Surgical checklist for cataract surgery:progress with the initiative by the Royal College of Ophthalmologists to improve patient safety

PurposeThe World Health Organisation (WHO) identified patient safety in surgery as an important public health matter and advised the adoption of a universal peri-operative surgical checklist. An adapted version of the WHO checklist has been mandatory in the National Health Service since 2010. Wrong intraocular lens (IOL) implantation is a particular safety concern in ophthalmology. The Royal College of Ophthalmologists launched a bespoke checklist for cataract surgery in 2010 to reduce the likelihood of preventable errors. We sought to ascertain the use of checklists in cataract surgery in 2012.Patients and methodsA survey of members of the Royal College of Ophthalmologists seeking views on the use of checklists in cataract surgery. Four hundred and sixty-nine completed responses were received (18% response rate).ResultsRespondents worked in England (75%), Scotland (11%), Wales (5%), Northern Ireland (2%), the Republic of Ireland (1%), and overseas (6%). Ninety-four per cent of respondents support the use of a checklist for cataract surgery and 85% say that they always use a checklist before cataract surgery. Sixty-seven per cent of cataract surgeons stated they undertake a pre-operative team brief. Thirty-six per cent use a cataract surgery checklist developed locally, 18% use the college's bespoke cataract surgery checklist, 39% use a generic surgical checklist, and 4% reported that they do not use a checklist.ConclusionNinety-three per cent of cataract surgeons responding to the questionnaire report using a surgical checklist and 67% use a team brief. However, only 54% use a checklist, which addresses the selection of the correct intraocular implant. We recommend wider adoption of checklists, which address risks relevant to cataract surgery, in particular the possibility of selection of an incorrect IOL.Eye advance online publication, 24 May 2013; doi:10.1038/eye.2013.101.

Promoting Evidence-informed Practice in Child Welfare in Ontario: Progress, Challenges and Future Directions.

Paper explores the findings from a province-wide program evaluation of Practice and Research Together (PART: www. partcanada.org); The paper is a unique evaluation of a knowledge exchange program and provides interesting analysis of how front-line practitioners, supervisors and senior leaders engage, utilize and contribute to evidence-informed practice.

Clinical and technical factors associated with skin intrinsic fluorescence in subjects with type 1 diabetes from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications(EDIC) studies have established multiyear mean hemoglobin A1c (HbA1c) as predictive of microvascular complications in persons with type 1 diabetes. However, multiyear mean HbA1c is not always available in the clinical setting. Skin advanced glycation end products (AGEs) are thought to partially reflect effects of hyperglycemia over time, and measurement of skin AGEs might be a surrogate for multiyear mean HbA1c. As certain AGEs fluoresce and skin fluorescence has been demonstrated to correlate with the concentration of skin AGEs, noninvasive measurement by skin intrinsic fluorescence(SIF) facilitates the exploration of the association of mean HbA1c and other clinical/technical factors with SIF using the detailed phenotypic database available in DCCT/EDIC.

The Effects of the Catalytic Converter on Two-Stroke Engine Performance, SAE Technical Paper 972741

The two-stroke engine, by its nature is very dependent on the unsteady gas dynamics within an exhaust system. This is demonstrated by the tuning effects on two-stroke engines, which have been well documented. In consideration of current emissions legislation, a two-stroke engine can be fitted with a catalytic converter for the outboard, utility or automotive markets. The catalytic substrate represents a major obstruction to the flow of exhaust gas, which hinders the progression of the main exhausted pulse, and in turn effects the scavenging of the cylinder and ultimately the performance of the engine.

Rigorous Specification and Low-Latency Implementation of Technical Market Indicators

Technical market indicators are tools used by technical an- alysts to understand trends in trading markets. Technical (market) indicators are often calculated in real-time, as trading progresses. This paper presents a mathematically- founded framework for calculating technical indicators. Our framework consists of a domain specific language for the un- ambiguous specification of technical indicators, and a run- time system based on Click, for computing the indicators. We argue that our solution enhances the ease of program- ming due to aligning our domain-specific language to the mathematical description of technical indicators, and that it enables executing programs in kernel space for decreased latency, without exposing the system to users’ programming errors.

The Biospheric Project - Manchester International Festival 2013:Technical food systems

The Biospheric Project is a nested multi-scalar urban agriculture project that aims to develop sustainable food systems in disadvantaged communities, though not only physical interventions, such as the urban masterplan and neighbourhood design to the building and its roof and façade, but also through social and commercial interventions, such as community involvement, businesses and a distribution system.

The project is focused around the Biospheric Foundation, a community interest company and research think-tank whose aim is to hasten our transition to a closed cycle, low-carbon economy. Its home is Irwell house, that houses a large-scale aquaponic-based food production system, which is directly linked to a whole-food shop (78 Steps, named after the distance from the productive system) and a whole food distribution system (the Whole Box). The building sits within a post-industrial landscape which is being developed into a new productive landscape, utilizing the the technologies developed by the Biospheric Foundation and Prof Greg Keeffe of Queens University Belfast. The collaboration links designer, academics and activists across the disciplines of Urban design, Architecture, Permaculture, landscape design, environmental science and business and community.

An accelerated method of developing DBT projects using CDIO partner institutions as parallel processors

The cycle of the academic year impacts on efforts to refine and improve major group design-build-test (DBT) projects since the time to run and evaluate projects is generally a full calendar year. By definition these major projects have a high degree of complexity since they act as the vehicle for the application of a range of technical knowledge and skills. There is also often an extensive list of desired learning outcomes which extends to include professional skills and attributes such as communication and team working. It is contended that student project definition and operation, like any other designed product, requires a number of iterations to achieve optimisation. The problem however is that if this cycle takes four or more years then by the time a project’s operational structure is fine tuned it is quite possible that the project theme is no longer relevant. The majority of the students will also inevitably experience a sub-optimal project experience over the 5 year development period. It would be much better if the ratio were flipped so that in 1 year an optimised project definition could be achieved which had sufficient longevity that it could run in the same efficient manner for 4 further years. An increased number of parallel investigators would also enable more varied and adventurous project concepts to be examined than a single institution could undertake alone in the same time frame.
This work-in-progress paper describes a parallel processing methodology for the accelerated definition of new student DBT project concepts. This methodology has been devised and implemented by a number of CDIO partner institutions in the UK & Ireland region. An agreed project theme was operated in parallel in one academic year with the objective of replacing a multi-year iterative cycle. Additionally the close collaboration and peer learning derived from the interaction between the coordinating academics facilitated the development of faculty teaching skills in line with CDIO standard 10.

Progress in Laser-Driven Ion Acceleration towards Applications in Radiotherapy

We will outline recent progress, in the UK ASAIL laser-ion acceleration programme, which aims to advance laser-driven ion beams to the point at which they will become a serious alternative to conventional accelerators for radiotherapy.