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    Sight Impairment registration in Trinidad: Trend in causes and populationcoverage in comparison to the National Eye Survey of Trinidad and Tobago

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    Background: Little was known about the population coverage and causes of sight impairment (SI) registration within the Caribbean, or the extent to which register studies offer insights into population eye health.Methods: We compared causes of SI registration in the Trinidad and Tobago Blind Welfare Association (TTBWA) register with findings from the 2014 National Eye Survey of Trinidad and Tobago (NESTT), and estimated registration coverage. Cross-sectional validation studies of registered clients included interviews, visual function and cause ascertainment in July 2013, and interviews and visual function in July 2016.Results: The TTBWA register included 863 people (all ages, 48.1%(n=415) male) registered between 1951 and 2015. The NESTT identified 1.1%(75/7158) people aged >5years eligible for partial or severe SI registration, of whom 49.3%(n=37) were male. Registration coverage was approximately 7% of the eligible population of Trinidad. Nevertheless, there was close agreement in the causes of SI comparing the register and population-representative survey. Glaucoma was the leading cause in both the register (26.1%,n=225) and population-based survey (26.1%, 18/69 adults), followed by cataract and diabetic retinopathy. In the validation studies combined, 62.6%(93/151) clients had severe SI, 28.5%(43/151) had partial SI and 9.9%(15/151) did not meet SI eligibility criteria. SI was potentially avoidable in at least 58%(n=36/62) adults and 50%(n=7/14) children.Conclusion: We report very low register coverage of the SI population, but close agreement in causes of SI to a contemporaneous national population-based eye survey, half of which resulted from preventable or treatable eye disease.</p

    How and why do medical students engage with or disengage from undergraduate psychiatry education in India - a study using constructivist grounded theory

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    For almost 60 years, the Indian psychiatry literature has called for medical students to learn psychiatry in order to help the millions of people in India who have a diagnosable mental illness but receive no treatment. For the same number of years, the literature says that medical students have not engaged in psychiatry education, leaving millions of people without the help they need. Many senior psychiatrists have expressed opinions as to how to improve engagement in psychiatry education, but until now, no-one has asked the students.This research has therefore sought to understand how and why medical students engage in or disengage from undergraduate psychiatry education in India. The methodology used was constructivist grounded theory, which in addition to being appropriate to explain a little understood social phenomenon, also aligns with a decolonisation research framework, which is vital for myself as a Western researcher undertaking intercultural research in India.The grounded theory produced explains how engagement or disengagement in psychiatry education is dependent on whether students’ learning goals are fulfilled or not. Most students attend psychiatry education wanting to learn clinical skills. If teaching faculty do not teach clinical skills, students disengage, perceiving psychiatry education as insignificant, despite the vast majority believing it is an important subject all doctors should know. This dual perception of psychiatry as simultaneously important yet insignificant is a recurring pattern seen throughout Indian society, including in governmental policies, mental health services and medical education – a pattern which makes student disengagement in psychiatry education almost inevitable.This research provides an evidence-based theory to underpin the governmental need to prioritise the teaching of clinical skills in undergraduate psychiatry education, both in policy and practice. If faculty are enabled to teach psychiatry skills, this would address the learning goals of medical students, who with consequentially increased engagement would learn how to address the unmet mental health needs across India.</p

    Simulation in Nursing Education: An Evidence Base for the Future

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    Executive summary: The purpose of this research project was to investigate how simulated learning can transform practice learning by comparing existing learning approaches with emerging simulated and technologyenhanced learning approaches. The project also maps the ability of simulation to meet the NMC (2018) future nurse standards of proficiency for registered nurses. Methods • Phase one – A systematic review of primary studies and regulatory and national standards. • Phase two – A cross-sectional survey to explore organisational readiness for simulation-based education (SBE) and opportunities and challenges of SBE in pre-registration nursing courses in the UK. • Phase three – A case study involving two self-reporting student surveys and a focus group with academic staff acting as practice supervisors. • Phase four - Focus groups with Council of Deans of Health (CoDH) members who have NMC approval for SPL to capture their experiences in the delivery of SPL in pre-registration nursing programmes. Findings and Conclusion This report provides an evidence base demonstrating how simulated learning can transform practice learning in nursing education and meet the NMC (2018) future nurse standards of proficiency for registered nurses. The findings emphasise the significant contribution of simulated practice learning (SPL) in the delivery of pre-registration nursing programmes. The systematic review indicated that, on average, SBE is more effective than traditional clinical education in improving nurse assessment outcomes. The cross-section survey of higher education institutions (HEIs) with pre-registration nursing programmes highlighted their commitment to SBE with the recognition that infrastructure, commitment by faculty leadership, access to facilities, resources and funding were critical for ensuring success and sustainability. SPL was acknowledged as an effective method that complements learning in clinical placements and enables attainment of the future nurse standards of proficiency for registered nurses. This research highlighted the difficulties HEIs face when delivering SPL. There was a strong desire for clarity and a benchmarking tool to ensure consistency in the approach of HEIs. In addition, the planning, design and delivery of simulation was viewed as an advanced skill for academic staff and thus they require sufficient training. There is a need to develop the evidence base of SPL and measure the impact and benefit on student learning and achievement of proficiencies. Creating a standardised tool to evaluate the outcomes of SPL would provide a benchmark for all HEIs to use. It would also be useful for the NMC to monitor the impact of the new definition of SPL. This research has been undertaken after several HEIs have already incorporated SPL into their programmes. In line with ambitions in the NHS England Long Term Workforce Plan, there is now an opportunity to expand the number of HEIs integrating SPL into their pre-registration nursing programmes. The findings provide an important bedrock of evidence for future decisions such as regulatory and financial support for simulated learning. Relevant stakeholders may take a range of positions on this subject, but this evidence base will further inform the conversations ahead.</p

    Architectural Materials between Rural and Urban Models of Settlement Principles in the Urban Transformation

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    The article focuses on the relationship between urban and rural in architectural transformations. It demonstrates through an analytical process the transposition of the characteristics of rural architecture into urban expansions.</p

    What Are the Economic Arguments for Mandating LGBT+ Health Training for Healthcare Providers? An Economic Evaluation of the Impacts of LGBT+ Health Training on Cervical Screening

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    Background: Equitable access to healthcare is a priority of many healthcare systems, aiming to ensure access is driven by need and not minority groups such as those defined by sexual orientation. However, there are healthcare areas where inequity in access across sexual orientation groups is found that are not justified based on need. Mandated LGBTQ+-specific training of the healthcare workforce may help address some barriers of access for these groups. The study aims to understand the potential economic implications for mandated LGBTQ+-specific healthcare training on the healthcare system in England, UK to inform commissioning of training provision. Methods: Cervical cancer screening was used as an exemplar case where there appears to be inequity in access for different sexual orientation groups. A decision model was developed and analysed that considered the impacts of greater uptake of screening for lesbian and bisexual women due to LGBTQ+ training. Costs took the perspective of the healthcare system and outcomes modelled were cancer cases averted in a timeframe of 5 years. Results: Based on cervical cancer screening alone, where training costs are fully attributed to this service, training would likely result in fewer cancer cases detected in the lesbian and bisexual populations, though this comes at a modest increase in healthcare sector costs, with this increase largely reflecting a greater volume of screens. Training costs do not appear to be a major component of the cost implications. Conclusions: In resource-constrained systems with increasing pressures for efficiency savings, the opportunity cost of delivering training is a realistic component of the commissioning decision. The findings in this paper provide a signal that mandated LGBTQ+ training in healthcare could lead to potentially greater outcomes and in breaking down barriers of access and could also enable the healthcare system to provide more equitable access to healthcare

    Architecture Through the Eyes of Joaquin Sorolla and New Hyperrealities

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    The duality of the real versus the hyperreal in architectural drawing is addressed through the analysis of the work of the painter Joaquín Sorolla and the new artificial intelligence representation systems</p

    Diclazepam and its metabolites: a chemometric interpretation

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    Diclazepam is a ‘designer’ benzodiazepine derivative and modified version of the existing pharmaceutically prescribed benzodiazepine diazepam. There is little knowledge regarding its pharmacokinetics, it has never undergone clinical trials, and it was deemed unfit for human consumption in the early 1970s. However, the possible illicit use of diclazepam as both a recreational and a drink spiking drug has recently been reported. Diclazepam metabolises into three pharmaceutically prescribed benzodiazepines (delorazepam, lormetazepam, and lorazepam) with overlapping metabolic pathways, which could make the identification of the parent drug challenging.The aim of this research was to identify whether delorazepam, lormetazepam, and lorazepam are parent drugs, or whether their detections are due to the metabolism of diclazepam. This was achieved by analysing the metabolite ratios of in vitro metabolised diclazepam, delorazepam, and lormetazepam in pooled human liver microsomes over 240 minutes. Liquid liquid extraction (LLE) was used to extract diclazepam and its metabolites from the incubated microsomes over different incubation times, and analytes detected by a validated gas chromatography-mass spectrometry (GC-MS) method. A calibration model provided limits of detection that ranged between 0.02 to 0.43 μg/ml for diclazepam and its metabolites delorazepam and lormetazepam, and >5 μg/ml for lorazepam, with all precisions below 8.9%.In vitro metabolism identified possible backward metabolism of diclazepam and its metabolites during incubation. Diclazepam and its metabolite ratios proved that one could differentiate whether the parent drug was diclazepam, or one of its metabolites, thus meeting the aim of this research. In addition, novel chemometric models using principal component analysis showed the potential for differentiating parent benzodiazepines based on their detected metabolite proportions.The findings from this research could contribute to improving and advancing drug identification and interpretation methods in biological samples. The findings also provides new information for the way in which benzodiazepines may undergo backwards metabolism or chemical conversion to predecessor drugs.</p

    National trends of allergic diseases and pandemic–related factors among individuals with obesity in South Korea: A nationwide representative serial study, 2005–2021

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    Background Although obesity is known to be related to allergic diseases, few studies have investigated the prevalence of allergic diseases in individuals with obesity, especially during the COVID–19 pandemic. Thus, this study aimed to analyze national trends of allergic diseases among individuals with obesity and sociodemographic factors. Methods This study used data from the Korea National Health and Nutrition Examination Survey to examine the prevalence of allergic diseases among individuals with obesity in South Korea from 2005 to 2021. A nationally representative sample of 118,275 participants aged over 2 years or above was divided into six groups for analysis. This study used weighted multivariate regression analysis to examine the estimates of related factors. It assessed the weighted odds ratios or β–coefficients for these factors across different categories, including age, sex, region of residence, education level, household income, and body mass index for the entire population. Results All allergic diseases showed a general upward trend from 2005 to 2021, but each disease showed different prevalence trends when compared by age. Before the pandemic, those aged ≤39 years had an increasing trend for asthma and AD, but those aged ≥40 years had a decreasing trend. For asthma, β–coefficients were 0.629 (95% CI, 0.299 to 0.958) for 19–39 years, –0.245 (–0.450 to –0.040) for 40–59 years, and –0.668 (–1.024 to –0.313) for ≥60 years. For AD, β–coefficients were 2.514 (1.258 to 3.769) in those aged 2–18 years, 0.630 (0.173 to 1.086) in those aged 19–39 years, –0.458 (–0.648 to –0.268) in those aged 40–59 years, and –0.253 (–0.454 to –0.052) in those aged ≥60 years. However, for both asthma and AD, there were no significant changes in prevalence during the pandemic. In the case of AR, trends were different from those of asthma and AD. Before the pandemic, AR showed an increasing trend in those aged ≤39 years and those aged ≥40 years: β–coefficients were 3.067 (2.344 to 3.790) in 19–39 years, 2.051 (1.609 to 2.493) in 40–59 years, and 1.173 (0.820 to 1.526) in ≥60 years. During the pandemic, there was an increasing trend only among those aged 40-59, with no significant changes in other age groups: β–coefficients were 1.438 (0.065 to 2.811) in 40–59 years. Conclusions From 2005 to 2021, all allergic diseases (asthma, AD, and AR) increased overall, but with different age-related trends. No significant link was found between COVID–19 and allergic diseases, possibly due to preventive measures like mask-wearing and social distancing. Anxiety about accessing healthcare during the pandemic likely contributed to a decline in allergy diagnoses, highlighting the need for comprehensive strategies to manage and prevent allergic diseases.</p

    Global estimates on the number of people blind or visually impaired by glaucoma: A meta-analysis from 2000 to 2020

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    Objectives To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. Methods A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but Results Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults ≥50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). Conclusions Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally.</p

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