OCT for glaucoma diagnosis, screening and detection of glaucoma progression.

Optical coherence tomography (OCT) is a commonly used imaging modality in the evaluation of glaucomatous damage. The commercially available spectral domain (SD)-OCT offers benefits in glaucoma assessment over the earlier generation of time domain-OCT due to increased axial resolution, faster scanning speeds and has been reported to have improved reproducibility but similar diagnostic accuracy. The capabilities of SD-OCT are rapidly advancing with 3D imaging, reproducible registration, and advanced segmentation algorithms of macular and optic nerve head regions. A review of the evidence to date suggests that retinal nerve fibre layer remains the dominant parameter for glaucoma diagnosis and detection of progression while initial studies of macular and optic nerve head parameters have shown promising results. SD-OCT still currently lacks the diagnostic performance for glaucoma screening

Adult Attachment and Personal Recovery in Clients With a Psychotic Disorder

Background: Personal recovery has become a key objective in the treatment of clients with a psychotic disorder. So far it has been established that the two attachment dimensions, ie, anxious and avoidant, are negatively associated with subjective well-being, self-esteem and hope. This study is the first to explore whether attachment styles are related to personal recovery in this population. Aims: To study the effects of anxious and avoidant attachment on personal recovery in a population with a psychotic disorder. Method: This cross-sectional study is part of the UP's multicenter cohort study on recovery from psychotic disorders, in which 265 participants are currently included. Attachment was assessed using the Psychosis Attachment Measure, including the anxious and avoidant attachment dimensions. Personal recovery was measured using the Recovering Quality of Life-10 (ReQOL-10) and the Individual Recovery Outcomes Counter (I.ROC). Regression analysis was used to investigate the effect of attachment on personal recovery. Results: We found negative effects of the anxious attachment style on the total scores of the ReQoL-10 (b = -4.54, SE = 0.69, β = β0.37) and the I.ROC (b = -5.21, SE = 0.89, β = -0.32). Although there were also negative effects of the avoidant attachment style on the total scores of the ReQoL-10 (b = -3.08, SE = 0.93, β = -0.18) and the I.ROC (b = -4.24, SE = 1.24, β = -0.19), these were less pronounced. Conclusion: Results show that both forms of insecure attachment (anxious and avoidant) are related to poorer personal recovery in clients with a psychotic disorder.</p

Glaucoma surgery calculator: limited additive IOP effect of phacoemulsification on Ab Interno Trabeculectomy

Purpose: To compare reduction of intraocular pressure (IOP) after Trabectome in pseudophakic patients and Trabectome combined with phacoemulsification (Trabectome-phaco) in phakic patients. Methods: Cases were excluded if patients were followed for less than 12 months, diagnosed with neovascular glaucoma, or required additional glaucoma surgery within 12 months after Trabectome or Trabectome-phaco. Missing data such as type of glaucoma, gender, or age was imputed by generating 5 similar but non-identical datasets. Groups were matched using Coarsened Exact Matching based on age, gender, type of glaucoma, race, preoperative number of glaucoma medications and baseline IOP. Linear regression was used to examine IOP reduction after surgery. Results: A total of 612 cases were included in the study with 248 Trabectome cases and 364 Trabectome-phaco cases. Baseline IOP was found to be statistically significant. An average of 0.73±0.03 mmHg IOP reduction is associated with an increment of 1 mmHg in baseline IOP. Type of surgery was not statistically significant after adjusting for baseline IOP, age, baseline number of glaucoma medications and type of glaucoma. Conclusion: Patients with higher baseline IOP are expected to have a greater IOP reduction

Beyond the plot: technology extrapolation domains for scaling out agronomic science

Ensuring an adequate food supply in systems that protect environmental quality and conserve natural resources requires productive and resource-efficient cropping systems on existing farmland.Meeting this challenge will be difficult without a robust spatial framework that facilitates rapid evaluation and scaling-out of currently available and emerging technologies. Here we develop a global spatial framework to delineate ‘technology extrapolation domains’ based on key climate and soil factors that govern crop yields and yield stability in rainfed crop production. The proposed framework adequately represents the spatial pattern of crop yields and stability when evaluated over the data-rich US Corn Belt. It also facilitates evaluation of cropping system performance across continents, which can improve efficiency of agricultural research that seeks to intensify production on existing farmland. Populating this biophysical spatial framework with appropriate socio-economic attributes provides the potential to amplify the return on investments in agricultural research and development by improving the effectiveness of research prioritization and impact assessment

Matched comparison of phaco-trabectome to trabectome in phakic patients

Coarsened Exact Matching allowed for a balanced comparison between phakic patients who received ab interno trabeculectomy and trabectome with same session phacoemulsification. Phacoemulsification was not found to be a statistically significant contributor to IOP reduction when combined with this microincisional glaucoma surgery

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity.

Prior glaucoma severity staging systems were mostly concerned with visual field function and retinal nerve fiber layer, but did not include intraocular pressure or medications to capture resistance to treatment. We recently introduced a simple index that combines pressure, medications, and visual field damage and applied it to stratify outcomes of trabectome surgery. In the analysis presented here, we combined data of trabectome alone and trabectome with same session cataract surgery to increase testing power and chances of effect discovery. This microincisional glaucoma surgery removes the primary resistance to outflow in glaucoma, the trabecular meshwork, and has been mostly used in mild glaucoma. Traditional glaucoma surgeries have a relatively high complication rate and have been reserved for more advanced disease stages. In the analysis presented here we include our data of trabectome combined with cataract surgery. This is a common practice pattern as both occur in the same age group with increasing frequency. For patients in higher glaucoma index (GI) groups, the intraocular pressure (IOP) reduction was 2.34+/-0.19 mmHg more than those in a GI group one level lower while holding everything else constant. Those who had undergone trabectome combined with phacoemulsification had an IOP reduction that was 1.29+/-0.39 mmHg less compared to those with trabectome alone. No statistically significant difference was found between genders and age groups while holding everything else constant. Hispanics had a 3.81+/-1.08 mmHg greater IOP reduction. Pseudoexfoliation and steroid glaucoma patients had an IOP reduction that was greater by 2.91+/-0.56 and 3.86+/-0.81 mmHg, respectively, than those with primary open angle glaucoma. These results suggest a role for trabectome-mediated ab interno trabeculectomy beyond mild forms of glaucoma. Additionally, the multifactorial glaucoma index demonstrates a role in staging patients when comparing glaucoma surgical modalities

Detailed analysis of the blade root flow of a horizontal axis wind turbine

The root flow of wind turbine blades is subjected to complex physical mechanisms that influence significantly the rotor aerodynamic performance. Spanwise flows, the Himmelskamp effect, and the formation of the root vortex are examples of interrelated aerodynamic phenomena that take place in the blade root region. In this study we address those phenomena by means of particle image velocimetry (PIV) measurements and Reynolds-averaged Navier&ndash;Stokes (RANS) simulations. The numerical results obtained in this study are in very good agreement with the experiments and unveil the details of the intricate root flow. The Himmelskamp effect is shown to delay the stall onset and to enhance the lift force coefficient Cl even at moderate angles of attack. This improvement in the aerodynamic performance occurs in spite of the negative influence of the mentioned effect on the suction peak of the involved blade sections. The results also show that the vortex emanating from the spanwise position of maximum chord length rotates in the opposite direction to the root vortex, which affects the wake evolution. Furthermore, the aerodynamic losses in the root region are demonstrated to take place much more gradually than at the tip

Stratification of phaco-trabectome surgery results using a glaucoma severity index

Purpose: Nonsurgical glaucoma therapy reduces intraocular pressure (IOP) by a percentage that is similar for most patients. Recently introduced microincisional glaucoma surgeries are different because they remove the trabecular meshwork that constitutes the primary resistance to outflow. We hypothesized that because of this, the resulting postoperative IOP, rather than the relative reduction, had to be independent of glaucoma severity. We applied a glaucoma index (GI) to analyze outcomes of trabectome surgery combined with phacoemulsification (PT) by glaucoma severity. Methods: Only PT with 12 month follow up and no other surgeries were included. GI incorporated preoperative IOP, medications (meds) and visual field (VF). Baseline IOP was divided into 4 groups

Endothelial dysfunction and low-grade inflammation are associated with greater arterial stiffness over a 6-year period

Endothelial dysfunction and low-grade inflammation are associated with cardiovascular disease. Arterial stiffening plays an important role in cardiovascular disease and, thus, may be a mechanism through which endothelial dysfunction and/or low-grade inflammation lead to cardiovascular disease. We investigated the associations between, on the one hand, biomarkers of endothelial dysfunction (soluble endothelial selectin, thrombomodulin, and both vascular and intercellular adhesion molecules 1 and von Willebrand factor) and of low-grade inflammation (C-reactive protein, serum amyloid A, interleukin 6, interleukin 8, tumor necrosis factor-α and, soluble intercellular adhesion molecule 1) and, on the other hand, arterial stiffness over a 6-year period, in 293 healthy adults (155 women). Biomarkers were combined into mean z scores. Carotid, femoral, and brachial arterial stiffness and carotid-femoral pulse wave velocity were determined by ultrasonography. Measurements were obtained when individuals were 36 and 42 years of age. Associations were analyzed with generalized estimating equation and adjusted for sex, height, and mean arterial pressure. The endothelial dysfunction z score was inversely associated with femoral distensibility (β:-0.51 [95% CI:-0.95 to-0.06]) and compliance coefficients (β:-0.041 [95% CI:-0.076 to-0.006]) but not with carotid or brachial stiffness or carotid-femoral pulse wave velocity. The low-grade inflammation z score was inversely associated with femoral distensibility (β:-0.51 [95% CI:-0.95 to-0.07]) and compliance coefficients (β:-0.050 [95% CI:-0.084 to-0.016]) and with carotid distensibility coefficient (β:-0.910 [95% CI:-1.810 to-0.008]) but not with brachial stiffness or carotid-femoral pulse wave velocity. Biomarkers of endothelial dysfunction and low-grade inflammation are associated with greater arterial stiffness. This provides evidence that arterial stiffening may be a mechanism through which endothelial dysfunction and low-grade inflammation lead to cardiovascular disease