Evaluation of Ophthalmic Technicians, Refractive Service Providers in Mozambique

Background One of the solutions to creating sustainable eye care structures is education of personnel.The Technological University Dublin (DIT) with ICEE (International Centre of Eyecare Education) is developing and implementing a sustainable model for optometric education and eye care service delivery in Unilurio in Mozambique.The Mozambique Eyecare Project aims to train Mozambique’s first professional optometrists who will provide a sustainable and comprehensive eye-care system as an integral part of the national health system. Mozambique currently has only 15 ophthalmologists for a population of 21 million and 34 trained Ophthalmic Technicians the only providers of refraction services within the local health system. Purpose Evaluate the confidence levels, knowledge and core competencies of the ophthalmic technicians in refraction to provide a better understanding of the existing situation. Method i) Background questionnaire to obtain data on their years of experience and what training they had received. ii) Investigative tools: Confidence levels questionnaire, oral refraction quiz and a refraction competency assessment Results The OT’s were trained in 2 different institutions, some in Cuba some in Mozambique. The Cuban trained OT’s had studied refraction to different levels but due to lack of equipment had never practised basic retinoscopy or subjective. They were not competent in performing refractions unsupervised. The ones trained in Mozambique had not studied refraction hence were not competent in performing refractions at all. Conclusion By identifying strengths and weaknesses of the OT’s refraction knowledge and skills, training and continuing education can be tailored accordingly. This information would also allow ICEE and DIT to compare and contrast refraction training for both the student Optometrists and the existing OT’s to improve overall refraction service provision in Mozambique

Refraction in Mozambique: Evaluations of Practice and Development of Competency Frameworks for Eye Care Personnel

Purpose The development of competency- based education for optometrists and mid-level eye-care personnel has been identified as an important component in the elimination of avoidable blindness and vision impairment. The Mozambique Eye care Project (MEP) is a multi-institutional collaboration, which seeks to facilitate greater access to training in eye health professions, which will ultimately contribute to providing affordable and accessible eye care within the public health system in Mozambique. An important tenet of the MEP is to develop and enhance the refraction training of all existing (ophthalmic technicians) and new eye care personnel (four-year training of optometrists and eighteen-month training of ophthalmic technicians) and evaluate the outcome of the training. The overall aim of my research was to develop competency frameworks for ophthalmic technicians (OTs) and optometrists and provide recommendations for developing a comprehensive training plan for eye care service provision in the country. Methods A comprehensive evaluation of refraction competencies of OTs was conducted by the use of demographic and confidence levels questionnaire and theoretical and practical competency assessments. A competency assessment process was developed for the assessment of optometry students at UniLúrio, which consisted of direct observation of refractions on two clinic patients, a two-part theory exam consisting of short answer questions and an oral structured viva. Qualitative observations of the competency assessment process were also made. Factors affecting student performance were identified using semi-structured individual interviews with the course lecturers and a course evaluation questionnaire with the students. A modified Delphi approach was used to develop competency frameworks for the two cadres, OTs and optometrists in Mozambique. Results, Initial evaluations of the OTs demonstrated that their refraction confidence and competence levels varied depending on their training (location and duration), and their location of work (clinical load, availability of equipment and other eye care personnel). The only skill the OTs and trainees demonstrated competence in was correcting presbyopia. Only four optometry students out of fifteen were graded as competent in all the elements of the clinical competency exam. Analysis of data from lecturer interviews and student questionnaire yielded four dominant themes that were viewed as important determinants of student performance: student learning context; teaching context; clinic conditions and assessment; and the existing operating healthcare context. Two socially responsive competency frameworks for both cadres were developed using the modified Delphi approach. Conclusion These evaluations identified factors affecting the refraction competencies of the OTs and optometrists at UniLúrio while taking country-specific factors into context. The socially responsive frameworks developed will inform the evolution of standardised curricula for both OTs and optometrists

Contribution of cloud computing in the reduction of carbon dioxide emission

The Information Technology industry is rapidly expanding and as a result its contribution to carbon dioxide emission is also rapidly increasing. Fortunately, the cloud computing industry is perceived by many to be a viable solution for reducing carbon dioxide emissions. Accordingly, there are numerous studies which try to prove that cloud computing can reduce carbon dioxide emissions up to more than half of the current carbon dioxide emissions. In this paper, two of such studies where reviewed to assess whether cloud computing is indeed a viable candidate for limiting and reducing the amount of carbon dioxide emitted by the IT industry. All the information gathered in this paper prove that; cloud computing is a promising technology which could reduce carbon dioxide emissions. The percentage of decrease can range from 10% to 90%. The effectiveness of the carbon dioxide emission reduction process is highly dependent on the size of the business organization. Accordingly the size of the organization is negatively correlated to the efficiency of carbon dioxide reduction. This means that as the size of the organization increase, carbon dioxide emission reduction decrease. This paper also presented the four reasons why cloud computing can reduce carbon dioxide emissions, which are: dynamic provisioning, multi-tenancy, server utilization, and data center efficiency

Detecting change from social networks using temporal analysis of email data

Social network analysis is one of the most recent areas of research which is being used to analyze behavior of a society, person and even to detect malicious activities. The information of time is very important while evaluating a social network and temporal information based analysis is being used in research to have better insight. Theories like similarity proximity, transitive closure and reciprocity are some well-known studies in this regard. Social networks are the representation of social relationships. It is quite natural to have a change in these relations with the passage of time. A longitudinal method is required to observe such changes. This research contributes to explore suitable parameters or features that can reflect the relationships between individual in network. Any foremost change in the values of these parameters can capture the change in network. In this paper we present a framework for extraction of parameters which can be used for temporal analysis of social networks. The proposed feature vector is based on the changes which are highlighted in a network on two consecutive time stamps using the differences in betweenness centrality, clustering coefficient and valued edges. This idea can further be used for detection of any specific change happening in a network. © Springer International Publishing AG 2018

Complications of exercise and pharmacologic stress echocardiography

Stress echocardiography is a diagnostic cardiovascular exam that is commonly utilized for multiple indications, including but not limited to the assessment of obstructive coronary artery disease, valvular disease, obstructive hypertrophic cardiomyopathy, and diastolic function. Stress echocardiography can be performed via both exercise and pharmacologic modalities. Exercise stress is performed with either treadmill or bicycle-based exercise. Pharmacologic stress is performed via either dobutamine or vasodilator-mediated (i.e., dipyridamole, adenosine) stress testing. Each of these modalities is associated with a low overall prevalence of major, life-threatening adverse outcomes, though adverse events are most common with dobutamine stress echocardiography. In light of the recent COVID-19 pandemic, the risk of infectious complications to both the patient and stress personnel cannot be negated; however, when certain precautions are taken, the risk of infectious complications appears minimal. In this article, we review each of the stress echocardiographic modalities, examine major potential adverse outcomes and contraindications, assess the risks of stress testing in the setting of a global pandemic, and examine the utilization and safety of stress testing in special patient populations (i.e., language barriers, pediatric patients, pregnancy)

Addressing vision impairment in Mozambique and the Africa region

The Mozambique Eyecare Project was an international partnership to implement and research eye health education in Mozambique and the Africa region. An optometry degree was developed at Universidade Lúrio, Mozambique. In addition, existing eye health workers were upskilled with training. Researchers from various disciplines evaluated the project and its potential for impact on eye health in the region. The body of evidence generated from the research provides useful lessons for development programmes in general, as well as specific lessons for delivering eye health education and service delivery models for low income settings

Integration of optometry at the national health system: the case of the first optometrists in Mozambique

Introduction: In the last two decades an increasing number of African countries have established Optometry training to tackle the largely unmet eye health needs of the population. However not sufficient evidence exist on how the profession is integrated and contributing to national health systems. In Mozambique, the optometry program started under the Faculty of Health Sciences in the public Lúrio University in 2009. From 2012 to 2016, 23 graduates were employed by the National Health System (NHS). Objective: The aim of this research is to document the integration of Optometrists at the National Health System in Mozambique. Methods: This is a descriptive, quantitative and cross-sectional study. Questionnaires and structured interviews were administered to all participants. Results: The response rate was 100% and the Optometrists were found practicing in 10 of the 11 provinces of the country distributed among primary, secondary and tertiary health facilities, providing refraction and managing common ocular pathologies along with the Ophthalmic Technicians, resolving the majority of patient needs and needing to refer 28% of cases to other professionals. The lack of equipment was the main expressed barrier to the provision of effective eye care services. According to them, the optometry curriculum responds well (91%) to the competencies required at the workplace. Areas for improvement training and provision of services were identified and presented in the study. Conclusion: Optometrists are providing effective services needing to work closely and in coordination with other professionals. This research revealed the need for equipment provision and continuing education

In vitro antioxidant properties and inhibitory effect of extracts and fractions of Plectranthus glandulosus leaves on copper sulfate (CuSO4)-induced oxidation in human low-density lipoprotein

Oxidation of LDL has been suggested to be an initial step in the development of atherosclerosis. This research work deals with the evaluation of antioxidant potential of Plectranthus glandulosus leaves extracts and fractions as well as its protective effects against human LDL oxidation. A preliminary quantitative phytochemical screening was carried out. Antioxidant potential was evaluated employing in vitro hydrogen peroxide, nitric oxide scavenging assays and TAOC test. The human LDL oxidation induced by CuSO4 inhibition test was also performed. Plectranthus glandulosus leaves exhibited the presence of 18.3% of saponines, 25.6% of terpenoids and 36.2% of flavonoids. EAF exhibited highest hydrogen peroxide and nitric oxide scavenger activity (IC50 13.63µg/ml and 24.59 µg/ml respectively). Ascorbic acid exhibited an IC50 value of 15.39µg/ml in hydrogen peroxide assay and 22.96 µg/ml in nitric oxide scavenging activity. EAF exhibited a higher TAOC (optical density 0.186±0.00) than that of ascorbic acid (0.162±0.001) at the concentration of 25µg/ml while at 200µg/ml N-BUTF exhibited a higher optical density (1.261±0.001) than that of ascorbic acid (1.065±0.001). EAF lengthened the lag time of the CD formation up to 150mins at the concentration 1mg/ml. TBARS formation inhibition at the concentration 0.5mg/ml, were no significant different between n-butanol (68.55%) ethyl acetate fraction (68.21%) and quercetin 67.69%). Plectranthus glandulosus is a promising prospect as an anti-atherosclerotic agent and needs a detailed study to establish the same. Key words: Plecthrantus glandulosus; oxidation; LDL; atherosclerosis, antioxidant

Addressing Avoidable Vision Impairment in Mozambique and the Africa Region

The Mozambique Eyecare Project was an international partnership to implement and research eye health education in Mozambique and the Africa region. An optometry degree was developed at Universidade Lúrio, Mozambique. In addition, existing eye health workers were upskilled with training. Researchers from various disciplines evaluated the project and its potential for impact on eye health in the region. The body of evidence generated from the research provides useful lessons for development programmes in general, as well as specific lessons for delivering eye health education and service delivery models for lowincome settings

Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study

Background: Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission. Methods: We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient’s medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon’s rank test was used to look at the correlation between two subgroups upon admission and discharge. Results: On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications. Conclusions: Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission