Waiting time for cataract surgery and its influence on patient attitudes.

PURPOSE:

To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong.

METHODS:

This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status.

RESULTS:

Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more.

CONCLUSIONS:

Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.

Understanding barriers to cataract surgery among older persons in rural China through focus groups.

PURPOSE: To utilize focus groups (FGs) to identify barriers to cataract surgery specific to older persons in rural Guangdong, China. METHODS: Three focus groups in separate locations were carried out for persons aged 60 years and above with best-corrected vision <= 6/18 due to cataract, either accepting or refusing surgery. Participants also ranked responses to questions about acceptance of surgery among the elderly. FG transcripts were coded independently by two investigators using qualitative data management software. RESULTS: Twenty participants had a mean age of 72.7 ± 6.1 years, 14 (70.0%) were women and 17 (85.0%) were blind (best-corrected vision <= 6/60) in at least one eye. Cost was ranked by two of three groups as the main barrier to surgery, and all groups listed reducing cost as the best strategy to increase surgical uptake. Many respondents planned to use China's New Cooperative Medical Scheme (NCMS) health insurance to pay for surgery. Participants showed poor understanding of cataract, but ranked educational interventions low as methods of increasing uptake. Though opinions of local service quality were poor, respondents did not see quality as an important barrier to accepting service. Participants frequently depended on family members to pay for surgery. CONCLUSIONS: Contrary to some previous reports, cost may be an important barrier to cataract surgery in rural China, which NCMS may help to alleviate. Educational interventions to increase knowledge about cataract are needed, but may face skepticism among patients. Strategies to promote cataract surgery should target the entire family.

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.

Compliance with follow-up after cataract surgery in rural China.

PURPOSE:

To evaluate reasons for non-compliance with post-cataract surgical follow-up in rural China, and assess the impact of incentives on improving compliance.

METHODS:

Patients having undergone cataract surgery more than 3 months previously at cataract surgery training hospitals in Guangdong were invited by telephone and advertisements to a hospital-based study examination, with compensation for travel costs (US$7). Information on prior post-surgical follow up was collected by questionnaire at the hospital or by telephone. Logistic regression was used to assess predictors of post-operative attendance with or without compensation.

RESULTS:

Among 518 eligible patients, 426 (82.2%) underwent interviews and 342 (66.0%) attended the compensated study examination. Ninety nine participants (23.2%) reported previously returning for uncompensated follow-up ≥ 3 months post-operatively, and 225 (52.8%) had returned for any prior post-operative examination. Uncompensated follow-up at ≥ 3 months was associated with higher income (P = 0.037), and recalling instruction by a doctor to follow-up (P = 0.001), while age, gender, travel cost, and post-operative satisfaction and vision were not associated. Younger (P = 0.002) patients and those reporting being instructed to follow up (P = 0.008) were more likely to return for the compensated research examination. Among all interviewed subjects, only 170 (39.9%) reported knowing they were to return to hospital.

CONCLUSIONS:

Modest compensation, advertisements and telephone contact can increase medium-term follow-up rates after cataract surgery by three-fold. Better communication of specific targets for follow-up may improve follow-up compliance.

Competency-Based Theory For Achieving Innovation: The Case Of Post-Disaster Reconstruction

For those working in the humanitarian sector, achieving positive outcomes for postdisaster communities through reconstruction projects is a pressing concern. In the wake of recent natural disasters, NGOs have become increasingly involved in the permanent reconstruction of affected communities. They have encountered significant barriers as they implement reconstruction programmes and this paper argues that it is important to address the visible lack of innovation that is partially to blame. The theoretical bedrock of a current research project will be used as the starting point for this argument, the overall goal of which is to design a competency-based framework model that can be used by NGOs in post-disaster reconstruction projects. Drawing on established theories of management, a unique perspective has been developed from which a competency-based reconstruction theory emerges. This theoretical framework brings together 3 distinct fields; Disaster Management, Strategic Management and Project Management, each vital
to the success of the model. The objectives of this paper are a) to investigate the role of NGOs in post-disaster reconstruction and establish the current standard of practice b) to determine the extent to which NGOs have the opportunity to contribute to sustainable community development through reconstruction c) to outline the main factors of a theoretical framework first proposed by Von Meding et al. 2009 and d) to identify the innovative measures that can be taken by NGOs to achieve more positive outcomes in their interventions. It is important that NGOs involved in post-disaster reconstruction become familiar with concepts and strategies such as those contained in this paper. Competency-based organizational change on the basis of this theory has the potential to help define the standard of best practice to which future NGO projects might align themselves.

An analysis of International NGOs design decision making for housing reconstruction in developing country contexts

The purpose of this paper is to explore the current design decision making process of selected foreign international non governmental organisations (INGO’s) operating in the field of housing and post disaster housing design and delivery in developing countries. The study forms part of a wider on-going study relation to a decision making in relation to affordable and sustainable housing in developing
countries. The paper highlights the main challenges and opportunities in relation to the design and delivery of low cost sustainable housing in developing countries as identified in current literature on the subject. Interviews and case studies with INGO’s highlight any specific challenges faced by foreign INGO’s operating in a developing country. The preliminary results of this research study provide a concise insight into the design decision making process of leading foreign INGO’s operating in developing countries and will be beneficial to policy makers, NGOs, government bodies and community organisations in practice as it offers unique evidence based insights into international bodies housing design decision making process.

A Community Driven Approach to Reconstruction Management

Without human beings, and human activities, hazards can strike but disasters cannot occur, they are not just natural phenomena but a social event (Van Der Zon, 2005). The rapid demand for reconstruction after disastrous events can result in the impacts of projects not being carefully considered from the outset and the opportunity to improve long-term physical and social community structures being neglected. The events that struck Banda Aceh in 2004 have been described as
a story of ‘two tsunamis’, the first being the natural hazard that struck and the second being the destruction of social structures that occurred as a result of unplanned, unregulated and uncoordinated response (Syukrizal et al, 2009). Measures must be in place to ensure that, while aiming to meet reconstruction
needs as rapidly as possible, the risk of re-occurring disaster impacts are reduced through both the physical structures and the capacity of the community who inhabit them. The paper explores issues facing reconstruction in a post-disaster scenario, drawing on the connections between physical and social reconstruction in order to address long term recovery solutions. It draws on a study of relevant literature and a six week pilot study spent in Haiti exploring the progress of recovery in the Haitian capital and the limitations still restricting reconstruction efforts. The study highlights the need for recovery management strategies that recognise the link between social and physical reconstruction and the significance of community based initiatives that see local residents driving recovery in terms of debris handling and rebuilding. It demonstrates how a community driven approach to physical reconstruction could also address the social impacts of events that, in the case of places such as Haiti, are still dramatically restricting recovery efforts.

Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China

Purpose: To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there. Methods: Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points). Results Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (≤6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up. Conclusions: Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up.

Molecular reconstruction of a genetic code alteration

The genetic code establishes the rules that govern gene translation into proteins. It was established more than 3.5 billion years ago and it is one of the most conserved features of life. Despite this, several alterations to the standard genetic code have been discovered in both prokaryotes and eukaryotes, namely in the fungal CTG clade where a unique seryl transfer RNA (tRNACAG Ser) decodes leucine CUG codons as serine. This tRNACAG Ser appeared 272±25 million years ago through insertion of an adenosine in the middle position of the anticodon of a tRNACGA Ser gene, which changed its anticodon from 5´-CGA-3´ to 5´-CAG-3´. This most dramatic genetic event restructured the proteome of the CTG clade species, but it is not yet clear how and why such deleterious genetic event was selected and became fixed in those fungal genomes. In this study we have attempted to shed new light on the evolution of this fungal genetic code alteration by reconstructing its evolutionary pathway in vivo in the yeast Saccharomyces cerevisiae. For this, we have expressed wild type and mutant versions of the C. albicans tRNACGA Ser gene into S. cerevisiae and evaluated the impact of the mutant tRNACGA Ser on fitness, tRNA stability, translation efficiency and aminoacylation kinetics. Our data demonstrate that these mutants are expressed and misincorporate Ser at CUGs, but their expression is repressed through an unknown molecular mechanism. We further demonstrate, using in vivo forced evolution methodologies, that the tRNACAG Ser can be easily inactivated through natural mutations that prevent its recognition by the seryl-tRNA synthetase. The overall data show that repression of expression of the mistranslating tRNACAG Ser played a critical role on the evolution of CUG reassignment from Leu to Ser. In order to better understand the evolution of natural genetic code alterations, we have also engineered partial reassignment of various codons in yeast. The data confirmed that genetic code ambiguity affects fitness, induces protein aggregation, interferes with the cell cycle and results in nuclear and morphologic alterations, genome instability and gene expression deregulation. Interestingly, it also generates phenotypic variability and phenotypes that confer growth advantages in certain environmental conditions. This study provides strong evidence for direct and critical roles of the environment on the evolution of genetic code alterations.

Improved line/edge detection and visual reconstruction

Lines and edges provide important information for object categorization and recognition. In addition, one brightness model is based on a symbolic interpretation of the cortical multi-scale line/edge representation. In this paper we present an improved scheme for line/edge extraction from simple and complex cells and we illustrate the multi-scale representation. This representation can be used for visual reconstruction, but also for nonphotorealistic rendering. Together with keypoints and a new model of disparity estimation, a 3D wireframe representation of e.g. faces can be obtained in the future.

Ecologic zonation model of the benthic foraminifera and thecamoebians of Guadiana river estuary and application in paleoenvironmental reconstruction

Tese de doutoramento, Ciências do Mar ( Processos de Ecossistemas Marinhos), Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2012

Applications of Statistical Modeling in Iterative CT Image Reconstruction

Thesis (Master's)--University of Washington, 2015

“I’m Not Waving, I’m Drowning”: An Autoethnographical Exploration of Biographical Disruption and Reconstruction During Recovery From Prescribed Benzodiazepine Use

Benzodiazepines are group of drugs used mainly as sedatives, hypnotics, muscle relaxants, and anti-epileptics. Tapering off benzodiazepines is, for some users, a painful, traumatic, and protracted process. In this article, I use an autoethnographic approach, adopting the metaphor of water, to examine heuristically my experience of iatrogenic illness and recovery. I draw on personal journals and blog entries and former users’ narratives to consider the particular form of biographical disruption associated with benzodiazepines and the processes involved in identity reconstruction. I emphasize the role of the online community in providing benzodiazepine users such as myself with a co-cultural community through which to share a voice and make sense of our experiences. I explain how the success stories of former users provided me with the hope that I, the “medical victim,” could become the “victor” and in the process construct a new life and fresh identity.

3D Reconstruction of Medical Images from Slices Automatically Landmarked with Growing Neural Models

In this study, we utilise a novel approach to segment out the ventricular system in a series of high resolution T1-weighted MR images. We present a brain ventricles fast reconstruction method. The method is based on the processing of brain sections and establishing a fixed number of landmarks onto those sections to reconstruct the ventricles 3D surface. Automated landmark extraction is accomplished through the use of the self-organising network, the growing neural gas (GNG), which is able to topographically map the low dimensionality of the network to the high dimensionality of the contour manifold without requiring a priori knowledge of the input space structure. Moreover, our GNG landmark method is tolerant to noise and eliminates outliers. Our method accelerates the classical surface reconstruction and filtering processes. The proposed method offers higher accuracy compared to methods with similar efficiency as Voxel Grid.

Força Muscular Isocinética após Reconstrução do Ligamento Cruzado Anterior – Influência do Tipo de Enxerto (Osso-Tendão-Osso/Isquio-Tibiais)

Introdução: É reconhecida a importância do ligamento cruzado anterior (LCA) no funcionamento normal do joelho. Em caso de rotura ligamentar, nomeadamente em desportos com marcada solicitação dos movimentos de rotação do joelho, é justificada a necessidade de reconstrução do LCA na maioria dos casos. Objetivo (s): Avaliar a influência do tipo de enxerto na reconstrução do ligamento cruzado anterior na força muscular isocinética, assim como na funcionalidade e sintomas após 6 meses. Métodos: Estudo transversal analítico, constituído por 20 indivíduos voluntários do sexo masculino, que haviam sido submetidos a uma ligamentoplastia do cruzado anterior, pelo mesmo cirurgião, seguido de uma intervenção individualizada por um fisioterapeuta. Em 10 indivíduos, o procedimento cirúrgico foi realizado com enxerto do tendão rotuliano (grupo OTO), e nos restantes 10 com enxerto do semitendinoso e gracilis (grupo STG). Como forma de avaliar a Força Muscular Isocinética (Peak Torque, Trabalho Total Muscular, ratio Isquiotibiais/Quadricipite), foi utilizado o Dinamómetro Isocinético Biodex. A avaliação foi efectuada apenas aos 6 meses após o procedimento cirúrgico. Para observação da funcionalidade, amplitude de movimento e sintomas, utilizou-se o questionário International Knee Documentation Committee (IKDC). Resultados: Foi possível observar que entre os grupos apenas se observaram diferenças significativas no peak torque de extensão a 180º no membro não lesado (p=0,019). Contudo, foi observada uma tendência para o grupo OTO apresentar um maior défice no peak torque e trabalho total muscular em extensão. Comparativamente ao membro contra-lateral, o membro lesado apresentou valores significativamente inferiores na maioria das variáveis ( p < 0,05). Conclusão: Após 6 meses de pós-cirúrgico com reabilitação de fisioterapia, não foi possível apontar qual o enxerto que garante uma melhor recuperação da força muscular. Aos 6 meses, ambos os grupos ainda apresentaram limitações musculares, quando comparados com o lado contra-lateral. Relativamente ao rácio isquiotibiais/quadricípite, assim como no IKDC, não se observaram diferenças entre os dois tipos de enxertos.