The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma:A systematic review and economic evaluation

Objectives: To assess whether open angle glaucoma (OAG) screening meets the UK National Screening Committee criteria, to compare screening strategies with case finding, to estimate test parameters, to model estimates of cost and cost-effectiveness, and to identify areas for future research. Data sources: Major electronic databases were searched up to December 2005. Review methods: Screening strategies were developed by wide consultation. Markov submodels were developed to represent screening strategies. Parameter estimates were determined by systematic reviews of epidemiology, economic evaluations of screening, and effectiveness (test accuracy, screening and treatment). Tailored highly sensitive electronic searches were undertaken. Results: Most potential screening tests reviewed had an estimated specificity of 85% or higher. No test was clearly most accurate, with only a few, heterogeneous studies for each test. No randomised controlled trials (RCTs) of screening were identified. Based on two treatment RCTs, early treatment reduces the risk of progression. Extrapolating from this, and assuming accelerated progression with advancing disease severity, without treatment the mean time to blindness in at least one eye was approximately 23 years, compared to 35 years with treatment. Prevalence would have to be about 3-4% in 40 year olds with a screening interval of 10 years to approach cost-effectiveness. It is predicted that screening might be cost-effective in a 50-year-old cohort at a prevalence of 4% with a 10-year screening interval. General population screening at any age, thus, appears not to be cost-effective. Selective screening of groups with higher prevalence (family history, black ethnicity) might be worthwhile, although this would only cover 6% of the population. Extension to include other at-risk cohorts (e.g. myopia and diabetes) would include 37% of the general population, but the prevalence is then too low for screening to be considered cost-effective. Screening using a test with initial automated classification followed by assessment by a specialised optometrist, for test positives, was more cost-effective than initial specialised optometric assessment. The cost-effectiveness of the screening programme was highly sensitive to the perspective on costs (NHS or societal). In the base-case model, the NHS costs of visual impairment were estimated as £669. If annual societal costs were £8800, then screening might be considered cost-effective for a 40-year-old cohort with 1% OAG prevalence assuming a willingness to pay of £30,000 per quality-adjusted life-year. Of lesser importance were changes to estimates of attendance for sight tests, incidence of OAG, rate of progression and utility values for each stage of OAG severity. Cost-effectiveness was not particularly sensitive to the accuracy of screening tests within the ranges observed. However, a highly specific test is required to reduce large numbers of false-positive referrals. The findings that population screening is unlikely to be cost-effective are based on an economic model whose parameter estimates have considerable uncertainty, in particular, if rate of progression and/or costs of visual impairment are higher than estimated then screening could be cost-effective. Conclusions: While population screening is not cost-effective, the targeted screening of high-risk groups may be. Procedures for identifying those at risk, for quality assuring the programme, as well as adequate service provision for those screened positive would all be needed. Glaucoma detection can be improved by increasing attendance for eye examination, and improving the performance of current testing by either refining practice or adding in a technology-based first assessment, the latter being the more cost-effective option. This has implications for any future organisational changes in community eye-care services. Further research should aim to develop and provide quality data to populate the economic model, by conducting a feasibility study of interventions to improve detection, by obtaining further data on costs of blindness, risk of progression and health outcomes, and by conducting an RCT of interventions to improve the uptake of glaucoma testing. © Queen's Printer and Controller of HMSO 2007. All rights reserved.

Unique Challenges in WiFi Intrusion Detection

The Intrusion Detection System (IDS) is a common means of protecting networked systems from attack or malicious misuse. The deployment of an IDS can take many different forms dependent on protocols, usage and cost. This is particularly true of Wireless Intrusion Detection Systems (WIDS) which have many detection challenges associated with data transmission through an open, shared medium, facilitated by fundamental changes at the Physical and MAC layers. WIDS need to be considered in more detail at these lower layers than their wired counterparts as they face unique challenges. The remainder of this chapter will investigate three of these challenges where WiFi deviates significantly from that of wired counterparts:

• Attacks Specific to WiFi Networks: Outlining the additional threats which WIDS must account for: Denial of Service, Encryption Bypass and AP Masquerading attacks.

• The Effect of Deployment Architecture on WIDS Performance: Demonstrating that the deployment environment of a network protected by a WIDS can influence the prioritisation of attacks.

• The Importance of Live Data in WiFi Research: Investigating the different choices for research data sources with an emphasis on encouraging live network data collection for future WiFi research.

Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals

Background: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. 

Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. 

Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (p_trend<0·0001).

Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. 

Self-perception of dentofacial attractiveness among patients requiring orthognathic surgery

Objective: To test the hypothesis that the self-perception of dental and facial attractiveness among patients requiring orthognathic surgery is no different from that of control patients.

Materials and Methods: Happiness with dental and facial appearance was assessed using questionnaires completed by 162 patients who required orthognathic treatment and 157 control subjects. Visual analog scale, binary, and open response data were collected. Analysis was carried out using a general linear model, logistic regression, and chi-square tests.

Results: Orthognathic patients were less happy with their dental appearance than were controls. Class II patients and women had lower happiness scores for their dental appearance. Among orthognathic patients, the "shape" and "prominence" of their teeth were the most frequent causes of concern. Older subjects, women, and orthognathic patients were less happy with their facial appearance. Class III orthognathic patients, older subjects, and women were more likely to have looked at their own face in profile. A greater proportion of Class II subjects than Class III subjects wished to change their appearance.

Conclusions: The hypothesis is rejected. The findings indicate that women and patients requiring orthognathic surgery had lower levels of happiness with their dentofacial appearance. Although Class II patients exhibited the lowest levels of happiness with their dental appearance, there was some evidence that concerns and awareness about their facial profile were more pronounced among the Class III patients.

Journeys into the unknown: shared schooling and social change in Quebec and Northern Ireland

This article compares experiences of shared schooling in societies with 2 distinctive traits: first, a history of intercommunity conflict and isolation; and second, a segregated school system. Drawing on Parekh’s (2006) reconceptualisation of multiculturalism, this article analyses issues arising from experiences of intercommunity contact in shared schools in Quebec and Northern Ireland—in one case, bringing Anglophones and Francophones together and, in the other, Protestants and Catholics. Research data from both contexts is drawn upon to reflect on how this experience is lived. The metaphor of a journey is used to capture what it represents for those involved. A need to clarify, recognize, and exploit the potential of shared schooling for the transformation of divided societies is identified.

Joining together or pushing apart? Building relations and exploring difference through shared education in Northern Ireland

In divided societies, the promotion of cross-cultural contact through the education system has been central to efforts to improve intergroup relations. This approach is informed by an understanding of the contact hypothesis, which suggests that positive contact with a member of a different group should contribute to improvements in attitudes towards the group as a whole. While a substantial body of research provides support for contact theory, critics have argued that its emphasis on harmonious encounters can result in the neglect of group differences and associated issues of conflict and discrimination during contact. The research discussed in this article explores this tension with reference to two shared education projects in Northern Ireland. Research data, gathered primarily through interviews with pupils, confirms that divisive issues are rarely addressed during contact and explores several influences on this: the nature of pupils’ relationships, the programme structure, and the prevailing social norms of avoidance.

Exploring the Findings from Three Randomised Controlled Trials of Bookgifting Programmes

Aims: This paper explores the effects from three similar bookgifting programmes on improving reading outcomes of early years’ children, their parents and teachers.
Methods: The paper draws on research data produced by the Centre for Effective Education during three randomised controlled trial (RCT) evaluations of bookgifting programmes (N=1694 participant families in total). The three studies used pre and post test measures to identify effects across a total of 15 social, cognitive and behavioural reading outcomes.
Results: The overall average effect across the 15 outcomes from data provided by 1694 participant families, was d=0.07. This is a relatively small overall effect and there was an overall pattern of small positive effects of this scale across the wide range of the reading outcomes assessed. However, only one significant effect was identified in the 15 outcomes assessed across all three studies.
Conclusions: The review of these three studies suggests that the RCTs struggle to identify significant effects in these low exposure and low cost bookgifting interventions. Furthermore, it is recommended that future RCT studies of this type of programme require very large sample sizes in the scale of 1000’s rather than 100’s to generate enough study power. Or alternatively, these programmes could be evaluated as a component part of more intensive reading interventions.

Catalysing open innovation through publicly funded R&D: A Comparison of University and Company-based research centres

Public funding of university and company-based R&D centres of excellence is widespread both in core and more peripheral regions. What is less well-known is whether these R&D centres can catalyse multi-directional, multi-actor and iterative innovation. Based on data from a real-time monitoring study, this article explores the development of 18 R&D centres’ external connections. University-based R&D centres establish more new connections than company-based centres and are more likely to be interacting with small or micro-firms. However, there is a general bias towards links with larger firms; micro, small and medium-sized enterprises also are less likely to be involved in collaborative R&D with research centres than other types of relationships. The results suggest the potential for R&D centres to act as a catalyst for open innovation but emphasise the need to ensure that the focus of the R&D being conducted is relevant to the needs of smaller firms.

Prising open the black box: Critical realism, action research and social work

There is a growing interest in critical realism and its application to social work. This article makes a case for adopting this philosophical position in qualitative social work research. More specifically, it suggests that there is a concordance between critical realist premises and action research with its cyclical inquiry and advancement of social change. This combination of philosophy and method, it is argued, promotes anti-oppressive social work research and illuminates the processes shaping outcomes in programme evaluations. Overall, the article underscores the importance of 'depth' in qualitative inquiry by conceiving the social world in terms of five interlacing, social domains.

Data mining approach identifies research priorities and data requirements for resolving the red algal tree of life

Background. The assembly of the tree of life has seen significant progress in recent years but algae and protists have been largely overlooked in this effort. Many groups of algae and protists have ancient roots and it is unclear how much data will be required to resolve their phylogenetic relationships for incorporation in the tree of life. The red algae, a group of primary photosynthetic eukaryotes of more than a billion years old, provide the earliest fossil evidence for eukaryotic multicellularity and sexual reproduction. Despite this evolutionary significance, their phylogenetic relationships are understudied. This study aims to infer a comprehensive red algal tree of life at the family level from a supermatrix containing data mined from GenBank. We aim to locate remaining regions of low support in the topology, evaluate their causes and estimate the amount of data required to resolve them. Results. Phylogenetic analysis of a supermatrix of 14 loci and 98 red algal families yielded the most complete red algal tree of life to date. Visualization of statistical support showed the presence of five poorly supported regions. Causes for low support were identified with statistics about the age of the region, data availability and node density, showing that poor support has different origins in different parts of the tree. Parametric simulation experiments yielded optimistic estimates of how much data will be needed to resolve the poorly supported regions (ca. 103 to ca. 104 nucleotides for the different regions). Nonparametric simulations gave a markedly more pessimistic image, some regions requiring more than 2.8 105 nucleotides or not achieving the desired level of support at all. The discrepancies between parametric and nonparametric simulations are discussed in light of our dataset and known attributes of both approaches. Conclusions. Our study takes the red algae one step closer to meaningful inclusion in the tree of life. In addition to the recovery of stable relationships, the recognition of five regions in need of further study is a significant outcome of this work. Based on our analyses of current availability and future requirements of data, we make clear recommendations for forthcoming research.