Initial experience in self-monitoring of intraocular pressure.

Background/aims: Diurnal variation in intraocular pressure (IOP) is a routine assessment in glaucoma management. Providing patients the opportunity to perform self-tonometry might empower them and free hospital resource. We previously demonstrated that 74% of patients can use the Icare® HOME tonometer. This study further explores Icare® HOME patient self-monitoring. Methods: Patients were trained by standard protocol to use the Icare® HOME rebound tonometer. Patient self-tonometry was compared to Goldmann applanation tonometry (GAT) over one clinical day. Following this, each patient was instructed to undertake further data collection that evening and over the subsequent two days. Results: Eighteen patients (35 eyes) participated. Good agreement was demonstrated between GAT and Icare® HOME for IOPs up to 15 mm Hg. Above this IOP the Icare® tended to over-read, largely explained by 2 patients with corneal thickness >600 um. The mean peak IOP during ‘clinic hours’ phasing was 16.7 mm Hg and 18.5 mm Hg (p = 0.24) over three days. An average range of 5.0, 7.0 and 9.8 mm Hg was shown during single day clinic, single day home and three day home phasing respectively (p =<0.001). The range of IOP was lower in eyes with prior trabeculectomy (6.1 mm Hg vs 12.2 mm Hg). All patients undertook one reading in the early morning at home with an average of 4.8 readings during, and 3.1 readings after office hours. Conclusions: This small study shows that self-tonometry is feasible. The findings from home phasing demonstrated higher peak and trough IOPs, providing additional clinical information. Home phasing is a viable alternative. The cost-effectiveness of this approach has yet to be addressed

Evaluation of a new rebound tonometer for self-measurement of intraocular pressure

Background/aims To compare the accuracy of self-obtained, partner-obtained and trainer-obtained measurements using the handheld Icare Home rebound tonometer with Goldmann applanation tonometry (GAT), and to evaluate the acceptability to subjects of Icare Home measurement. Methods 76 subjects were trained to use Icare Home for self-measurement using a standardised protocol. A prespecified checklist was used to assess the ability of a subject to perform self-tonometry. Accuracy of Icare Home self-measurement was compared with GAT using one eye per subject, randomly selected. Bland-Altman difference analysis was used to compare Icare Home and GAT intraocular pressure (IOP) estimates. Acceptability of self-tonometry was evaluated using a questionnaire. Results 56 subjects (74%, 95% CI 64 to 84) were able to correctly perform self-tonometry. Mean bias (95% limits of agreement) was 0.3 mm Hg (−4.6 to 5.2), 1.1 mm Hg (−3.2 to 5.3) and 1.2 mm Hg (−3.9 to 6.3) for self-assessment, partner-assessment and trainer-assessment, respectively, suggesting underestimation of IOP by Icare Home tonometry. Differences between GAT and Icare Home IOP were greater for central corneal thickness below 500 µm and above 600 µm than data points within this range. Acceptability questionnaire responses showed high agreement that the self-pressure device was easy to use (84%), the reading was quick to obtain (88%) and the measurement was comfortable (95%). Conclusions Icare Home tonometry can be used for self-measurement by a majority of trained subjects. IOP measurements obtained using Icare Home tonometry by self-assessment and third party-assessment showed slight underestimation compared with GAT

Randomised controlled trial of specialist nurse intervention in heart failure

&lt;p&gt;Objectives. To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure.&lt;/p&gt; &lt;p&gt;Design. Randomised controlled trial.&lt;/p&gt; &lt;p&gt;Setting. Acute medical admissions unit in a teaching hospital.&lt;/p&gt; &lt;p&gt;Participants. 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year.&lt;/p&gt; &lt;p&gt;Main outcome measures. Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure.&lt;/p&gt; &lt;p&gt;Results. 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96).Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P&#60;0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051).&lt;/p&gt; &lt;p&gt;Conclusions. Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.&lt;/p&gt

Noncontact Screening Methods for the Detection of Narrow Anterior Chamber Angles

PURPOSE: Comparing diagnostic accuracy of biomicroscope techniques (van Herick and Smith's tests, evaluating limbal and central anterior chamber depth, respectively) and advanced imaging (Visante OCT and Pentacam) for detection of gonioscopically narrow anterior chamber angles (ACAs). METHODS: A total of 78 subjects with narrow or open ACAs underwent four index tests, performed on both eyes by examiners masked to other test results. Diagnostic performance was compared with gonioscopy, using International Society of Geographical and Epidemiological Ophthalmology (ISGEO) definition of primary angle closure and a classification based on clinical opinion of occludability. Data were analyzed using both the eye and the individual as unit of analysis. Sensitivity, specificity, and partial area under the receiver operating characteristic curve (AUROC) were generated. RESULTS: Using the eye as the unit of analysis, the van Herick grading cutoff of 25% or less and ISGEO gonioscopic classification achieved 80% (confidence interval [CI] 65 to 89) sensitivity and 92% specificity (CI 80 to 97) for narrow angle detection, with specificity reaching 97% (CI 87 to 100) for a cutoff of less than or equal to 15%. Notably, with a gonioscopic classification based on clinical opinion of occludability, van Herick (≤25%) together with Smith's test (≤2.50 mm) detected 100% of narrow angle subjects. Of the three Pentacam parameters, anterior chamber volume achieved highest test sensitivity of 85% (CI 70 to 94) using the ISGEO definition. Visante OCT ACA had greatest partial AUROC at 90% specificity, also yielding sensitivity and specificity greater than 85% using the Youden-derived cutoff of less than or equal to 20.7°and ISGEO definition. CONCLUSIONS: Van Herick test and Visante OCT ACA exhibited best discrimination between narrow and open angles both alone, and in combination. Van Herick test affords advantages over Visante OCT, showing potential for identifying individuals who may benefit from further gonioscopic assessment in a case-finding or screening setting

Educating through Exemplars: Alternative Paths to Virtue

This paper confronts Zagzebski’s exemplarism with the intertwined debates over the conditions of exemplarity and the unity-disunity of the virtues, to show the advantages of a pluralistic exemplar-based approach to moral education (PEBAME). PEBAME is based on a prima facie disunitarist perspective in moral theory, which amounts to admitting both exemplarity in all respects and single-virtue exemplarity. First, we account for the advantages of PEBAME, and we show how two figures in recent Italian history (Giorgio Perlasca and Gino Bartali) satisfy Blum’s definitions of ‘moral hero’ and ‘moral saint’ (1988). Then, we offer a comparative analysis of the effectiveness of heroes and saints with respect to character education, according to four criteria derived from PEBAME: admirability, virtuousness, transparency, and imitability. Finally, we conclude that both unitarist and disunitarist exemplars are fundamental to character education; this is because of the hero's superiority to the saint with respect to imitability, a fundamental feature of the exemplar for character education

Stage‐dependent responses to emergent habitat heterogeneity: consequences for a predatory insect population in a coffee agroecosystem

Interactions among members of biological communities can create spatial patterns that effectively generate habitat heterogeneity for other members in the community, and this heterogeneity might be crucial for their persistence. For example, stage‐dependent vulnerability of a predatory lady beetle to aggression of the ant, Azteca instabilis, creates two habitat types that are utilized differently by the immature and adult life stages of the beetle. Due to a mutualistic association between A. instabilis and the hemipteran Coccus viridis – which is A. orbigera main prey in the area – only plants around ant nests have high C. viridis populations. Here, we report on a series of surveys at three different scales aimed at detecting how the presence and clustered distribution of ant nests affect the distribution of the different life stages of this predatory lady beetle in a coffee farm in Chiapas, Mexico. Both beetle adults and larvae were more abundant in areas with ant nests, but adults were restricted to the peripheries of highest ant activity and outside the reach of coffee bushes containing the highest densities of lady beetle larvae. The abundance of adult beetles located around trees with ants increased with the size of the ant nest clusters but the relationship is not significant for larvae. Thus, we suggest that A. orbigera undergoes an ontogenetic niche shift, not through shifting prey species, but through stage‐specific vulnerability differences against a competitor that renders areas of abundant prey populations inaccessible for adults but not for larvae. Together with evidence presented elsewhere, this study shows how an important predator is not only dependent on the existence of two qualitatively distinct habitat types, but also on the spatial distribution of these habitats. We suggest that this dependency arises due to the different responses that the predator's life stages have to this emergent spatial pattern. Interactions among members of biological communities can create spatial patterns that effectively generate habitat heterogeneity for other members in the community and this heterogeneity might be crucial for their persistence. Here we report how a voracious predatory ladybeetle in a coffee farm in Chiapas, Mexico undergoes an ontogenetic niche shift, not through shifting prey species, but through stage‐specific vulnerability differences against a competitor that renders areas of abundant prey populations inaccessible for adults but not for larvae. Our study suggests that the resulting spatial separation of resources may be crucial for the predator population persistence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108324/1/ece31161.pd

High resolution infrared absorption spectra, crystal field, and relaxation processes in CsCdBr_3:Pr^3+

High resolution low-temperature absorption spectra of 0.2% Pr^3+ doped CsCdBr_3 were measured in the spectral region 2000--7000 cm-1. Positions and widths of the crystal field levels within the 3H5, 3H4, 3F2, and 3F3 multiplets of the Pr^3+ main center have been determined. Hyperfine structure of several spectral lines has been found. Crystal field calculations were carried out in the framework of the semiphenomenological exchange charge model (ECM). Parameters of the ECM were determined by fitting to the measured total splittings of the 3H4 and 3H6 multiplets and to the observed in this work hyperfine splittings of the crystal field levels. One- and two-phonon relaxation rates were calculated using the phonon Green's functions of the perfect (CsCdBr_3) and locally perturbed (impurity dimer centers in CsCdBr_3:Pr^3+) crystal lattice. Comparison with the measured linewidths confirmed an essential redistribution of the phonon density of states in CsCdBr_3 crystals doped with rare-earth ions.Comment: 16 pages, 5 tables, 3 figure

The unacknowledged legacy

This paper presents a critical discussion of the treatment of mimetic art, and particularly poetry and the theatre, in the work of the Athenian philosopher Plato (427-347 BC). It centres on Plato's discussion of the corrupting powers of the arts in the Republic, and the implications that his fierce attack on poetry and theatre have for his construction of the ideal polity. The legacy of Platonic ideas in later elaborations of the corrupting power of the arts is discussed. Furthermore, the paper investigates the relationship between current debates on cultural policy and the Platonic idea that the transformative powers of the arts ought to be harnessed by the state to promote a just society. The conclusion thus reached is that “instrumental cultural policy”, rather then being a modern invention, was in fact first theorized precisely in Plato's Republic

The Molonglo Reference Catalog 1-Jy radio source survey IV. Optical spectroscopy of a complete quasar sample

Optical spectroscopic data are presented here for quasars from the Molonglo Quasar Sample (MQS), which forms part of a complete survey of 1-Jy radio sources from the Molonglo Reference Catalogue. The combination of low-frequency selection and complete identifications means that the MQS is relatively free from the orientation biases which affect most other quasar samples. To date, the sample includes 105 quasars and 6 BL Lac objects, 106 of which have now been confirmed spectroscopically. This paper presents a homogenous set of low-resolution optical spectra for 79 MQS quasars, the majority of which have been obtained at the Anglo-Australian Telescope. Full observational details are given and redshifts, continuum and emission-line data tabulated for all confirmed quasars.Comment: 40 pages, ApJS in pres