Outcomes and projected impact on vision restoration of the China million cataract surgeries program

Purpose: The recently completed Chinese "Million Cataract Surgeries Program" (MCSP) is among the largest such campaigns ever, providing 1.05 million operations. We report MCSP outcomes for the first time, in Jiangxi, the province with the greatest program output. Methods: Ten county hospitals participating in MCSP were selected in Jiangxi (range of gross domestic product per capita US$743-2998). Each hospital sought to enroll 75 consecutive MCSP patients aged ≥50 years. Data recorded included type of cataract procedure, bilateral uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), and refractive error pre- and ≥50 days postoperatively. Results: Among 715 patients (mean age 72.3±9.1 years, 55.5% female), preoperative UCVA was <3/60 (legally blind) bilaterally in 13.3% and unilaterally in the operated eye in 50.9%. No subjects had UCVA >6/18 preoperatively. Small incision cataract surgery was performed in 92.3% patients. Among 662 patients (92.6%) completing follow-up was ≥ 40 days after surgery, BCVA was ≥6/18 in 80.1%, UCVA was ≥6/18 in 57.1% and UCVA was <3/60 in 2.1%. Older age (p<0.001), female sex (p=0.04), worse refractive error (p=0.02) and presence of intra- (p=0.002) and postoperative surgical complications (p<0.001), were independently associated with worse postoperative UCVA. Based on these results, the MCSP cured an estimated 124,950 cases (13.3%×[100-2.1%]×1.05 million) of bilateral and 502,500 (50.9%×[100-2.1%]×1.05 million) of unilateral blindness. Conclusions: Due to relatively good outcomes and the large number of surgeries performed on blind persons, the sight-restoring impact of the MCSP was probably substantial. © Informa Healthcare USA, Inc.

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.

The African Pediatric Fellowship Program: Training in Africa for Africans

Africa has a significant burden of childhood disease, with relatively few skilled health care professionals. The African Paediatric Fellowship Programme was developed by the Department of Pediatrics and Child Health at the University of Cape Town to provide relevant training for African child health professionals, by Africans, within Africa. Trainees identified by partner academic institutions spend 6 months to 2 years training in the Department of Pediatrics and allied disciplines. They then return to their home institution to build practice, training, research, and advocacy. From 2008 to 2015, 73 physicians have completed or are completing training in general pediatrics or a pediatric subspecialty. At 1 year posttraining, 98% to 100% are practicing back in their home institution. The impact of the returning fellows is evident from their practice interventions, research collaborations, and positions as stakeholders who can change health care policies. Thirty-three centers in 13 African countries are partners with the program, and the program template is now followed by other partner sites in Africa. Increasing and retaining the skills pool of African child health specialists is building a network of motivated, highly skilled clinicians who are equipped to advance child health in Africa.

Supporting Creative, Whole Peacebuilders: An Apprenticeship Program

This chapter has two major sections, one by Lederach and the apprentices, and one by Goldberg. The introduction above represents an amalgam of Lederach’s own writing and Goldberg’s, which summarizes some key information, but loses in written flow what it gains in information. As Goldberg reviewed Lederach’s initial chapter, she became deeply interested and asked Lederach for further materials. She conducted two interviews and collected background and supplementary materials and used them to explore some areas that were touched on by Lederach, but, if expanded, offered greater richness. In order to preserve the clarity of writing, the material will be presented in two sections. The first will include Lederach’s original chapter with the apprentice narratives. We start with an overview provided by John Paul that describes several practices incorporated into the process of the past three years. Each of the four apprentices will then reflect on how they experienced these practices and the impact, if any, they have had on their lives and professional careers. Each segment written by Lederach and the apprentices is written in the first person, starting with Lederach’s practices, below. Following will be Goldberg’s work deepening the information presented in Lederach’s section, and the conclusion.

Off-Duty Resilience: Re-orienting Tourism, Leisure and Recreation in the US Army BOSS program

Understanding how US imperial strategy is sustained by tourism and militarism requires an account of how American soldiers learn to understand themselves in relation to a variety of marginalized others. This paper explores how the US Army’s ‘Ready and Resilient’ (R2) campaign constructs soldier / other relations by mobilizing off-duty time through the ‘Better Opportunities for Single Soldiers’ (BOSS) program. BOSS’s first two platforms of ‘Well-Being’ and ‘Community Service’ feed into the R2 agenda by producing highly-skilled leaders (who govern a disengaged rank and file) and benevolent humanitarians (who provide charity for abject civilians). When these dispositions are transposed into BOSS’s third platform of ‘Recreation and Leisure’, soldiers turn away from the goals of leadership and humanitarianism to reveal the privileged narcissism underscoring the R2 agenda. This self-focus is intensified by familiar power relations in the tourism industry as soldiers pursue self-improvement by commodifying, distancing and effacing local tourist workers. Using the BOSS program as a case study, this paper critically interrogates how the US Army is assimilating off-duty practices of tourism, leisure and recreation into the wider program of resilience training.

A tool to include gamma analysis software into a quality assurance program

PURPOSE: To provide a tool to enable gamma analysis software algorithms to be included in a quality assurance (QA) program.

METHODS: Four image sets were created comprising two geometric images to independently test the distance to agreement (DTA) and dose difference (DD) elements of the gamma algorithm, a clinical step and shoot IMRT field and a clinical VMAT arc. The images were analysed using global and local gamma analysis with 2 in-house and 8 commercially available software encompassing 15 software versions. The effect of image resolution on gamma pass rates was also investigated.

RESULTS: All but one software accurately calculated the gamma passing rate for the geometric images. Variation in global gamma passing rates of 1% at 3%/3mm and over 2% at 1%/1mm was measured between software and software versions with analysis of appropriately sampled images.

CONCLUSION: This study provides a suite of test images and the gamma pass rates achieved for a selection of commercially available software. This image suite will enable validation of gamma analysis software within a QA program and provide a frame of reference by which to compare results reported in the literature from various manufacturers and software versions.

Process Evaluation of the Roots of Empathy Program

This paper presents the findings of a qualitative process evaluation of the Roots of Empathy (ROE) programme. ROE is a universal, classroom-based intervention, which aims to enhance social and emotional learning of primary (elementary) school children. Effective delivery of such complex social interventions in real-world settings requires in-depth knowledge and understanding of factors that interact to influence implementation and fidelity. A case study methodology was employed with six schools, to explore the views of key actors and stakeholders involved in the delivery and receipt of the programme. Overall, ROE was delivered with high fidelity and the programme was viewed positively across the schools. However, one issue was the varied level of interest and awareness of the programme from parents.

Desenvolvimento profissional de professores de ciências: um estudo no contexto da geologia

Os grandes desafios colocados à educação têm vindo a dar centralidade à formação dos professores. O presente estudo pretende ser uma contribuição para o desenvolvimento profissional de professores (DPP) de ciências na sociedade atual. Trata-se de uma investigação em supervisão da formação, mais especificamente, na supervisão da formação de professores em didática das ciências. Insere-se na formação contínua e reflete preocupações que se prendem com saberes profissionais dos professores de ciências num contexto da educação em geociências no ensino secundário. Foi concebido, implementado e avaliado um programa de formação (PF), integrado num percurso de desenvolvimento profissional, que contemplou uma abordagem multidisciplinar de natureza ciência-tecnologia-sociedade (CTS). Valorizaram-se os ambientes exteriores à sala de aula (AESA), bem como a avaliação do seu impacte no DPP, no final do PF e, também, no final do ano letivo seguinte. O estudo integrou três fases: aprofundamento do quadro teórico que contextualiza a investigação (Fase I); conceção, implementação e avaliação do PF (Fase II); elaboração de linhas orientadoras para o DPP de ciências e redação do trabalho final (Fase III). Na Fase I foi aprofundado o quadro teórico que enquadrou e sustentou o estudo realizado, fundamentando as opções tomadas nas fases subsequentes. Foram relevadas temáticas como o conhecimento profissional e o desenvolvimento profissional docente, a formação contínua e a supervisão da formação, a educação em geociências e o seu contributo para a formação científica do cidadão numa perspetiva CTS. A avaliação das aprendizagens, de uma forma especial em AESA, bem como as dificuldades inerentes ao nível da sua integração curricular foi abordada. Na Fase II, foi concebido um PF, sustentado em indicadores da investigação, que assentou numa matriz multidisciplinar, de natureza CTS, o qual valorizou os AESA. Na modalidade de oficina de formação, o PF decorreu ao longo do ano letivo 2010/2011, teve a duração de cinquenta horas presenciais - em ambientes de aprendizagem diversos - e cinquenta não presenciais e foi frequentado por dezasseis professores do grupo 520, pertencentes a dez escolas diferentes. Na primeira sessão, foi administrado um questionário aos professores para diagnosticar as suas conceções sobre o ensino das ciências desenvolvido numa matriz CTS e em AESA. Os indicadores obtidos mostram que a maior parte dos professores não desenvolve atividades daquela natureza e que as realizadas são pouco exigentes do ponto de vista cognitivo. Foi igualmente reconhecido que a implementação deste tipo de atividades necessita de conhecimentos de outras áreas do saber e de materiais de apoio, e, ainda, que a formação inicial é insuficiente. Esta fase terminou com a avaliação das perceções sobre o impacte do programa de formação no DPP e na melhoria das práticas de formação contínua de professores de ciências. Os indicadores obtidos revelam que o percurso formativo contribuiu para: − o desenvolvimento do conhecimento profissional dos participantes, ao nível dos saberes associados à exploração, transformação e utilização dos recursos geológicos e das implicações sociais e ambientais associadas e, também, do conhecimento didático acerca do ensino das ciências nos contextos aqui considerados, bem como da avaliação das aprendizagens; − a construção de materiais didáticos específicos, que os professores reconhecem que promovem a aprendizagem contextualizada, a integração de saberes, o desenvolvimento de competências (conceptuais, procedimentais e atitudinais), a avaliação das aprendizagens integrada, permitindo, ainda, atingir os objetivos educacionais previstos no programa da disciplina e motivar os alunos para a aprendizagem da geologia; − a modificação de algumas práticas pedagógicas, ao nível da utilização curricular da perspetiva CTS nos ambientes aqui estudados, com destaque para a respetiva avaliação dos alunos; − o desenvolvimento de capacidades necessárias ao trabalho colaborativo e da capacidade reflexiva dos professores participantes; − a identificação de potencialidades no PF implementado, ao nível da organização, da metodologia e da supervisão da formação. Na Fase III, as conclusões obtidas levaram à apresentação de linhas orientadoras para o DPP de ciências, ao nível da formação contínua de professores, da supervisão da formação e do ensino e aprendizagem das ciências. Considera-se que as propostas referidas, ao alterarem as práticas vigentes, podem contribuir para aproximar a prática letiva dos professores de ciências da investigação em didática e, assim, para a melhoria da qualidade das aprendizagens dos alunos.

Biology, ecology, population dynamics and distribution of metals in Sepia officinalis on a typical estuarine coastal lagoon - Ria de Aveiro

The common cuttlefish, Sepia officinalis, is a necto-benthic cephalopod that can live in coastal ecosystems, with high influence of anthropogenic pressures and thus be vulnerable to exposure to various types of contaminants. The cuttlefish is a species of great importance to the local economy of Aveiro, considering the global data of catches of this species in the Ria de Aveiro. However, studies on this species in Ria de Aveiro are scarce, so the present study aims to fill this information gap about the cuttlefish in the Ria de Aveiro. The cuttlefish enters Ria de Aveiro in the spring and summer to reproduce, returning to deeper waters in the winter. In terms of abundance, the eastern and center regions of the lagoon, closer to the sea, showed the highest values of abundance, while the northern and southern regions of the main channel had the lowest abundance. This fact may be related to abiotic factors, as well as depth, salinity and temperature. In the most southern point of the Ria de Aveiro (Areão) no cuttlefish was caught. This site had the lowest values of salinity and depth. The cuttlefish has an allometric the females being heavier than males to mantle lengths greater than 82.4 mm. Males reach sexual maturity first than females. In Ria de Aveiro in a generation of parents was found. The cuttlefish, presents itself as opportunistic predators, consuming a wide variety of prey from different taxa. The diet was similar in different sampling locations observing significant differences for the seasons. S. officinalis was captured at 10 sites in the Ria de Aveiro with different anthropogenic sources of contamination. Thus, levels of metals analyzed were similar at all sampling sites, with the exception of a restricted area, Laranjo, which showed higher values. The cuttlefish has the ability to accumulate metals in your body. The levels of Fe, Zn, Cu, Cd, Pb and Hg found in the digestive gland and mantle reflect a differential accumulation of metals in the tissues. This accumulation is related to the type and function of tissue analyzed and the type of metal analysis (essential and non-essential). The metal concentrations in the digestive gland are higher than in the mantle, with the exception of mercury. This may be due to the high affinity of the mantle for the incorporation of methylmercury (MeHg), the most abundant form of mercury. The accumulation of metals can vary over a lifetime, depending on the metal. The concentrations of Zn, Cd and Hg increases throughout life, while Pb decreases and essential metals such as Fe and Cu remain constant. The data collected suggest that the cuttlefish (Sepia officinalis) can be used as a bioindicator of environmental contamination for some metals.

The Well London program - a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results

Background The Well London programme used community engagement, complemented by changes to the physical and social neighbourhood environment, to improve physical activity levels, healthy eating and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomised trial (CRT). The baseline survey data are reported here. Methods The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas; ranked in the 11% most deprived LSOAs in London by Index of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighbourhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating and mental wellbeing were assessed using standardised, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. Results There were 4107 adults and 1214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighbourhoods were broadly similar. There was greater between cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking and self-reported anxiety/depression were similar in the Well London population and the national Health Survey for England. Levels of physical activity were higher in the Well London population but this is likely to be due to the different measurement tools used in the two surveys. Conclusions Randomisation of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.

ORBS and the limits of static slicing

Observation-based slicing is a recently-introduced, language-independent, slicing technique based on the dependencies observable from program behaviour. Due to the wellknown limits of dynamic analysis, we may only compute an under-approximation of the true observation-based slice. However, because the observation-based slice captures all possible dependence that can be observed, even such approximations can yield insight into the limitations of static slicing. For example, a static slice, S that is strictly smaller than the corresponding observation based slice is guaranteed to be unsafe. We present the results of three sets of experiments on 12 different programs, including benchmarks and larger programs, which investigate the relationship between static and observation-based slicing. We show that, in extreme cases, observation-based slices can find the true static minimal slice, where static techniques cannot. For more typical cases, our results illustrate the potential for observation-based slicing to highlight unsafe static slices. Finally, we report on the sensitivity of observation-based slicing to test quality.

Sediment dynamics and tidal inlet relocation in mixed-energy settings: the case of Ancão inlet (Algarve - Portugal)

Tese de dout., Ciências do Mar, Faculdade de Ciências do Mar e do Ambiente, Univ. do Algarve, 2003

Increasing the use of group interventions in a pediatric rehabilitation program: perceptions of administrators, therapists, and parents

Objectives. To explore perceptions related to increased utilization of group interventions as a part of the service reorganization within a pediatric rehabilitation program. Methods. Individual interviews with program administrators (n=13) and focus groups with therapists (n=19) and parents of children with disabilities (n=5) were conducted. Data were analyzed using a coding grid inspired by the organized action systems theory. Results. Administrators and therapists identified several issues including the need to improve the referral process for groups and the coordination across services. Groups considerably modified practice and required substantial efforts from therapists. Administrators felt groups contributed to increased service accessibility. Although therapists had some doubts about service quality in groups, especially in regard to the reduced attention to individual needs, they reported positive benefits on children’s social participation. Generally, parents were satisfied with group interventions. Conclusion. Groups appear to be a promising method of service delivery, but organizational-related issues should be considered.

Hotel Valuation Software, Version 4.0

[Updated August 2016] The Hotel Valuation Software, freely available from Cornell’s Center for Hospitality Research, has been updated to reflect the many changes in the 11th Edition of the Uniform System of Accounts for the Lodging Industry (USALI). Version 4.0 of the Hotel Valuation Software provides numerous enhancements over the original tool from 2011. In addition to a significant increase in functionality and an update to reflect the 11th edition of the USALI, Version 4.0 takes advantage of the power of the latest release of Microsoft Excel®. Note that Version 4.0 works only on a PC running Microsoft Windows, it does not work on a Mac running OS X. Users desiring an OS X compatible version should click here (Labeled as Version 2.5). 酒店评估软件手册和三个程序（点击这里 ) Users desiring a Mandarin version of the Hotel Valuation Software should click here The Hotel Valuation Software remains the only non-proprietary computer software designed specifically to assist in the preparation of market studies, forecasts of income and expense, and valuations for lodging property. The software provides an accurate, consistent, and cost-effective way for hospitality professionals to forecast occupancy, revenues and expenses and to perform hotel valuations. Version 4.0 of the Hotel Valuation Software includes the following upgrades – a complete update to reflect the 11th edition of the USALI – the most significant change to the chart of accounts in a generation, an average daily rate forecasting tool, a much more sophisticated valuation module, and an optional valuation tool useful in periods of limited capital liquidity. Using established methodology, the Hotel Valuation Software is a sophisticated tool for lodging professionals. The tool consists of three separate software programs written as Microsoft Excel files and a software users' guide. The tool is provided through the generosity of HVS and the School of Hotel Administration. The three software modules are: Room Night Analysis and Average Daily Rate: Enables the analyst to evaluate the various competitive factors such as occupancy, average room rate, and market segmentation for competitive hotels in a local market. Calculates the area-wide occupancy and average room rate, as well as the competitive market mix. Produce a forecast of occupancy and average daily rate for existing and proposed hotels in a local market. The program incorporates such factors as competitive occupancies, market segmentation, unaccommodated demand, latent demand, growth of demand, and the relative competitiveness of each property in the local market. The program outputs include ten-year projections of occupancy and average daily rate. Fixed and Variable Revenue and Expense Analysis: The key to any market study and valuation is a supportable forecast of revenues and expenses. Hotel revenue and expenses are comprised of many different components that display certain fixed and variable relationships to each other. This program enables the analyst to input comparable financial operating data and forecast a complete 11-year income and expense statement by defining a small set of inputs: The expected future occupancy levels for the subject hotel Base year operating data for the subject hotel Fixed and variable relationships for revenues and expenses Expected inflation rates for revenues and expenses Hotel Capitalization Software: A discounted cash flow valuation model utilizing the mortgage-equity technique forms the basis for this program. Values are produced using three distinct underwriting criteria: A loan-to-value ratio, in which the size of the mortgage is based on property value. A debt coverage ratio (also known as a debt-service coverage ratio), in which the size of the mortgage is based on property level cash flow, mortgage interest rate, and mortgage amortization. A debt yield, in which the size of the mortgage is based on property level cash flow. By entering the terms of typical lodging financing, along with a forecast of revenue and expense, the program determines the value that provides the stated returns to the mortgage and equity components. The program allows for a variable holding period from four to ten years The program includes an optional model useful during periods of capital market illiquidity that assumes a property refinancing during the holding period