Visual outcomes of cataract surgery performed by supervised novice surgeons during training in rural China

To assess the outcomes of cataract surgery performed by novice surgeons during training in a rural programme. Design: Retrospective study. Participants: Three hundred thirty-four patients operated by two trainees under supervision at rural Chinese county hospitals. Methods: Two trainees performed surgeries under supervision. Visual acuity, refraction and examinations were carried out 3 months postoperatively. Main Outcome Measures: Postoperative uncorrected visual acuity, pinhole visual acuity, causes of visual impairment (postoperative uncorrected visual acuity<6/18) Results: Among 518 operated patients, 426 (82.2%) could be contacted and 334 (64.4% of operated patients) completed the examinations. The mean age was 74.1±8.8 years and 62.9% were women. Postoperative uncorrected visual acuity was available in 372 eyes. Among them, uncorrected visual acuity was ≥6/18 in 278 eyes (74.7%) and <6/60 in 60 eyes (16.1%), and 323 eyes (86.8%) had pinhole visual acuity≥6/18 and 38 eyes (10.2%) had pinhole visual acuity<6/60. Main causes of visual impairment were uncorrected refractive error (63.9%) and comorbid eye disease (24.5%). Comorbid eye diseases associated with pinhole visual acuity<6/60 (n=23, 6.2%) included glaucoma, other optic nerve atrophy, vitreous haemorrhage and retinal detachment. Conclusions: The findings suggest that hands-on training remains safe and effective even when not implemented in centralized training centres. Further refinement of the training protocol, providing postoperative refractive services and more accurate preoperative intraocular lens calculations, can help optimize outcomes. © 2012 The Authors Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Functional expression of thermo-sensitive TRP channels in human odontoblasts

Introduction: Accumulating evidence supports a role for odontoblasts in initiating tooth pain, however direct ionic mechanisms underlying dentine nociceptive function remain unclear. The transient receptor potential (TRP) ion channels are directly related to cellular mechanisms of nociception and thermo-sensitive function but their expression by human odontoblasts remains to be determined. Objectives: To investigate the expression and functionality of the thermo-sensitive TRP channels TRPV1, TRPV4, TRPM8 and TRPA1 in human odontoblasts. Methods: Human odontoblasts were derived from dental pulp of immature permanent third molars by explant method. Cell lysates of odontoblasts were subject to SDS- polyacrylamide gel electrophoresis and proteins were blotted onto nitrocellulose membranes. Blots were probed with primary antibodies to TRPA1, TRPM8, TRPV4 and TRPV1. Detection of bound primary antibodies was achieved using appropriate anti-species antibody conjugates and chemiluminescent substrates. Functionality of the channels was determined with Ca2+ microfluorimetry, where cells grown in cover slips and incubated with Fura 2AM prior to stimulation with capsaicin (TRPV1 agonist), 4 alpha-phorbol 12,13-didecanoate (4áPDD) (TRPV4 agonist), icilin (TRPA1 agonist) and menthol (TRPM8 agonist). Emitted fluorescence was measured and the fluorescence ratio (R) was calculated as F340/F380 to determine the level of [Ca2+]i. Results: Western blotting confirmed the molecular localisation of thermo-sensitive TRP channels in human odontoblasts. Functionality assays revealed increase in [Ca2+]i in response to capsacin, icillin, methanol and 4áPDD indicating functional expression of TRPV1, TRPA1, TRPM8 and TRPV4 respectively. Conclusions: Functional expression of thermo-sensitive TRP channels in human odontoblasts may indicate a crucial role for odontoblasts in thermally induced dental pain. (Supported by a Research Grant from the Royal College of Surgeons of Edinburgh)

Cataract surgical outcomes, visual function and quality of life in four rural districts in Vietnam.

BACKGROUND: To evaluate cataract surgical outcomes in four rural districts of Ha Tinh Province, Vietnam. DESIGN: Cross-sectional study. PARTICIPANTS: Post-cataract surgery patients sampled randomly from facilities in four rural districts of Ha Tinh Province >3 months after surgery. MAIN OUTCOME MEASURES: Postoperative visual acuity (VA), visual function and quality of life. RESULTS: Among 412 patients, the mean age was 74.5 ± 9.4 years, 67% (276) were female, and 377 (91.5%) received intraocular lenses (IOL). Nearly two-thirds of patients had no postoperative visits after discharge. Postoperatively, more than 40% of eyes had presenting VA <6/18, while 20% remained <6/60. The mean self-reported visual function and quality of life for all patients were 68.7 ± 23.8 and 73.8 ± 21.6, respectively. Most patients (89.5%) were satisfied with surgery and the majority (94.4%) would recommend surgery to others. One-third of patients paid ≥$US50 for surgery. In multiple regression modelling, older age (P < 0.01), intraoperative complications (P < 0.01) and failure to receive an IOL (P < 0.01) were associated with postoperative VA <6/60. CONCLUSION: Satisfaction with surgery was high, and many patients were willing to pay for their operations. Poor visual outcomes were common; however, and better surgical training is needed to reduce complications and their impact on visual outcomes. More intensive postoperative follow-up may also be beneficial. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Early assessment of visual acuity after cataract surgery in rural Indonesia.

BACKGROUND: The accuracy and impact on service uptake of early examination after cataract surgery is not known. DESIGN:   Prospective cohort study. PARTICIPANTS: Cataract patients in rural Indonesia. METHODS: Visual acuity was measured preoperatively, 1day, 1-3, 4-6 and >12weeks after surgery, and 6-8months postoperatively at an outreach examination. Acceptance of second-eye surgery and spectacles was evaluated. MAIN OUTCOME MEASURE: Presenting visual acuity in the operated eye. RESULTS: Among 241 subjects (extracapsular surgery 84%), examinations at 1day, 1-3, 4-6 and >12weeks and 6-8months were completed for 100% (241), 90.9% (219), 67.6% (163), 22.0% (53) and 80.0% (193), respectively. Among subjects at the final examination (mean age 65.8±10.6years, 51.8% male), 73.6% had bilateral preoperative presenting visual acuity≤6/60. By 4-6weeks, the proportion with good (≥6/18) or poor (≤6/60) visual acuity did not differ significantly from the final examination. Among 49 persons accepting free second-eye surgery, 69.4% (34) and 16.3% (8) returned to clinic at 4-6 and >12weeks, respectively. Among 131 patients (67.9%) paying US$7 for glasses, 94 (71.8%) and 30 (22.9%) attended 4- to 6- and >12-week examinations, respectively. CONCLUSION: Even with large-incision surgery, early assessment of postoperative vision is representative of final vision, and may help deliver postoperative services to more of those needing them. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Current status of Gerodontology teaching in Europe: preliminary findings

Aim(s): The aim of this study was to explore the findings of a survey on the prevalence, contents and status of Gerodontology teaching amongst the European Dental Schools.
Materials and Methods: A first wave of emails, including an electronic questionnaire in English, and two weeks later a first reminder, were sent to the Deans or other contact persons in 185 dental schools in 40 European countries. The electronic questionnaire recorded the prevalence, contents and status of Gerodontology education at the undergraduate, postgraduate and continuing education levels.
Results: The first wave of responses included 70 dental schools from 28 countries. Gerodontology was included in the undergraduate curricula of 77% of the respondents and was compulsory in 61% of them. It was taught as an independent course in 39% of the respondents. When embedded in other courses, these were mainly the Prosthodontics lectures. Clinical training in Gerodontology was on the curriculum of 56% of the respondents. Sixteen percent of the schools had a Gerodontology Division, and 43% an assigned Programme Director. Gerodontology was taught in the postgraduate programmes of 33% of the schools, again mostly embedded in Prosthodontic programmes. Continuing education courses in Gerodontology were offered by 34% of the responding schools.
Discussion and Conclusions: When interpreting the results of this still ongoing study, a "worst case scenario" has to be born in mind, where dental schools, who failed to participate in the survey, may not be teaching in Gerodontology. Under this perspective, a moderate prevalence of Gerodontology is recorded in the undergraduate curricula of European dental schools. At a postgraduate level, it is less frequently offered, and mainly embedded in the Prosthodontic programmes. European guidelines on the dental curriculum might help to increase awareness and introduce Gerodontology to undergraduate, postgraduate and continuing education.

A compendium of modelling techniques

This Integration Insight provides a brief overview of the most popular modelling techniques used to analyse complex real-world problems, as well as some less popular but highly relevant techniques. The modelling methods are divided into three categories, with each encompassing a number of methods, as follows: 1) Qualitative Aggregate Models (Soft Systems Methodology, Concept Maps and Mind Mapping, Scenario Planning, Causal (Loop) Diagrams), 2) Quantitative Aggregate Models (Function fitting and Regression, Bayesian Nets, System of differential equations / Dynamical systems, System Dynamics, Evolutionary Algorithms) and 3) Individual Oriented Models (Cellular Automata, Microsimulation, Agent Based Models, Discrete Event Simulation, Social Network
Analysis). Each technique is broadly described with example uses, key attributes and reference material.

Revival: The Aesthetics of Revival Subcultures and Re-enactment Groups Explored Through Fashion Image-making

This research aims, through performance, fashion photography, video making and the theatrical devices that accompany such practice, to explore the style of a contemporary, largely male, subcultural collective. The common term that joins these loosely bound groups is revival as they appear driven by an impulse to simulate and re-enact the dress, rites and rituals of British and American subcultures from a perceived golden era. The similarities with re-enactment societies are also explored and exploited to the end of developing new style- based aesthetics in male fashion image-making formed around an elaborate re- enactment of Spartacus and the Third Servile Wars. Examined through comparative visuals (revivalists / re-enactors) a common thread is found in the wearing of leather as a metaphor for resistance, style and a pupa-like second skin. Subsequent findings of this research suggest that the cuirass of popular culture emerges as the motorcycle jacket of both the sword and sandal epic and the historical re-enactor. Addressing extremes in narcissistic dress and behaviour amongst certain individuals within these older male communities, this study also questions parts of established theory on subcultural development within the field of cultural studies and postulates on a metaphorical dandy gene. Citing two leading practitioners in the field of fashion photography the work of both Richard Prince and Bruce Weber is viewed through the lens of the subcultural aesthete and conclusions drawn as to their role as agents provocateurs in the development of the fashion image with a revival based narrative. In addition the often used term retro is examined, categorised and granted its own genre within fashion image- making and defined as being separate from the practice element of this research. Reflecting a multi-disciplinary approach that engages the researcher as Bricoleur and participant observer this research operates in the reflexive realm and uses simulation as a key method of enquiry. The practice-led outcome of this investigation takes the form of a final research exhibition that takes the form of a substantial installation of photography, video, clothing and textile prints. Key terms: dandy gene, historical re-enactment groups, internal theatre, narcissism, narrative image-making, reflexive practice, revival as theatre, subcultures,

Piñatex, the design development of a new sustainable material

This is a research project by practice, which firstly develops a new material invention derived from natural fibres extracted from waste pineapple leaves; secondly it articulates the contemporary designer’s role in facilitating sustainable solutions through: Insights from my own material invention, PiñatexTM, which integrates the materiality of design with the immateriality of concepts and values Developing a visual model of mapping I began with these questions: ‘What are the challenges in seeking to make a new and sustainable material from the waste products of pineapple agriculture in the Philippines?’ and ‘How can a design practice link elements of materiality (artifacts) with immaterial elements (value systems) in order to improve sustainable social and economic development?’ Significant influences have been the work of Papanek1 (2003), Hawken2 (1999) and Abouleish3 (2008) and in particular the ethical business model initiated by McDonough and Braungart in Cradle to Cradle®4 (2002). My own research project is inspired by the Cradle to Cradle® model. It proposes the development of a new material, PiñatexTM which is derived from natural fibres extracted from waste pineapple leaves and could be used in a wide variety of products that are currently fabricated in leather or petroleum-based materials. The methods have comprised: Contextual reviews; case studies (SEKEM, Cradle to Cradle® and Gawad Kalinga); practical experiments in the field of natural fibres, chemistry, product development, manufacturing and prototyping, leading to an invention and a theoretical model of mapping. In addition, collaboration has taken place across scientific, technological, social, ecological, academic and business fields. The outcome is a new material based on the synchronicity between the pineapple fibres, polymers, resins and coatings specially formulated. The invention of the new material that I developed as a central part of this research by practice has a patent in the national phase (PCT/GB 2011/000802) and is in the first stages of manufacturing, commercial testing and further design input (Summer 2014). The contribution to knowledge is firstly the material, PiñatexTM, which exhibits certain key qualities, namely environmentally non-toxic, biodegradable, income-generating potential and marketability. This is alongside its intrinsic qualities as a textile product: aesthetic potential, durability and stability, which will make it suitable for the accessories, interiors and furnishing markets. The theoretical mapping system Upstream and Downstream forms a secondary contribution.

Digital Debris of Internet Art: An Allegorical and Entropic Resistance to the Epistemology of Search

This Ph.D., by thesis, proposes a speculative lens to read Internet Art via the concept of digital debris. In order to do so, the research explores the idea of digital debris in Internet Art from 1993 to 2011 in a series of nine case studies. Here, digital debris are understood as words typed in search engines and which then disappear; bits of obsolete codes which are lingering on the Internet, abandoned website, broken links or pieces of ephemeral information circulating on the Internet and which are used as a material by practitioners. In this context, the thesis asks what are digital debris? The thesis argues that the digital debris of Internet Art represent an allegorical and entropic resistance to the what Art Historian David Joselit calls the Epistemology of Search. The ambition of the research is to develop a language in-between the agency of the artist and the autonomy of the algorithm, as a way of introducing Internet Art to a pluridisciplinary audience, hence the presence of the comparative studies unfolding throughout the thesis, between Internet Art and pionners in the recycling of waste in art, the use of instructions as a medium and the programming of poetry. While many anthropological and ethnographical studies are concerned with the material object of the computer as debris once it becomes obsolete, very few studies have analysed waste as discarded data. The research shifts the focus from an industrial production of digital debris (such as pieces of hardware) to obsolete pieces of information in art practice. The research demonstrates that illustrations of such considerations can be found, for instance, in Cory Arcangel’s work Data Diaries (2001) where QuickTime files are stolen, disassembled, and then re-used in new displays. The thesis also looks at Jodi’s approach in Jodi.org (1993) and Asdfg (1998), where websites and hyperlinks are detourned, deconstructed, and presented in abstract collages that reveals the architecture of the Internet. The research starts in a typological manner and classifies the pieces of Internet Art according to the structure at play in the work. Indeed if some online works dealing with discarded documents offer a self-contained and closed system, others nurture the idea of openness and unpredictability. The thesis foregrounds the ideas generated through the artworks and interprets how those latter are visually constructed and displayed. Not only does the research questions the status of digital debris once they are incorporated into art practice but it also examine the method according to which they are retrieved, manipulated and displayed to submit that digital debris of Internet Art are the result of both semantic and automated processes, rendering them both an object of discourse and a technical reality. Finally, in order to frame the serendipity and process-based nature of the digital debris, the Ph.D. concludes that digital debris are entropic . In other words that they are items of language to-be, paradoxically locked in a constant state of realisation.

The Structure of Design Processes: ideal and reality in Bruce Archer’s 1968 doctoral thesis

The paper centres on a single document, the 1968 doctoral thesis of L Bruce Archer. It traces the author’s earlier publications and the sources that informed and inspired his thinking, as a way of understanding the trajectory of his ideas and the motivations for his work at the Royal College of Art from 1962. Analysis of the thesis suggests that Archer’s ambition for a rigorous ‘science of design’ inspired by algorithmic approaches was increasingly threatened with disruption by his experience of large, complex design projects. His attempts to deal with this problem are shown to involve a particular interpretation of cybernetics. The paper ends with Archer’s own retrospective view and a brief account of his dramatically changed opinions. Archer is located as both a theorist and someone intensely interested in the commercial world of industrial design.