Compassionate Efficiency: A Study of Sankara Eye Foundation’s Gift of Vision Program

The prevalence of curable blindness in India is among the highest in the world. There is a strong correlation between blindness and poverty. Sankara Eye Foundation Inida addresses this problem by providing high quality and affordable eye care to the rural poor in India. Sankara’s outreach strategy focuses on equitable care for marginalized groups. Though Sankara seeks to make eye care a reality for all, the emphasis on equality is especially evident in its treatment of women. In the past year, women have been Sankara’s largest group of adult beneficiaries. Founded in 1977 by Dr. R.V Ramani and Dr. Radha Ramani, Sankara has expanded to 13 eye hospitals covering 7 states. Through its community outreach program, Gift of Vision, Sankara has performed over 1 million sight-restoring cataract surgeries and has become one of the major eye care providers in India. The Gift of Vision program operates by integrating with a community, capitalizing on preexisting community networks and a highly efficient patient care system. This report focuses on the importance of community networks in the outreach process and the impact of cataract surgery on patients’ lives. It includes a detailed outline of the patient treatment process, two patient case studies and quantitative analysis of Gift of Vision’s social impact

Comparing the Efficiency of Nursery and Direct Transplanting Methods for Restoring Endangered Corals

Restoration of plants, corals, and other sessile species often involves transplanting individuals to sites chosen for rehabilitation. Transplanted individuals are sometimes harvested directly from wild populations (direct transplanting), and sometimes propagated or cultured in a “nursery” before being transplanted (nursery outplanting). The ecological effectiveness and cost-efficiency of these methods have rarely been compared, so we performed an experiment to address this. Coral fragments, Acropora cervicornis (n = 780), were collected and assigned to one of three treatments: 1) directly transplanted to a restoration site and placed loose on the reef; 2) directly transplanted and manually attached to the reef; 3) moved to a nursery site near the restoration site for three months before being transplanted and manually attached to the reef. Treatment 1 was inefficient simply because these corals survived poorly. After 15 months, the survival and growth of corals assigned to treatments 2 and 3 was similar. The nursery method (3) was more expensive and time-consuming than direct transplanting (2), so treatment 2 yielded twice as many surviving corals per hour of work invested and three times as many survivors per dollar of set-up costs as treatment 3. The net production of live coral tissue per hour or per dollar invested was also greatest for direct-attached transplants. Cost- and time-efficiency are important considerations for practitioners seeking to maximize the area of reef rehabilitated and, in this case study, were maximized by bypassing a nursery stage

Treatment of Water and Wastewater for Reuse and Energy Generation-Emerging Technologies

Fresh water quality and supply, particularly for domestic and industrial purposes, are deteriorating with contamination threats on water resources. Multiple technologies in the conventional wastewater treatment (WWT) settings have been adopted to purify water to a desirable quality. However, the design and selection of a suitable cost-effective treatment scheme for a catchment area are essential and have many considerations including land availability, energy, effluent quality and operational simplicity. Three emerging technologies are discussed, including anaerobic digestion, advanced oxidation processes (AOPs) and membrane technology, which holds great promise to provide integrational alternatives for manifold WWT process and distribution systems to mitigate contaminants and meet acceptable limitations. The main applications, basic principles, merits and demerits of the aforementioned technologies are addressed in relation to their current limitations and future research needs in terms of renewable energy. Hence, the advancement in manufacturing industry along with WWT blueprints will enhance the application of these technologies for the sustainable management and conservation of water

Educational Technology Primer: A Guide for Pre-Service Teachers

The Educational Technology Primer grew out of the realization that today’s teacher education students have different needs than their predecessors. Current students arrive on campus less intimidated by technology and more experienced with the use of technology in instruction. However, many introductory educational technology texts still highlight the acquisition of basic technology operations; knowledge and skills that made sense when students entering an introductory educational technology course lacked technology experiences, but not today

Daily physical activity and related risk factors in COPD

Background Factors associated with reduced daily physical activity (DPA) in patients with COPD are still controversial. Physical inactivity in COPD increases risk of cardiovascular disease, frequent exacerbations, reduced health status, and increased symptoms. We hypothesised that reduced DPA in patients with COPD is independent of traditional risk factors including age and spirometry. Methods In this cross-sectional study, DPA (over 7 days) was assessed on 88 community stable patients with COPD and 40 controls free from cardiorespiratory disease. Spirometry, body composition, number of exacerbations, handgrip strength (HGS), modified Medical Research Council (mMRC), arterial stiffness, 6-min walking distance (6MWD) and BODE index were also determined. Frequent exacerbation was defined as ≥2 and non-frequent exacerbation < 2. Results Patients with COPD had reduced DPA and exercise capacity compared with controls similar in age, BMI and gender, p  0.05. The level of breathlessness was superior to lung function in predicting the level of DPA. Conclusion The level of DPA in COPD was independent of traditional risk factors. Breathlessness score is a better predictor of the DPA than lung function and handgrip strength

Treatment effect heterogeneity following type 2 diabetes treatment with GLP1-receptor agonists and SGLT2-inhibitors:a systematic review

Background: A precision medicine approach in type 2 diabetes requires the identification of clinical and biological features that are reproducibly associated with differences in clinical outcomes with specific anti-hyperglycaemic therapies. Robust evidence of such treatment effect heterogeneity could support more individualized clinical decisions on optimal type 2 diabetes therapy.Methods: We performed a pre-registered systematic review of meta-analysis studies, randomized control trials, and observational studies evaluating clinical and biological features associated with heterogenous treatment effects for SGLT2-inhibitor and GLP1-receptor agonist therapies, considering glycaemic, cardiovascular, and renal outcomes. After screening 5,686 studies, we included 101 studies of SGLT2-inhibitors and 75 studies of GLP1-receptor agonists in the final systematic review.Results: Here we show that the majority of included papers have methodological limitations precluding robust assessment of treatment effect heterogeneity. For SGLT2-inhibitors, multiple observational studies suggest lower renal function as a predictor of lesser glycaemic response, while markers of reduced insulin secretion predict lesser glycaemic response with GLP1-receptor agonists. For both therapies, multiple post-hoc analyses of randomized control trials (including trial meta-analysis) identify minimal clinically relevant treatment effect heterogeneity for cardiovascular and renal outcomes.Conclusions: Current evidence on treatment effect heterogeneity for SGLT2-inhibitor and GLP1-receptor agonist therapies is limited, likely reflecting the methodological limitations of published studies. Robust and appropriately powered studies are required to understand type 2 diabetes treatment effect heterogeneity and evaluate the potential for precision medicine to inform future clinical care.</p

Effect of cross-platform gene-expression, computational methods on breast cancer subtyping in PALOMA-2 and PALLET studies.

Intrinsic breast cancer molecular subtyping (IBCMS) provides significant prognostic information for patients with breast cancer and helps determine treatment. This study compared IBCMS methods on various gene-expression platforms in PALOMA-2 and PALLET trials. PALOMA-2 tumor samples were profiled using EdgeSeq and nanostring and subtyped with AIMS, PAM50, and research-use-only (ruo)Prosigna. PALLET tumor biopsies were profiled using mRNA sequencing and subtyped with AIMS and PAM50. In PALOMA-2 (n = 222), a 54% agreement was observed between results from AIMS and gold-standard ruoProsigna, with AIMS assigning 67% basal-like to HER2-enriched. In PALLET (n = 224), a 69% agreement was observed between results from PAM50 and AIMS. Different IBCMS methods may lead to different results and could misguide treatment selection; hence, a standardized clinical PAM50 assay and computational approach should be used.Trial number: NCT01740427

Mothers’ accounts of the impact on emotional wellbeing of organised peer support in pregnancy and early parenthood: a qualitative study

Background The transition to parenthood is a potentially vulnerable time for mothers’ mental health and approximately 9–21% of women experience depression and/or anxiety at this time. Many more experience sub-clinical symptoms of depression and anxiety, as well as stress, low self-esteem and a loss of confidence. Women’s emotional wellbeing is more at risk if they have little social support, a low income, are single parents or have a poor relationship with their partner. Peer support can comprise emotional, affirmational, informational and practical support; evidence of its impact on emotional wellbeing during pregnancy and afterwards is mixed. Methods This was a descriptive qualitative study, informed by phenomenological social psychology, exploring women’s experiences of the impact of organised peer support on their emotional wellbeing during pregnancy and in early parenthood. Semi-structured qualitative interviews were undertaken with women who had received peer support provided by ten projects in different parts of England, including both projects offering ‘mental health’ peer support and others offering more broadly-based peer support. The majority of participants were disadvantaged Black and ethnic minority women, including recent migrants. Interviews were audio-recorded and transcripts were analysed using inductive thematic analysis. Results 47 mothers were interviewed. Two key themes emerged: (1) ‘mothers’ self-identified emotional needs’, containing the subthemes ‘emotional distress’, ‘stressful circumstances’, ‘lack of social support’, and ‘unwilling to be open with professionals’; and (2) ‘how peer support affects mothers’, containing the subthemes ‘social connection’, ‘being heard’, ‘building confidence’, ‘empowerment’, ‘feeling valued’, ‘reducing stress through practical support’ and ‘the significance of “mental health” peer experiences’. Women described how peer support contributed to reducing their low mood and anxiety by overcoming feelings of isolation, disempowerment and stress, and increasing feelings of self-esteem, self-efficacy and parenting competence. Conclusion One-to-one peer support during pregnancy and after birth can have a number of interrelated positive impacts on the emotional wellbeing of mothers. Peer support is a promising and valued intervention, and may have particular salience for ethnic minority women, those who are recent migrants and women experiencing multiple disadvantages

Protein-coding variants implicate novel genes related to lipid homeostasis contributing to body-fat distribution.

Body-fat distribution is a risk factor for adverse cardiovascular health consequences. We analyzed the association of body-fat distribution, assessed by waist-to-hip ratio adjusted for body mass index, with 228,985 predicted coding and splice site variants available on exome arrays in up to 344,369 individuals from five major ancestries (discovery) and 132,177 European-ancestry individuals (validation). We identified 15 common (minor allele frequency, MAF ≥5%) and nine low-frequency or rare (MAF &lt;5%) coding novel variants. Pathway/gene set enrichment analyses identified lipid particle, adiponectin, abnormal white adipose tissue physiology and bone development and morphology as important contributors to fat distribution, while cross-trait associations highlight cardiometabolic traits. In functional follow-up analyses, specifically in Drosophila RNAi-knockdowns, we observed a significant increase in the total body triglyceride levels for two genes (DNAH10 and PLXND1). We implicate novel genes in fat distribution, stressing the importance of interrogating low-frequency and protein-coding variants