Description and training of neural network dynamics

Attractor properties of a popular discrete-time neural network model are illustrated through numerical simulations. The most complex dynamics is found to occur within particular ranges of parameters controlling the symmetry and magnitude of the weight matrix. A small network model is observed to produce fixed points, limit cycles, mode-locking, the Ruelle-Takens route to chaos, and the period-doubling route to chaos. Training algorithms for tuning this dynamical behaviour are discussed. Training can be an easy or difficult task, depending whether the problem requires the use of temporal information distributed over long time intervals. Such problems require training algorithms which can handle hidden nodes. The most prominent of these algorithms, back propagation through time, solves the temporal credit assignment problem in a way which can work only if the relevant information is distributed locally in time. The Moving Targets algorithm works for the more general case, but is computationally intensive, and prone to local minima.

Efficient training of RBF networks for classification.

Radial Basis Function networks with linear outputs are often used in regression problems because they can be substantially faster to train than Multi-layer Perceptrons. For classification problems, the use of linear outputs is less appropriate as the outputs are not guaranteed to represent probabilities. We show how RBFs with logistic and softmax outputs can be trained efficiently using the Fisher scoring algorithm. This approach can be used with any model which consists of a generalised linear output function applied to a model which is linear in its parameters. We compare this approach with standard non-linear optimisation algorithms on a number of datasets.

Bayesian training of mixture density networks

Mixture Density Networks (MDNs) are a well-established method for modelling the conditional probability density which is useful for complex multi-valued functions where regression methods (such as MLPs) fail. In this paper we extend earlier research of a regularisation method for a special case of MDNs to the general case using evidence based regularisation and we show how the Hessian of the MDN error function can be evaluated using R-propagation. The method is tested on two data sets and compared with early stopping.

Efficient training of RBF networks for classification

Radial Basis Function networks with linear outputs are often used in regression problems because they can be substantially faster to train than Multi-layer Perceptrons. For classification problems, the use of linear outputs is less appropriate as the outputs are not guaranteed to represent probabilities. In this paper we show how RBFs with logistic and softmax outputs can be trained efficiently using algorithms derived from Generalised Linear Models. This approach is compared with standard non-linear optimisation algorithms on a number of datasets.

Discriminative training of the hidden vector state model for semantic parsing

In this paper, we discuss how discriminative training can be applied to the hidden vector state (HVS) model in different task domains. The HVS model is a discrete hidden Markov model (HMM) in which each HMM state represents the state of a push-down automaton with a finite stack size. In previous applications, maximum-likelihood estimation (MLE) is used to derive the parameters of the HVS model. However, MLE makes a number of assumptions and unfortunately some of these assumptions do not hold. Discriminative training, without making such assumptions, can improve the performance of the HVS model by discriminating the correct hypothesis from the competing hypotheses. Experiments have been conducted in two domains: the travel domain for the semantic parsing task using the DARPA Communicator data and the Air Travel Information Services (ATIS) data and the bioinformatics domain for the information extraction task using the GENIA corpus. The results demonstrate modest improvements of the performance of the HVS model using discriminative training. In the travel domain, discriminative training of the HVS model gives a relative error reduction rate of 31 percent in F-measure when compared with MLE on the DARPA Communicator data and 9 percent on the ATIS data. In the bioinformatics domain, a relative error reduction rate of 4 percent in F-measure is achieved on the GENIA corpus.

Patients’ and physicians’ experiences of atrial fibrillation and anticoagulation therapy:a qualitative journey

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF) however it is often underutilized and sometimes refused by patients. This programme of work included a meta-synthesis and two inter-linking studies aiming to explore patients’ and physicians’ experiences of AF and OAC. Methods: A meta-synthesis of qualitative evidence was conducted which informed the empirical work. Semi-structured individual interviews were utilised. Study 1: Three AF patient sub-groups were interviewed; accepted (n=4), refused (n=4), or discontinued (n=3) warfarin. Study 2: Four physician sub-groups (n=4 each group) prescribing OAC to AF patients were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Data was analysed using interpretative phenomenological analysis. Results: Study 1: Three over-arching themes comprised patients’ experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients’ reflections. Patients commented on the relief and reassurance experienced during the consultation but they perceived the decision making process mostly led by the physician. Lack of education and take-home materials distributed during the initial consultation was highlighted. Patients who had experienced stroke themselves or were caregivers, were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Warfarin monitoring was challenging for patients, however some patients perceived it as beneficial as it served to enhance patient-physician relationship. Study 2: Two over-arching themes emerged from physicians’ experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians’ approach to the consultation style shifted through a continuum of compliance-adherence-concordance during the consultation. They aimed for concordance, however challenges such as time and the perceived patient trust in them as the expert, led to physicians adopting a paternalistic approach. Physicians also pointed out challenges associated with guideline adherence and the need to adopt a multi-disciplinary approach, where other health professionals could provide on-going education. Conclusion: This programme of work has illustrated the benefit of taking an in depth phenomenological approach to understanding the lived experience of the physician-patient consultation. Together with the meta-synthesis, this work has strengthened the evidence base and demonstrated that there is a need to target patients' and physicians' ability to communicate with each other in a comprehensible way.

The use of open learning in the training of neurotechnologists:a regional case study

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The education and training of technicians in the construction industry

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The effectiveness of an organisations' equal opportunities policy for the role and training of women, particularly in the fire service

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Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making:a multi-perspective IPA design

OBJECTIVE: To explore patients' and physicians' experiences of atrial fibrillation consultations and oral anticoagulation decision-making. DESIGN: Multi-perspective interpretative phenomenological analyses. METHODS: Participants included small homogeneous subgroups: AF patients who accepted (n=4), refused (n=4), or discontinued (n=3) warfarin, and four physician subgroups (n=4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective IPA analyses to attend to individuals within subgroups and making comparisons within and between groups. RESULTS: Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision, and Negotiating systemic factors. CONCLUSIONS: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care, and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

Oral anticoagulation in atrial fibrillation, the patients and physicians experiences of the consultation:a qualitative study

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF), however it is still underutilized and sometimes refused by patients. This project was divided in two inter-related studies. Study 1 explored the experiences that influence prescription of OAC by physicians. Study 2 explored the experiences which influence patients' decisions to accept, decline or discontinue OAC. Methods: Semi-structured individual interviews were conducted in both studies. In Study 1four sub-groups of physicians (n = 16) experienced with OAC in AF were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. In Study 2 three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued warfarin. Results: Study 1: Two over-arching themes emerged from doctors' experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians still adopt a paternalistic approach to decision-making. They should instead motivate patients to take part in treatment discussions and choices should reflect the patient's needs and concerns. Physician education should focus more on communication skills, individualised care and time-management as these are critical for patient adherence. Continuous OAC education for AF should adopt a multi-disciplinary approach. Further, interpreters should also be educated on medical communication skills. Study 2: Three over-arching themes comprised patients' experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients' reflections. Patient education during the initial consultation was critical in increasing patient's knowledge of OAC. On-going patient education is imperative to maintain adherence. Patients valued physicians' concern for their needs during decision-making. Patients who had experience of stroke were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Patients' perceptions of warfarin are also influenced by the media. Comment: Qualitative research is crucial in exploring barriers to treatment as it provides an excellent insight into patients' experiences of healthcare. A patient-centred approach should be adopted and incorporated into physicians' education. Education and patient involvement in the decision-making process is essential to promote treatment acceptance and long-term adherence

The training experience of primary care pharmacists

Objectives — To map the tasks, activities and training provision for primary care pharmacists (PCPs) and to identify perceived future training needs. Methods — Survey undertaken in 1998/1999 using a pre-piloted, postal, self-completion questionnaire to two samples of PCPs. Setting — PCPs in (a) the West Midlands and (b) England (outside West Midlands). Key findings — The response rate was 66 per cent. A majority (68 per cent) had worked in the role for less than two years. Eighty per cent had some form of continuing education or training for the role although only 50 per cent had a formal qualification. Over two-thirds had contributed to the funding of their training, with one-third providing all funding. Seventy-four per cent of PCPs agreed that pharmacists should go through a procedure to ensure competence (accreditation) before being allowed to work for a general medical practice or primary care group. Views on the need for formal education/training prior to work differed: 82 per cent of those with formal qualifications, but only 46 per cent of those without, considered that this should be a requirement. There was general agreement that training/education had met training needs. Views on future training closely reflected previous training experiences, with a focus upon pharmaceutical roles rather than upon generic skill development and the acquisition of management skills. Conclusions — The study provides a snapshot in time of the experience of pioneer PCPs and the training available to them. PCPs will need further training or updating if they are to provide the wider roles required by the developing needs of the National Health Service. Consideration should be given to formal recognition of the training of PCPs in order to assure competence. The expectation that pharmacists should fund their own training is likely to be a barrier to uptake of training and uncertainties over funding will militate against consistency of training.

Substances hazardous to health:the nature of the expertise associated with competent risk assessment

This research investigated expertise in hazardous substance risk assessment (HSRA). Competent pro-active risk assessment is needed to prevent occupational ill-health caused by hazardous substance exposure occurring in the future. In recent years there has been a strong demand for HSRA expertise and a shortage of expert practitioners. The discipline of Occupational Hygiene was identified as the key repository of knowledge and skills for HSRA and one objective of this research was to develop a method to elicit this expertise from experienced occupational hygienists. In the study of generic expertise, many methods of knowledge elicitation (KE) have been investigated, since this has been relevant to the development of 'expert systems' (thinking computers). Here, knowledge needed to be elicited from human experts, and this stage was often a bottleneck in system development, since experts could not explain the basis of their expertise. At an intermediate stage, information collected was used to structure a basic model of hazardous substance risk assessment activity (HSRA Model B) and this formed the basis of tape transcript analysis in the main study with derivation of a 'classification' and a 'performance matrix'. The study aimed to elicit the expertise of occupational hygienists and compare their performance with other health and safety professionals (occupational health physicians, occupational health nurses, health and safety practitioners and trainee health and safety inspectors), as evaluated using the matrix. As a group, the hygienists performed best in the exercise, and this group were particularly good at process elicitation and at recommending specific control measures, although the other groups also performed well in selected aspects of the matrix and the work provided useful findings and insights. From the research, two models of HSRA have been derived, an HSRA aid, together with a novel videotape KE technique and interesting research findings. The implications of this are discussed with respect to future training of HS professionals and wider application of the videotape KE method.

Everyday use of Spanish among bilingual teachers in New York City and their attitudes toward the language

The attitudes that bilingual teachers have toward the use of foreign languages seem to have an effect on the success of bilingual education programs. In this study, our purpose is to shed light on how often bilingual teachers in New York City use Spanish in their everyday lives, and to examine their attitudes toward the use of Spanish in the U.S. Overall, results indicate only moderate frequencies of use of Spanish in everyday life among bilingual teachers. In addition, the study shows that bilingual teachers have a favorable attitude toward the use of Spanish in the U.S. However, bilingual teachers whose first language is English seem to have a more favorable attitude than those whose first language is Spanish. Among the native Spanish speakers, those born abroad show a more favorable attitude than those born in the U.S. Although no group seems to favor the use of lexical borrowings and code-switching, bilingual native Spanish-speaking teachers born in the U.S. seem to have a less favorable attitude than native Spanish-speaking teachers born abroad. In addition, native Spanish-speaking teachers born abroad seem to have a less favorable attitude toward lexical borrowings and code-switching than U.S.-born teachers whose first language is English. Recommendations for the training of bilingual teachers are discussed in the conclusions of the study.

Aspects of health among an employed population

This survey collected information on aspects of health amongst an employed population, employees in 14 different organisations in the West Midlands Regional Health Authority; and was a stratified sample of senior managers, middle managers and operatives. Nine hundred and sixty questionnaires were distributed asking for both quantitative and qualitative information on 58 questions covering health, work, family, leisure activities and life-style. A response rate of 48% (459 returned questionnaires) came from 290 men (63%), 165 women (36%) and four people (1%) who did not answer the gender question. The initial findings from this study are unique in that there has not been a specific review of the health of people at work. In answer to the main research questions, 92% felt they were healthy. Compared to others of a similar age, 34% felt their health was `above average', 58% `average', and 7&37 `below average'. Thirty two percent of respondents had visited their GP in the past 1-2 months; the highest reason given was disorders of the respiratory system, 20%. People's perceptions on the effects of work on their health were: good effect, 13% fair effect, 20% no effect, 27% poor effect, 27% and bad effect, 7%. The effects of leisure activities on health were thought to be more positive: good effect, 46% fair effect, 20% no effect, 21% poor effect, 3% and bad effect, 2%. The perceptions of effects of life-style on health were considered to be: good effect, 32% fair effect, 32% no effect, 20% poor effect, 9% and bad effect, 1%.  In this survey, leisure and life-style were seen by employees to have more beneficial effects on health than work. Future implications include a review of occupational health as a major policy development area within primary care. There is a need to influence the education and training of health care practitioners in order to affect their ability to practise effectively in this new and challenging area of work.