Sources of patient knowledge and financing of cataract surgery in rural China: the Sanrao Study of Cataract Outcomes and Up-Take of Services (SCOUTS), report 6.

AIM: To study patient sources of knowledge about cataract surgical services, and strategies for financing surgery in rural China. DESIGN: Cross-sectional case series. METHODS: Patients undergoing cataract surgery by local surgeons in a government, village-level facility in Sanrao, Guangdong between 8 August and 31 December 2005 were examined and had standardised interviews an average of 12 months after surgery. RESULTS: Of 313 eligible patients, 239 (76%) completed the questionnaire. Subjects had a mean (SD) age of 69.9 (10.2) years, 36.4% (87/239) were male, and 87.0% (208/239) had been blind (presenting visual acuity < or = 6/60) before surgery. Word-of-mouth advertising was particularly important: 198 (85.0%) of the subjects knew a person who had undergone cataract surgery, of whom 191 (96.5%) had had cataract surgery at Sanrao itself. Over 70% of subjects (166/239) watched TV daily, whereas 80.0% (188/239) "never" read the newspaper. Nearly two-thirds of suggestions from participants (n = 211, 59.6%) favoured either TV advertisements or word-of-mouth to publicise the programme. While the son or daughter had paid for surgery in over 70% of cases (164/233), the patient's having paid without help was the sole predictor of undergoing second-eye surgery (OR 2.27 (95% CI 1.01 to 5.0, p = 0.04)). DISCUSSION: Strategies to increase uptake of cataract surgery in rural China may benefit from enhancing word-of-mouth advertising (such as with pseudophakic motivators), using television advertising where affordable, and micro-credit or other programmes to enable patients to pay their own fees, thus increasing uptake of second-eye surgery.

Risk adjustment for hospital use using social security data: cross sectional small area analysis

Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting: Northern Ireland. Main outcome measure: Intensity of use of inpatient services. Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

New York City: 12 December, 1980

This article compares two documentary treatments of the Central Park vigil for John Lennon in 1980: Happy Birthday to John (Jonas Mekas, 1995, 16mm, 18 min.), and Dix minutes de silence pour John Lennon/Ten Minutes Silence for John Lennon (Raymond Depardon, 1980, 16mm, 10 min.). Mekas and Depardon might seem an improbable combination but as the article demonstrates there are affinities, if not direct points of convergence, in outlook and documentary method: both sensibilities have been shaped by migrant experiences, and much of their work, for all its formal and structural differences, is preoccupied with experiences of exile and displacement, rootedness and the meaning of home, the country and the city (and in Mekas’s case, the country in the city). Mekas and Depardon are also Europeans who have developed an intimate social and artistic relationship with New York City; both are concerned with the place of autobiography in their work, using captions, inter-titles, diary entries, photographs, and 1st person commentary to complicate relations between the imaginary and the documentary. In addition to discussing the significance of these preoccupations, and differences in the manner in which both filmmakers witness the apotheosis of Lennon as cultural martyr (and natural New Yorker), the article also examines the phenomenon of public mourning, and how it often displaces its ostensible subject: associatively, in the case of Mekas; incidentally, in the case of Depardon; and intentionally, in the case of the mass media, and popular culture.

The Fraternity of Metaphors: Jean-Luc Godard's Film Socialisme

Since the 'completion' of Histoire(s) du cinema (1988-1998), Jean-Luc Godard's work has become increasingly mosaic-like in its forms and configurations, and markedly elegiac in its ruminations on history, cinema, art, and thought. While his associative aesthetic and citational method –including his choice of ‘actors’, and the fragmentariness of his ‘soundtracks’ – can combine to create a distinctive cinematic event, the films themselves refuse to cohere around a unifying concern, or yield to a thematic schema. Not surprisingly, Film Socialisme does not offer us the illusion of narrative or structural integrity anymore than it contributes to the quotidian rhetoric of political and moral argument. It is, however, a political film in the sense that it alters something more fundamental than opinions and points of view. It transforms a way of seeing and understanding reality and history, fiction and documentary, images, and images of images. If anything, it belongs to that dissident or ‘dissensual’ category of artwork capable of ‘emancipating the spectator’ by disturbing what Jacques Rancière terms ‘the distribution of the sensible’ in that it generates gaps, openings, and spaces, poses questions, invites associations without positing a fixed position, imposing an interpretation, or allowing itself to invest in the illusion of expressive objectivity and the stability of meaning. The myriad citations and fragments that comprise the film are never intended to culminate into anything cohesive, never mind conclusive. In one sense, they have no source and no context beyond their moment in the film itself, and what we make of that moment. This article studies the degree to which Godard allows these images and sounds to combine and collide, associate and dissolve in this film, arguing that Film Socialisme is both an important intervention in the history of contemporary cinema, and necessary point of reference in any serious discussion of the relations between that cinema and political reality.

Recording Memories from Political Violence: a Filmmaker's Journey

Based on the work the author has carried out with survivors groups in Northern Ireland and South Africa, this book describes and analyses the use of documentary filmmaking in recording experiences of political conflict. A variety of issues relevant to the genre are addressed at length, including the importance of ethics in the collaboration between the filmmaker and the participant and the effect of location on the accounts of participants.

Further Information:
This monograph reflects on and analyses the work of the author/director over the past decade. His documentary films have been produced in the context of how to address storytelling in post conflict societies by drawing on the disciplines of oral history, ethnography, memory studies and documentary film. All the documentary films under discussion have been produced collaboratively with NGOs, including the Victims and Survivors Trust and WAVE Trauma Centre (both Belfast) and the Human Rights Media Centre, Cape Town. Investigating the influence of location in memory stimulation and the role of collaboration on authorship during trauma recovery, the author offers insights into the process of collaboratively production, which attends to both ethical and aesthetic considerations. While most emphasis is placed on the research, production and post-production phases, thought is also given to the reception of these films and the impact they have on the participants, wider communities, and on policy decisions.

Considering the impact of the 'Right to Bargain' Legislation in Ireland: A Review

Ireland is rare among advanced economies in not having statutory trade union recognition legislation for collective bargaining purposes. The matter has been a source of policy contention over the years with attempts to resolve it encapsulated in the so-called ‘Right to Bargain’ legislation, introduced in 2001. This legislation has sought to circumvent statutory recognition in Ireland by putting in place an alternative mechanism for unions to represent members in non-union firms where collective bargaining is not practiced. This review, based on a mixture of empirical and documentary evidence, demonstrates that this legislation was moderately successful for a short period in generating pay rises, improved employment conditions and better access to procedures for union members in non-unionised firms. Indeed, in some respects, it was a superior institutional mechanism to a statutory recognition regime.

Government Influence on the Construction Industry during the Economic Recession 2007 - 2013

Due to the high degree of international and economic integration across the globe, the 2007 global financial crisis quickly spread, causing recessions and widespread credit restrictions in advanced nations. During recessions, economic fluctuations cause dramatic changes to the market structure of industries, in particular, that of the construction sector. These structural changes can be further influenced by government strategies and policies; which if used incorrectly, can serve to fuel and exacerbate downturns. In contrasting form, during an economic recession, government strategies and policies can also be used to aid in exiting such economic turbulence. From an extensive review of literature it became apparent that very little research offered a comprehensive and systematic overview of Irish and UK construction related government policies and strategies adopted during recessions; hence the emergence of this topic. As part of an ongoing research PhD, the purpose of this paper is to collate and group Irish and UK Government strategies and policies adopted for the construction sector during the recession period 2007-2013; resulting in the establishment of a construction industry development framework and a taxonomic framework. The results reveal serious problems with the national strategic plan for the Irish construction industry, given that there is no overseeing body or target dates for implementation of the proposed actions. Furthermore, both countries failed to prioritize the proposed key actions within their strategic plans. The findings of this paper can be applied in the context of the construction sector to address shortcomings in the respective sub-sectors, while also aiding policy makers and company executives in mapping out future strategic milestones.

Fatih Akin Filmlerinde Gercekligin Temsili

This article explores Turkish German film director Fatih Akin's search for his roots and identity via the representation of urban space in his fiction and documentary films. Through the analyses of In July (2000), Head-on (2004), Crossing the Bridge (2005) and The Edge of Heaven (2007), the study focuses on Istanbul, and its portrayal by the Hamburg-based filmmaker. The fact that Akin uses the city as a vehicle to open up a discussion on belonging and identity is in the heart of the research, which is written from an architectural point of view..

Managing patient deterioration: evaluation of what works.

Background: Rapid Response Systems (RRS) have been implemented nationally and internationally to improve patient safety in hospital. However, to date the majority of the RRS research evidence has focused on measuring the effectiveness of the intervention on patient outcomes. To evaluate RRS it has been recommended that a multimodal approach is required to address the broad range of process and outcome measures required to determine the effectiveness of the RRS concept. Aim: The aim of this paper is to evaluate the official RRS programme theoretical assumptions regarding how the programme is meant to work against actual practice in order to determine what works. Methods: The research design was a multiple case study approach of four wards in two hospitals in Northern Ireland. It followed the principles of realist evaluation research which allowed empirical data to be gathered to test and refine RRS programme theory [1]. This approach used a variety of mixed methods to test the programme theories including individual and focus group interviews with a purposive sample of 75 nurses and doctors, observation of ward practices and documentary analysis. The findings from the case studies were analysed and compared within and across cases to identify what works for whom and in what circumstances. Results: The RRS programme theories were critically evaluated and compared with study findings to develop a mid-range theory to explain what works, for whom in what circumstances. The findings of what works suggests that clinical experience, established working relationships, flexible implementation of protocols, ongoing experiential learning, empowerment and pre-emptive management are key to the success of RRS implementation.  Conclusion:These findings highlight the combination of factors that can improve the implementation of RRS and in light of this evidence several recommendations are made to provide policymakers with guidance and direction for their success and sustainability.References: 1.Pawson R and Tilley N. (1997) Realistic Evaluation. Sage Publications; LondonType of submission: Concurrent session Source of funding: Sandra Ryan Fellowship funded by the School of Nursing & Midwifery, Queen’s University of Belfast

Participation of Smallholders in Agroforestry Agri-Environmental Scheme: A lesson from the rural Mount Kenya region

The likelihood of smallholder farmers not participating in agroforestry agri-environmental schemes and payments for ecosystem services (PES) may be due to limited farmland endowment and formal credit constraints. These deficits may lead to an ‘exclusive club’ of successful farmers, which are not necessarily poor, enjoying the benefits of agri-environmental schemes and PES although agrienvironmental schemes and PES have been devised as a means of fostering rural sustainable development and improving the livelihood of poor smallholder farmers. Smallholder farmers in parts of rural Kenya continue to enroll in ‘The International Small Group Tree Planting Programme’ (TIST), an agri-environmental scheme, promoting agroforestry, carbon sequestration and conservation agriculture (CA). The question remains if these farmers are really poor? This study examines factors that determine the participation of smallholder farmers in TIST in parts of rural Kenya. We use survey data compiled in 2013 on 210 randomly selected smallholder farmers from Embu, Meru and Nanyuki communities; the sample consists of TIST and non-TIST members. A random utility model and logit regression were used to test a set of non-monetary and monetary factors that influence participation in the TIST. The utility function is conceptualized to give non-monetary factors, particularly the common medium of communication in rural areas – formal and informal – a central role. Furthermore, we investigate other factors (incl. credit accessibility and interest rate) that reveal the nature of farmers participating in TIST. The findings suggest that spread of information via formal and informal networks is a major driver of participation in the TIST program. Furthermore, variables such credit constrains, age and labour supply positively correlate with TIST participation, while for education the opposite is true. It is important to mention that these correlations, although somewhat consistent, were all found to be weak. The results indicate that participation in the TIST program is not influenced by farm size; therefore we argue that the TIST scheme is NOT an ‘exclusive club’ comprising wealthy and successful farmers. Older farmers’ being more likely to join the TIST is an argument for their long- rather than widely assumed short-term planning horizon and a new contribution to the literature. Given the importance of poverty alleviation and climate smart agriculture in developing countries, sustainable policy should strengthening the social and human capital as well as informal networks in rural areas. Extension services should effectively communicate benefits to less educated and credit constrained farmers.

Reassembled, Slightly Askew:Composition & Sound Design

Reassembled, Slightly Askew is an autobiographical, immersive audio-based artwork based on Shannon Sickels’ experience of falling critically ill with a rare brain infection and her journey of rehabilitation with an acquired brain injury. Audience members experience Reassembled individually, listening to the audio via headphones while lying on a bed. The piece makes use of binaural microphone technology and spatial sound design techniques, causing listeners to feel they are inside Shannon’s head, viscerally experiencing her descent into coma, brain surgeries, early days in the hospital, and re-integration into the world with a hidden disability. It is a new kind of storytelling, never done before about this topic, that places the listener safely in the first-person perspective with the aim of increasing empathy and understanding. Reassembled… was made through a 5-year collaboration with an interdisciplinary team of artists led by Shannon Sickels (writer & performer), Paul Stapleton (composer & sound designer), Anna Newell (director), Hanna Slattne (dramaturgy), Stevie Prickett (choreography), and Shannon’s consultant neurosurgeon and head injury nurse. It’s development and production has been made possible with the support of a Wellcome Trust Arts Award, the Arts Council NI, Sonic Arts Research Centre, Belfast's Metropolitan Arts Centre, and grants from the Arts & Disability Award Ireland scheme. In its 2015 premiere year, Reassembled had 99 shows across Northern Ireland, including at the Cathedral Quarter Arts Festival (the MAC, Belfast) and BOUNCE Arts & Disability Forum Festival (Lyric Theatre, Belfast). It was awarded 5 stars in the Stage, a Hospital Club h100 Theatre & Performance Award, and been shared at medical conferences and trainings across the UK. It continues to be presented in diverse artistic and educational contexts, including as part of A Nation’s Theatre Festival in 2016 at Battersea Arts Centre in London where it was given 4 star reviews in the Guardian, Time Out London and the Evening Standard. "A real-life ordeal, captured by a daring, disorientating artistic collaboration, which works brilliantly on so many levels…It should be available on prescription.” — The Stage ★★★★★ www.reassembled.co.uk Audio clips and documentary footage available here: http://www.paulstapleton.net/portfolio/reassembled-slightly-askew