Methodological variations in estimating apparent progressive visual field loss in clinical trials of glaucoma treatment.

OBJECTIVES:

To compare methods to estimate the incidence of visual field progression used by 3 large randomized trials of glaucoma treatment by applying these methods to a common data set of annually obtained visual field measurements of patients with glaucoma followed up for an average of 6 years.

METHODS:

The methods used by the Advanced Glaucoma Intervention Study (AGIS), the Collaborative Initial Glaucoma Treatment Study (CIGTS), and the Early Manifest Glaucoma Treatment study (EMGT) were applied to 67 eyes of 56 patients with glaucoma enrolled in a 10-year natural history study of glaucoma using Program 30-2 of the Humphrey Field Analyzer (Humphrey Instruments, San Leandro, Calif). The incidence of apparent visual field progression was estimated for each method. Extent of agreement between the methods was calculated, and time to apparent progression was compared.

RESULTS:

The proportion of patients progressing was 11%, 22%, and 23% with AGIS, CIGTS, and EMGT methods, respectively. Clinical assessment identified 23% of patients who progressed, but only half of these were also identified by CIGTS or EMGT methods. The CIGTS and the EMGT had comparable incidence rates, but only half of those identified by 1 method were also identified by the other.

CONCLUSIONS:

The EMGT and CIGTS methods produced rates of apparent progression that were twice those of the AGIS method. Although EMGT, CIGTS, and clinical assessment rates were comparable, they did not identify the same patients as having had field progression.

Out on the Inside: The Rights, Experiences and Needs of LGBT People in Prison

Lesbian, Gay, Bisexual and Transgender (LGBT) people have long been a ‘hidden’ or overlooked population in prisons. In recent years, however, international research and policy has begun to focus on the experiences and needs of this group. This research has revealed a range of issues that affect LGBT individuals in prison. This includes heteronormativity, homophobia and transphobia both within and outside prison, the threat of physical and sexual violence within prison, institutional discrimination and neglect, health needs, and social isolation. Based on a review of international literature and primary research with representatives from the LGBT and criminal justice sectors, prisoners and former prisoners, this report represents the first study of the needs and experiences of LGBT prisoners within the Irish context.

Growing Up On an Interface: Findings and Implications for the Social Needs, Mental Health and Lifetime Opportunities of Belfast Youth

In this research we aimed to find out what types of risk (if any) affected young people and children growing up in places of high religious segregation or what we normally call interface communities. This is important as we know that risk and experiences of harm and violence can have negative impacts upon development, emotional well-being and future prospects. It is important to understand what types of risk affect young people and children so as we can respond to these in terms of aiding better personal and community development with regard to health, work, education and wider opportunities.

Hearing the voices of kinship foster carers in Northern Ireland: An inquiry into characteristics, needs and experiences

This study describes an investigation into the characteristics, needs and experiences of kinship foster carers in Northern Ireland. By adopting a mixed-methods approach with 54 carers, a number of salient themes was captured. The respondents were predominantly grandparents who experienced a significant incidence of health-related issues. The cohort also endured high levels of stress, particularly at the beginning stage of the foster placement. Consequently, their need for practical, emotional and respite support was most evident. In terms of the children for whom they cared, many required help at school, and some presented with challenging emotions and behaviours. Overall, these findings emphasised the importance of relationship-based social work and demonstration of accurate empathy to the carer.

L'adoption d'une innovation technopédagogique par une communauté enseignante universitaire

Résumé: L'adoption d'une innovation technopédagogique par une communauté enseignante universitaire La thèse traite de l'adoption d'une innovation technopédagogique par une communauté enseignante universitaire. Cette étude longitudinale, réalisée dans le cadre d'une recherche-action, vise à comprendre la dynamique globale du processus d'adoption d'une innovation. Le cadre de réflexion théorique de l'étude provient de la recherche en management, en systèmes d'information et en éducation. Il tient à la fois compte des motivations et des besoins des individus (dimension individuelle), de la compatibilité des technologies de l'information selon les théories usuelles de l'apprentissage (dimension pédagogique) et du type de soutien à offrir aux utilisatrices-utilisateurs (dimension organisationnelle). Le modèle d'accompagnement émergeant de cette recherche se compose de cycles itératifs au cours desquels un groupe définit et résout un problème, puis réfléchit successivement aux enjeux émergents d'un cycle à l'autre. Le modèle tient explicitement compte des trois éléments clés suivants: l'individu, la pédagogie et l'organisation qui forment une dynamique systémique indissociable et en interaction les unes les autres pendant toute la durée du processus d'adoption de l'innovation. Il met aussi en lumière la nécessité de stimuler une réflexion critique grâce au concours de ressources externes crédibles pour déterminer la compatibilité des technologies à partir d'expériences concrètes. Une telle démarche participative systématique permet d'accroître la cohésion des idées du groupe par le dialogue et les débats d'opinions_ Par ailleurs, la proximité avec notre milieu de recherche sur une période de deux ans offre la possibilité de saisir plusieurs facettes de la dynamique organisationnelle. Lorsque l'on réalise une étude longitudinale qui met en évidence l'incidence d'événements concomitants, on constate la fragilité du processus et la réversibilité de la décision d'adoption. L'intention d'adoption évolue constamment au gré des expériences des individus et du contexte qui évolue lui-même. L'établissement de relations partenariales avec les groupes intéressés représente une activité essentielle pour pallier ou neutraliser les effets indésirables d'événements concomitants.||Abstract: This thesis deals with a university teaching community adopting a technological/pedagogical innovation. This longitudinal study--part of an action-research study--aims at gaining understanding of the overall dynamics involved in adopting an innovation. The study's conceptual framework derives from management, information-systems, and teaching research. It takes into account the motivations and needs of individuals (individual dimension), the compatibility of information technologies according to current learning theories (pedagogical dimension), and the type of support to be offered to users (organizational dimension). The companion model issuing from this research work comprises iterative cycles during which a group defines and solves a problem and then successively reflects on the issues emerging from one cycle to the next. The model takes explicit account of three key elements: the individual, pedagogical approach, and organization form an indissociable system dynamic in which all dimensions interact during the entire process of adopting innovation. It also sheds light on the need to stimulate critical reflection about the combination of credible external resources so that tangible experiences can be used to determine technology compatibility. This kind of systematic participative process yields greater cohesiveness of group ideas through dialogue and discussion. Moreover, the proximity to our research setting over two years provides the opportunity to seize the many facets of organizational dynamics. During the course of a longitudinal study that highlights the incidence of concomitant events, the fragility of the process and reversibility of the adoption decision become apparent. The adoption intention constantly fluctuates through the experiences of individuals and the context, which also changes. Establishing partnership relations with interested groups stands out as an essential activity in attenuating or counteracting the undesirable effects produced by concomitant events.

Understanding the Needs of People with Dementia and Family Carers

This is the first in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. When a person with dementia is in hospital, poor understanding of individual needs and preferences can contribute to a lack of person-centred care. Similarly, the needs of family carers can often be overlooked and staff do not always appreciate these needs at such a stressful time. This article illustrates how three NHS trusts have addressed these issues. To help staff get to know patients with dementia, Salford Royal NHS Foundation Trust has implemented a patient passport. Similarly, The Shrewsbury and Telford Hospital NHS Trust has implemented a carer passport that overcomes the restrictions imposed by hospital visiting hours. Royal Devon and Exeter NHS Foundation Trust also focused on carers, holding a workshop to elicit feedback on what was important to them. This was a useful means of engaging with carers and helped staff to realise that even simple changes can have a significant effect.

BESTUFS policy and research recommendations IV: environmental zones in European cities, accommodating the needs of passenger and freight transport in cities, and BESTUFS Project recommendations

Recommendations report produced as part of the EC-funded BESTUFS project on urban freight transport.

Old conflicts, new rivals? Airline competition in the European market

Christoph Franz of Lufthansa recently identified Ryanair, easyJet, Air Berlin and Emirates as the company’s main competitors – gone are the days when it could benchmark itself against BA or Air France-KLM! This paper probes behind the headlines to assess the extent to which different airlines are in competition, using evidence from the UK and mainland European markets. The issue of route versus network competition is addressed. Many regulators have put an emphasis on the former whereas the latter, although less obvious, can be more relevant. For example, BA and American will cease to compete between London and Dallas Fort Worth if their alliance obtains anti-trust immunity but 80% of the passengers on this route are connecting at one or both ends and hence arguably belong to different markets (e.g. London-San Francisco, Zurich-Dallas, Edinburgh-New Orleans) which may be highly contested. The remaining 20% of local traffic is actually insufficient to support a single point to point service in its own right. Estimates are made of the seat capacity major airlines are offering to the local market as distinct from feeding other routes. On a sector such as Manchester–Amsterdam, 60% of KLM’s passengers are transferring at Schiphol as against only 1% of bmibaby’s. Thus although KLM operates 5 flights and 630 seats per day against bmibaby’s 2 flights and 298 seats, in the point to point market bmibaby offers more seats than KLM. The growth of the Low Cost Carriers (LCCs) means that competition increasingly needs to be viewed on city pair markets (e.g. London-Rome) rather than airport pair markets (e.g. Heathrow-Fiumicino). As the stronger LCCs drive out weaker rivals and mainline carriers retrench to their major hubs, some markets now have fewer direct options than existed prior to the low cost boom. Timings and frequencies are considered, in particular the extent to which services are a true alternative especially for business travellers. LCCs typically offer lower frequencies and more unsociable timings (e.g. late evening arrivals at remote airports) as they are more focused on providing the cheapest service rather than the most convenient schedule. Interesting findings on ‘monopoly’ services are presented (including alliances) - certain airlines have many more of these than others. Lufthansa has a significant number of sectors to itself whereas at the other extreme British Airways has direct competition on almost every route in its network. Ryanair and flybe have a higher proportion of monopoly routes than easyJet or Air Berlin. In the domestic US market it has become apparent since deregulation that better financial returns can come from dominating a large number of smaller markets rather than being heavily exposed in the major markets - which are hotly fought over. Regional niches that appear too thin for Ryanair to serve (with its all 189 seat 737-800 fleet) are identified. Fare comparisons in contrasting markets provide some insights to marketing and pricing strategies. Data sources used include OAG (schedules and capacity), AEA (traditional European airlines traffic by region), the UK CAA (airport, airline and route traffic plus survey information of passenger types) and ICAO (international route traffic and capacity by carrier). It is concluded that airlines often have different competitors depending on the context but in surprisingly many cases there are actually few or no direct substitutes. The competitive process set in train by deregulation of European air services in the 1990s is leading back to one of natural monopolies and oblique alternatives. It is the names of the main participants that have changed however!