International Council of Ophthalmology

Incidental entrainment of fishes at large-scale state and federal water diversion facilities in the Sacramento-San Joaquin Delta, California, can trigger protective management actions when limits imposed by environmental regulations are approached or exceeded. These actions can result in substantial economic costs, and likewise they can affect the status of vulnerable species. Here, we examine data relevant to water management actions during January–June; the period when juvenile salmonids are present in the Delta. We use a quantile regression forest approach to create a risk forecasting tool, which can inform adjustments of diversions based on near real-time predictions. Models were trained using historical entrainment data (Water Years 1999–2019) for Sacramento River winter-run Chinook Salmon or Central Valley Steelhead and a suite of environmental and water operations metrics. A range of models was developed; their performance was evaluated by comparison of a quantile loss metric. The models were validated through examination of partial dependence plots, cross-validation procedures, and further evaluated through WY 2019 pilot testing, which integrated real-world uncertainty in environmental parameters into model predictions. For both species, the strongest predictor of loss was the previous week’s entrainment loss. In addition, risk increased with higher water exports and more negative Old and Middle Rivers (OMR) flows. Point estimates of loss were modestly correlated with observations (R2 0.4 to 0.6), but the use of a quantile regression approach provided reliable prediction intervals. For both species, the predicted 75th quantile appears to be a robust and conservative estimator of entrainment risk, with overprediction occurring in fewer than 20% of cases. This quantile balances the magnitude of over- and under-prediction and results in a low probability (< 5% of predictions) of unexpected high-take events. These models, and the web-based application through which they are made accessible to non-technical users, can provide a useful and complementary approach to the current system of managing entrainment risk.

India is producing a large number of ophthalmologists, but many institutions have limited facilities to impart proper surgical training during post-graduation.[1] In order to improve the surgical acumen of these ophthalmologists, several skills transfer courses are being offered in different centers of the country. There is a sudden spurt in such centers. Thus, there are a lot of variations in the quality of training. Following the skills transfer and hands-on courses, assessment methods are hardly or never used to assess the transferred skills and competence level achieved by the trainees. Recording the feedback from the trainees is essential, which lacks uniformity. Several tools, like written feedbacks, have been tried by a few centers. However, they are not well recognized. In order to make it more useful, International Council of Ophthalmology (ICO) has developed several methods. The Ophthalmic Clinical Evaluation Exercise (OCEX) is used for assessing the residents' competence. But this is for ability to diagnose and discuss various other probabilities around the diagnosis.[2] Similarly, tools are available like “Objective Assessment of Skill in Intraocular Surgery” (OASIS) for assessment of competence in surgical skill of phacoemulsification[3] and “Global Rating of Skills in Intraocular Surgery” (GRASIS) for the assessment of knowledge of preoperative instruments.[4] A tool like “Objective Structure Assessment of Cataract Surgical Skill”(OSACSS) was developed by Saleh et al.[5] They are objective evaluation to test surgical technique and postoperative results including complications. This has been modified by ICO called ICO-OSCAR to assess the acquisition of the skills for various degrees.[6] The ICO-OSCARs are designed to facilitate assessment and teaching of surgical skill. Surgical procedures are broken down to individual steps and each step is graded on a scale of novice, beginner, advanced, and competent. A description of the performance necessary to achieve each grade in each step is given. The assessor simply circles the observed performance description at each step of the procedure. The ICO-OSCAR should be completed at the end of the case and immediately discussed with the student to provide timely, structured, specific performance feedback. These tools were developed by panels of international experts and are valid assessments of surgical skill. A modified OSCAR has been developed by Farooqui et al. to assess the competence of the learner for wet labs. This tool has 22 questions to be used before and after the end of the wet lab sessions.[7] The ICO-OSCAR has been evaluated in this issue of the IJO by looking at the training parameters in first and last five cases operated by the trainee in short-term phacoemulsification skill training sessions.[8] The authors have done this study in a group of trainees having previous surgical experience of SICS to advance to phacoemulsification by using ICO-OSCAR. They have found the tool to be valid and comprehensive in the assessment of the surgical skill achieved by the trainee in short-term period. Energetic and enthusiastic incorporation of the national curriculum for training, competency-based learning, robust formative and summative assessment, common certification of the trainees, and rigorous accreditation of the training programs are much needed to standardize ophthalmic training in India.[9] There has been a problem of difference in the matching of trainer's comments and trainees' self-evaluation. This ICO-OSCAR tool may solve this problem. Hence, rather than having an independent method of assessment by different centers, it may be recommended to use an easily available tool ICO-OSCAR, which is well researched by the ICO in order to bring about a standardized method for uniformity in the skill training.

Abstract Engineering activity possess robust methods for designing, realizing, and managing complex engineered systems. As engineered systems become more complex, engineering activity's complexity is growing along with it. Current engineering management tools and methods, although they serve well for many engineering activities, begin to fail when the complexity of the engineered systems exceeds a threshold. Part of the problem is that social, organizational, and psychological sciences have been integrated in limited capacity into engineering activity. Further, the methods and tools for managing engineering activities tend to be rigid and often do not adapt well to complex engineering environments. To address these limitations, the author proposes for the use of the purposeful human activity systems framework as a systems perspective on engineering activity. The framework provides a flexible approach to managing engineering activity by enabling the selection and application and effectiveness measurement of the best social, organizational, and psychological methods and tools according to the specific needs of the engineering organization.

Emissions from the transportation sector are a major contributor to ambient air pollution, the leading environmental health risk factor globally. This study aims to quantify the contribution of tailpipe emissions from global transportation, disaggregated by four sub-sectors, to the global disease burden associated with ambient fine particulate matter (PM2.5) and ground-level ozone in 2010 and 2015. We use the GEOS-Chem global chemical transport model to simulate transportation-attributable PM2.5 and ozone concentrations, combined with epidemiological health impact assessment methods consistent with the Global Burden of Disease 2017 study to estimate the associated burden of disease. We estimate that emissions from the transportation sector were associated with 361 000 (95% CI, 258 000–462 000) PM2.5 and ozone deaths in 2010 and 385 000 (95% CI, 274 000–493 000) in 2015. These results translate into 11.7% of total global ambient PM2.5 and ozone deaths in 2010 and 11.4% in 2015. Together, PM2.5 and ozone concentrations from transportation tailpipe emissions resulted in an estimated 7.8 million years of life lost and approximately $1 trillion (2015 US$) in health damages globally in 2015. Among transportation sub-sectors, on-road diesels contributed most to the health burden from transportation tailpipe emissions in nearly all trade blocs, for both PM2.5 and ozone, though other sub-sectors also contributed substantially (particularly on-road non-diesel vehicles for ozone mortality, and shipping and non-road mobile sources for PM2.5 mortality). These results indicate that despite recent adoption of more stringent vehicle emission regulations in many countries, the transportation sector remains a major contributor to the air pollution disease burden globally. Future work may explore the degree to which currently adopted policies, as well as expected growth in the transportation sector in India, Africa, and other rapidly developing locations, will influence future transportation-attributable public health burdens.

Background/aimsTo estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita.MethodsOnline surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed.ResultsIn 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions.ConclusionsAlthough the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.

This article was migrated. The article was marked as recommended. Implementing CPD programs for medical professionals has been demonstrated to improve patient outcomes, and is increasingly required for continuing medical licensure. However, implementing programs in low-resource settings is challenging. This review has identified 5 different models for implementation: 1) twinning, 2) greenfield, 3) formal program guided by international medical bodies, 4) directed by regulators and 5) informal program guided by international medical bodies. The models, advantages and disadvantages and costs are discussed. There is minimal evidence on success of implementation models, and further studies are necessary.

In this article, the author explains how African dances are created in many social venues as a form of communicating within specific societies. However, from her travels, she has discovered that there are many misconceptions outside of the continent, and many people who view African dances as exotic or as only entertainment. The article discusses specific societies, by means of specific dances as models, in order to understand that aesthetics and purpose in execution are a social perception built by a community's values.

Abstract. We quantify the concentrations change of atmospheric pollutants and Radiative Forcing (RF) of short-lived components due to shipping emissions of NOx, SOx, CO, NMVOCs, BC and OC. A set of models is used to evaluate the period 2004–2030. This time period reflects expected increasing traffic in the Arctic region. Two datasets for ship emissions are used that may characterize the potential impact from shipping and the degree to which shipping controls may mitigate impacts: A high (HIGH) scenario and a low scenario with Maximum Feasible Reduction (MFR) of black carbon in the Arctic. In MFR, BC emissions in the Arctic are reduced with 70% representing a combination technology performance and/or reasonable advances in single-technology performance. Both scenarios result in moderate to substantial increases in concentrations of pollutants both globally and in the Arctic. Exceptions are black carbon in the MFR scenario, and sulfur species and organic carbon in both scenarios due to the future phase-in of current regulation that reduces fuel sulfur content. In the season with potential transit traffic through the Arctic in 2030 significant increases occur for all pollutants in large parts of the Arctic. Net global RFs from 2004–2030 of 53 mW m−2 (HIGH) and 73 mW m−2 (MFR) are similar to those found for preindustrial to present net global aircraft RF. The found warming contrasts the cooling from historical ship emissions. The reason for this difference and the higher global forcing for the MFR scenario is mainly the reduced future fuel sulfur content resulting in less cooling from sulfate aerosols. Arctic regional forcing is largest in the HIGH scenario because other components become locally more important in polar latitudes. In the HIGH scenario ozone dominates the RF during Arctic summer and the transit season. RF due to BC in air, and snow and ice becomes of significance in Arctic spring. For the HIGH scenario the net Arctic RF during spring is 5 times higher than in winter.