A comparison of anterior and posterior chamber lenses after cataract extraction in rural Africa: a within patient randomised trial.

BACKGROUND: Extracapsular cataract extraction (ECCE) with a posterior chamber intraocular lens (PC IOL) is the preferred method of cataract surgery in developed countries. However, intracapsular cataract extraction (ICCE) with an anterior chamber lens (AC IOL) may be appropriate in rural Africa. A randomised controlled trial was carried out to compare these surgical strategies. METHODS: Participants over 50 years requiring bilateral cataract surgery were recruited from outreach clinics in rural north and east Uganda. One eye was randomly allocated to AC IOL or PC IOL, the other eye being allocated to the second strategy. The main outcome measure was WHO distance visual acuity (VA) category after a minimum of 1 year. Secondary outcomes were numbers and causes of complications and refractive corrections. RESULTS: Of the 110 participants recruited, 98 (89%) were assessed at least 1 year after the operation (median follow up 17.5 months). Nine eyes randomised to PC IOL were converted to AC IOL; one eye randomised to AC IOL inadvertently received PC IOL. There was no difference in VA between 95 pairs of eyes for which data for both eyes were available (uncorrected VA, p = 0.26; corrected VA, p = 0.59). 80 (82%, 95% CI 73 to 89) and 82 (84%, 95% CI 75 to 90) eyes randomised to AC IOL and PC IOL respectively had corrected VA of 6/18 or better. 16 (16%, 95% CI 10 to 25) and eight (8%, 95% CI 4 to 15) eyes respectively had secondary procedures or other complications. CONCLUSIONS: Where both strategies are available, ECCE with PC IOL should be first choice because of fewer complications. Where ECCE with PC IOL is not immediately feasible, ICCE with AC IOL is an acceptable interim technique

Optimizing Provider Templates to Support APP Independent Practice

Melinda Harris (left), Cynae Johnson (center),Tracy Benson (right) pictured.https://openworks.mdanderson.org/aprn-week-22/1020/thumbnail.jp

Evidence of unexplained discrepancies between planned and conducted statistical analyses: a review of randomized trials

Evidence of unexplained discrepancies between planned and conducted statistical analyses: a review of randomised trial

Fluorescent emission in different silicon carbide polytypes

Silicon carbide (SiC) is a widely used material in several industrial applications such as high power electronics, light emitting diodes, and in research application such as photo-voltaic and quantum technologies. As nanoparticles it can be synthetised in many sizes and different polytypes from 200 nm down to 1 nm. In the form of quantum dots they are used as optical biomarkers, and their emission, occurring from the blue to the orange spectral region, is based on quantum confinement effect. In this work we report on emission in the red and near infrared in different SiC polytypes, specifically in 4H, 6H and 3C. In 4H SiC the red visible emission yielded non classical light attributed to an intrinsic defect, identified as a carbon-antisite vacancy pair. Similar spectral emission was observed in 3C SiC bulk and nanoparticles, also yielding very bright single photon emission. Emission in the far red has been observed in homogeneous hetero-structure in SiC tetrapods. © 2013 Copyright SPIE

Widespread impact-generated porosity in early planetary crusts.

NASA's Gravity Recovery and Interior Laboratory (GRAIL) spacecraft revealed the crust of the Moon is highly porous, with ~4% porosity at 20 km deep. The deep lying porosity discovered by GRAIL has been difficult to explain, with most current models only able to explain high porosity near the lunar surface (first few kilometers) or inside complex craters. Using hydrocode routines we simulated fracturing and generation of porosity by large impacts in lunar, martian, and Earth crust. Our simulations indicate impacts that produce 100-1000 km scale basins alone are capable of producing all observed porosity within the lunar crust. Simulations under the higher surface gravity of Mars and Earth suggest basin forming impacts can be a primary source of porosity and fracturing of ancient planetary crusts. Thus, we show that impacts could have supported widespread crustal fluid circulation, with important implications for subsurface habitable environments on early Earth and Mars

The use of infrared thermography to detect the skin temperature response to physical activity

Physical activity has a noticeable effect on skin blood flow and temperature. The thermal regulatory and hemodynamic processes during physical activity are controlled by two conflicting mechanisms: the skin vasoconstriction induced by the blood flow demand to active muscles and the skin vasodilation required by thermoregulation to increase warm blood flow and heat conduction to the skin. The time-evolution of skin temperature during exercise can give useful information about the adaptation of the subject as a function of specific type, intensity and duration of exercise. In this paper, infrared thermography is used to investigate the thermal response of skin temperature during running exercise on treadmill for a group of seven healthy and trained runners. Two different treadmill exercises are considered: a graded load exercise and a constant load exercise; for both exercises the duration was 30 minutes. Within the limits due to the relatively small size of the sample group, results typically indicate a fall in skin temperature during the initial stage of running exercise. As the exercise progresses, the dynamics of the skin temperature response depends on the type of exercise (graded versus constant load) and probably on the level of training of the subject

Controls on the formation of lunar multiring basins

Multiring basins dominate the crustal structure, tectonics, and stratigraphy of the Moon. Understanding how these basins form is crucial for understanding the evolution of ancient planetary crusts. To understand how preimpact thermal structure and crustal thickness affect the formation of multiring basins, we simulate the formation of lunar basins and their rings under a range of target and impactor conditions. We find that ring locations, spacing, and offsets are sensitive to lunar thermal gradient (strength of the lithosphere), temperature of the deep lunar mantle (strength of the asthenosphere), and preimpact crustal thickness. We also explore the effect of impactor size on the formation of basin rings and reproduce the observed transition from peak‐ring basins to multiring basins and reproduced many observed aspects of ring spacing and location. Our results are in broad agreement with the ring tectonic theory for the formation of basin rings and also suggest that ring tectonic theory applies to the rim scarp of smaller peak‐ring basins

Are regulations safe? Reflections from developing a digital cancer decision support tool

PURPOSE Informatics solutions to early diagnosis of cancer in primary care are increasingly prevalent, but it is not clear whether existing and planned standards and regulations sufficiently address patients' safety nor whether these standards are fit for purpose. We use a patient safety perspective to reflect on the development of a computerized cancer risk assessment tool embedded within a UK primary care electronic health record system. METHODS We developed a computerized version of the CAncer Prevention in ExetER studies risk assessment tool, in compliance with the European Union's Medical Device Regulations. The process of building this tool afforded an opportunity to reflect on clinical concerns and whether current regulations for medical devices are fit for purpose. We identified concerns for patient safety and developed nine practical recommendations to mitigate these concerns. RESULTS We noted that medical device regulations (1) were initially created for hardware devices rather than software, (2) offer one-shot approval rather than supporting iterative innovation and learning, (3) are biased toward loss-transfer approaches that attempt to manage the fallout of harm instead of mitigating hazards becoming harmful, and (4) are biased toward known hazards, despite unknown hazards being an expected consequence of health care as a complex adaptive system. Our nine recommendations focus on embedding less-reductionist and stronger system perspectives into regulations and standards. CONCLUSION Our intention is to share our experience to support research-led collaborative development of health informatics solutions in cancer. We argue that regulations in the European Union do not sufficiently address the complexity of healthcare information systems with consequences for patient safety. Future standards and regulations should continue to follow a system-based approach to risk, safety, and accident avoidance

Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria – A qualitative study

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization. (Afr J Reprod Health 2022; 26 [12]: 23-31). La fistule obstétricale continue d'être une menace au Nigéria et dans d'autres pays à revenu faible ou intermédiaire. La politique nationale d'élimination rend la réparation chirurgicale gratuite dans des centres nationaux dédiés. Cependant, la majorité des clients se présentent en retard pour la réparation. L'objectif de l'étude était d'explorer les raisons de ce retard à se faire soigner. Il s'agissait d'une étude qualitative (exploratoire) réalisée au Centre national de la fistule obstétricale (NOFIC), Abakaliki, au Nigeria, chez des patientes atteintes de fistule obstétricale qui se sont présentées pour un traitement avec une durée de fuite de plus de six mois. La technique d'échantillonnage consécutif a été utilisée pour le recrutement des patients. Les données ont été recueillies auprès de vingt patients à l'aide d'entretiens approfondis. Une analyse thématique des réponses et des schémas récurrents a été effectuée, avec des thèmes illustrés à l'aide du nuage de mots. L'âge moyen des participants était de 37,1 ans (intervalle = 21-75 ans) tandis que la durée moyenne des fuites était de 64,3 mois (intervalle = 8-564 mois). Les raisons du retard dans l'accès au traitement de la fistuleobstétricale étaient le manque de sensibilisation à la disponibilité d'un traitement gratuit dans un centre spécialisé, le retard dans l'orientation des établissements de soins de santé de référence, les informations erronées des agents de santé, l'échec des réparationsdans d'autres établissements de santé, le retard secondaire dû aux difficultés de transport, aux croyances culturelles et à d'autres problèmes propres aux patients. La raison la plus courante du retard dans l'accès au traitement de la fistule obstétricale est le manque de sensibilisation de la part des patientes, du public et des agents de santé. Nous recommandons d'améliorer les campagnes, le plaidoyer et la mobilisation communautaire. (Afr J Reprod Health 2022; 26[12]: 23-31)

LARC Method Appropriateness in Substance Use Treatment: A Quality Improvement Project for Integrated Care

Problem: Individuals with substance use disorder (SUD) have disproportionately higher rates of unintended pregnancy when compared to the general population, estimated to be 85% (Heil et al., 2011). Not only are poor maternal and fetal outcomes associated with unplanned pregnancies, but pregnancies in women with SUD are further complicated by additional risks and adverse outcomes (Black & Day, 2016). Context: Addiction treatment centers and programs are primed with opportunity to offer family planning services, when contact with medical providers is increased for substance use treatment. In response to the opioid crisis and unprecedented rates of unintended pregnancy, this project was designed to identify, develop, and implement an evidence-based approach to integrate birth control education and services, emphasizing long-acting reversible contraception (LARC) in substance use treatment. Interventions: A two-part interdisciplinary training was designed to include best practice recommendations regarding LARC utilization and comprehensive contraceptive counseling, hands-on skills training with vaginal simulators, and subdermal implant training and certification. Measures: A pre/post training assessment was utilized to assess change in provider confidence and readiness in offering contraceptive counseling, as well as, performing LARC procedures in preparation for service integration on site. Results: Through data analysis, results indicated a 33.33% increase in provider comfort in providing contraceptive counseling and confidence in identifying LARC eligible candidates. The greatest changes were seen in provider self-assessed preparedness in providing counseling regarding LARC safety and efficacy, with a 44.44% increase, and a 57.89% increase in provider comfortability with the Nexplanon insertion and removal procedures compared with pre- training assessments. Conclusions: Didactic and hands-on training are effective approaches to prepare providers for service expansion to include contraceptive services at addiction treatment centers