Effectiveness of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual non-inferiority trial

OBJECTIVES: To compare the ability of ophthalmologists versus optometrists to correctly classify retinal lesions due to neovascular age-related macular degeneration (nAMD).

DESIGN: Randomised balanced incomplete block trial. Optometrists in the community and ophthalmologists in the Hospital Eye Service classified lesions from vignettes comprising clinical information, colour fundus photographs and optical coherence tomographic images. Participants' classifications were validated against experts' classifications (reference standard).

SETTING: Internet-based application.

PARTICIPANTS: Ophthalmologists with experience in the age-related macular degeneration service; fully qualified optometrists not participating in nAMD shared care.

INTERVENTIONS: The trial emulated a conventional trial comparing optometrists' and ophthalmologists' decision-making, but vignettes, not patients, were assessed. Therefore, there were no interventions and the trial was virtual. Participants received training before assessing vignettes.

MAIN OUTCOME MEASURES: Primary outcome-correct classification of the activity status of a lesion based on a vignette, compared with a reference standard. Secondary outcomes-potentially sight-threatening errors, judgements about specific lesion components and participants' confidence in their decisions.

RESULTS: In total, 155 participants registered for the trial; 96 (48 in each group) completed all assessments and formed the analysis population. Optometrists and ophthalmologists achieved 1702/2016 (84.4%) and 1722/2016 (85.4%) correct classifications, respectively (OR 0.91, 95% CI 0.66 to 1.25; p=0.543). Optometrists' decision-making was non-inferior to ophthalmologists' with respect to the prespecified limit of 10% absolute difference (0.298 on the odds scale). Optometrists and ophthalmologists made similar numbers of sight-threatening errors (57/994 (5.7%) vs 62/994 (6.2%), OR 0.93, 95% CI 0.55 to 1.57; p=0.789). Ophthalmologists assessed lesion components as present less often than optometrists and were more confident about their classifications than optometrists.

CONCLUSIONS: Optometrists' ability to make nAMD retreatment decisions from vignettes is not inferior to ophthalmologists' ability. Shared care with optometrists monitoring quiescent nAMD lesions has the potential to reduce workload in hospitals.

TRIAL REGISTRATION NUMBER: ISRCTN07479761; pre-results registration.

The Development and Evaluation of a School-Based Programme to Promote and the Enhance Well-Being of Primary School Children

The current study was carried out to evaluate the impact of a well-being curriculum based on existing knowledge of themes within PP, which contribute to well-being. The Positive Well-Being Curriculum consists of twelve ninety minute sessions delivered weekly during a school term. The twelve well-being sessions fit into four domains: positive experience, positive emotions, positive relationships, achievement and meaning (Seligman, 2007). The objectives of the study were to test the practical implications of running a well-being curriculum, to develop a range of activities within each domain and to evaluate the impact on student well-being with regard to life satisfaction, positive affectivity and subjective happiness. A pilot was carried out as preparation for the main mixed method intervention study, which was conducted in two London primary schools. Pre and post data was collected using standardised measures, focus groups and one to one interviews. Findings from the pilot demonstrated a significant increase in well-being as demonstrated by increases in: life satisfaction, positive affect and subjective happiness. Additional information was gathered which informed the content and implementation of the curriculum in the main study. The experience of taking part in the study as evidenced through qualitative and quantitative results, indicate that the Positive Well-being Curriculum was perceived by participating teachers and children to contribute positively to the well-being of the children. These findings would be of interest to educational psychologists as there is an increasing interest by schools to include creative and validated resources to support and enhance the well-being of all children. A number of useful insights were developed about the usefulness of the curriculum for children in a variety of educational settings.

Primary Care Service Areas in South Carolina

This project was developed in collaboration with the South Carolina Department of Health and Environmental Control Primary Care Office in order to identify primary care market areas and resources within South Carolina. Primary Care Service Areas are designed to identify small geographic areas that are relatively self-contained markets for primary care. Included is a map and listing for Primary Care Service Areas in the state.

Guided portfolio writing as a scaffold for reflective learning in in-service contexts: a case study

Language is widely recognized as an inescapable mediating tool for professional learning, and with this text we want to contribute to a better understanding of the particular role that guided writing can play in in-service professional reflective learning. We analysed one pre-school teacher’s written portfolio, the construction of which was guided to scaffold deep thinking about (and the transference of theory into) practice during participation in an in-service program about language education. Our case study shows that the writing process sustained robust learning about professional knowing, doing and learning itself: The teacher elaborated an integrative ethical understanding of the discussed theory, fully experienced newly informed practices and assessed her own learning by using theory to confront her previous knowledge and practices. Throughout the portfolio, the learning stance revealed by her voice varied accordingly. The study illustrates the potential of guided writing to scaffold reflective learning in in-service contexts.

Job satisfaction among primary school personnel in Madagascar

This article analyzes the job satisfaction of primary school teachers in Madagascar. Based on the estimation of multilevel models, low wages and problems getting paid, job insecurity, lack of in-service training, high pupil-teacher ratios, and lack of basic infrastructure and teaching materials are identified as the main reasons for dissatisfaction. Principals’ control of teachers’ activities also adversely affects satisfaction, suggesting that, in Malagasy schools, neither school directors nor teachers have succeeded in adopting organizational cultures based on cooperation among their members. These results are likely to stimulate debates on educational policy, both in Madagascar and in many other developing countries.

Prevalence of vocal problems in portuguese primary and secondary shool level teachers

This study compared the prevalence of vocal problems in two Portuguese groups: 73 teachers that use their voice as professional tool (teachers’ group) and 73 non-voice professionals (control group). It also identified the risk factors that contributed to teachers’ group voice problems. A questionnaire was applied to both goups in order to obtain information about vocal health, hygiene and behavior, professional activity and general physical health. Statistical results revealed that the teachers’ group presented a higher prevalence of vocal problems than the control group: 52% reported hoarseness, 46.6% vocal fatigue and 45.2% vocal discomfort compared with 31.5%, 20.5 % e 28.7%, respectively. Environmental factors (eg., smoke and cold temperatures), vocal abuse and upper respiratory pathologies (e.g., colds, laryngitis and pharyngitis) seemed to increase teachers’ voice disorders (p-value < .05). In conclusion, the absence of vocal pedagogy in the curricular plan of teachers’ higher education associated to poor working environmental conditions and professional voice demands explained the higher prevalence of vocal problems in teachers’ group.

Analysis of english teachers' perceptions related to strategies studied in a in-service course in Cuenca

El presente estudio describe las percepciones de los profesores fiscales de inglés en relación a las estrategias aprendidas durante una capacitación realizada en el año 2012 por un grupo de investigadores de la Facultad de Filosofía de la Universidad de Cuenca. En el año 2014, este grupo de investigadores inició un proyecto para analizar el impacto de dicha capacitación. Este es el marco contextual en el cual se desarrolla el análisis de la percepción docente. La propuesta está basada en el método exploratorio. El instrumento de investigación fue la entrevista personal a diez profesores que participaron de la capacitación en el año 2012. Los resultados fueron analizados con la ayuda del Software Atlas ti. Se identificaron catorce códigos diferentes que fueron agrupados en cuatro grupos de familias: estrategias comunicativas, aprendizaje significativo, percepciones de las necesidades e inconsistencias. Todas estas familias de códigos convergieron alrededor del Aprendizaje Basado en Tareas (ABT), el cual permitía generar un outcome, cuyo significado específico es la generación de un producto a partir del uso del idioma inglés por parte de los estudiantes. Un hallazgo importante fue que casi todos los profesores recordaron varias estrategias aprendidas en la capacitación, mismas que sumaron un total de nueve, además la mitad de docentes estaba usando el outcome en sus clases, ello da cuenta de la percepción positiva que tienen los docentes sobre el curso, a pesar de haber transcurrido dos años de su clausura.

99% - Dall’1% dell'idea al 99% della fase Pre-Seed: ciò che serve sapere (e forse non tutti dicono) su questo percorso, visto dalla prospettiva di un Service Designer

Oggigiorno, quando una persona “ha un’idea” e vuole concretizzarla si rivolge agli incubatori: la diffusa metodologia Lean Startup è determinante nel far comprendere agli aspiranti founders la portata della propria “idea” abbattendo i rischi. Tuttavia, ci sono due problemi: accedere ai percorsi di incubazione non è scontato e, una volta concluso il percorso, si hanno diverse conoscenze per passare dalla validazione alla fase Seed, ma non sufficienti per un’efficace Execution. Partendo dalla personale esperienza del progetto Climby, si cercherà di dare un’overview sugli aspetti più importanti da considerare, evidenziando ciò che si potrebbe sottovalutare. Il fine è dunque supportare chi “ha un’idea” nell’intraprendere il percorso di incubazione in modo più consapevole e illustrare i limiti dei percorsi stessi, suggerendo approfondimenti di immediata applicazione ed utilità nelle diverse fasi citate, come integrazioni tratte dal Service Design. Pertanto, sarà posta particolare attenzione a ciò che è stato appreso in prima persona, considerando errori e aspetti positivi del percorso di un’“idea” nata nel 2019 e trasformatasi drasticamente durante l’incubazione, fino a ciò che accade dopo il Pitch Day. In tal modo, si intende anche esplicitare alcuni aspetti importanti, talvolta trascurati, ma rilevanti per le scelte da compiere prima ancora di iniziare un percorso. Il fine, quindi, è quello di produrre un contenuto complementare agli autorevoli scritti che trattano di Lean Startup, invece di proporne trattazione alternativa. Infine, conducendo queste riflessioni, si proporrà anche un confronto più specifico tra le metodologie e gli strumenti di Lean Startup e Service Design e - anticipando le conclusioni - suggerendo che sarebbe interessante approfondire l’integrazione di questi due ambiti, di cui emerge ancora una forte mancanza di reciproca conoscenza e che, invece, potrebbero rappresentare reciprocamente una risorsa se considerati senza visioni di parte.

Temporomandibular Dysfunction Post-craniotomy: Evaluation Between Pre- And Post-operative Status.

To identify risk factors associated with post-operative temporomandibular joint dysfunction after craniotomy. The study sample included 24 patients, mean age of 37.3 ± 10 years; eligible for surgery for refractory epilepsy, evaluated according to RDC/TMD before and after surgery. The primary predictor was the time after the surgery. The primary outcome variable was maximal mouth opening. Other outcome variables were: disc displacement, bruxism, TMJ sound, TMJ pain, and pain associated to mandibular movements. Data analyses were performed using bivariate and multiple regression methods. The maximal mouth opening was significantly reduced after surgery in all patients (p = 0.03). In the multiple regression model, time of evaluation and pre-operative bruxism were significantly (p < .05) associated with an increased risk for TMD post-surgery. A significant correlation between surgery follow-up time and maximal opening mouth was found. Pre-operative bruxism was associated with increased risk for temporomandibular joint dysfunction after craniotomy.

The Environment Of Professional Practice And Burnout In Nurses In Primary Healthcare.

to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas.

Formação de professores: aspectos históricos e teóricos do problema no contexto brasileiro

This article deals with the theme of teacher training from the historical and theoretical perspectives. In the first part, the historical focus is introduced and the trajectory of teacher training in Brazil is examined, dividing it into six periods beginning with the passing of the Law of Schools of First Letters in 1827 and closing with the promulgation of the new law for national education in 1996. The second part deals with theoretical aspects, considering the two basic models of teacher training, their implications for the training of teachers of primary and pre-school education, the dilemma resulting from the contraposition between the two models and the way for overcoming it and concluding with observations on the training of teachers for special education.

Crescimento e desempenho motor em pre-escolares de Itapira SP : um enfoque bio-social-cultural

Universidade Estadual de Campinas. Faculdade de Educação Física

Synergistic effect of simvastatin and ezetimibe on lipid and pro-inflammatory profiles in pre-diabetic subjects

Background: Ezetimibe specifically blocks the absorption of dietary and biliary cholesterol and plant sterols. Synergism of ezetimibe-statin therapy on LDL-cholesterol has been demonstrated, but data concerning the pleiotropic effects of this combination are controversial. Objective: This open-label trial evaluated whether the combination of simvastatin and ezetimibe also results in a synergistic effect that reduces the pro-inflammatory status of pre-diabetic subjects. Methods: Fifty pre-diabetic subjects were randomly assigned to one of 2 groups, one receiving ezetimibe (10 mg/day), the other, simvastatin (20 mg/d) for 12 weeks, followed by an additional 12-week period of combined therapy. Blood samples were collected at baseline, 12 and 24 weeks. RESULTS: Total cholesterol, LDL-cholesterol and apolipoprotein B levels decreased in all the periods analyzed (p < 0.01), but triglycerides declined significantly only after combined therapy. Both drugs induced reductions in C-reactive protein, reaching statistical significance after combining ezetimibe with the simvastatin therapy (baseline 0.59 +/- 0.14, simvastatin monotherapy 0.48 +/- 0.12 mg/dL and 0.35 +/- 0.12 mg/dL, p < 0.023). Such a reduction was independent of LDL-cholesterol change. However, mean levels of TNF-alpha and interleukin-6 and leukocyte count did not vary during the whole study. Conclusion: Expected synergistic lowering effects of a simvastatin and ezetimibe combination on LDL-cholesterol, apolipoprotein B and triglycerides levels were confirmed in subjects with early disturbances of glucose metabolism. We suggest an additive effect of this combination also on inflammatory status based on the reduction of C-reactive protein. Attenuation of pro-inflammatory conditions may be relevant in reducing cardiometabolic risk.

Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

Background: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage. Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution. Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.