What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise.

PURPOSE: The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development. METHODS: An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking. RESULTS: Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases). CONCLUSION: Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated

Insights and guidance for offshore CO2 storage monitoring based on the QICS, ETI MMV, and STEMM-CCS projects

Carbon Capture and Storage (CCS) is a collective term for technologies that allow society to unlock the benefits of energy intensive processes like fertiliser production and combustion of fuels (fossil or biologically sourced) without releasing the CO2 to the atmosphere. Hence, CCS could assist in accelerating decarbonisation while society pursues a just energy transition. This paper aims to summarise the learnings of three research projects that all investigated aspects of marine monitoring for CCS from a CO2 storage operator’s perspective. The QICS (Quantifying and Monitoring Potential Ecosystem Impacts of Geological Carbon Storage), ETI MMV (Energy Technologies Institute Measurement, Monitoring and Verification of CO2 Storage), and STEMM-CCS (Strategies for Environmental Monitoring of Marine CCS) projects collectively represent over twelve years of dedicated research to assess environmental impacts and to develop technologies for detection, location, and quantification of potential leakage from offshore geological storage of CO2. Each project used controlled releases in representative environments to test their methods and technologies. QICS as the first of the three projects, focused on the understanding of sensitivities of the UK marine environment to a potential leak from a CO2 storage complex and tested technologies to detect such emissions. The ETI MMV project brought together research and industry partners to develop and sea trial an operational, integrated and cost-effective marine monitoring system for geological CO2 storage. As a commercial project, these results have never been published before and this paper shares for the first-time insights from this work. In February 2020, STEMM-CCS, completed its quest to test techniques for environmental monitoring over a marine CO2 storage site in the UK North Sea, further improved near seabed leakage characterisation capabilities, and delivered a first marine CCS demonstration level ecological baseline. This paper aims to summarise some of the key insights from the three projects and provides references where available for the interested reader. The key finding of all three projects is that the impacts of small to medium CO2 leakages from large-scale storage are limited and localised. Technology capabilities exist for integrated marine CO2 storage monitoring and their performance has been benchmarked at controlled release trials. Even small leakages of 10− 50 L/min can be detected at unknown locations in a large area of interest. Finally, the first important steps towards automated monitoring data analysis have been made, including automated leakage signal detection from Side Scan Sonar data (ETI MMV project) and automated species identification from marine biology images (STEMM-CCS project). Some remaining challenges include missed/ false alerts because of large variations in the background signal, the cost of monitoring large areas over long periods, and making real-time decisions based on big data. Continued work to reduce the cost of marine monitoring technologies and advancing automation of data processing and analysis will be important in order to support safe and efficient offshore CCS deployment at large scale

A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Adherence is an important factor contributing to the effectiveness of exercise-based rehabilitation. However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises.NIH

On the Computational Complexity of MapReduce

In this paper we study MapReduce computations from a complexity-theoretic perspective. First, we formulate a uniform version of the MRC model of Karloff et al. (2010). We then show that the class of regular languages, and moreover all of sublogarithmic space, lies in constant round MRC. This result also applies to the MPC model of Andoni et al. (2014). In addition, we prove that, conditioned on a variant of the Exponential Time Hypothesis, there are strict hierarchies within MRC so that increasing the number of rounds or the amount of time per processor increases the power of MRC. To the best of our knowledge we are the first to approach the MapReduce model with complexity-theoretic techniques, and our work lays the foundation for further analysis relating MapReduce to established complexity classes

The Contribution of Registered Dietitians in the Management of Hyperemesis Gravidarum in the United Kingdom.

Hyperemesis Gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, which can cause poor oral intake, malnutrition, dehydration and weight loss. The aim of this study is to explore the role of Registered Dietitians (RD) in the management of HG in the United Kingdom (UK). A survey was designed and distributed electronically to members of the British Dietetic Association. There were 45 respondents, 76% (n = 34) worked in secondary care hospitals, 11% (n = 5) were in maternal health specialist roles. The most commonly used referral criteria was the Malnutrition Universal Screening Tool (40%, n = 18), followed by second admission (36%, n = 16). However 36% (n = 16) reported no specific referral criteria. About 87% (n = 37) of respondents did not have specific clinical guidelines to follow. Oral nutrition supplements were used by 73% (n = 33) either 'sometimes' or 'most of the time'. Enteral and parenteral nutrition were less commonly used. There was an inconsistent use of referral criteria to dietetic services and a lack of specific clinical guidelines and patient resources. Further training for all clinicians and earlier recognition of malnutrition, alongside investment in the role of dietitians were recommended to improve the nutritional care of those with HG

Boomerang: Redundancy Improves Latency and Throughput in Payment-Channel Networks

In multi-path routing schemes for payment-channel networks, Alice transfers funds to Bob by splitting them into partial payments and routing them along multiple paths. Undisclosed channel balances and mismatched transaction fees cause delays and failures on some payment paths. For atomic transfer schemes, these straggling paths stall the whole transfer. We show that the latency of transfers reduces when redundant payment paths are added. This frees up liquidity in payment channels and hence increases the throughput of the network. We devise Boomerang, a generic technique to be used on top of multi-path routing schemes to construct redundant payment paths free of counterparty risk. In our experiments, applying Boomerang to a baseline routing scheme leads to 40% latency reduction and 2x throughput increase. We build on ideas from publicly verifiable secret sharing, such that Alice learns a secret of Bob iff Bob overdraws funds from the redundant paths. Funds are forwarded using Boomerang contracts, which allow Alice to revert the transfer iff she has learned Bob's secret. We implement the Boomerang contract in Bitcoin Script

Adherence to physical rehabilitation delivered via tele-rehabilitation for people with multiple sclerosis: a scoping review protocol

IntroductionUsing tele-rehabilitation methods to deliver exercise, physical activity (PA) and behaviour change interventions for people with multiple sclerosis (pwMS) has increased in recent years, especially since the SARS-CoV-2 pandemic. This scoping review aims to provide an overview of the literature regarding adherence to therapeutic exercise and PA delivered via tele-rehabilitation for pwMS.Methods and analysisFrameworks described by Arksey and O’Malley and Levacet alunderpin the methods. The following databases will be searched from 1998 to the present: Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Health Management Information Consortium Database, ProQuest Dissertations and Theses Global, Pedro, Cochrane Central Register of Controlled Trials, US National Library of Medicine Registry of Clinical Trials, WHO International Clinical Trials Registry Platform portal and The Cochrane Database of Systematic Reviews. To identify papers not included in databases, relevant websites will be searched. Searches are planned for 2023. With the exception of study protocols, papers on any study design will be included. Papers reporting information regarding adherence in the context of prescribed therapeutic exercise and PA delivered via tele-rehabilitation for pwMS will be included. Information relating to adherence may comprise; methods of reporting adherence, adherence levels (eg, exercise diaries, pedometers), investigation of pwMS’ and therapists’ experiences of adherence or a discussion of adherence. Eligibility criteria and a custom data extraction form will be piloted on a sample of papers. Quality assessment of included studies will use Critical Appraisal Skills Programme checklists. Data analysis will involve categorisation, enabling findings relating to study characteristics and research questions to be presented in narrative and tabular format.Ethics and disseminationEthical approval was not required for this protocol. Findings will be submitted to a peer-reviewed journal and presented at conferences. Consultation with pwMS and clinicians will help to identify other dissemination methods.</jats:sec

Experimental evolution of a novel sexually antagonistic allele.

Evolutionary conflict permeates biological systems. In sexually reproducing organisms, sex-specific optima mean that the same allele can have sexually antagonistic expression, i.e. beneficial in one sex and detrimental in the other, a phenomenon known as intralocus sexual conflict. Intralocus sexual conflict is emerging as a potentially fundamental factor for the genetic architecture of fitness, with important consequences for evolutionary processes. However, no study to date has directly experimentally tested the evolutionary fate of a sexually antagonistic allele. Using genetic constructs to manipulate female fecundity and male mating success, we engineered a novel sexually antagonistic allele (SAA) in Drosophila melanogaster. The SAA is nearly twice as costly to females as it is beneficial to males, but the harmful effects to females are recessive and X-linked, and thus are rarely expressed when SAA occurs at low frequency. We experimentally show how the evolutionary dynamics of the novel SAA are qualitatively consistent with the predictions of population genetic models: SAA frequency decreases when common, but increases when rare, converging toward an equilibrium frequency of ∼8%. Furthermore, we show that persistence of the SAA requires the mating advantage it provides to males: the SAA frequency declines towards extinction when the male advantage is experimentally abolished. Our results empirically demonstrate the dynamics underlying the evolutionary fate of a sexually antagonistic allele, validating a central assumption of intralocus sexual conflict theory: that variation in fitness-related traits within populations can be maintained via sex-linked sexually antagonistic loci

Deciphering interplay between Salmonella invasion effectors

Bacterial pathogens have evolved a specialized type III secretion system (T3SS) to translocate virulence effector proteins directly into eukaryotic target cells. Salmonellae deploy effectors that trigger localized actin reorganization to force their own entry into non-phagocytic host cells. Six effectors (SipC, SipA, SopE/2, SopB, SptP) can individually manipulate actin dynamics at the plasma membrane, which acts as a ‘signaling hub’ during Salmonella invasion. The extent of crosstalk between these spatially coincident effectors remains unknown. Here we describe trans and cis binary entry effector interplay (BENEFIT) screens that systematically examine functional associations between effectors following their delivery into the host cell. The results reveal extensive ordered synergistic and antagonistic relationships and their relative potency, and illuminate an unexpectedly sophisticated signaling network evolved through longstanding pathogen–host interaction

The experience of linking Victorian emergency medical service trauma data

<p>Abstract</p> <p>Background</p> <p>The linking of a large Emergency Medical Service (EMS) dataset with the Victorian Department of Human Services (DHS) hospital datasets and Victorian State Trauma Outcome Registry and Monitoring (VSTORM) dataset to determine patient outcomes has not previously been undertaken in Victoria. The objective of this study was to identify the linkage rate of a large EMS trauma dataset with the Department of Human Services hospital datasets and VSTORM dataset.</p> <p>Methods</p> <p>The linking of an EMS trauma dataset to the hospital datasets utilised deterministic and probabilistic matching. The linking of three EMS trauma datasets to the VSTORM dataset utilised deterministic, probabilistic and manual matching.</p> <p>Results</p> <p>There were 66.7% of patients from the EMS dataset located in the VEMD. There were 96% of patients located in the VAED who were defined in the VEMD as being admitted to hospital. 3.7% of patients located in the VAED could not be found in the VEMD due to hospitals not reporting to the VEMD. For the EMS datasets, there was a 146% increase in successful links with the trauma profile dataset, a 221% increase in successful links with the mechanism of injury only dataset, and a 46% increase with sudden deterioration dataset, to VSTORM when using manual compared to deterministic matching.</p> <p>Conclusion</p> <p>This study has demonstrated that EMS data can be successfully linked to other health related datasets using deterministic and probabilistic matching with varying levels of success. The quality of EMS data needs to be improved to ensure better linkage success rates with other health related datasets.</p