Ultrasound and phakometry measurements of the primate eye Technical report, Aug. 1965

Ultrasonic testing and phakometry measurements of primate ey

Modelling the Inflammatory Bowel Disease Specialist Nurse Workforce standards by determination of optimum caseloads in the United Kingdom.

Background and Aims Crohn’s disease and ulcerative colitis are the most common forms of inflammatory bowel disease affecting 1 in 250 of the population in the UK. It is accepted that access to a specialist nurse service improves patient experience and outcome. National Standards for inflammatory bowel disease care (2013) defined the number of nurse specialists required at 1.5 full time equivalent per 250,000 population. The aim of this study was to determine if these standards were being met and to publish a new, robust validated standard optimising the UK nursing workforce model. Methods Existing national data and specific workload and service data was collected from 164 IBD specialist nurses who completed a questionnaire designed to collect information on activity and complexity of work both done and undone. Results Data was received from all of the UK. Thirty-six percent of respondents were specialist nurses in the field for 3 years or less. A higher caseload than the recommended level was reported by 63% of respondents. Unpaid overtime was regularly carried out by 84%of respondents. The IBD specialist nurse was involved in all areas of the patient pathway. Areas of work left undone were psychological interventions, prescribing medicines and physical assessments. Conclusions Compared to other specialties IBD specialist nurses are less experienced. It is recommended that the current standard be increased to 2.5 full time equivalent specialist nurses per 250,000. patients to mitigate for the increasing complexity of the role, care and the “rookie” factor. Keywords: Inflammatory Bowel Disease, Specialist Nurse, Workforce Modellin

Determining acute nurse staffing, a hermeneutic review of an evolving science.

Abstract Background Calculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review aims to examine current approaches to the issue across many disciplines. Design The approach taken is iterative and in the form of a hermeneutic review. 769 pieces of evidence were reviewed from across disciplines such as nursing, medicine, engineering, statistics, population science, computer science and mathematics where hospital nurse staffing was the subject of the study. Results A number of themes emerged. The first iteration showed the predominance of unit base approaches (e.g. nurse numbers, ratios, activity and workload) the second was the development of methodologies. Subsequent iterations examined issues such as demand, safety, nurse education, turnover, patient outcomes, patient or staff satisfaction, workload and activity. The majority of studies examined (n=767) demonstrated some association between staffing (units or type/skill) and various factors such as staff or patient satisfaction, working conditions, safety parameters, outcomes complexity of work achieved, work left undone or other factors. Many potential areas such as operational safety research were not utilised. Conclusion Although the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution. The nature of these relationships should be further examined in order to determine nurse staffing. The body of knowledge appears substantial and complex yet appears to have little impact on policy

Observation of Interaction of Spin and Intrinsic Orbital Angular Momentum of Light

Interaction of spin and intrinsic orbital angular momentum of light is observed, as evidenced by length-dependent rotations of both spatial patterns and optical polarization in a cylindrically-symmetric isotropic optical fiber. Such rotations occur in straight few-mode fiber when superpositions of two modes with parallel and anti-parallel orientation of spin and intrinsic orbital angular momentum (IOAM=$2\hslash$) are excited, resulting from a degeneracy splitting of the propagation constants of the modes.Comment: 6 pages, 5 figures, and a detailed supplement. Version 3 corrects a typo and adds the journal referenc

Behavioural early-life exposures and body composition at age 15 years

BACKGROUND/OBJECTIVES: Previous studies have demonstrated associations between some early-life exposures and later obesity, but most have used body mass index in childhood or adulthood as the outcome. The objective of this study was to investigate whether early-life exposures were associated with directly measured fat and lean mass in adolescence. SUBJECTS/METHODS: This study used data on 4750 mother–offspring pairs, collected as a part of the Avon Longitudinal Study of Parents and Children, Bristol, UK between 1991 and 1992; associations between behavioural exposures occurring from conception up to 5 years of age (maternal and paternal smoking during pregnancy, breastfeeding, age at introduction to solids, dietary patterns and physical inactivity during early childhood) and offspring body composition measured by dual-energy X-ray absorptiometry at ~ 15 years were assessed. RESULTS: After full adjustment for potential confounders, maternal smoking during pregnancy, having a junk food diet and spending more time watching television in early childhood were all associated with higher fat mass at age 15, whereas maternal smoking, having a healthy diet and playing computer games more frequently in early childhood were all associated with a higher lean mass at age 15. Associations with paternal smoking were generally weaker for both fat and lean mass, but as there was no strong statistical evidence for maternal vs paternal differences, confounding by social factors rather than a direct effect of maternal smoking cannot be ruled out. Early feeding was not associated with fat or lean mass at age 15. CONCLUSIONS: This study does not provide compelling evidence for associations between most early-life factors and body composition in adolescence. However, possible associations with dietary patterns and physical inactivity in early childhood require further investigation in other cohorts that have direct measurements of adolescent body composition.SD Leary, DA Lawlor, G Davey Smith, MJ Brion and AR Nes

Emergency care patient driven solutions for severe asthma

Purpose Patients with severe asthma were choosing not to use the emergency department in extremis and were self-medicating when experiencing severe asthma, putting their lives at risk. This local issue was a reflection of a nationwide situation. The aim of this study was to better understand the reasons for this locally and consider practical solutions in a structured way with users of the service Methodology Systems thinking was used (soft systems methodology) to better understand the problem and examine possible solutions in co-production with people who live with severe asthma. Findings and Practical implications The problem was identified and fully revealed-patients felt vulnerable and fearful of the emergency department. This appeared to be a well-defined problem with possible solutions. Once this tame problem was revealed a possible solution was developed in co-production with patients. The solution was an Asthma Patient Passport (APP) which increased confidence in patient’s ability to communicate their needs in severe distress by facilitating communication of needs and decreased the work patients had to do to achieve care from twelve steps to five steps. The implementation of the APP is currently being evaluated. Value By revisiting systems thinking and identifying problems, a solution was possible. Although methods such as soft systems methodology have limitations when used to in wicked problems, such methods still appear to have merit in tame problems and could be used in these circumstances to fully understand problems and design practical solutions

Stable Mode Sorting by Two-Dimensional Parity of Photonic Transverse Spatial States

We describe a mode sorter for two-dimensional parity of transverse spatial states of light based on an out-of-plane Sagnac interferometer. Both Hermite-Gauss (HG) and Laguerre-Gauss (LG) modes can be guided into one of two output ports according to the two-dimensional parity of the mode in question. Our interferometer sorts HG_nm input modes depending upon whether they have even or odd order n+m; it equivalently sorts LG modes depending upon whether they have an even or odd value of their orbital angular momentum. It functions efficiently at the single-photon level, and therefore can be used to sort single-photon states. Due to the inherent phase stability of this type of interferometer as compared to those of the Mach-Zehnder type, it provides a promising tool for the manipulation and filtering of higher order transverse spatial modes for the purposes of quantum information processing. For example, several similar Sagnacs cascaded together may allow, for the first time, a stable measurement of the orbital angular momentum of a true single-photon state. Furthermore, as an alternative to well-known holographic techniques, one can use the Sagnac in conjunction with a multi-mode fiber as a spatial mode filter, which can be used to produce spatial-mode entangled Bell states and heralded single photons in arbitrary first-order (n+m=1) spatial states, covering the entire Poincare sphere of first-order transverse modes.Comment: 11 pages, 12 figures, 2 appendice

The Experiences of Specialist Nurses Working Within the Uro-oncology Multidisciplinary Team in the United Kingdom.

PURPOSE: United Kingdom prostate cancer nursing care is provided by a variety of urology and uro-oncology nurses. The experience of working in multidisciplinary teams (MDT) was investigated in a national study. DESIGN: The study consisted of a national survey with descriptive statistics and thematic analysis. METHODS: A secondary analysis of a data subset from a UK whole population survey was undertaken (n = 285) of the specialist nursing workforce and the services they provide. Data were collected on the experience of working in the MDT. RESULTS: Forty-five percent of the respondents felt that they worked in a functional MDT, 12% felt that they worked in a dysfunctional MDT, and 3.5% found the MDT meeting intimidating. Furthermore, 34% of the nurses felt that they could constructively challenge all members of the MDT in meetings. Themes emerging from open-ended questions were lack of interest in nonmedical concerns by other team members, ability to constructively challenge decisions or views within the meeting, and little opportunity for patients' wishes to be expressed. CONCLUSIONS: Despite expertise and experience, nurses had a variable, often negative, experience of the MDT. It is necessary to ensure that all participants can contribute and are heard and valued. More emphasis should be given to patients' nonmedical needs

Bevacizumab for newly diagnosed ovarian cancers: Best candidates among high-risk disease patients (icon-7)

Bevacizumab is approved as a maintenance treatment in first-line setting in advanced-stage III-IV ovarian cancers, because GOG-0218 and ICON-7 phase III trials demonstrated progression-free survival benefits. However, only the subgroup of patients with high-risk diseases (stage IV, and incompletely resected stage III) derived an overall survival (OS) gain in the ICON-7 trial (4.8 months). The modeled CA-125 elimination rate constant K (KELIM) parameter, based on the longitudinal CA- 125 kinetics during the first 100 days of chemotherapy, is a potential indicator of the tumor primary chemo-sensitivity. In the ICON-7 trial dataset, the OS of patients within the low- and high-risk disease groups was assessed according to treatment arms and KELIM. Among the patients with high-risk diseases, those with favorable standardized KELIM of at least 1.0 (n=214, 46.7%) had no survival benefit from bevacizumab, whereas those with unfavorable KELIM less than 1.0 (n=244, 53.2%) derived the highest OS benefit (absolute difference = 9.1 months, 2-sided log-rank P=.10; Cox hazard ratio = 0.78, 95% confidence interval = 0.58 to 1.04, 2-sided P=.09)

Observation of Interaction of Spin and Intrinsic Orbital Angular Momentum of Light

The interaction of spin and intrinsic orbital angular momentum of light is observed, as evidenced by length-dependent rotations of both spatial patterns and optical polarization in a cylindrically symmetric isotropic optical fiber. Such rotations occur in a straight few-mode fiber when superpositions of two modes with parallel and antiparallel orientation of spin and intrinsic orbital angular momentum (IOAM=2ℏ) are excited, resulting from a degeneracy splitting of the propagation constants of the modes