4,266 research outputs found
Assault-related severe ocular chemical injury at a London ophthalmic referral hospital: a 3-year retrospective observational study
Objectives: To understand the incidence, causes, management and outcomes of intentional (assault) and unintentional severe ocular chemical injuries (SOCI) at an urban tertiary referral centre in the UK.
Design: Retrospective observational study.
Setting: A London tertiary referral ophthalmic centre, Moorfields Eye Hospital.
Participants: All cases of SOCI presenting between 1 September 2011 and 31 August 2014 were identified. The definition of SOCI was grade 3 or 4 on the Hughes-Roper-Hall classification system. We identified 25 cases (6 in 2011–2012, 8 in 2012–2013, 11 in 2013–2014). Median age was 31.1 years. 23 cases (92%) were male.
Primary and secondary outcome measures: The primary outcome was the proportion of cases of SOCI caused by assault, per year. Secondary outcome measures included the number of cases of SOCI, injury characteristics and mechanism, initial and long-term management, visual outcome and the need for surgical intervention.
Results: Between 2011 and 2012, 3/6 cases were due to assault (50%); between 2012 and 2013, 7/8 were due to assault (87.5%); and between 2013 and 2014, 6/11 were due to assault (54.4%). Assault was responsible for 16/25 (64%) cases overall, while 8/25 (32%) cases were work related. The causative agent was known to be alkali in 16/25 (64%), while 10/25 (40%) did not complete the follow-up. The mean number of clock hours of limbal ischaemia was 5.24 (SD 2.97). 17/25 (68%) were Hughes-Roper-Hall grade 3. Surgical intervention occurred in 1/25. The final best-corrected visual acuity was 6/12 or worse in 11/25 (44%) and was counting fingers or worse in 4/25 (16%).
Conclusions: Previous studies found that SOCI had a low incidence and that work-related injuries were the most common cause. Our study demonstrates an increasing incidence of SOCI, which may be accounted for by a rise in assault using corrosive substances. A high number of patients did not attend regularly for follow-up and visual outcomes from these injuries are poor
HTA – algorithm or process? Comment on ‘Expanded HTA: enhancing fairness and legitimacy’
Daniels, Porteny and Urrutia et al make a good case for the idea that that public decisions ought to be made not
only “in the light of ” evidence but also “on the basis of ” budget impact, financial protection and equity. Health
technology assessment (HTA) should, they say, be accordingly expanded to consider matters additional to safety
and cost-effectiveness. They also complain that most HTA reports fail to develop ethical arguments and generally
do not even mention ethical issues. This comment argues that some of these defects are more apparent than real and
are not inherent in HTA – as distinct from being common characteristics found in poorly conducted HTAs. More
generally, HTA does not need “extension” since (1) ethical issues are already embedded in HTA processes, not least in
their scoping phases, and (2) HTA processes are already sufficiently flexible to accommodate evidence about a wide
range of factors, and will not need fundamental change in order to accommodate the new forms of decision-relevant
evidence about distributional impact and financial protection that are now starting to emerge. HTA and related
techniques are there to support decision-makers who have authority to make decisions. Analysts like us are there to
support and advise them (and not to assume the responsibilities for which they, and not we, are accountable). The
required quality in HTA then becomes its effectiveness as a means of addressing the issues of concern to decisionmakers. What is also required is adherence by competent analysts to a standard template of good analytical practice.
The competencies include not merely those of the usual disciplines (particularly biostatistics, cognitive psychology,
health economics, epidemiology, and ethics) but also the imaginative and interpersonal skills for exploring the “real”
question behind the decision-maker’s brief (actual or postulated) and eliciting the social values that necessarily
pervade the entire analysis. The product of such exploration defines the authoritative scope of an HTA
Graphs Identified by Logics with Counting
We classify graphs and, more generally, finite relational structures that are
identified by C2, that is, two-variable first-order logic with counting. Using
this classification, we show that it can be decided in almost linear time
whether a structure is identified by C2. Our classification implies that for
every graph identified by this logic, all vertex-colored versions of it are
also identified. A similar statement is true for finite relational structures.
We provide constructions that solve the inversion problem for finite
structures in linear time. This problem has previously been shown to be
polynomial time solvable by Martin Otto. For graphs, we conclude that every
C2-equivalence class contains a graph whose orbits are exactly the classes of
the C2-partition of its vertex set and which has a single automorphism
witnessing this fact.
For general k, we show that such statements are not true by providing
examples of graphs of size linear in k which are identified by C3 but for which
the orbit partition is strictly finer than the Ck-partition. We also provide
identified graphs which have vertex-colored versions that are not identified by
Ck.Comment: 33 pages, 8 Figure
Visualizing the microscopic coexistence of spin density wave and superconductivity in underdoped NaFe1-xCoxAs
Although the origin of high temperature superconductivity in the iron
pnictides is still under debate, it is widely believed that magnetic
interactions or fluctuations play an important role in triggering Cooper
pairing. Because of the relevance of magnetism to pairing, the question of
whether long range spin magnetic order can coexist with superconductivity
microscopically has attracted strong interests. The available experimental
methods used to answer this question are either bulk probes or local ones
without control of probing position, thus the answers range from mutual
exclusion to homogeneous coexistence. To definitively answer this question,
here we use scanning tunneling microscopy to investigate the local electronic
structure of an underdoped NaFe1-xCoxAs near the spin density wave (SDW) and
superconducting (SC) phase boundary. Spatially resolved spectroscopy directly
reveal both the SDW and SC gap features at the same atomic location, providing
compelling evidence for the microscopic coexistence of the two phases. The
strengths of the SDW and SC features are shown to anti correlate with each
other, indicating the competition of the two orders. The microscopic
coexistence clearly indicates that Cooper pairing occurs when portions of the
Fermi surface (FS) are already gapped by the SDW order. The regime TC < T <
TSDW thus show a strong resemblance to the pseudogap phase of the cuprates
where growing experimental evidences suggest a FS reconstruction due to certain
density wave order. In this phase of the pnictides, the residual FS has a
favorable topology for magnetically mediated pairing when the ordering moment
of the SDW is small.Comment: 18 pages, 4 figure
Attitudes towards the use and acceptance of eHealth technologies : a case study of older adults living with chronic pain and implications for rural healthcare
Acknowledgements The research described here is supported by the award made by the RCUK Digital Economy programme to the dot.rural Digital Economy Hub; award reference: EP/G066051/1. MC’s time writing the paper is funded by the Scottish Government’s Rural and Environmental Science and Analytical Services Division (RESAS) under Theme 8 ‘Vibrant Rural Communities’ of the Food, Land and People Programme (2011–2016). MC is also an Honorary Research Fellow at the Division of Applied Health Sciences, University of Aberdeen. The input of other members of the TOPS research team, Alastair Mort, Fiona Williams, Sophie Corbett, Phil Wilson and Paul MacNamee who contributed to be wider study and discussed preliminary findings reported here with the authors of the paper is acknowledged. We acknowledge the feedback on earlier versions of this paper provided by members of the Trans-Atlantic Rural Research Network, especially Stefanie Doebler and Carmen Hubbard. We also thank Deb Roberts for her comments.Peer reviewedPublisher PD
Thromboelastography results on citrated whole blood from clinically healthy cats depend on modes of activation
<p>Abstract</p> <p>Background</p> <p>During the last decade, thromboelastography (TEG) has gained increasing acceptance as a diagnostic test in veterinary medicine for evaluation of haemostasis in dogs, however the use of TEG in cats has to date only been described in one previous study and a few abstracts. The objective of the present study was to evaluate and compare three different TEG assays in healthy cats, in order to establish which assay may be best suited for TEG analyses in cats.</p> <p>Methods</p> <p>90 TEG analyses were performed on citrated whole blood samples from 15 clinically healthy cats using assays without activator (native) or with human recombinant tissue factor (TF) or kaolin as activators. Results for reaction time (R), clotting time (K), angle (α), maximum amplitude (MA) and clot lysis (LY30; LY60) were recorded.</p> <p>Results</p> <p>Coefficients of variation (CVs) were highest in the native assay and comparable in TF and kaolin activated assays. Significant differences were observed between native and kaolin assays for all measured parameters, between kaolin and TF for all measured parameters except LY60 and between native and TF assays for R and K.</p> <p>Conclusion</p> <p>The results indicate that TEG is a reproducible method for evaluation of haemostasis in clinically healthy cats. However, the three assays cannot be used interchangeably and the kaolin- and TF activated assays have the lowest analytical variation indicating that using an activator may be superior for performing TEG in cats.</p
Inhibition of the glycaemic response by onion : a comparison between lactose-tolerant and lactose-intolerant adults
This document is the Accepted Manuscript of the following article: R Hoffman, G Ranjbar and A M Madden, ‘Inhibition of the glycaemic response by onion: a comparison between lactose-tolerant and lactose-intolerant adults’, European Journal of Clinical Nutritin, (2016), 70: 1089-1091. The Version of Record is available online at doi: 10.1038/ejcn.2016.44.This pilot study compared inhibition of the glycaemic response to glucose by a dietary source of quercetin glucosides (onion) in lactose-tolerant adults (n = 12) and lactose-intolerant adults (n = 12). We hypothesised that lactose-intolerant people (who do not express lactase) will retain intact quercetin glucosides that can inhibit glucose uptake via the glucose transporter SGLT1 whereas lactose-tolerant people (who do express lactase) will hydrolyse quercetin glucosides to free quercetin which does not inhibit glucose uptake. In a glucose tolerance test, reduction of peak glucose levels by an onion meal was higher in lactose-intolerant people than lactose-tolerant people (44.2% versus 19.3%, p = 0.04). Incremental area under the blood glucose curve was reduced more in lactose-intolerant people, but was not statistically significantly (54.5% versus 42.1%, p = 0.42). A diet containing quercetin glucosides may be of greater benefit for glycaemic control in lactose-intolerant people than in lactose-tolerant people.Peer reviewedFinal Accepted Versio
A Visual Metaphor Describing Neural Dynamics in Schizophrenia
Background: In many scientific disciplines the use of a metaphor as an heuristic aid is not uncommon. A well known example in somatic medicine is the 'defense army metaphor' used to characterize the immune system. In fact, probably a large part of the everyday work of doctors consists of 'translating' scientific and clinical information (i.e. causes of disease, percentage of succes versus risk of side-effects) into information tailored to the needs and capacities of the individual patient. The ability to do so in an effective way is at least partly what makes a clinician a good communicator. Schizophrenia is a severe psychiatric disorder which affects approximately 1% of the population. Over the last two decades a large amount of molecular-biological, imaging and genetic data have been accumulated regarding the biological underpinnings of schizophrenia. However, it remains difficult to understand how the characteristic symptoms of schizophrenia such as hallucinations and delusions are related to disturbances on the molecular-biological level. In general, psychiatry seems to lack a conceptual framework with sufficient explanatory power to link the mental- and molecular-biological domains. Methodology/Principal Findings: Here, we present an essay-like study in which we propose to use visualized concepts stemming from the theory on dynamical complex systems as a 'visual metaphor' to bridge the mental- and molecular-biological domains in schizophrenia. We first describe a computer model of neural information processing; we show how the information processing in this model can be visualized, using concepts from the theory on complex systems. We then describe two computer models which have been used to investigate the primary theory on schizophrenia, the neurodevelopmental model, and show how disturbed information processing in these two computer models can be presented in terms of the visual metaphor previously described. Finally, we describe the effects of dopamine neuromodulation, of which disturbances have been frequently described in schizophrenia, in terms of the same visualized metaphor. Conclusions/Significance: The conceptual framework and metaphor described offers a heuristic tool to understand the relationship between the mental- and molecular-biological domains in an intuitive way. The concepts we present may serve to facilitate communicatio
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