Is there overutilisation of cataract surgery in England?

<b>Objectives:</b> Following a 3.7-fold increase in the rate of cataract surgery in the UK between 1989 and 2004, concern has been raised as to whether this has been accompanied by an excessive decline in the threshold such that some operations are inappropriate. The objective was to measure the impact of surgery on a representative sample of patients so as to determine whether or not overutilisation of surgery is occurring. <b>Design:</b> Prospective cohort assessed before and 3 months after surgery. <b>Setting:</b> Ten providers (four NHS hospitals, three NHS treatment centres, three independent sector treatment centres) from across England. <b>Participants:</b> 861 patients undergoing first eye (569) or second eye (292) cataract surgery provided preoperative data of whom 745 (87%) completed postoperative questionnaires. <b>Main outcome measures:</b> Patient-reported visual function (VF-14); general health status and quality of life (EQ5D); postoperative complications; overall view of the operation and its impact. <b>Results:</b> Overall, visual function improved (mean VF-14 score increased from 83.2 (SD 17.3) to 93.7 (SD 13.2)). Self-reported general health status deteriorated (20.3% fair or poor before surgery compared with 25% afterwards) which was reflected in the mean EQ5D score (0.82 vs 0.79; p = 0.003). At least one complication was reported by 66 (8.9%) patients, though this probably overestimated the true incidence. If the appropriateness of surgery is based on an increase in VF-14 score of 5.5 (that corresponds to patients’ reporting being "a little better"), 30% of operations would be deemed inappropriate. If an increase of 12.2 (patients’ reports of being "much better") is adopted, the proportion inappropriate is 49%. Using a different approach to determining a minimally important difference, the proportion inappropriate would be closer to 20%. Although visual function (VF-14) scores were unchanged or deteriorated in 25% of patients, 93.1% rated the results of the operation as "good," "very good" or "excellent," and 93.5% felt their eye problem was "better." This partly reflects inadequacies in the validity of the VF-14. <b>Conclusions:</b> Improvement in the provision of cataract surgery has been accompanied by a reduction in the visual function threshold. However, methodological difficulties in measuring the impact of cataract surgery on visual function and quality of life mean it is impossible to determine whether or not overutilisation of cataract surgery is occurring. N Black1, J Browne1, J van der Meulen1, L Jamieson2, L Copley2 and J Lewsey

Developing an Observing Air–Sea Interactions Strategy (OASIS) for the global ocean

The Observing Air–Sea Interactions Strategy (OASIS) is a new United Nations Decade of Ocean Science for Sustainable Development programme working to develop a practical, integrated approach for observing air–sea interactions globally for improved Earth system (including ecosystem) forecasts, CO2 uptake assessments called for by the Paris Agreement, and invaluable surface ocean information for decision makers. Our “Theory of Change” relies upon leveraged multi-disciplinary activities, partnerships, and capacity strengthening. Recommendations from >40 OceanObs’19 community papers and a series of workshops have been consolidated into three interlinked Grand Ideas for creating #1: a globally distributed network of mobile air–sea observing platforms built around an expanded array of long-term time-series stations; #2: a satellite network, with high spatial and temporal resolution, optimized for measuring air–sea fluxes; and #3: improved representation of air–sea coupling in a hierarchy of Earth system models. OASIS activities are organized across five Theme Teams: (1) Observing Network Design & Model Improvement; (2) Partnership & Capacity Strengthening; (3) UN Decade OASIS Actions; (4) Best Practices & Interoperability Experiments; and (5) Findable–Accessible–Interoperable–Reusable (FAIR) models, data, and OASIS products. Stakeholders, including researchers, are actively recruited to participate in Theme Teams to help promote a predicted, safe, clean, healthy, resilient, and productive ocean.publishedVersio

Non-contrast free-breathing whole-heart 3D cine cardiovascular magnetic resonance with a novel 3D radial leaf trajectory

Purpose: To develop and validate a non-contrast free-breathing whole-heart 3D cine steady-state free precession (SSFP) sequence with a novel 3D radial leaf trajectory.Methods: We used a respiratory navigator to trigger acquisition of 3D cine data at end-expiration to minimize respiratory motion in our 3D cine SSFP sequence. We developed a novel 3D radial leaf trajectory to reduce gradient jumps and associated eddy-current artifacts. We then reconstructed the 3D cine images with a resolution of 2.0mm3 using an iterative nonlinear optimization algorithm. Prospective validation was performed by comparing ventricular volumetric measurements from a conventional breath-hold 2D cine ventricular short-axis stack against the non-contrast free-breathing whole-heart 3D cine dataset in each patient (n = 13).Results: All 3D cine SSFP acquisitions were successful and mean scan time was 07:09 +/- 01:31 min. End-diastolic ventricular volumes for left ventricle (LV) and right ventricle (RV) measured from the 3D datasets were smaller than those from 2D (LV: 159.99 +/- 42.99 vs. 173.16 +/- 47.42; RV: 180.35 +/- 46.08 vs. 193.13 +/- 49.38; p-value = 0.190, bias<6%). The 3D cine data had a lower subjective image quality score.Conclusion: Our non-contrast free-breathing whole-heart 3D cine sequence with novel leaf trajectory was robust and yielded smaller ventricular end-diastolic volumes compared to 2D cine imaging. It has the potential to make examinations easier and more comfortable for patients

Learning through online discussion:A framework evidenced in learners' interactions

Online learning, often supported through online discussion, is not only a popular means of supporting off-campus learners, but increasingly has a place within campus-based learning courses. Laurillard and others suggest that there are assumptions being made about learning through online discussion that have yet to be fully tested, and therefore there is a need to examine this area further. Tutors and learners may benefit from having a greater insight and understanding of how engaging in asynchronous online discussion presents opportunities for learning on an individual and a collective basis. This research study focused on learners’ engagement with online discussion and their perceptions of how engaging in online discussion impacts on learning. This paper revisits learning through online discussion and proposes a framework, which emerges from the analysis of learners’ experiences. A grounded theory approach was used in the collection and analysis of six learner case studies within a higher education setting, exploring learners’ interactions in online discussion, and their perceptions of learning through online discussion. Insights into the learners ’ interactions were provided by the learners themselves through semi-structured interviews. The grounded approach to the analysis of the interviews enabled the learners ’ voices to be heard in terms of what they thought about learning through online discussion. The insight enabled through the depth of description from the learners and the examination of the online interactions led to the development of a framework for learning through online discussion. The framework raises the importance of articulation as a key process in learning whilst highlighting the opportunities for collaborative informed thinking by engaging with the ideas of others. The focus given to the learning process through the framework will be of interest to tutors and learners who use online asynchronous discussion environments for learning

Statistical choices and apparent work outcomes in auditing

The public accounting sector of the accounting profession has long been very concerned with the problem of employee recruitment and retention. As early as the 1970s, the then Big 8 firms funded extensive studies of the determinants of employee turnover. The problem is no less real today. Indeed, much has been written about the problem of the vanishing accounting student. If reducing employee turnover and dissatisfaction becomes important in order for the public accounting firms to fulfill their mission of helping to assure the quality of information that investors receive, then having tools that foster an understanding of the determinants of employee dissatisfaction, stress, and turnover is vital Sheds light on these issues by demonstrating how sophisticated statistical techniques can illuminate the underlying determinants of employee turnover and other important job attitudes. Applies structural equation modeling to Collins and Killough\u27s dataset in order to demonstrate how it can provide important additional substantive insights about relationships between the stressors and job outcomes in public accounting. This important interpretive information is not available, or is available in only limited fashion, in the comparison method of canonical correlation analysis