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

Through struggle and indifference: the UK academy's engagement with the open intellectual commons

The academy has long relied on publisher-facilitated research dissemination; yet digital dissemination has dramatically transformed the scholarly publishing field. Particularly, open access (OA) has disrupted an increasingly commodified and fetishised publishing praxis, creating an open intellectual commons. However, despite OA's public good, academics remain indifferent to its praxis. The UK academy's policy environment and cultural practices, represent a unique arena to consider these issues within. Limited research concerning the UK academy's rationales for OA engagement exists, particularly qualitative work critically evaluating influences and barriers to achieving cultural change. From a novel ethnographically-framed sociological perspective, combined with empirical investigations, this research addresses this gap in knowledge through comprehending academics' OA responses, publishing influences, actor power-relationships and related HE policy environments. A novel theoretical framework employing Marx, Foucault, Gramsci and the Italian Autonomous-Marxists' conceptualisations of power-relations, struggle and resistance, empower an ideological critique analysis. An examination of how increasingly marketised universities have embraced cognitive capitalism and academic alienation, contrasts with the tensions, events and concepts underlying UK OA's development. Extensive semi-structured interviews with different publishing actors provide cultural-native insights. OA practitioners expose the publication field's configuration, academics and other publishing actors' discourse develop further insights, while academic activists reveal how differing approaches affect dissemination praxis. Analysis indicates actors, including governmental bodies, commercial publishers and funders, dominate a hegemonic ruling-bloc, through controlling economic and symbolic esteem capital. An academy is revealed shifting from idealised OA, towards pragmatic compliance with a normative gold-OA form, although concerns about perceived cost barriers and diminished prestige capital remain. Despite ruling-bloc efforts to address the conjunctural crisis OA represents, a disaggregated counter-hegemonic resistance exists: providing platforms, sustainable publishing, and exposing inequities. While gold-OA praxis proliferates, a struggle for agency within scholarly publishing praxis continues. Hence, ostensibly future dissemination will contain OA elements, but its conformation remains uncertain

Preserved stratigraphic architecture and evolution of a net-transgressive mixed wave- and tide-influenced coastal system: Cliff House Sandstone, northwestern New Mexico, USA

The Cretaceous Cliff House Sandstone comprises a thick (400 m) net- transgressive succession representing a mixed wave- and tide-influenced shallow-marine system that migrated episodically landwards. This study examines the youngest part (middle Campanian) of the Cliff House Sandstone, exposed in Chaco Cultural Natural Historical Park, northwest New Mexico, U.S. A. Detailed mapping of facies architecture between a three-dimensional network of measured sections has allowed the character, geometry, and distribution of key stratigraphic surfaces and stratal units to be reconstructed. Upward-shallowing facies successions (parasequences) are separated by laterally extensive transgressive erosion (ravinement) surfaces cut by both wave and tide processes. Preservation of facies tracts in each parasequence is controlled by the depth of erosion and migration trajectory of the overlying ravinement surfaces. In most parasequences, there is no preservation of the proximal wave-dominated facies tracts (foreshore, upper-shoreface), resulting in thin (4–7 m) top-truncated packages. Four distinct shallow marine tongues (parasequence sets) have been identified, consisting of ten parasequences with a total stratigraphic thickness of ~ 100 m. Each tongue records an episode of complex shoreline migration history (multiple regressive–transgressive phases) in an overall net-transgressive system. The ravinement surfaces provide a stratigraphic framework in which to understand partitioning of tide- and wave-dominated deposits in a net-transgressive system, and a model is presented to account for the sediment distribution and stratigraphic architecture observed in each parasequence. Despite a complex internal architecture, parasequences exhibit a predictable pattern which can be related to the regressive and transgressive phases of deposition. Preservation of wave-dominated facies tracts is associated with shoreline regression, while tide-dominated facies tracts are interpreted to record sediment accumulation during shoreline transgression that also resulted in significant erosion of the underlying regressive deposits. The interplay between erosion, sediment bypass, and deposition during regression and transgression is shown to ultimately control the preservation and stratigraphic architecture of the larger-scale net-transgressive coastal system. While the Cliff House Sandstone exhibits a facies composition and quantitative stacking patterns (shoreline trajectory) similar to other studied examples, differences in the dip-extent of the wave-dominated sandstone tongue has resulted in a more disconnected architecture between the high-fr equency cycles. Understanding the variety of stratal geometries that ravinement surfaces can generate is therefore crucial to predicting the spatial distribution and facies architecture in transgressive systems

Diagnosis of pancreaticobiliary malignancy by detection of minichromosome maintenance protein 5 in biliary brush cytology

Background: Biliary brush cytology is the standard method of evaluating biliary strictures, but is insensitive at detecting malignancy. In pancreaticobiliary cancer minichromosome maintenance replication proteins (MCM 2–7) are dysregulated in the biliary epithelium and MCM5 levels are elevated in bile samples. This study aimed to validate an immunocolorimetric ELISA assay for MCM5 as a pancreaticobiliary cancer biomarker in biliary brush samples. methods: Biliary brush specimens were collected prospectively at ERCP from patients with a biliary stricture. Collected samples were frozen at −80 °C. The supernatant was washed and lysed cells incubated with HRP-labelled anti-MCM5 mouse monoclonal antibody. Test positivity was determined by optical density absorbance. Patients underwent biliary brush cytology or additional investigations as per clinical routine. results: Ninety-seven patients were included in the study; 50 had malignant strictures. Median age was 65 years (range 21–94) and 51 were male. Compared with final diagnosis the MCM5 assay had a sensitivity for malignancy of 65.4% compared with 25.0% for cytology. In the 72 patients with paired MCM5 assay and biliary brush cytology, MCM5 demonstrated an improved sensitivity (55.6% vs 25.0%; P=0.0002) for the detection of malignancy. conclusions: Minichromosome maintenance replication protein5 is a more sensitive indicator of pancreaticobiliary malignancy than standard biliary brush cytology

Depositional evolution of a progradational to aggradational, mixed-influenced deltaic succession: Jurassic Tofte and Ile formations, southern Halten Terrace, offshore Norway

Predicting the hydrodynamics, morphology and evolution of ancient deltaic successions requires the evaluation of the three-dimensional depositional process regime based on sedimentary facies analysis. This has been applied to a core-based subsurface facies analysis of a mixed-energy, clastic coastal-deltaic succession in the Lower-to-Middle Jurassic of the Halten Terrace, offshore mid-Norway. Three genetically related successions with a total thickness of 100–300 m and a total duration of 12.5 Myr comprising eight facies associations record two initial progradational phases and a final aggradational phase. The progradational phases (I and II) consist of coarsening upward successions that pass from prodelta and offshore mudstones (FA1), through delta front and mouth bar sandstones (FA2) and into erosionally based fluvial- (FA3) and marine-influenced (FA4) channel fills. The two progradational phases are interpreted as fluvial- and wave-dominated, tide-influenced deltas. The aggradational phase (III) consists of distributary channel fills (FA3 and FA4), tide-dominated channels (FA5), intertidal to subtidal heterolithic fine-grained sandstones (FA6) and coals (FA7). The aggradational phase displays more complex facies relationships and a wider range of environments, including (1) mixed tide- and fluvial-dominated, wave-influenced deltas, (2) non-deltaic shorelines (tidal channels, tidal flats and vegetated swamps), and (3) lower shoreface deposits (FA8). The progradational to aggradational evolution of this coastal succession is represented by an overall upward decrease in grain size, decrease in fluvial influence and increase in tidal influence. This evolution is attributed to an allogenic increase in the rate of accommodation space generation relative to sediment supply due to tectonic activity of the rift basin. In addition, during progradation, there was also an autogenic increase in sediment storage on the coastal plain, resulting in a gradual autoretreat of the depositional system. This is manifested in the subsequent aggradation of the system, when coarse-grained sandstones were trapped in proximal locations, while only finer grained sediment reached the coastline, where it was readily reworked by tidal and wave processes

Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre

INTRODUCTION: Endoscopic transmural drainage (ED) or percutaneous drainage (PD) has mostly replaced surgery for the initial management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare outcomes for patients undergoing ED or PD of symptomatic PFCs. METHODS: Between January 2000 and December 2013, all patients who required PD or ED of a PFC were included. Rates of treatment success, length of hospital stay, adverse events, re-interventions and length of follow-up were recorded retrospectively in all cases. RESULTS: In total, 164 patients were included in the study; 109 patients underwent ED; and 55 had PD alone. During the 14-year study period, the incidence of ED increased and PD fell. In the 109 patients who were managed by ED, treatment success was considerably higher than in those managed by PD (70 vs. 31 %). Rates of procedural adverse events were higher in the ED cohort compared to the PD group (10 vs. 1 %), but patients managed by ED required fewer interventions (median of 1.8 vs. 3.3) had lower rates of residual collections (21 vs. 67 %) and need for surgical intervention (4 vs. 11 %). In the ED group, treatment success was similar for walled-off pancreatic necrosis (WOPN) and pseudocysts (67 vs. 72 %, P = 0.77). There were no procedure-related deaths. CONCLUSION: Compared with PD, ED of symptomatic PFCs was associated with higher rates of treatment success, lower rates of re-intervention, including surgery and shorter lengths of hospital stay. Outcomes in WOPN were comparable to those in patients with pseudocysts

Laser Generation of Narrow Band Ultrasound

Laser based sensor systems to replace conventional piezoelectric contact transducers for ultrasonic testing continue under development for applications where contact with the specimen surface is undesirable or impossible. To date, such systems are considerably less sensitive than their piezoelectric counterparts. As a result, a great deal of effort has contributed to the development of a number of interferoroetric transducer systems to detect ultrasound. Increasingly, however, researchers have begun looking at laser ultrasonic sources to see what improvements might be made to enhance overall system sensitivity for laser generation and detection of ultrasound