The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

Introduction
Standard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.

Methods
The Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.

Discussion
This trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.

Habitat-species interactions in a carnivore community

Na maioria das area protegidas nacionais existe uma considerável falta de informação científica relativa aos mamíferos carnívoros. A Reserva Natural da Serra da Malcata, localizada no centro-este de Portugal, tem vindo a desenvolver, desde os últimos 20 anos, estudos de ecologia e esta tese pretende dar seguimento a esse esforço de monitorização, através do desenvolvimento de métodos simples e eficientes, de monitorização de carnívoros, que possam servir como percursores de trabalhos a longo-prazo em áreas relevantes para a conservação. Através do uso de armadilhagem fotográfica, foram estudadas relações espécies-habitats para 5 espécies: gato-bravo (Felis silvestris), fuinha (Martes foina), raposa (Vulpes vulpes), gineta (Genetta genetta), e sacarrabos (Herpestes ichneumon). Foram desenvolvidos métodos para se determinar a densidade absoluta de raposa e gineta e a população de gato-bravo foi estudada em detalhe. As principais conclusões do estudo foram: 1) a ocupação de raposas é uniforme e parece ser independente de variáveis ambientais; 2) a ocupação de fuinha encontra-se relacionada com variáveis de habitat, estrutura paisagística e presas; 3) a ocupação de gineta está relacionada com a cobertura de folhosas e distribuição de presas; 4) para o sacarrabos verificase que a ocupação é influenciada pelas extensões de habitat arbustivos, 5) a população de gato-bravo sofreu um forte declínio durante o trabalho e requer urgentes medidas de conservação. Metodologicamente foi demonstrada a importância da modelação das probabilidades de detecção para espécies para as quais este parâmetros apresenta valores baixos ou é muito variável. Esta tese também demonstrou a grande importância da Serra da Malcata para a conservação de carnívoros e a necessidade do desenvolvimento de técnicas de monitorização padronizadas para uma correcta gestão adaptativa das áreas protegidas.

Establishment of stackable community networks

Uma das áreas de investigação em Telecomunicações de interesse crescente prende-se com os futuros sistemas de comunicações móveis de 4a geração e além destes. Nos últimos anos tem sido desenvolvido o conceito de redes comunitárias, no qual os utilizadores se agregam de acordo com interesses comuns. Estes conceitos têm sido explorados de uma forma horizontal em diferentes camadas da comunicação, desde as redes comunitárias de comunicação (Seattle Wireless ou Personal Telco, p.ex.) até às redes de interesses peer-to-peer. No entanto, estas redes são usualmente vistas como redes de overlay, ou simplesmente redes de associação livre. Na prática, a noção de uma rede auto-organizada, completamente orientada ao serviço/comunidade, integralmente suportada em termos de arquitetura, não existe. Assim este trabalho apresenta uma realização original nesta área de criação de redes comunitárias, com uma arquitetura subjacente orientada a serviço, e que suporta integralmente múltiplas redes comunitárias no mesmo dispositivo, com todas as características de segurança, confiança e disponibilização de serviço necessárias neste tipo de cenários (um nó pode pertencer simultaneamente a mais do que uma rede comunitária). Devido à sua importância para os sistemas de redes comunitárias, foi dado particular atenção a aspetos de gestão de recursos e controlo de acessos. Ambos realizados de uma forma descentralizada e considerando mecanismos dotados de grande escalabilidade. Para isso, é apresentada uma linguagem de políticas que suporta a criação de comunidades virtuais. Esta linguagem não é apenas utilizada para o mapeamento da estrutura social dos membros da comunidade, como para, gerir dispositivos, recursos e serviços detidos pelos membros, de uma forma controlada e distribuída.

Community response in disasters: an ecological learning framework

Natural disasters are frequently exacerbated by anthropogenic mechanisms and have social and political consequences for communities. The role of community learning in disasters is seen to be increasingly important. However, the ways in which such learning unfolds in a disaster can differ substantially from case to case. This article uses a comparative case study methodology to examine catastrophes and major disasters from five countries (Japan, New Zealand, UK, US and Germany) to consider how community learning and adaptation occurs. An ecological model of learning is considered, where community learning is of small loop (adaptive, incremental, experimental) type or large loop (paradigm changing) type. Using this model we consider that there are three types of community learning that occur in disasters (navigation, organisation, reframing). The type of community learning that actually develops in a disaster depends upon a range of social factors such as stress and trauma, civic innovation and coercion.

Cape Verde coastal ecosystem: a study of community structure, trophic interactions and exploitation pattern

Tese de dout., Ciências e Tecnologia das Pescas, Faculdade de Ciências do Mar e do Ambiente, Universidade do Algarve, 2005

Identification of Predictive Factors of BMI and High Risk Hypertension in Rural Nicaraguan Community

Thesis (Master's)--University of Washington, 2013

A Community-Level, Mesoscale Analysis of Fish Assemblage Structure in Shoreline Habitats of a Large River Using Multivariate Regression Trees.

The mesoscale (100–102 m) of river habitats has been identified as the scale that simultaneously offers insights into ecological structure and falls within the practical bounds of river management. Mesoscale habitat (mesohabitat) classifications for relatively large rivers, however, are underdeveloped compared with those produced for smaller streams. Approaches to habitat modelling have traditionally focused on individual species or proceeded on a species-by-species basis. This is particularly problematic in larger rivers where the effects of biological interactions are more complex and intense. Community-level approaches can rapidly model many species simultaneously, thereby integrating the effects of biological interactions while providing information on the relative importance of environmental variables in structuring the community. One such community-level approach, multivariate regression trees, was applied in order to determine the relative influences of abiotic factors on fish assemblages within shoreline mesohabitats of San Pedro River, Chile, and to define reference communities prior to the planned construction of a hydroelectric power plant. Flow depth, bank materials and the availability of riparian and instream cover, including woody debris, were the main variables driving differences between the assemblages. Species strongly indicative of distinctive mesohabitat types included the endemic Galaxias platei. Among other outcomes, the results provide information on the impact of non-native salmonids on river-dwelling Galaxias platei, suggesting a degree of habitat segregation between these taxa based on flow depth. The results support the use of the mesohabitat concept in large, relatively pristine river systems, and they represent a basis for assessing the impact of any future hydroelectric power plant construction and operation. By combing community classifications with simple sets of environmental rules, the multivariate regression trees produced can be used to predict the community structure of any mesohabitat along the reach.

A Community Hub Approach to Older People’s Housing

Purpose. This paper explores the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators. Design/methodology/approach. Data is presented from the ASSET project (Adult Social Services Environments and Settings) which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews. Findings. Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public. Originality and Value. This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings.

Governing through community? A comparative study of changing management practices in mixed tenure housing development

An important feature of UK housing policy has been the promotion of consortia between local authorities, private developers and housing associations in order to develop mixed tenure estates to meet a wide range of housing needs. Central to this approach has been a focus on the management of neighbourhoods, based on the assumption that high densities and the inter-mixing of tenure exacerbates the potential for incivility and anti-social behaviour and exerts a disproportionate impact on residents' quality of life. Landlord strategies are therefore based on a need to address such issues at an early stage in the development. In some cases community-based, third sector organisations are established in order to manage community assets and to provide a community development service to residents. In others, a common response is to appoint caretakers and wardens to tackle social and environmental problems before they escalate and undermine residents’ quality of life. A number of innovative developments have promoted such neighbourhood governance approaches to housing practice by applying community development methods to address potential management problems. In the process, there is an increasing trend towards strategies that shape behaviour, govern ethical conduct, promote aesthetic standards and determine resident and landlord expectations. These processes can be related to the wider concept of governmentality whereby residents are encouraged to become actively engaged in managing their own environments, based on the assumption that this produces more cohesive, integrated communities and projects positive images. Evidence is emerging from a number of countries that increasingly integrated and mutually supportive roles and relationships between public, private and third sector agencies are transforming neighbourhood governance in similar ways. This paper will review the evidence for this trend towards community governance in mixed housing developments by drawing on a series of UK case studies prepared for two national agencies in 2007. It will review in particular the contractual arrangements with different tenures, identify codes and guidelines promoting 'good neighbour' behaviour and discuss the role of community development trusts and other neighbourhood organisations in providing facilities and services, designed to generate a well integrated community. The second part of the paper will review evidence from the USA and Australia to see how far there is a convergence in this respect in advanced economies. The paper will conclude by discussing the extent to which housing management practice is changing, particularly in areas of mixed development, whether there is a convergence in practice between different countries and how far these trends are supported by theories of governmentality.

Zooplankton community structure in response to turbulent flow over a sill in Nootka Sound

Senior thesis written for Oceanography 445

Four years on: a longitudinal study assessing the impact of a virtual community of practice

This paper explores the long term impact of a virtual learning community (VLC) from the perspective of community members and their employing organization. It argues that membership potentially has a significant impact on individual identities and careers, and that managed communities provide an important means for strategic workforce development. The study evaluates the impact of membership of a VLC over a four year period within the context of the theoretical frameworks of communities of practice and identity theory. The concept of boundary crossing is also explored in relation to VLCs. The paper considers the benefits to host organisations in supporting structured VLCs as a means of enabling workforce development and supporting change and innovation.

Community politics of the GLC (Greater London Council)

Loraine spoke with Hilary Wainwright and members of The GLC Story archiving project on the community politics of the 1980’s Greater London Council (GLC), its legacy and lessons for today.