With a growing aging population, the prevalence of age-related eye disease and associated eye care is expected to increase. The anticipated growth in demand, coupled with recent medical advances that have transformed eye care for people living with retinal diseases, particularly neovascular age-related macular degeneration (nAMD) and diabetic eye disease, has presented an opportunity for health systems to proactively manage the expected burden of these diseases. To do so, we must take collective action to address existing and anticipated capacity limitations by designing and implementing sustainable strategies that enable health systems to provide an optimal standard of care. Sufficient capacity will enable us to streamline and personalize the patient experience, reduce treatment burden, enable more equitable access to care and ensure optimal health outcomes. Through a multi-modal approach that gathered unbiased perspectives from clinical experts and patient advocates from eight high-income countries, substantiated perspectives with evidence from the published literature and validated findings with the broader eye care community, we have exposed capacity challenges that are motivating the community to take action and advocate for change. Herein, we propose a collective call-to-action for the future management of retinal diseases and potential strategies to achieve better health outcomes for individuals at-risk of, or living with, retinal disease.
We propose a new method to estimate the unobservable natural real rate of interest in the United States (US). We begin by describing the natural rate in the New Keynesian model and then theoretically linking its evolution to both demand and supply-side shocks hitting the US economy. Our results indicate that the technology shock dominated the shift in the natural real rate of interest during the sample period 1947–2017. In addition, we also examine whether the Taylor rule should be augmented for changes in the estimated natural rate. Our maximum likelihood estimation shows that the inclusion of the natural interest rate shift in the Taylor rule leads to significant improvement of the interest rate modelling.
The release of the 2021 Intergovernmental Panel on Climate Change (IPCC) report makes clear that human activities have resulted in significant alterations in global climate. There is no doubt that climate change is upon us; chronic global warming has been punctuated by more frequent extreme weather events. Humanity will have to mitigate climate change and adapt to these changing conditions or face dire consequences. One under-appreciated aspect of this global crisis is its impact on healthcare, particularly people with epilepsy and temperature-sensitive seizures. As members of the inaugural International League Against Epilepsy (ILAE) Climate Change Commission, we recount the personal motivations that have led each team member to decide to take action, in the hope that our journeys as ordinary clinicians and scientists will help persuade others that they too can act to foster change within their spheres of influence.
This meta-review aimed to appraise and synthesise findings from existing systematic reviews that measured the impact of compression therapy on venous leg ulcers healing. We searched five databases to identify potential papers; three authors extracted data, and a fourth author adjudicated the findings. The AMSTAR-2 tool was used for quality appraisal and the certainty of the evidence was appraised using GRADEpro. Data analysis was undertaken using RevMan. We identified 12 systematic reviews published between 1997 and 2021. AMSTAR-2 assessment identified three as high quality, five as moderate quality, and four as low quality. Seven comparisons were reported, with a meta-analysis undertaken for five of these comparisons: compression vs no compression (risk ratio [RR]: 1.55; 95% confidence interval [CI] 1.34-1.78; P < .00001; moderate-certainty evidence); elastic compression vs inelastic compression (RR: 1.02; 95% CI: 0.96-1.08; P < .61 moderate-certainty evidence); four layer vs <four-layer bandage systems (RR: 1.07; 95% CI: 0.82-1.40; P < .63; moderate-certainty evidence); comparison between different four-layer bandage systems (RR: 1.08; 95% CI: 0.93-1.25; P = .34; moderate-certainty evidence); compression bandage vs compression stocking (RR 0.95; 95% CI 0.87-1.03; P = .18; moderate-certainty evidence). The main conclusion from this review is that there is a statistically significant difference in healing rates when compression is used compared with no compression, with moderate-certainty evidence. Otherwise, there is no statistically different difference in healing rates using elastic compression vs inelastic compression, four layer vs <four-layer bandage systems, different four-layer bandage systems, or compression bandages vs compression stockings.
Researchers and scientists face globally, and parallel to their core research activities, increased pressure to successfully lead or participate in fundraising activities. The field has been experiencing fierce competition with success rates of proposals falling dramatically down, while the complexity of the funding instruments and the need for acquiring a wide understanding of issues related to impacts, research priorities in connection to wider national and transnational (e.g. EU-wide) policy aspects, increase discomfort levels for the individual researchers and scientists. In this paper, we suggest the use of transdisciplinary AI tools to support (semi-)- automation of several steps of the application and proposal preparation processes.
Objective To implement and measure the effects of a multi-level multi-sectoral social behavior change (SBC) intervention in Agago District of Northern Uganda and to determine the potential for scale-up. Intervention Compare the Nutrition Impact and Positive Practice (NIPP) approach to a NIPP+ approach. The NIPP approach involves nutrition education and SBC, whereas the NIPP+ adds agricultural inputs, training, and tools to support improved farm and water quality practices. The intervention effect will be measured through lower levels of aflatoxin in grain, lower water contamination, and improved knowledge on nutrition and health. Design This is a three-arm cluster-randomized controlled superiority trial (cRCT). The study arms include the following: group 1: NIPP; group 2: NIPP+, and group 3: control. Groups 1 and 2 will receive a 12-week intervention (NIPP or NIPP+) with active monitoring and longitudinal follow-up at 2, 6, and 12 months post-intervention. Additionally, an in-depth process and performance evaluation of each intervention arm will be undertaken using quantitative and qualitative methods. A total of 60 clusters from 5 subcounties of the Agago district will be randomly selected, and 15 households per cluster will be recruited using specific inclusion/exclusion criteria for a total of 900 households (300/arm). Respondents for the qualitative portion will be purposely selected. Analysis We will collect data from all participants at 3 time points: baseline, endline, and 12 months post-intervention. The analysis will utilize intent-to-treat (ITT) using the initial randomization of the treatment arms to determine the overall impact of having the NIPP vs. NIPP+ vs. control. Mixed effects models will be used to determine the role of time-variant and invariant individual household, and community characteristics, as well as measures of exposure and integration on key outcome indicators. A difference-in-difference analysis (baseline/endline, baseline/12 months post-intervention, endline/12 months post-intervention) will also be used to triangulate findings. Trial registration NCT04209569 . One Nutrition in Complex Environments (ONCE) Registered 24 December 2019
Language learning in tourism is increasingly embracing digital technologies for both synchronous and asynchronous content delivery and interaction. Blended learning combining online and traditional face-to-face forms as well as immersive forms such as 3D virtual worlds, where participants may travel as they learn from the comfort of their sofa, offer promising benefits, namely in times of pandemic and other turbulent events. Involving culturally and geographically distant tutors in the learning process may increase learners’ motivation as well as satisfaction, provided that the course curricula and lesson plans utilize the potential by appropriate selection of activities. Despite all the potential benefits, however, troubles caused by the increased complexity of digitally enhanced courses may ruin learners’ experience. The paper provides a conceptual basis for a systemic approach in planning, creating, and delivering courses, considering both technical and psychological aspects, which may assist in the prevention or mitigation of the challenges. To provide a relevant context, presentations of several language schools are briefly examined. The study of changes in their presentations between 2014 and 2021, in the light of web search trends, provides an additional glimpse into the evolution of the adoption and perception of relevant forms of education and technologies, further supporting the necessity of a systematic approach. Experience from three separate projects implementing innovative language courses collected both qualitatively and quantitatively via questionnaires is summarized, pointing out both successes and challenges.
This paper describes a tool using an extended Data Privacy Vocabulary (the DPV) to audit and monitor GDPR compliance of international transfers of personal data. New terms were identified which have been proposed as extensions to the DPV W3C Working Group. A prototype software tool was built based on the model plus a set of validation rules, and synthetic use-cases created to test the capabilities of the model and tool (together a compliance framework). This framework was created because the rules around international transfer compliance are complex and changing, there is an absence of a common approach to ensuring compliance, few tools exist to assist, and those that do lack interoperability. Evaluation results demonstrate that the proposed model improves compliance identification and standardisation. The tool received positive feedback from the data protection practitioners who participated in the evaluation, and an initial version of is now in use in one financial services organisation. While currently the tool only addresses international transfers, in theory the framework can be extended through further work to the broader area of compliance of other aspects of the GPDR.
Aim: Poor adherence to chronic disease therapy is a critical global problem that negatively effects the long-term therapy for chronic diseases, resulting in negative population health and economic effects. The WHO multidimensional model proposed a systems-based approach for improving adherence to chronic disease therapy. Patients & methods: In the current study, the WHO five-dimension framework was used to evaluate factors among, chronic-disease patients in the United Arab Emirates. Results: We show that patient’s understanding of disease, involvement in treatment decision, age more than 40 years, time spent with physician and fear of how patients were perceived by others were the most predictive factors associated with a high ability to self-manage a chronic disease. Conclusion: Sociocultural factors have an indirect impact on disease self-management.
Artificial intelligence (AI)-based diagnostic algorithms have achieved ambitious aims through automated image pattern recognition. For neurological disorders, this includes neurodegeneration and inflammation. Scalable imaging technology for big data in neurology is optical coherence tomography (OCT). We highlight that OCT changes observed in the retina, as a window to the brain, are small, requiring rigorous quality control pipelines. There are existing tools for this purpose. Firstly, there are human-led validated consensus quality control criteria (OSCAR-IB) for OCT. Secondly, these criteria are embedded into OCT reporting guidelines (APOSTEL). The use of the described annotation of failed OCT scans advances machine learning. This is illustrated through the present review of the advantages and disadvantages of AI-based applications to OCT data. The neurological conditions reviewed here for the use of big data include Alzheimer disease, stroke, multiple sclerosis (MS), Parkinson disease, and epilepsy. It is noted that while big data is relevant for AI, ownership is complex. For this reason, we also reached out to involve representatives from patient organizations and the public domain in addition to clinical and research centers. The evidence reviewed can be grouped in a five-point expansion of the OSCAR-IB criteria to embrace AI (OSCAR-AI). The review concludes by specific recommendations on how this can be achieved practically and in compliance with existing guidelines.
Ireland has a rather distinctive relationship with the European Union (EU). Ireland embraced the European project from the start of its EU membership, and the values and benefits of membership have been significant for Ireland. Brexit and EU solidarity with Ireland in the Brexit negotiations in particular, increased EU standing in Ireland. Although Ireland has not escaped dimensions of populism or Euroscepticism to varying degrees, this chapter analyses and explores why Ireland remains consistently a pro-EU country.
Background and objectives The importance of selectively measuring available and unavailable carbohydrates in the human diet has been recognized for over 100 years. The levels of available carbohydrates in diets can be directly linked to major diseases of the Western world, namely Type II diabetes and obesity. Methodology for measurement of total carbohydrates by difference was introduced in the 1880s, and this forms the basis of carbohydrate determination in the United States. In the United Kingdom, a method to directly measure available carbohydrates was introduced in the 1920s to assist diabetic patients with food selection. The aim of the current work was to develop simple, specific, and reliable methods for available carbohydrates and digestible starch (and resistant starch). The major component of available carbohydrates in most foods is digestible starch. Findings Simple methods for the measurement of rapidly digested starch, slowly digested starch, total digestible starch, resistant starch, and available carbohydrates have been developed, and the digestibility of phosphate cross‐linked starch has been studied in detail. The resistant starch procedure developed is an update of current procedures and incorporates incubation conditions with pancreatic α‐amylase (PAA) and amyloglucosidase (AMG) that parallel those used AOAC Method 2017.16 for total dietary fiber. Available carbohydrates are measured as glucose, fructose, and galactose, following complete and selective hydrolysis of digestible starch, maltodextrins, maltose, sucrose, and lactose to glucose, fructose, and galactose. Sucrose is hydrolyzed with a specific sucrase enzyme that has no action on fructo‐oligosaccharides (FOS). Conclusions The currently described “available carbohydrates” method together with the total dietary fiber method (AOAC Method 2017.16) allows the measurement of all carbohydrates in food products, including digestible starch. Significance and novelty This paper describes a simple and specific method for measurement of available carbohydrates in cereal, food, and feed products. This is the first method that provides the correct measurement of digestible starch and sucrose in the presence of FOS. Such methodology is essential for accurate labeling of food products, allowing consumers to make informed decisions in food selection.
The humanitarian system has grown organically over a generation into a complex system bound by a common primary mandate. The guiding principles of the humanitarian system provide humanitarian actors with its unique identity and separates it from other aid stakeholders. However, all evidence suggests that humanitarian actors will extend their reach and engage in new and unprecedented ways with an expanded mandate. Now more than ever humanitarian actors are challenged to retain the moral high ground and put disaster affected people at the centre of humanitarian action. This paper proposes that the humanitarian system introduce a new principle – Humanitarian Subsidiarity. It moves the conception of subsidiarity beyond meanings ascribed by the Catholic Church and the European Union and links it instead to the attributes of agency, accountability and trust to find accommodation with the core humanitarian principles. This article is protected by copyright. All rights reserved
Most commonly used methods for the measurement of starch in food, feeds and ingredients employ the combined action of α‐amylase and amyloglucosidase to hydrolyse the starch to glucose, followed by glucose determination with a glucose oxidase/peroxidase reagent. Recently, a number of questions have been raised concerning possible complications in starch analytical methods. In this paper, each of these concerns, including starch hydrolysis, isomerisation of maltose to maltulose, effective hydrolysis of maltodextrins by amyloglucosidase, enzyme purity and hydrolysis of sucrose and β‐glucans have been studied in detailed. Results obtained for a range of starch containing samples using AOAC Methods 996.11 and 2014 .10 are compared and a new simpler format for starch measurement is introduced. With this method that employs a thermostable α‐amylase (as distinct from a heat stable α‐amylase) which is both stable and active at 100°C and pH 5.0, 10 samples can be analysed within 2 h, as compared to the 6 h required with AOAC Method 2014.10.
Context: Decreased postural balance is a primary risk factor for lower-limb injuries. Cryotherapy is commonly utilized by clinicians to provide local analgesia for minor acute knee joint musculoskeletal injuries during breaks in play or at halftime. Its effect on dynamic postural balance remains unclear. Objective: To investigate the acute effects of a 15-minute knee joint cryotherapy application on dynamic postural balance, as assessed primarily via a clinically oriented outcome measure. Design: Experimental study. Setting: University biomechanics laboratory. Patients or participants: A total of 28 elite-level college male field-sport athletes. Intervention: Participants were tested on the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test both before and after a 15-minute knee joint cryotherapy application. Main outcome measure(s): Normalized reach distances, 3-dimensional knee joint kinematics, sagittal plane hip and ankle joint kinematics, as well as fractal dimension of the center-of-pressure path during the performance of the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test. Results: There was a statistically significant decrease in reach distance scores achieved on anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test from precryotherapy to postcryotherapy (P < .05). None of the decreases in reach distance scores exceeded the reported smallest detectable difference values. No significant differences were observed in hip, knee, or ankle joint kinematics (P > .05). No significant change in fractal dimension was observed for any reach direction following cryotherapy application (P > .05). Conclusions: The results of the present study indicate that dynamic postural balance is unlikely to be adversely affected immediately following cryotherapy application to the knee joint.
Institution pages aggregate content on ResearchGate related to an institution. The members listed on this page have self-identified as being affiliated with this institution. Publications listed on this page were identified by our algorithms as relating to this institution. This page was not created or approved by the institution. If you represent an institution and have questions about these pages or wish to report inaccurate content, you can contact us here.