Developing the specifications of an open angle glaucoma screening intervention in the United Kingdom: a Delphi approach.

Abstract
BACKGROUND:
Glaucoma is a leading cause of blindness. Early detection is advocated but there is insufficient evidence from randomized controlled trials (RCTs) to inform health policy on population screening. Primarily, there is no agreed screening intervention. For a screening programme, agreement is required on the screening tests to be used, either individually or in combination, the person to deliver the test and the location where testing should take place. This study aimed to use ophthalmologists (who were experienced glaucoma subspecialists), optometrists, ophthalmic nurses and patients to develop a reduced set of potential screening tests and testing arrangements that could then be explored in depth in a further study of their feasibility for evaluation in a glaucoma screening RCT.
METHODS:
A two-round Delphi survey involving 38 participants was conducted. Materials were developed from a prior evidence synthesis. For round one, after some initial priming questions in four domains, specialists were asked to nominate three screening interventions, the intervention being a combination of the four domains; target population, (age and higher risk groups), site, screening test and test operator (provider). More than 250 screening interventions were identified. For round two, responses were condensed into 72 interventions and each was rated by participants on a 0-10 scale in terms of feasibility.
RESULTS:
Using a cut-off of a median rating of feasibility of =5.5 as evidence of agreement of intervention feasibility, six interventions were identified from round 2. These were initiating screening at age 50, with a combination of two or three screening tests (varying combinations of tonometry/measures of visual function/optic nerve damage) organized in a community setting with an ophthalmic trained technical assistant delivering the tests. An alternative intervention was a 'glaucoma risk score' ascertained by questionnaire. The advisory panel recommended that further exploration of the feasibility of screening higher risk populations and detailed specification of the screening tests was required.
CONCLUSIONS:
With systematic use of expert opinions, a shortlist of potential screening interventions was identified. Views of users, service providers and cost-effectiveness modeling are now required to identify a feasible intervention to evaluate in a future glaucoma screening trial.

Research Protocol: A Randomized Controlled Trial of Functional Family Therapy: An Early Intervention Foundation (EIF) Partnership between Croydon Council and Queen's University Belfast

The paper presents a protocol for ‘A Randomized Controlled Trial of Functional Family Therapy (FFT): An Early Intervention Foundation (EIF) Partnership between Croydon Council and Queen's University Belfast’. The protocol describes a trial that uses FFT as an alternative intervention to current use of the youth justice system and local authority care with the aim of reducing crime/recidivism in young people referred to Croydon Council. The trial will take place over a period of 36 months and will involve up to 154 families. Croydon Council will employ a team of five Functional Family Therapists who will work with families to promote effective outcomes. The Centre for Effective Education at Queen’s University Belfast will act as independent evaluators of outcomes for families and young people. The work is supported from the United Kingdom Economic & Social Research Council/Early Intervention Foundation Grant Number ES/M006921/1.

Lactobacilli antagonize the growth, motility, and adherence of brachyspira pilosicoli: a potential intervention against avian intestinal spirochetosis

Avian intestinal spirochetosis (AIS) results from the colonization of the ceca and colorectum of poultry by pathogenic Brachyspira species. The number of cases of AIS has increased since the 2006 European Union ban on the use of antibiotic growth promoters, which, together with emerging antimicrobial resistance in Brachyspira, has driven renewed interest in alternative intervention strategies. Probiotics have been reported as protecting livestock against infection with common enteric pathogens, and here we investigate which aspects of the biology of Brachyspira they antagonize in order to identify possible interventions against AIS. The cell-free supernatants (CFS) of two Lactobacillus strains, Lactobacillus reuteri LM1 and Lactobacillus salivarius LM2, suppressed the growth of Brachyspira pilosicoli B2904 in a pH-dependent manner. In in vitro adherence and invasion assays with HT29-16E three-dimensional (3D) cells and in a novel avian cecal in vitro organ culture (IVOC) model, the adherence and invasion of B. pilosicoli in epithelial cells were reduced significantly by the presence of lactobacilli (P < 0.001). In addition, live and heat-inactivated lactobacilli inhibited the motility of B. pilosicoli, and electron microscopic observations indicated that contact between the lactobacilli and Brachyspira was crucial in inhibiting both adherence and motility. These data suggest that motility is essential for B. pilosicoli to adhere to and invade the gut epithelium and that any interference of motility may be a useful tool for the development of control strategies.

Broader or deeper? Exploring the most effective intervention profile for public small business support

Most advanced economies offer publicly financed advice services to start-up firms and SMEs. In England, local or regional Business Links organisations have provided these services, and divided their support into nonintensive one-off contacts providing information or advice and more intensive support involving a diagnostic process and repeated interaction with firms. A key choice for Business Link managers is how to shape their intervention strategies, balancing resources between intensive and nonintensive support. Drawing on resource dependency theory, we develop a typology of intervention strategies for Business Links in England which reflects differences in the breadth and depth of the support provided. We then test the impacts of these alternative intervention models on client companies using both subjective assessments by firms and econometric treatment models that allow for selection bias. Our key empirical result is that Business Links’ choice of intervention strategy has a significant effect both on actual and on perceived business outcomes, with our results emphasising the value of depth over breadth. The implication is that where additional resources are available for business support these should be used to deepen the assistance provided rather than extend assistance to a wider group of firms.

Extensão universitária: caminhos para o desenvolvimento de ações emancipadoras nas comunidades em vulnerabilidade social

Uma das principais discussões na dimensão social perpassa sobre o tema emancipação social, o que na concepção de Santos (2007, p.17) é um conceito absolutamente central na modernidade. Estudos que venham revelar as evidências emancipadoras por meio das práticas de projetos sociais são relevantes socialmente e representam alternativas de intervenção social. A tese central é a de que os projetos de intervenção social em áreas de vulnerabilidade social propiciam a emancipação dos atores locais. Este estudo se justifica pela necessidade de compreender como são construídas essas redes de intervenção social que atuam em comunidades pobres. Os objetivos do estudo foram: i) verificar as possibilidades de emancipação que se associam às políticas e práticas de extensão universitária; ii) identificar as representações de mulheres sobre o tempo que destinam a esperar os filhos que participam de atividades em uma Vila Olímpica; iii) analisar os objetivos e ações que mobilizaram a Central Única das Favelas (CUFA), com atenção na fundação e sua trajetória, do Street Basket das Favelas, em 2005, à competição Taça das Favelas, em 2011; iv) identificar o conteúdo das representações sociais (RS) acerca da participação de jovens adolescentes na Taça das Favelas. Para a realização dos estudos, adotou-se a abordagem qualitativa. No primeiro estudo utilizou-se a metodologia da análise documental para seleção dos documentos e análise de conteúdo de Bardin (2009) para identificação das categorias a serem analisadas. Definimos um marco referencial básico a partir das reflexões de Boaventura de Sousa Santos e Paulo Freire para conceituar a extensão e emancipação social. Os tópicos contemplados na análise se desdobraram em três questões: qual a concepção de extensão universitária está presente nos documentos institucionais; de que forma a universidade promove a articulação com o território; como se dá a prática da extensão universitária na UNISUAM. Os resultados da análise evidenciaram processos emancipadores nas práticas extensionistas. O segundo estudo é de natureza etnográfica, com aportes da etnometodologia e da pesquisa-ação colaborativa. O grupo pesquisado se caracteriza por mulheres que frequentam a Vila Olímpica do Complexo do Alemão. Os resultados em relação à representação das mulheres sobre o tempo que esperam os filhos revelaram que é um tempo para a aprendizagem. O terceiro estudo é sobre o papel da CUFA na cultura hip hop no basquetebol, no Rio de Janeiro e na Taça das Favelas, uma competição de futebol de campo entre 80 seleções, com jovens moradores das favelas. O estudo seguinte é sobre representações sociais acerca da participação de jovens adolescentes na Taça das Favelas. Os dados provêm de entrevista semiestruturada com 11 jogadores da Taça das Favelas.

Implementation of ‘School Back’ by the ‘Core’ technique in a factory of geotextiles to prevent back pain

Introduction: This article aims to show an alternative intervention for the prevention and control of back pain to the people of a production plant of geotextiles for the construction exposed to handling and awkward postures through the implementation of the Back School using the CORE technique. This technique being understood as trainer of the stability musculature of the spine; whose benefit is proportionate the muscular complex of the back, stability and avoid osteomuscular lesions and improved posture. Objective: To present the results about the implementation of the back school by the CORE technique for prevention of back pain in a population of forty-eight male collaborators. Materials and methods: The back school began with talks of awareness by the occupational health physician explaining the objectives and benefits of it to all participants. Once this activity was done, was continued to evaluate all plant employees to establish health status through the PAR-Q questionnaire, who were surveyed for the perception of pain using visual analog scale (VAS) and stability was determined column through the CORE assessment, to determine the training plan. Then, were made every six months the revaluations and implementation of a survey of assistant public perception to identify the impact of the implementation of the school back on the two variables referred (pain perception and stability of column). Results: The pain perception according VAS increased in the number of workers asymptomatic in 12% and based in the satisfaction survey 94% of population reported that with the development of this technique decrease the muscle fatigue in lumbar level; and 96% of population reported an improvement in the performance of their work activities. Discussion: Posterior to the analysis of all results, it is interpreted that back schools practice through CORE technique, contributes to the prevention and / or control of symptoms at the lumbar level in population of productive sector exposed to risks derived from the physical load, provided that ensure its continuously development and supervised for a competent professional.

Costos asociados al soporte nutricional enteral en la unidad de cuidados intensivos, revisión de literatura

Objetivo:Describir los costos asociados al soporte nutricional enteral en pacientes adultos hospitalizados en Unidades de Cuidados Intensivos (UCI), Metodología: La elaboración de este documento se realizó en una búsqueda exhaustiva de acuerdo a las especificaciones y recomendaciones de la revisión de literatura, en MEDLINE, PUBMED, SCIENCE DIRECT, EBSCO por considerarse como bases de datos reconocidas por contener artículos de mayor fiabilidad y más usadas en el ámbito académico. Se evidencio en los 70 artículosel cumplimiento de los criterios de inclusión, enel cual se realizó un análisis de costos en el manejo del soporte nutricional enteral y se identificó la importancia del manejo de la nutrición en pacientes adultos del servicio de UCI. Resultados: De tal manera la importancia del soporte nutricional enteral, en su proceso precoz se identifica la reducción de costos y de recursos que se puede manejar ante el paciente crítico. Dentro de este marco se resalta que el soporte nutricional enteral debe ser la primera opción en paciente. Conclusión:La nutrición enteral considerada un modelo de innovación al soporte nutricional en las últimas décadas, ha evolucionado contribuyendo una adecuada alternativa de intervención y sin efectos adversos clínicos relevantes, que además mejoran la calidad de vida y contribuyen a la toma de decisiones clínicas basadas en la evidencia y en los análisis de costes con el uso racional de los recursos, así mismo, es una práctica costo- efectiva,con componente de costo- beneficio para el usuario al mejorar calidad de vida, obteniendo mayores beneficios a un menor costo.

Oral treatment of chickens with Lactobacillus reuteri LM1 reduces Brachyspira pilosicoli-induced pathology

Avian intestinal spirochaetosis (AIS) results from the colonization of the caeca and colon of poultry by pathogenic Brachyspira, notably Brachyspira pilosicoli. Following the ban on the use of antibiotic growth promoters in the European Union in 2006, the number of cases of AIS has increased, which, alongside emerging antimicrobial resistance in Brachyspira, has driven renewed interest in alternative intervention strategies. Lactobacillus-based probiotics have been shown to protect against infection with common enteric pathogens in livestock. Our previous studies have shown that Lactobacillus reuteri LM1 antagonizes aspects of the pathobiology of Brachyspira in vitro. Here, we showed that L. reuteri LM1 mitigates the clinical symptoms of AIS in chickens experimentally challenged with B. pilosicoli. Two groups of 15 commercial laying hens were challenged experimentally by oral gavage with B. pilosicoli B2904 at 18 weeks of age; one group received unsupplemented drinking water and the other received L. reuteri LM1 in drinking water from 1 week prior to challenge with Brachyspira and thereafter for the duration of the study. This treatment regime was protective. Specifically, B. pilosicoli was detected by culture in fewer birds, bird weights were higher, faecal moisture contents were significantly lower (P<0.05) and egg production as assessed by egg weight and faecal staining score was improved (P<0.05). Also, at post-mortem examination, significantly fewer B. pilosicoli were recovered from treated birds (P<0.05), with only mild–moderate histopathological changes observed. These data suggest that L. reuteri LM1 may be a useful tool in the control of AIS.

Redes de educação ambiental: um meio como proposta pedagógica para o mundo entrelaçado

The networks terminology has been growing in different meanings, in which emergent structures coming from one not so recently typology aquired, in the 90 s, fluid shapes impelled by waves without borders of the New Information and Communication Technologies. Ever since, the pattern and the morphology are being multiply and strengthen. With this backdrop, this study deals with the Education for Environment Networks, as a political and social, educative and cultural alternative intervention, as an answer for some contemporary demands. But what are these networks? In wich way they organize themselves to germinate political actions? Where is the core of these actions? What are their limits or potentialities? These are some of the questions that are presented along the study proposed. Therefore, we have in view to unveil the network social and environmental pedagogic dimension, as an alternative proposal towards to the planetary cintzenship formation for persons and coletivity. The study employs the exploration reasearch as the analysis of the organizational reference basis and the dinamics of conections that support the dialogue among the groups that belong to the Education for Environment Networks. We conclude that the networks overcome themselves as a powerfull tool to articulate and moblize people. They establish a potential pedagogic act for political and social intervention, as an alternative proposal for the citizen formation and his world vision. We sinalize that the networks are sometimes limited by the poorness of knowledge that still remains on those who find themselves twisted on them, and on the decreasing optics by those who are absent.

Aplicação do processo hierárquico analítico (AHP) na priorização de áreas de risco geológico para a implantação de intervenções em assentamentos urbanos precários

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The use of the Dade County student assistance profile in the identification of at -risk students at a minority senior high school

Current high school completion rates in Dade County and across the nation are considered to be unacceptable. This has led to the development of student assistance profiles to aid in the early identification of students considered to be at risk to allow for some form of intervention. The purpose of this research was to examine the current Dade County Public Schools profile as applied to one specific high school in which most of the students are Hispanic (mostly of Mexican descent) and Black (African-Americans, as well as recent Haitian immigrants). Additionally, the effectiveness of the alternative intervention program provided at this high school--a school within a school--were evaluated. School records of the 1992 in-coming ninth grade class became the initial data base. The individual student records of this cohort were then examined over a four-year period until their expected date or graduation. The DCPS profile used to identify potential dropouts from this group was evaluated, using chi-square and multivariate analysis, to determine its overall effectiveness, as well as the effectiveness of the individual indicators which comprise the profile. The Student Assistance Profile was found to an effective predictor, but it over-identified students from this cohort, particularly minorities, to the extent that it became largely ineffective, especially considering the limited resources available for intervention. The intervention program was found to be ineffective in reducing the dropout rate. Further analysis of the individual indicators used in the DCPS profile as they applied to this school population resulted in the development of an improved profile. By reducing the number of indicators to those found to be most highly associated with failure to graduate--academic performance and absences--a simpler student assistance profile was developed which appears to be better suited to high schools with similar demographics and budget restraints. ^

Alternativas ao internamento juvenil através da colaboração de família madrinha

As intervenções alternativas são medidas que não devem ser rechaçadas por nenhum governante. O sistema de encarceramento penal existente no Brasil, assim como em muitas nações mundo afora, vem mostrando há décadas, ser um sistema falido, vez que é impossível (res)socializar alguém em cadeias que são verdadeiras masmorras. Não há condições de melhoramento, nem na esfera física ou psíquica deste sistema nefasto, que só funciona para pegar pobres, pretos, analfabetos e moradores das periferias. Dentro dos maiores problemas apontados por pesquisas atuais, a superlotação, a violência, o tráfico de drogas, o abuso sexual e a falta de uma ocupação que garanta a (res)socialização, forma verdadeiras faculdades do crime, onde o preso ou o adolescente chega como estagiário e sai como mestre na arte da criminalidade delinquente. Esta pesquisa em Criminologia e direito comparado, com foco no Brasil (Recife) e na Alemanha (Freiburg), faz uma contextualização histórica do tema, de forma geral e mais focada nos países comparados. Após esta contextualização, o trabalho retrata e analisa a situação dos jovens em conflito com a Lei, e explana as intervenções alternativas à internação, aconselhando a solução do acolhimento por famílias madrinhas.

Alternative Tasks for the Teaching and the Learning of functions: analysis of an intervention in the High School

In this paper we focus on the application of two mathematical alternative tasks to the teaching and learning of functions with high school students. The tasks were elaborated according to the following methodological approach: (i) Problem Solving and/or mathematics investigation and (ii) a pedagogical proposal, which defends that mathematical knowledge is developed by means of a balance between logic and intuition. We employed a qualitative research approach (characterized as a case study) aimed at analyzing the didactic pedagogical potential of this type of methodology in high school. We found that tasks such as those presented and discussed in this paper provide a more significant learning for the students, allowing a better conceptual understanding, becoming still more powerful when one considers the social-cultural context of the students.

Moderating drinking by correspondence : an evaluation of a new method of intervention

Recognizing the need to offer alternative methods of brief interventions, this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact. One hundred and twenty-one problem drinkers were recruited by media advertisements and were randomly allocated to a full cognitive behavioural treatment programme (CBT) or to a minimal intervention condition (MI) that gave information regarding alcohol misuse and instructions to record drinking. As predicted, CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period. CBT produced a 50% fall in consumption, bringing the average intake of subjects within recommended maximum levels. Treatment gains at 6 months were well maintained to 12 months. High levels of consumer satisfaction, a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment. However, some drinking occasions still involved high intake for a significant subgroup of subjects, and this issue will be addressed in future programmes. The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas.

Cost-effectiveness of a telephone-delivered intervention for physical activity and diet

Background: Given escalating rates of chronic disease, broad-reach and cost-effective interventions to increase physical activity and improve dietary intake are needed. The cost-effectiveness of a Telephone Counselling intervention to improve physical activity and diet, targeting adults with established chronic diseases in a low socio-economic area of a major Australian city was examined. Methodology/Principal Findings: A cost-effectiveness modelling study using data collected between February 2005 and November 2007 from a cluster-randomised trial that compared Telephone Counselling with a “Usual Care” (brief intervention) alternative. Economic outcomes were assessed using a state-transition Markov model, which predicted the progress of participants through five health states relating to physical activity and dietary improvement, for ten years after recruitment. The costs and health benefits of Telephone Counselling, Usual Care and an existing practice (Real Control) group were compared. Telephone Counselling compared to Usual Care was not cost-effective ($78,489 per quality adjusted life year gained). However, the Usual Care group did not represent existing practice and is not a useful comparator for decision making. Comparing Telephone Counselling outcomes to existing practice (Real Control), the intervention was found to be cost-effective ($29,375 per quality adjusted life year gained). Usual Care (brief intervention) compared to existing practice (Real Control) was also cost-effective ($12,153 per quality adjusted life year gained). Conclusions/Significance: This modelling study shows that a decision to adopt a Telephone Counselling program over existing practice (Real Control) is likely to be cost-effective. Choosing the ‘Usual Care’ brief intervention over existing practice (Real Control) shows a lower cost per quality adjusted life year, but the lack of supporting evidence for efficacy or sustainability is an important consideration for decision makers. The economics of behavioural approaches to improving health must be made explicit if decision makers are to be convinced that allocating resources toward such programs is worthwhile.