data or new tasks. The novelty of our method lies in offering a hybrid multi-task/transfer learning model to exploit sharing across tasks at the data-level and joint parameter learning.

A new transfer learning framework with application to model-agnostic multi-task learning

Learning from small number of examples is a challenging problem in machine learning. An effective way to improve the performance is through exploiting knowledge from other related tasks. Multi-task learning (MTL) is one such useful paradigm that aims to improve the performance through jointly modeling multiple related tasks. Although there exist numerous classification or regression models in machine learning literature, most of the MTL models are built around ridge or logistic regression. There exist some limited works, which propose multi-task extension of techniques such as support vector machine, Gaussian processes. However, all these MTL models are tied to specific classification or regression algorithms and there is no single MTL algorithm that can be used at a meta level for any given learning algorithm. Addressing this problem, we propose a generic, model-agnostic joint modeling framework that can take any classification or regression algorithm of a practitioner’s choice (standard or custom-built) and build its MTL variant. The key observation that drives our framework is that due to small number of examples, the estimates of task parameters are usually poor, and we show that this leads to an under-estimation of task relatedness between any two tasks with high probability. We derive an algorithm that brings the tasks closer to their true relatedness by improving the estimates of task parameters. This is achieved by appropriate sharing of data across tasks. We provide the detail theoretical underpinning of the algorithm. Through our experiments with both synthetic and real datasets, we demonstrate that the multi-task variants of several classifiers/regressors (logistic regression, support vector machine, K-nearest neighbor, Random Forest, ridge regression, support vector regression) convincingly outperform their single-task counterparts. We also show that the proposed model performs comparable or better than many state-of-the-art MTL and transfer learning baselines.