Health technology assessment: a primer for ophthalmology

Rising healthcare costs and increasing demands for health care require techniques to choose between competing uses and even rationing of health care. Economic evaluations and health technology assessments are increasingly a means to assess the cost effectiveness of healthcare interventions so as to inform such resource allocation decisions. To date, the adoption of health technology assessments, as a way of assessing cost effectiveness, in ophthalmology has been slower, relative to their implementation in other specialities. Nevertheless, demands for eye services are increasing due to an ageing population. The prevalence of conditions such as glaucoma, cataract, diabetic eye disease and age-related macular degeneration increases with age, and it is predicted that global blindness will triple by 2050. So there is a challenge for ophthalmologists to ensure that they can contribute to, interpret, critically evaluate, and use findings from economic evaluations in their clinical practice. To aid this, this article serves as a primer on the use of health technology assessments to assess cost effectiveness using economic evaluation techniques for ophthalmologists. Healthcare systems face many challenges worldwide – changing demographics and evolution of new technologies are only going to intensify. With this in mind, ophthalmology needs to be ready and able to engage with health economists to prepare, interpret, critically evaluate and use findings of economic evaluations and health technology assessments

Student Wellbeing at Junior-Cycle Level: Teachers’ Perceptions of Relevant Policies and Curricula

Research has demonstrated that initiatives aimed at promoting the development of social and emotional wellbeing in second-level students can help to insulate students against the many factors that may otherwise result in negative affect [1]. In 2017, the National Council for Curriculum and Assessment (NCCA) published new wellbeing guidelines which mandate all Irish post-primary schools to allocate 300 hours of junior-cycle instruction to the promotion of students’ social and emotional wellbeing. While much is understood about the potential benefits of such programmes [2], little is known within an Irish context about the attitudes and views of educators in this regard. The purpose of this study is to address this gap in knowledge by analysing the attitudes/opinions of post-primary educators with regard to how best to promote students’ wellbeing. This research will be conducted in two phases using a sequential mixed-methods design. Phase one will be quantitative in nature and will consist of a large-scale survey of second level educators. Phase two will consist of a series of focus groups and interviews. The information garnered from this study may be utilised to assist in possible refinements of the NCCA wellbeing guidelines and the greater wellbeing curriculum. References [1] Duckworth, A. L., & Seligman, M. E. (2005). Self- Discipline Outdoes IQ in Predicting Academic Performance of Adolescents. Psychological Science, 16(12), 939-944. doi:10.1111/j.1467- 9280.2005.01641.x [2] Spilt, J. L., Koomen, H. M., & Thijs, J. T. (2011). Teacher Wellbeing: The Importance of Teacher–Student Relationships. Educational Psychology Review, 23(4), 457-477. doi:10.1007/s10648-011-9170-

Exercise Beliefs In Elderly Nursing Home Residents: A Cross-Sectional, Case Control Study

Introduction The number of Irish older adults receiving long term care is steadily growing in line with increased life expectancy. Nursing home residents are typically sedentary, leading to poor health and functional outcomes in this population. There is a lack of research concerning the exercise beliefs of this inactive subgroup of the older adult population. Aims and Objectives The primary aim of this study was to examine the hypothesis that older adults in a nursing home have poor outcome expectations for exercise, and reduced self- efficacy for exercise, when compared to older adults residing in the community. A secondary aim was to assess if an association exists between these exercise beliefs and the participants’ functional scores, number of comorbidities and psychological health. Methods A cross sectional, case control study design was employed, using a sample of convenience. Twenty two nursing home residents, and twenty active retirement group members (≥65 years) living independently in the community completed a written survey. Exercise beliefs were measured using the Outcome Expectations for Exercise Scale (OEE), and the Self-Efficacy for Exercise Scale (SEE).Secondary outcome measures were the Barthel Index of Activities of Daily Living (BI), number of comorbidities, and the Geriatric Depression Scale-15 (GDS-15). Results The groups were significantly different in terms of age (p=0.03), number of comorbidities (p= Conclusion Self-efficacy for exercise is lower amongst nursing home residents than in community dwelling older adults. Both groups demonstrate high outcome expectations for exercise. The presence of depressive symptoms is significantly associated with lower self-efficacy and outcome expectations for exercise. It is evident that the presence of depressive symptoms may represent a significant barrier to participation in physical activity for older adults both in nursing homes and in the community

Formulation, characterisation and stability assessment of a food derived 1 tripeptide, Leucine-Lysine-Proline loaded chitosan nanoparticles

The chicken or fish derived tripeptide, Leucine-Lysine-Proline (LKP), inhibits the Angiotensin Converting Enzyme and may be used as an alternative treatment for pre-hypertension. However, it has low permeation across the small intestine. The formulation of LKP into a nanoparticle (NP) has the potential to address this issue. LKP-loaded NPs were produced using an ionotropic gelation technique, using chitosan (CL113). Following optimisation of unloaded NPs, a mixture amount design was constructed using variable concentration of CL113 and tripolyphosphate at a fixed LKP concentration. Resultant particle sizes ranged from 120-271 nm, zeta potential values from 29-37 mV and polydispersity values from 0.3-0.6. A ratio of 6:1 (CL113: TPP) produced the best encapsulation of approximately 65%. Accelerated studies of the loaded nanoparticles indicated stability under normal storage conditions (room temperature). Cytotoxicity assessment showed no significant loss of cell viability and in vitro release studies indicated an initial burst followed by a slower and sustained release

Quantifying the Concentration of Glucose, Urea, and Lactic Acid in Mixture by Confocal Raman Microscopy

Raman spectroscopy has numerous applications in the field of biology. One such application is the simultaneously measurement of the concentration of multiple biochemical components in low volume aqueous mixtures, for example, a single drop of blood serum. Over twenty years ago, it was shown for the first time that it was possible to estimate the concentration of glucose, urea, and lactic acid in mixture by combining Raman Spectroscopy with Partial Least Squares Regression analysis. This was followed by numerous contributions in the literature designed to increase the number of components and reduce the limits of concentration that could be simultaneously measured using Raman spectroscopy, by developing various optical architectures to maximise the signal to noise ratio. The aim of this paper is to demonstrate the potential of a confocal Raman microscopy system for multicomponent analysis for the case of physiologically relevant mixtures of glucose, urea, and lactic acid

Improved Performance of Near infrared Excitation Raman Spectroscopy Using Reflective Thin-film Gold on Glass Substrates for Cytology Samples

Confocal near-infrared Raman spectroscopy has been shown to have applications in the area of clinical biology. A source wavelength in the near infrared is preferred over visible wavelengths for inspecting biological samples due to superior wave number resolution and reduced photo damage. However, these excitation sources have a number of drawbacks when compared to lasers in the visible wavelength region, including the requirement to use expensive highly pure crystal substrates such as Raman grade calcium fluoride as well as long acquisition times due to the lower Raman scattering efficiency. This paper investigates the use of a reflective substrate comprising a low cost 100 nm thin-film gold on glass substrate, as an alternative. Similar to recent work that used stainless steel substrates, it is demonstrated that the thin-film gold coated substrates, which are relatively inexpensive, produce cell spectra with 1.65 times the signal to noise ratio when compared with spectra obtained from calcium fluoride under identical conditions, with no apparent background signal in the fingerprint region. Two prostate cell lines are examined having been deposited on glass, calcium fluoride, and thin-film gold on glass substrates using the Thin Prep standard. Background spectra from, and cell adhesion on, these three substrates are compared. A comparison of the intensities and signal to noise ratios of the resulting spectra, and their viability for classification using principle components analysis is performed, which further demonstrates the benefit of reflective substrates

Refractive change following pseudophakic vitrectomy: a retrospective review

Background To assess the occurrence and magnitude of refractive change in pseudophakic eyes undergoing 20 gauge pars plana vitrectomy without scleral buckling and to investigate possible aetiological factors. Methods Retrospective case note review of 87 pseudophakic eyes undergoing 20 gauge pars plana vitrectomy for a variety of vitreo-retinal conditions over a three-year period. Anterior chamber depth (ACD) was measured before and after vitrectomy surgery in 32 eyes. Forty-three pseudophakic fellow eyes were used as controls. Results Eighty-seven eyes (84 patients) were included in the study. Mean spherical equivalent refraction prior to vitrectomy was -0.20 dioptres, which changed to a mean of -0.65 dioptres postoperatively (standard deviation of refractive change 0.59, range-2.13 to 0.75 dioptres) (p < 0.001). Sixty-one of the 87(70%) eyes experienced a myopic shift and 45(52%) eyes had a myopic shift of -0.5 dioptres or more. Mean fellow eye refraction was -0.19 dioptres preoperatively and -0.17 dioptres postoperatively (p = 0.14)(n = 37) Mean ACD preoperatively was 3.29 mm and postoperatively 3.27 mm (p = 0.53) (n = 32) and there was no significant change in ACD with tamponade use. Regression analysis revealed no statistically significant association between changes in anterior chamber depth, as well as a wide variety of other pre-, intra and postoperative factors examined, and the refractive change observed. Conclusion Significant refractive changes occur in some pseudophakic patients undergoing 20 g pars plana vitrectomy. The mean change observed was a small myopic shift but the range was large. The aetiology of the refractive change is uncertain

Analysis of genetic variability in Turner syndrome linked to long-term clinical features

Background: Women with Turner syndrome (TS) (45,X and related karyotypes) have an increased prevalence of conditions such as diabetes mellitus, obesity, hypothyroidism, autoimmunity, hypertension, and congenital cardiovascular anomalies (CCA). Whilst the risk of developing these co-morbidities may be partly related to haploinsufficiency of key genes on the X chromosome, other mechanisms may be involved. Improving our understanding of underlying processes is important to develop personalized approaches to management. // Objective: We investigated whether: 1) global genetic variability differs in women with TS, which might contribute to co-morbidities; 2) common variants in X genes - on the background of haploinsufficiency - are associated with phenotype (a “two-hit” hypothesis); 3) the previously reported association of autosomal TIMP3 variants with CCA can be replicated. // Methods: Whole exome sequencing was undertaken in leukocyte DNA from 134 adult women with TS and compared to 46,XX controls (n=23), 46,XX women with primary ovarian insufficiency (n=101), and 46,XY controls (n=11). 1) Variability in autosomal and X chromosome genes was analyzed for all individuals; 2) the relation between common X chromosome variants and the long-term phenotypes listed above was investigated in a subgroup of women with monosomy X; 3) TIMP3 variance was investigated in relation to CCA. // Results: Standard filtering identified 6,457,085 autosomal variants and 126,335 X chromosome variants for the entire cohort, whereas a somatic variant pipeline identified 16,223 autosomal and 477 X chromosome changes. 1) Overall exome variability of autosomal genes was similar in women with TS and control/comparison groups, whereas X chromosome variants were proportionate to the complement of X chromosome material; 2) when adjusted for multiple comparisons, no X chromosome gene/variants were strongly enriched in monosomy X women with key phenotypes compared to monosomy X women without these conditions, although several variants of interest emerged; 3) an association between TIMP3 22:32857305:C-T and CCA was found (CCA 13.6%; non-CCA 3.4%, p<0.02). // Conclusions: Women with TS do not have an excess of genetic variability in exome analysis. No obvious X-chromosome variants driving phenotype were found, but several possible genes/variants of interest emerged. A reported association between autosomal TIMP3 variance and congenital cardiac anomalies was replicated

Improved performance of near infrared excitation Raman spectroscopy using reflective thin-film gold on glass substrates for cytology samples

Confocal near-infrared Raman spectroscopy has been shown to have applications in the area of clinical biology. A source wavelength in the near infrared is preferred over visible wavelengths for inspecting biological samples due to superior wavenumber resolution and reduced photodamage. However, these excitation sources have a number of drawbacks when compared to lasers in the visible wavelength region, including the requirement to use expensive highly pure crystal substrates such as Raman grade calcium fluoride as well as long acquisition times due to the lower Raman scattering efficiency. This paper investigates the use of a reflective substrate comprising a low cost 100 nm thin-film gold on glass substrate, as an alternative. Similar to recent work that used stainless steel substrates, it is demonstrated that the thin-film gold coated substrates, which are relatively inexpensive, produce cell spectra with 1.65 times the signal to noise ratio when compared with spectra obtained from calcium fluoride under identical conditions, with no apparent background signal in the fingerprint region. Two prostate cell lines are examined having been deposited on glass, calcium fluoride, and thin-film gold on glass substrates using the ThinPrep standard. Background spectra from, and cell adhesion on, these three substrates are compared. A comparison of the intensities and signal to noise ratios of the resulting spectra, and their viability for classification using principle components analysis is performed, which further demonstrates the benefit of reflective substrates

Which treatment is most effective for patients with patellofemoral pain? A protocol for a living systematic review including network meta-analysis

INTRODUCTION: Patellofemoral pain (PFP) affects 1 in every 14 adults. Many treatments for PFP have been evaluated, but the comparative effectiveness of all available treatments has never been examined. Network meta-analysis is the only design to study the comparative effectiveness of all available treatments in one synthesis. This protocol describes the methods for a systematic review including network meta-analysis to assess which treatment is most likely to be effective for patients with PFP. METHODS AND ANALYSIS: The primary outcome measures of this network meta-analysis are the global rating of change scale at 6-12 weeks, 13-52 weeks and >52 weeks. The secondary outcome measures are patient-rated pain scales at 6-12 weeks, 13-52 weeks and >52 weeks. Completed published and unpublished randomised controlled trials with full-text reports are eligible for inclusion. We will search Embase, PubMed (including MEDLINE), CENTRAL, Scopus, Web of Science, and CINAHL, SPORTDiscus, OpenGrey, WorldCat, conference Proceedings and multiple trial registers for relevant reports. Two researchers will appraise the study eligibility and perform data extraction. Risk of bias will be assessed with the Cochrane Risk of Bias Tool V.2.0.Bayesian network meta-analyses will be constructed for global rating of change scale and patient-rated pain. Consistency between direct and indirect comparisons will be assessed. Between study variability will be explored, and a threshold analysis for the credibility of the network meta-analyses' conclusions will be performed. ETHICS AND DISSEMINATION: Ethical approval is not required, as this study will be based on published data. The study commenced at 1 February 2018, and its expected completion date is 15 January 2019. Full publication of the work will be sought in an international peer-reviewed journal, as well as translational articles to disseminate the work to clinical practitioners