Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

BACKGROUND: Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).

OBJECTIVES: The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?

ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) for efficacy but other designs also used.

REVIEW METHODS: Systematic review and economic modelling.

RESULTS: The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.

LIMITATION: The current evidence is insufficient to recommend PRP for severe NPDR.

CONCLUSIONS: There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005408.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Rent: apartment blocks and their uses

In 1974, pursuing his interest in the infra-ordinary – ‘the banal, the quotidian, the obvious, the common, the ordinary, the back-ground noise, the habitual’ – Georges Perec wrote about an idea for a novel:
‘I imagine a Parisian apartment building whose façade has been removed … so that all the rooms in the front, from the ground floor up to the attics, are instantly and simultaneously visible’.
In Life A User’s Manual (1978) the consummation of this precis, patterns of existence are measured within architectural space with an archaeological sensibility that sifts through narrative and décor, structure and history, services and emotion, the personal and the system, ascribing commensurate value to each.
Apartment comes from the Italian appartare meaning ‘to separate’. The space of the boundary between activities is reduced to a series of intimately thin lines: the depth of a floor, a party wall, a window, the convex peep-hole in a door, or the façade that Perec seeks to render invisible. The apartness of the apartment is accelerated when aligned with short-term tenancies. Here Perec’s interweaving of personal histories over time using the structure of the block, gives way to convivialities of detachment: inhabitants are temporary, their personalities anonymous, their activities unknown or overlooked.
Borrowing methods from Perec, to move somewhere between conjecture, analysis and other documentation and tracing relationships between form, structure, materiality, technology, organisation, tenure and narrative use, this paper interrogates the late twentieth-century speculative apartment block in Britain and Ireland arguing that its speculative and commodified purpose allows a series of lives that are often less than ordinary to inhabit its spaces.
Henri Lefebvre described the emergence of an ‘abstract space’ under capitalism in terms which can be applied to the apartment building: the division of space into freely alienable privatised parcels which can be exchanged. Vertical distributions of class and other new, contiguous social and spatial relationships are couched within a paradox: the building which allows such proximities is also a conductor of division. Apartment comes from the Italian appartare meaning ‘to separate’. The space of the boundary between activities is reduced to a series of intimately thin lines: the depth of a floor, a party wall, a window, the convex peep-hole in a door, or the façade that Perec seeks to render invisible. The apartness of the apartment is accelerated when aligned with short-term tenancies. Here Perec’s interweaving of personal histories over time using the structure of the block, gives way to convivialities of detachment: inhabitants are temporary, their personalities anonymous, their activities unknown or overlooked.

Gaze behavior of the visually impaired during street crossing.

PURPOSE:

This study explored the gaze patterns of fully sighted and visually impaired subjects during the high-risk activity of crossing the street.

METHODS:

Gaze behavior of 12 fully sighted subjects, nine with visual impairment resulting from age-related macular degeneration and 12 with impairment resulting from glaucoma, was monitored using a portable eye tracker as they crossed at two unfamiliar intersections.

RESULTS:

All subject groups fixated primarily on vehicles and crossing elements but changed their fixation behavior as they moved from "walking to the curb" to "standing at the curb" and to "crossing the street." A comparison of where subjects fixated in the 4-second time period before crossing showed that the fully sighted who waited for the light to change fixated on the light, whereas the fully sighted who crossed early fixated primarily on vehicles. Visually impaired subjects crossing early or waiting for the light fixate primarily on vehicles.

CONCLUSIONS:

Vision status affects fixation allocation while performing the high-risk activity of street crossing. Crossing decision-making strategy corresponds to fixation behavior only for the fully sighted subjects.

Health care professionals’ experience, understanding and perception of need of advanced cancer patients with cachexia and their families: The benefits of a dedicated clinic.

Background: Cachexia has been defined as an on-going loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support. It can be found in up to 80% of patients with advanced cancer and has profound psycho-social consequences for patients and their families. There is a paucity of studies examining the role and experience of healthcare professionals in relation to cachexia and existing studies suggest that professional staff have limited understanding and do not intervene effectively.
Aim: To identify barriers and facilitators to good practice in cachexia care in order to inform future developments in service provision.
Design: An exploratory qualitative study was conducted employing semi-structured interviews with a range of healthcare professionals recruited purposefully from an Australian hospital. Interviews were conducted in private rooms within the hospital.
Setting/participants: A range of healthcare professionals responsible for cancer care were recruited from a large Australian teaching hospital.
Results: Interviews were conducted with 8 healthcare professionals responsible for delivering cancer care. Four themes were identified: formal and informal education, knowledge and understanding, truth telling in cachexia and palliative care, and, a multi-disciplinary approach. Findings show how improved knowledge and understanding across a staff body can lead to improved staff confidence and a willingness to address cancer cachexia and its consequences with patients and their families.
Conclusion: Comparison with previous studies illustrates the importance of improving knowledge and understanding about cachexia and how this can contribute to staff having the skills and experience necessary to address cachexia and provide an improved care experience for patients and carers.

Effects of a book gifting programme on literacy outcomes for foster children: A randomised controlled trial evaluation of the Letterbox Club in Northern Ireland

The poor educational outcomes of children in care is a significant concern internationally. Whilst there have been many interventions developed to address this problem, very few of these have been rigorously evaluated. This article presents the findings of a randomised controlled trial that sought to measure the effectiveness of a book gifting programme (the Letterbox Club) that aims to improve literacy skills amongst children aged 7-11 years in foster care. The programme involves children receiving six parcels of books sent through the post over a six-month period. The trial, which ran between April 2013 and June 2014, involved a sample of 116 children in Northern Ireland (56 randomly allocated to the intervention group and 60 to a waiting list control group). Outcome measures focused on reading skills (reading accuracy, comprehension and rate) and attitudes to reading and school. The trial found no evidence that the book-gifting programme had any effect on any of the outcomes measured. Drawing upon some of the emergent themes from the accompanying qualitative process evaluation that sought to determine foster carer/child attitude towards and engagement with the parcels, it is suggested that one plausible reason for the ineffectiveness of the Letterbox Club, as intimated by carers and children (rather than explicitly explored with them), is the lack of support provided to the carers/children in relation to the packs received. Reflective of an ecological model of children’s development, it is recommended that for book-gifting programmes to be effective they need to include a focus on encouraging the direct involvement of foster carers in shared literacy activities with the children using the books that are gifted.

Laser Driven Nuclear Physics at ELI–NP

High power lasers have proven being capable to produce high energy γ-rays, charged particles and neutrons, and to induce all kinds of nuclear reactions. At ELI, the studies with high power lasers will enter for the first time into new domains of power and intensities: 10 PW and 10^23 W/cm^2. While the development of laser based radiation sources is the main focus at the ELI-Beamlines pillar of ELI, at ELI-NP the studies that will benefit from High Power Laser System pulses will focus on Laser Driven Nuclear Physics (this TDR, acronym LDNP, associated to the E1 experimental area), High Field Physics and QED (associated to the E6 area) and fundamental research opened by the unique combination of the two 10 PW laser pulses with a gamma beam provided by the Gamma Beam System (associated to E7 area). The scientific case of the LDNP TDR encompasses studies of laser induced nuclear reactions, aiming for a better understanding of nuclear properties, of nuclear reaction rates in laser-plasmas, as well as on the development of radiation source characterization methods based on nuclear techniques. As an example of proposed studies: the promise of achieving solid-state density bunches of (very) heavy ions accelerated to about 10 MeV/nucleon through the RPA mechanism will be exploited to produce highly astrophysical relevant neutron rich nuclei around the N~126 waiting point, using the sequential fission-fusion scheme, complementary to any other existing or planned method of producing radioactive nuclei.

The studies will be implemented predominantly in the E1 area of ELI-NP. However, many of them can be, in a first stage, performed in the E5 and/or E4 areas, where higher repetition laser pulses are available, while the harsh X-ray and electromagnetic pulse (EMP) environments are less damaging compared to E1.

A number of options are discussed through the document, having an important impact on the budget and needed resources. Depending on the TDR review and subsequent project decisions, they may be taken into account for space reservation, while their detailed design and implementation will be postponed.

The present TDR is the result of contributions from several institutions engaged in nuclear physics and high power laser research. A significant part of the proposed equipment can be designed, and afterwards can be built, only in close collaboration with (or subcontracting to) some of these institutions. A Memorandum of Understanding (MOU) is currently under preparation with each of these key partners as well as with others that are interested to participate in the design or in the future experimental program.

The Pine Wood Nematode: a personal view

The first report of the disease (“pine wilt disease”) associated with the pinewood nematode, goes back to 1905, when Yano reported an unusual decline of pines from Nagasaki. For a long time thereafter, the cause of he disease was sought, but without success. Because of the large number of insect species that were usually seen around and on infected trees, it had always been assumed that the causal agent would prove to be one of these. However, in 1971, Kiyohara and Tokushike found a nematode of the genus Bursaphelenchus in infected trees. The nematode found was multiplied on fungal culture, inoculated into healthy trees and then re-isolated from the resulting wilted trees. The subsequent published reports were impressive: this Bursaphelenchus species could kill fully-grown trees within a few months in the warmer areas of Japan, and could destroy complete forests of susceptible pine species within a few years. Pinus densiflora, P. thunbergii und P. luchuensis were particularly affected. In 1972, Mamiya and Kiyohara described the new species of nematode extracted from the wood of diseased pines; it was a named Bursaphelenchus lignicolus. Since 1975, the species has spread to the north of Japan, with the exception of the most northerly prefectures. In 1977, the loss of wood in the west of the country reached 80%. Probably as a result of unusually high summer temperatures and reduced rainfall in the years 1978 and 1979, the losses were more than 2 million m3 per year. From the beginning, B. lignicolus was always considered by Japanese scientists to be an exotic pest. But where did it come from? That this nematode could also cause damage in the USA became clear in 1979 when B. lignicolus was isolated in great numbers from wood of a 39 year-old pine tree (Pinus nigra) in Missouri which had suddenly died after the colour of its needles changed to a reddish-brown colour (Dropkin und Foudin, 2 1979). In 1981, B. lignicolus was synonymised by Nickle et al. with B. xylophilus which had been found for the first time in the USA as far back as 1929, and reported by Steiner and Buhrer in 1934. It had originally been named Aphelenchoides xylophilus, the wood-inhabiting Aphelenchoides but was recognised by Nickle, in 1970,to belong in the genus Bursaphelenchus. Its common name in the USA was the "pine wood nematode" (PWN. After its detection in Missouri, it became known that B. xylophilus was widespread throughout the USA and Canada. It occurred there on native species of conifers where, as a rule, it did not show the symptoms of pine wilt disease unless susceptible species were stressed eg., by high temperature. This fact was an illuminating piece of evidence that North America could be the homeland of PWN. Dwinell (1993) later reported the presence of B. xylophilus in Mexico. The main vector of the PWN in Japan was shown to be the long-horned beetle Monochamus alternatus, belonging to the family Cerambycidae. This beetle lays its eggs in dead or dying trees where the developing larvae then feed in the cambium layer. It was already known in Japan in the 19th century but in the 1930s, it was said to be present in most areas of Japan, but was generally uncommon. However, with the spread of the pine wilt disease, and the resulting increase of weakened trees that could act as breeding sites for beetles, the populations of Monochamus spp. increased significantly In North America, other Monochamus species transmit PWN, and the main vector is M. carolinensis. In Japan, there are also other, less efficient vectors in the genus Monochamus. Possibly, all Monochamus species that breed in conifers can transmit the PWN. The occasional transmission by less efficient species of Monochamus or by some of the many other beetle genera in the bark or wood is of little significance. In Europe, M. galloprovincialis and M. sutor transmits the closely related species B. mucronatus. Some speculate that these two insect species are “standing by” and waiting for the arrival of B. xylophilus. In 1982, the nematode was detected and China. It was first found in dead pines near the Zhongshan Monument of Nanjing (CHENG et. al. 1983); 265 trees were then killed by pine wilt disease. Despite great efforts at eradication in China, the nematode spread further and pine wilt disease has been 3 reported from parts of the provinces of Jiangsu, Anhui, Guangdong, Shandong, Zhejiang and Hubei (YANG, 2003). In 1986, the spread of the PWN to Taiwan was discovered and in 1989, the nematode was reported to be present in the Republic of Korea where it had first been detected in Pinus thunbergii and P. densiflora. It was though to have been introduced with packing material from Japan. PWN was advancing. In 1984, B. xylophilus was found in wood chips imported into Finland from the USA and Canada, and this was the impetus to establish phytosanitary measures to prevent any possible spread into Europe. Finland prohibited the import of coniferous wood chips from these sources, and the other Nordic countries soon followed suit. EPPO (the European and Mediterranean Plant Protection Organization) made a recommendation to its member countries in 1986 to refuse wood imports from infested countries. With its Directive of 1989 (77/93 EEC), the European Community (later called the European Union or EU) recognised the potential danger of B. xylophilus for European forests and imposed restrictions on imports into the Europe. PWN was placed on the quarantine list of the EU and also of other European countries. Later, in 1991, a dispensation was allowed by the Commission of the EU(92/13 EEC) for coniferous wood from North America provided that certain specified requirements were fulfilled that would prevent introduction.

(Re)construir a prática pedagógica e criar oportunidades para pensar

Apresenta-se nesta tese um estudo de natureza qualitativa que inclui seis estudos de caso, a partir dos quais se desocultam as práticas pedagógicas de três salas de jardim de infância e de três salas do 1.º Ciclo do Ensino Básico. O quadro narrativo, interpretativo e de reflexão que elegemos, permitiu-nos identificar e discutir os processos de construção e gestão curricular e os estilos dos educadores e dos professores na promoção de oportunidades para a construção do pensamento crítico das crianças que frequentam a Educação Pré-escolar e o 1.º Ciclo do Ensino Básico.

Mercado electrónico para serviços de teleradiologia

O desenvolvimento das soluções baseadas em telemedicina tem permitido a criação e o desenvolvimento de novas formas de prestar cuidados de saúde, aproximando prestadores de pacientes e diminuindo os tempos de espera associados, melhorando a qualidade do serviço prestado. No entanto, nem sempre a introdução de tecnologia nos processos de saúde corresponde a uma redução nas assimetrias existentes a nível nacional na prestação de cuidados. O principal objectivo deste trabalho consistiu em desenvolver um sistema que permita a criação de um mercado electrónico de teleradiologia tirando partido das soluções tecnologicamente evoluídas já existentes e da boa distribuição de equipamento a nível nacional. Neste mercado é possível maximizar a satisfação de pacientes e entidades requisitantes de exames radiológicos em relação ao serviço prestado, sem prejudicar a qualidade do serviço prestado, ao mesmo tempo que optimiza a utilização do equipamento disponibilizado. Para tal, foi verificado o actual estado da arte em termos de sistemas de telemedicina e de teleradiologia, tendo igualmente sido confirmada a percepção existente das assimetrias a nível nacional em termos de distribuição de recursos humanos no sector da saúde. Depois de verificar o actual fluxo de trabalho em termos de requisição, execução e interpretação de exames imagiológicos, procedeu-se à sua optimização e adaptação para um mercado de teleradiologia, desenhando um conjunto de requisitos associados com as principais etapas de execução dos exames, identificando os principais entraves ao seu funcionamento e propondo mecanismos originais de resolução com base em sistemas de informação. Ao nível de sistemas de informação, é apresentado um protótipo que possibilita a demonstração da implementação de alguns dos mais importantes requisitos anteriormente apresentados e o seu funcionamento, demonstrando o funcionamento prático do sistema de mercado de imagens baseado em teleradiologia. Finalmente é demonstrada a exequibilidade prática desta solução mediante a apresentação de um modelo de negócio onde se apresentam os benefícios decorrentes da implementação deste sistema e os respectivos custos associados com a implementação de uma infra-estrutura desta natureza.

Optimization models for a short sea fuel oil distribution problem

O transporte marítimo e o principal meio de transporte de mercadorias em todo o mundo. Combustíveis e produtos petrolíferos representam grande parte das mercadorias transportadas por via marítima. Sendo Cabo Verde um arquipelago o transporte por mar desempenha um papel de grande relevância na economia do país. Consideramos o problema da distribuicao de combustíveis em Cabo Verde, onde uma companhia e responsavel por coordenar a distribuicao de produtos petrolíferos com a gestão dos respetivos níveis armazenados em cada porto, de modo a satisfazer a procura dos varios produtos. O objetivo consiste em determinar políticas de distribuicão de combustíveis que minimizam o custo total de distribuiçao (transporte e operacões) enquanto os n íveis de armazenamento sao mantidos nos n íveis desejados. Por conveniencia, de acordo com o planeamento temporal, o prob¬lema e divido em dois sub-problemas interligados. Um de curto prazo e outro de medio prazo. Para o problema de curto prazo sao discutidos modelos matemáticos de programacao inteira mista, que consideram simultaneamente uma medicao temporal cont ínua e uma discreta de modo a modelar multiplas janelas temporais e taxas de consumo que variam diariamente. Os modelos sao fortalecidos com a inclusão de desigualdades validas. O problema e então resolvido usando um "software" comercial. Para o problema de medio prazo sao inicialmente discutidos e comparados varios modelos de programacao inteira mista para um horizonte temporal curto assumindo agora uma taxa de consumo constante, e sao introduzidas novas desigualdades validas. Com base no modelo escolhido sao compara¬das estrategias heurísticas que combinam três heur ísticas bem conhecidas: "Rolling Horizon", "Feasibility Pump" e "Local Branching", de modo a gerar boas soluçoes admissíveis para planeamentos com horizontes temporais de varios meses. Finalmente, de modo a lidar com situaçoes imprevistas, mas impor¬tantes no transporte marítimo, como as mas condicões meteorológicas e congestionamento dos portos, apresentamos um modelo estocastico para um problema de curto prazo, onde os tempos de viagens e os tempos de espera nos portos sao aleatórios. O problema e formulado como um modelo em duas etapas, onde na primeira etapa sao tomadas as decisões relativas as rotas do navio e quantidades a carregar e descarregar e na segunda etapa (designada por sub-problema) sao consideradas as decisoes (com recurso) relativas ao escalonamento das operacões. O problema e resolvido por um metodo de decomposto que usa um algoritmo eficiente para separar as desigualdades violadas no sub-problema.

Dissenting Exhibitions by Artists (1968-1998). Reframing Marxist Exhibition Legacy.

The goal of this thesis is to look at the critical and dissenting value of exhibitions through the examination of four cases studies, based on six exhibitions taking place between 1968 and 1998 in Latin and North America. The exhibitions belong to the history of modern and contemporary exhibitions and curating, a field of research and study that has only started to be written about in the last two decades. This investigation contributes to it, in its creation of new genealogies by connecting previously overlooked antecedents, or by proposing new relations within established lineages, at the intersection of a specific historiography; to address exhibitions, a tradition of artists acting as curators and an emerging history of curating. The examined exhibitions were put together by artists or artist collectives and were placed in a liminal position between artistic and curatorial practice. All the cases presented a distinct proposal in relation to art and social change, a fact that connects them, in their aims and modus operandi, to a Marxist and neo-Marxist critical and transformative legacy. The cases address the following connections: exhibition as political site (Tucumán Arde, 1968); exhibition as social space (The People’s Choice (Arroz con Mango), 1981); exhibition as encounter (Rooms with a view, We the People, Art/Artifact, 1987-88); and exhibition as an exchange situation (El Museo de la Calle, 1998-2001). Key to their analysis is the concept of dissensus, as put forward by Jacques Rancière. Within this theoretical framework, these exhibitions put into practice particular cases of dissensus in a given distribution of the sensible. All of them tried to deal with their thematic concerns by performing them as a praxis. They dissent with the way in which reality was formatted in their historical moment and challenge the exhibition medium itself opening new ways of doing and making in the exhibition field. Therefore, in this thesis the dissenting value of exhibitions is closely related to its main features as a medium, namely their temporality, heterogeneity and flexibility, which contribute to their potential for creative analysis and propositioning. In the case of these exhibitions, this capability is brought into play for institutional interrogation, for offering alternative cultural narratives and also for inspiring new imaginary realms.

The Trembling Line

The Trembling Line is a film and multi-channel sound installation exploring the visual and acoustic echoes between decipherable musical gestures and abstract patterning, orchestral swells and extreme high-speed slow-motion close-ups of strings and percussion. It features a score by Leo Grant and a newly devised multichannel audio system by the Institute of Sound and Vibration Research, University of Southampton. The multi-channel speaker array is devised as an intimate sound spatialisation system in which each element of sound can be pried apart and reconfigured, to create a dynamically disorienting sonic experience. It becomes the inside of a musical instrument, an acoustic envelope or cage of sorts, through which viewers are invited to experience the film and generate cross-sensory connections and counterpoints between the sound and the visuals. Funded by a Leverhulme Artist-in-Residence Award and John Hansard Gallery, with support from ISVR and the Music Department, University of Southampton. The project provided a rare opportunity to work creatively with new cutting edge developments in sound distribution devised by ISVR, devising a new speaker array, a multi- channel surround listening sphere which spatialises the auditory experience. The sphere is currently used by ISVR for outreach and teaching purposes, and has enables future collaborations between music staff and students at Southampton University and staff and ISVR. Exhibitions: Solo exhibition at John Hansard Gallery, Southampton (Dec 2015-Jan 2016), across 5 rooms, including a retrospective of five previous film-works and a new series of photographic stills. Public lectures: two within the gallery. Reviews and interviews: Art Monthly, Studio International, The Quietus, The Wire Magazine.

Intelligent predictive control for thermal comfort and energy savings in public buildings

This talk addresses the problem of controlling a heating ventilating and air conditioning system with the purpose of achieving a desired thermal comfort level and energy savings. The formulation uses the thermal comfort, assessed using the predicted mean vote (PMV) index, as a restriction and minimises the energy spent to comply with it. This results in the maintenance of thermal comfort and on the minimisation of energy, which in most operating conditions are conflicting goals requiring some sort of optimisation method to find appropriate solutions over time. In this work a discrete model based predictive control methodology is applied to the problem. It consists of three major components: the predictive models, implemented by radial basis function neural networks identifed by means of a multi-objective genetic algorithm [1]; the cost function that will be optimised to minimise energy consumption and provide adequate thermal comfort; and finally the optimisation method, in this case a discrete branch and bound approach. Each component will be described, with a special emphasis on a fast and accurate computation of the PMV indices [2]. Experimental results obtained within different rooms in a building of the University of Algarve will be presented, both in summer [3] and winter [4] conditions, demonstrating the feasibility and performance of the approach. Energy savings resulting from the application of the method are estimated to be greater than 50%.

SWOT analysis of a pediatric rehabilitation programme : a participatory evaluation fostering quality improvement

Purpose. To present the results of a strengths, weaknesses, opportunities and threats (SWOT) analysis used as part of a process aimed at reorganising services provided within a pediatric rehabilitation programme (PRP) in Quebec, Canada and to report the perceptions of the planning committee members regarding the usefulness of the SWOT in this process. Method. Thirty-six service providers working in the PRP completed a SWOT questionnaire and reported what they felt worked and what did not work in the existing model of care. Their responses were used by a planning committee over a 12- month period to assist in the development of a new service delivery model. Committee members shared their thoughts about the usefulness of the SWOT. Results. Current programme strengths included favourable organisational climate and interdisciplinary work whereas weaknesses included lack of psychosocial support to families and long waiting times for children. Opportunities included working with community partners, whereas fear of losing professional autonomy with the new service model was a threat. The SWOT results helped the planning committee redefine the programme goals and make decisions to improve service coordination. SWOT analysis was deemed as a very useful tool to help guide service reorganisation. Conclusions. SWOT analysis appears to be an interesting evaluation tool to promote awareness among service providers regarding the current functioning of a rehabilitation programme. It fosters their active participation in the reorganisation of a new service delivery model for pediatric rehabilitation.

Development and implementation of a new service delivery model for children with disabilities : implications for DCD

There is a general consensus that new service delivery models are needed for children with developmental coordination disorder (DCD). Emerging principles to guide service delivery include the use of graduated levels of intensity and evidence-based services that focus on function and participation. Interdisciplinary, community-based service delivery models based on best practice principles are needed. In this case report, we propose the Apollo model as an example of an innovative service delivery model for children with DCD. We describe the context that led to the creation of a program for children with DCD, describe the service delivery model and services, and share lessons learned through implementation. The Apollo model has 5 components: first contact, service delivery coordination, community-, group- and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups and individual interventions. Following implementation of the Apollo model, waiting times decreased and numbers of children receiving services increased, without compromising service quality. Lessons learned are shared to facilitate development of other practice models to support children with DCD.