The Only Eye Study (OnES): a qualitative study of surgeon experiences of only eye surgery and recommendations for patient safety

OBJECTIVE: Performing surgery on patients with only one seeing-eye, where complications may result in catastrophic vision loss, presents unique challenges for the ophthalmic care team. There is currently no evidence regarding how surgeons augment their care when treating only eye patients and no guidelines for how these patients should be managed in hospital eye services. This study aimed to explore ophthalmic surgeons' experiences of only eye surgery and perceptions of current practice. DESIGN AND PARTICIPANTS: Ten ophthalmic surgeons were asked to relate their experiences and views on performing only eye surgery in indepth, semistructured interviews. Interviews were audio-recorded and transcribed. Qualitative data were subjected to thematic analysis to identify key themes. SETTING: Hospital eye service. RESULTS: Five key themes emerged relating to surgeons' experiences and perceptions of only eye surgery: (1) differences in approach to consent, (2) strategies for risk reduction, (3) unmet training needs, (4) value of surgical mentor and (5) emotional impact of unsuccessful outcomes. Recommendations for improving the surgical journey for both the patient and the surgeon related primarily to better recognition and understanding of the complexities inherent with only eye surgery. CONCLUSIONS: Outcomes of only eye surgery may be improved through a number of methods, including development of purpose-designed training fellowships, adoption of stress-reducing strategies and enhancement of available support services. The findings identify emerging themes unique to only eye surgery and the need for guidelines on the provision of care for these high-stakes surgical patients

Efecto de la hormona de crecimiento sobre los parámetros seminales, el hemograma parcial y el nivel de testosterona en búfalos Nili Ravi

The purpose of this trial was to examine the possible effects of exogenous growth hormone (GH) on semen quality, hematological variables and serum testosterone concentration in Nili Ravi buffalo. Bulls of the treatment group (n=3) were injected with recombinant GH 500 mg in a 15 day interval for 10 consecutive weeks, while bulls of control group (n=3) received equal volume of normal saline solution. Semen samples were collected twice per week and analyzed for physiological parameters. Blood samples collected fortnightly were analyzed for red blood cells count (RBC), hemoglobin concentration (Hb), packed cell volume (PCV), mean corpuscular volume (MCV), white blood cell (WBC), neutrophils, lymphocytes, and serum testosterone levels. Data were analyzed statistically using t-test. Results indicated that GH treatment of Nili-Ravi buffaloes significantly (p<0.05) increased ejaculatory volume (8.8±0.2 vs 7.7±0.2 ml), sperm motility (72.6±0.4 vs 67.4±0.7%), mass activity (3.35±0.07 vs 2.52±0.08), sperm concentration (982.2±67.8 vs 731.9±50.5 million/ml), live sperm (80.1±0.3 vs 75.8±0.5%) and serum testosterone (4.02±0.21 vs 2.37±0.07 ng/ml) compared to control bulls. Among hematological variables, lymphocytes were increased (p<0.05), but MCV, WBC count, and neutrophils decreased (p<0.05). Hb, RBC and PCV remained unchanged. However, values of these variables were within normal ranges for buffalo bulls. In conclusion, treatment of Nili-Ravi bulls with GH improved semen quality and increased serum testosterone without ostensible adverse effects on the general state.El propósito de este ensayo fue examinar los posibles efectos de la hormona de crecimiento exógena (GH) sobre la calidad del semen, algunas variables del hemograma y la concentración de testosterona en suero de toros bubalinos Nili Ravi. Los búfalos del grupo tratado (n=3) fueron inyectados con 500 mg de somatotropina recombinante cada 15 días durante 10 semanas consecutivas, mientras que los del grupo control (n=3) recibieron igual volumen de solución fisiológica salina. Las muestras de semen fueron tomadas dos veces por semana y analizadas para evaluar los parámetros fisiológicos. Las muestras de sangre colectadas quincenalmente fueron analizadas para establecer el recuento de glóbulos rojos, la  concentración de hemoglobina, el hematocrito, el volumen corpuscular medio (MCV), recuento de glóbulos blancos (WBC), tasa de neutrófilos y linfocitos, así como los niveles séricos de testosterona. Los datos obtenidos fueron analizados estadísticamente por medio del test-t de Student. Los resultados indicaron que el tratamiento con somatotropina aumentó significativamente (p<0,05) el volumen eyaculado (8,8±0,2 versus 7,7±0,2 ml), la motilidad del semen (72,6±0,4 versus 67,4±0,7%), la actividad de masa (3,35±0,07 versus 2,52±0,08), la concentración de espermatozoides (982,2±67,8 versus 731,9±50,5 millones/ml), los espermatozoides vivos (80,1±0,3 versus 75,8±0,5%) y el nivel de testosterona sérica (4,02±0,21 versus 2,37±0,07 ng/ml), comparados con los animales controles. En el hemograma aumentaron los linfocitos (p<0,05) y disminuyeron variables como volumen corpuscular medio, recuento de leucocitos y tasa de neutrófilos (p<0,05). Hemoglobina, concentración de eritrocitos y hematocrito permanecieron inalterados. Todos los parámetros investigados se situaron dentro de los rangos normales para toros bubalinos. En conclusión, el tratamiento de búfalos Nili-Ravi con somatotropina mejoró la calidad del semen y aumentó la testosterona sérica, sin provocar ostensibles efectos adversos en el estado general de los toro

A Framework for Complex Product Architecture Analysis using an Integrated Approach

YesContemporary design decomposition and synthesis analytical tasks at the conceptual design stage reply on functional and structural modelling approaches. There is a wide diversity of elements used by various modelling approaches for information and representation of product architecture, which incurs difficulties for multidisciplinary engineers working across different phases of design in capturing, visualising, sharing and tracing consistent yet common knowledge and elements across the function and structure domains. This prompts for fixation of detail and common modelling knowledge across both functional and structural analytical approaches which is also critical from automatized software perspective. A limitation of existing approaches is that they tend to focus more on ‘what’ and less on ‘how’ (and vice versa). This paper proposes an integrated conceptual product architecting approach that combines and expands the functional and structural modelling approaches, enabling capturing and tracing knowledge coherently through a common binding domain. This is underpinned by the view that most interaction requirements amongst the physical components during structural modelling can be derived from functional modelling. The proposed integrated approach is underpinned by the critical analysis and synthesis of existing approaches in literature dealing with functional and structural architecture analysis, integrated within a Multiple Domain Matrix (MDM) to fuse the knowledge of both solution independent (functional) and dependent (structural) analyses. The proposed framework is illustrated with a case study of solar robot toy, followed by discussion and suggestions for future work

Future Challenges and Mitigation Methods for High Photovoltaic Penetration: A Survey

: Integration of high volume (high penetration) of photovoltaic (PV) generation with power grids consequently leads to some technical challenges that are mainly due to the intermittent nature of solar energy, the volume of data involved in the smart grid architecture, and the impact power electronic-based smart inverters. These challenges include reverse power flow, voltage fluctuations, power quality issues, dynamic stability, big data challenges and others. This paper investigates the existing challenges with the current level of PV penetration and looks into the challenges with high PV penetration in future scenarios such as smart cities, transactive energy, proliferation of plug-in hybrid electric vehicles (PHEVs), possible eclipse events, big data issues and environmental impacts. Within the context of these future scenarios, this paper reviewed the existing solutions and provides insights to new and future solutions that could be explored to ultimately address these issues and improve the smart grid’s security, reliability and resilienc

Appendicitis with appendicular atresia: A rare presentation

Acute appendicitis is the most common acute surgical condition; making appendectomy the most commonly performed emergency surgical procedure in the world. Anomalies of the appendix are relatively  uncommon. However, their presence may alter the course of pre-operativediagnosis and the surgical treatment provided, leading to medico-legal issues in certain cases as well. We hereby present the case of a 17  year-old female who had the suggestive signs, symptoms and  investigations of appendicular lump. She was managed according to the Ochsner-Sherren regimen and then underwent interval open appendectomy 6 weeks later. During the procedure, the findings of a 5 cm long appendix were noted. The base of the appendix was attached to the caecum, however there was complete mucosal discontinuity between the base and the remaining portion of the appendix. A fibrous strand connected the two blind ending parts together. After thorough literature search, the authors concluded that this is only the fourth reported case of appendicular atresia ever to have been reported. Considering the rarity of this finding we feel this could be of valuable interest to surgeons and readers alik

A novel CYP1A1 gene polymorphism and the risk of head and neck cancer in Pakistani population

Several polymorphisms in the CYP1A1 locus have been identified and their genotypes appear to exhibit population frequencies that depend on ethnicity. In this study, we assessed the role of CYP1A1 genotype in 388 head and neck cancer patients in Pakistani population via a case-control study. Polymerase chain reaction (PCR) and single stranded conformational polymorphism assays were used. Most of the patients (51%) enrolled for the study, were from the age group of 40 to 60 years (±16.59). Mean age of the cancer patients involved in the study was 48 ± 16.59 years. Statistical analysis has shown that, tobacco users have more chances of head and neck cancer (P < 0.05) than non tobacco users, whereas male to female ratio is 1:1 (P > 0.05). Jobless persons are more prone to head and neck cancer (P < 0.01) compared with employers and housewives. After the genetic analysis, it was found that no already reported variants of CYP1A1 gene were found in Pakistani population. A novel mutation in CYP1A1 gene at exon 2 in 21 patients (P < 0.001, Odd Ratio (OR) = 9.4 and 95% confidence interval (CI) 1.3 to 70.8) has been found with a serine formation instead of tyrosine at amino acid 110. The patients showing this mutation have the mean age of 51.75 (±15.7). Therefore, mutation in CYP1A1 gene may be one of several factors that increase the chance of developing head and neck cancer.Key words: Cytochrome P450 1A1 gene (CYP1A1), head and neck cancer (HNC), mutation, novel polymorphism, Pakistani population

Identifying Unnatural Variation in Precision Rotational Part Manufacturing

In the manufacturing industry, it is well known that in-process variation is a major contributor to poor quality products. In order to fabricate a precise part, the source of unnatural variation (UV) needed to be properly identified, monitored and controlled while the process is running. In relation to this issue, this study aims to identify the error root causes of UV in bivariate process associated with statistical process control (SPC) chart patterns. In research methodology, in-process variation in manufacturing roller head component was discussed systematically based on real product of roller head, computer aided design (CAD) and statistical process control (SPC) chart patterns. Initially, the CAD software was used to model a precise rotational part, and to analyse the cause of UV. Then, the programming software was used to generate the artificial SPC data streams based on an established mathematical model. Data generation also involved linear correlation between two dependent variables (bivariate). The outcome of this study would be helpful for industrial practitioners as a database when applying SPC for monitoring bivariate process