Determinants of pediatric cataract program outcomes and follow-up in a large series in Mexico.

PURPOSE:

To report determinants of outcomes and follow-up in a large Mexican pediatric cataract project.

SETTING:

Hospital Luis Sanchez Bulnes, Mexico City, Mexico.

METHODS:

Data were collected prospectively from a pediatric cataract surgery program at the Hospital Luis Sanchez Bulnes, implemented by Helen Keller International. Preoperative data included age, sex, baseline visual acuity, type of cataract, laterality, and presence of conditions such as amblyopia. Surgical data included vitrectomy, capsulotomy, complications, and use of intraocular lenses (IOLs). Postoperative data included final visual acuity, refraction, number of follow-up visits, and program support for follow-up.

RESULTS:

Of 574 eyes of 415 children (mean age 7.1 years +/- 4.7 [SD]), IOLs were placed in 416 (87%). At least 1 follow-up was attended by 408 patients (98.3%) (mean total follow-up 3.5 +/- 1.8 months); 40% of eyes achieved a final visual acuity of 6/18 or better. Children living farther from the hospital had fewer postoperative visits (P = .04), while children receiving program support had more visits (P = .001). Factors predictive of better acuity included receiving an IOL during surgery (P = .04) and provision of postoperative spectacles (P = .001). Predictive of worse acuity were amblyopia (P = .003), postoperative complications (P = .0001), unilateral surgery (P = .0075), and female sex (P = .045).

CONCLUSIONS:

The results underscore the importance of surgical training in reducing complications, early intervention before amblyopia (observed in 40% of patients) can develop, and vigorous treatment if amblyopia is present. The positive impact of program support on follow-up is encouraging, although direct financial support may pose a problem for sustainability. More work is needed to understand reasons for worse outcomes in girls.

Sources of patient knowledge and financing of cataract surgery in rural China: the Sanrao Study of Cataract Outcomes and Up-Take of Services (SCOUTS), report 6.

AIM: To study patient sources of knowledge about cataract surgical services, and strategies for financing surgery in rural China. DESIGN: Cross-sectional case series. METHODS: Patients undergoing cataract surgery by local surgeons in a government, village-level facility in Sanrao, Guangdong between 8 August and 31 December 2005 were examined and had standardised interviews an average of 12 months after surgery. RESULTS: Of 313 eligible patients, 239 (76%) completed the questionnaire. Subjects had a mean (SD) age of 69.9 (10.2) years, 36.4% (87/239) were male, and 87.0% (208/239) had been blind (presenting visual acuity < or = 6/60) before surgery. Word-of-mouth advertising was particularly important: 198 (85.0%) of the subjects knew a person who had undergone cataract surgery, of whom 191 (96.5%) had had cataract surgery at Sanrao itself. Over 70% of subjects (166/239) watched TV daily, whereas 80.0% (188/239) "never" read the newspaper. Nearly two-thirds of suggestions from participants (n = 211, 59.6%) favoured either TV advertisements or word-of-mouth to publicise the programme. While the son or daughter had paid for surgery in over 70% of cases (164/233), the patient's having paid without help was the sole predictor of undergoing second-eye surgery (OR 2.27 (95% CI 1.01 to 5.0, p = 0.04)). DISCUSSION: Strategies to increase uptake of cataract surgery in rural China may benefit from enhancing word-of-mouth advertising (such as with pseudophakic motivators), using television advertising where affordable, and micro-credit or other programmes to enable patients to pay their own fees, thus increasing uptake of second-eye surgery.

Parallel Time Series Analysis and Income Inequality: A New Approach to Comparative Case Studies

This case study deals with the role of time series analysis in sociology, and its relationship with the wider literature and methodology of comparative case study research. Time series analysis is now well-represented in top-ranked sociology journals, often in the form of ‘pooled time series’ research designs. These studies typically pool multiple countries together into a pooled time series cross-section panel, in order to provide a larger sample for more robust and comprehensive analysis. This approach is well suited to exploring trans-national phenomena, and for elaborating useful macro-level theories specific to social structures, national policies, and long-term historical processes. It is less suited however, to understanding how these global social processes work in different countries. As such, the complexities of individual countries - which often display very different or contradictory dynamics than those suggested in pooled studies – are subsumed. Meanwhile, a robust literature on comparative case-based methods exists in the social sciences, where researchers focus on differences between cases, and the complex ways in which they co-evolve or diverge over time. A good example of this is the inequality literature, where although panel studies suggest a general trend of rising inequality driven by the weakening power of labour, marketisation of welfare, and the rising power of capital, some countries have still managed to remain resilient. This case study takes a closer look at what can be learned by applying the insights of case-based comparative research to the method of time series analysis. Taking international income inequality as its point of departure, it argues that we have much to learn about the viability of different combinations of policy options by examining how they work in different countries over time. By taking representative cases from different welfare systems (liberal, social democratic, corporatist, or antipodean), we can better sharpen our theories of how policies can be more specifically engineered to offset rising inequality. This involves a fundamental realignment of the strategy of time series analysis, grounding it instead in a qualitative appreciation of the historical context of cases, as a basis for comparing effects between different countries.

Seasons, Family and Nation in American Horror Story

Arguably, the title of American Horror Story sets out an agenda for the program: this is not just a horror story, but it is a particularly American one. This chapter examines the way that the program uses seasonal celebrations as a way of expressing that national identity, with special emphasis on the importance of family to those celebrations. The particular seasonal celebrations focused on are those of Halloween and Christmas, each of which has associations with the supernatural. However, the use of the supernatural at those seasons is one which is particularly associated with the US, presenting Halloween as a time of supernatural incursion and horror, and of disruption to society and the normal order of things, while Christmas is presented more as a time of unity for the family. Where the supernatural emerges in American Christmas television, it is typically as a force to encourage togetherness and reconciliation, rather than as a dark reminder of the past. While these interpretations of these festivals have been broadcast abroad by American cultural products, not least American television, they have different associations and implications elsewhere, as will be shown. So the particular uses of these festivals is part of what marks American Horror Story out as American, as is the way that the program's narratives have been structured to fit in with US television scheduling. This chapter, then, argues that the structures of the narratives combines with their use of the festivals of Halloween and Christmas in order to enhance the sense of this series as a particularly American horror story.

Optimal alarms systems and its application to financial time series

This thesis focuses on the application of optimal alarm systems to non linear time series models. The most common classes of models in the analysis of real-valued and integer-valued time series are described. The construction of optimal alarm systems is covered and its applications explored. Considering models with conditional heteroscedasticity, particular attention is given to the Fractionally Integrated Asymmetric Power ARCH, FIAPARCH(p; d; q) model and an optimal alarm system is implemented, following both classical and Bayesian methodologies. Taking into consideration the particular characteristics of the APARCH(p; q) representation for financial time series, the introduction of a possible counterpart for modelling time series of counts is proposed: the INteger-valued Asymmetric Power ARCH, INAPARCH(p; q). The probabilistic properties of the INAPARCH(1; 1) model are comprehensively studied, the conditional maximum likelihood (ML) estimation method is applied and the asymptotic properties of the conditional ML estimator are obtained. The final part of the work consists on the implementation of an optimal alarm system to the INAPARCH(1; 1) model. An application is presented to real data series.

Integer-valued APARCH processes in the analysis of time series of counts

The Asymmetric Power Arch representation for the volatility was introduced by Ding et al.(1993) in order to account for asymmetric responses in the volatility in the analysis of continuous-valued financial time series like, for instance, the log-return series of foreign exchange rates, stock indices or share prices. As reported by Brannas and Quoreshi (2010), asymmetric responses in volatility are also observed in time series of counts such as the number of intra-day transactions in stocks. In this work, an asymmetric power autoregressive conditional Poisson model is introduced for the analysis of time series of counts exhibiting asymmetric overdispersion. Basic probabilistic and statistical properties are summarized and parameter estimation is discussed. A simulation study is presented to illustrate the proposed model. Finally, an empirical application to a set of data concerning the daily number of stock transactions is also presented to attest for its practical applicability in data analysis.

The Ethical Gold series

A series of five articles, published over six months in 2010, which explained the key ethical issues relating to sourcing gold. The Ethical Gold Series was written for practising jewellers, industrial jewellery manufacturers and the wider design community. The Ethical Gold Series was published in the Benchpeg Newsletter, an online jewellery industry journal, which in 2010 had over 5,500 subscribers. The material for the articles was drawn from a year of ethnographic fieldwork in the UK jewellery sector, funded by the AHRC, and field visits to preserved, operating and proposed gold mining sites in Alaska, California, Sweden, Wales and Scotland. The ethnographic fieldwork included ‘ethical gold’ promotional events, private industry meetings and jewellery trade shows and meetings with jewellery manufacturers and retailers, assayers, gold refiners and traders and environmental and fair trade campaigners.

Case-series Evaluating a Transdiagnostic Cognitive-behavioral Treatment For Co-occurring Anxiety Disorders.

Background. Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioral interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating cooccurring anxiety disorders. Aims. To evaluate the efficacy of a transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders. Methods. An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13 session modular transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Results. Five of the six participants completed treatment. At post-treatment assessment the five treatment completers achieved diagnostic and symptomatic change with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the three-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre- to post-intervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at three-month follow-up. Conclusions. Results suggest that transdiagnostic cognitive behavioral interventions can be of benefit to patients with co-occurring anxiety disorders.

Introduction to the Transforming Dementia Care in Hospitals Series

A short series of articles in Nursing Older People, starting in September, presents case study examples of the positive work achieved by trusts that participated in the RCN’s development programme to improve dementia care in acute hospitals. This introductory article reports on the independent evaluation of the programme. The programme included a launch event, development days, site visits, ongoing support by the RCN lead and carer representatives and a conference to showcase service improvements. The evaluation drew on data from a survey, the site visits, trust action plans and a range of self-assessment tools for dementia care. The findings highlight substantial progress towards programme objectives and learning outcomes and suggest that the programme provided the focus, impetus and structure for trusts to make sustainable changes. It also equipped participants with the strategies and confidence to change practice. Recommendations are made for taking the programme forward.

The Media as a Window on the Past? The Impact of Television and Newspaper Consumption on Knowledge of the Democratic Transition in Portugal

This study seeks to expand our understanding of how the media increase the level of political information, by focusing on an understudied yet important learning outcome: knowledge of the political past. The article explores the factors underlying variation in the recognition of the leading actors in the transitional process in Portugal. The results show that television news and newspaper exposure foster recognition of these actors, but that media use interacts with personal experience of the transition (stronger effects among younger cohorts) and party identification (stronger impact on those who do not feel close to a political party).

Children's television: the soft underbelly of public service broadcasting

The provision of children's content should be a key constituent of the public service brand, but has often been viewed as a programme category at risk. Certainly in many countries children's television has moved from the 'scarcity' associated with terrestrial provision, to the 'plenty' of digital (see Ellis 2000). However in spite of a range of dedicated public service children's channels in Europe (CBeebies, Kika, Z@ppelin), domestically produced children's television in Europe is notoriously under-resourced if not marginalised. There is a pronounced reliance on imports (particularly on commercial television) notwithstanding the launch by US-owned multinationals (Disney, Nickelodeon, Cartoon Network) of localised versions of their children's television channels in many European countries. Within the broader context of global developments in children's media, this paper starts by outlining the recent and rapid crisis in British children's television and the factors that caused it. This was a crisis, which caught broadcasters and producers by surprise in the middle of 2006, but reflects many of the challenges faced by the children's television sector in other countries. It clearly demonstrated how a combination of the lack of regulatory protection, a change in commercial priorities among broadcasters, advertising restrictions, budgetary pressures and the competitive environment at home and abroad all combined to reinforce the trend towards a contraction of domestic production. The crisis also served to underline the dominance of the BBC - both as a representative of public service principles, and as the dominant producer and commissioner in the market. With the reasons underpinning the crisis explained, the paper will then analyse how the children's television community responded to the crisis and with what effect. Based on interviews, contemporary accounts and documentary evidence the paper will chart the converging and diverging views of broadcasters, producers, regulatory authority Ofcom, and a range of advocacy groups which represent children's interests and the industry. What arguments were elaborated in favour of protecting children's television as an integral part of the public service media brand? Can lessons be learned about how best to ensure the origination of children's media within a public service environment? Can developments in the UK be used to provide insight into how children's media might develop further?

The BBC's role in the changing production ecology of pre-school television in Britain

This paper examines the changing production ecology of British pre-school television in light of developments since the mid-1990s and the specific role played by the BBC. Underpinning the research is the perception that pre-school television is characterised by a complex set of industry relationships and dependencies that demands content which needs to satisfy a wide range of international circumstances and commercial prerogatives. For the BBC this has created tension between its public service goals and commercial priorities. Pre-school programming began in Britain in 1950, but it was not until the mid-1990s that Britain emerged as a leading producer of pre-school programming worldwide with government/industry reports regularly identifying the children’s production sector as an important contributor to exports. The rise of pre-school niche channels (CBeebies, Nick Junior, Playhouse Disney), audience fragmentation and the internationalisation and commercialisation of markets have radically altered the funding base of children’s television and the relationships that the BBC enjoys with key players. The international success of much of its pre-school programming is based on the relationships it enjoys with independent producers who generate significant revenues from programme-related consumer products. This paper focuses on the complex and changing relationships between the BBC, independent producers, and financiers, that constitute the production ecology of pre-school television and shape its output. Within the broader setting of cultural production and global trends the paper investigates the following questions: 1) In the light of changes to the sector since the mid-1990s, what makes pre-school television significant both generally and as an ideal public service project? 2) What is the nature of the current funding crisis in British children’s television and what implications does this crisis have for the BBC’s involvement in pre-school television? 3) How is the Corporation reacting to and managing the wider commercial, cultural, regulatory and technological forces that are likely to affect its strategies for the commissioning, production and acquisition of pre-school content?