Phakic anterior chamber intraocular lens (Verisyse™) implantation in children for treatment of severe ansiometropia myopia and amblyopia: Six-month pilot clincial trial and review of literature

Amir Pirouzian1,3, Kenneth C Ip2, Henry S O’Halloran31The Permanente Medical Group, Santa Clara, CA, USA; 2The Permanente Medical Group, San Francisco, CA, USA; 3Rady’s Children’s Hospital of San Diego, San Diego, CA, USAPurpose: The current study aims to evaluate both safety and efficacy of Verisyse™ (AMO, Irvine, CA) phakic anterior chamber intraocular lens (IOL) in the reduction of clinically significant (>-8 D) myopic anisometropia in children who are noncompliant to traditional medical treatment including spectacle correction or contact lenses.Design: Retrospective interventional case series.Methods: Six anisometropic myopic pediatric patients in one practice were identified through chart-review. None of the patients were compliant with specatacle correction or contact lens wear and as a result had dense amblyopia of less than 20/400 by Snellen or Allen visual acuity (mean <20/400). All patients underwent Verisyse™ phakic IOL implantation in the more myopic eye by one surgeon (AP). Pre- and post-operative visual acuity, anterior/posterior segment examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients whenever feasible.Results: The age of patients ranged from 5–11 years. The mean post-operative follow-up time was six months from the time of IOL insertion. Improvement in visual acuity >6 lines was achieved in four patients (mean visual acuity of 20/70 at six months). Improvement in stereoacuity was noted in all six patients (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by randot stereoacuity testing). Improvement of >2 lines of visual acuity lines was achieved in the other two patients. No patient lost any lines of visual acuity. Enhanced physical activity, coordination, and improved social interaction were noted in patients and were reported by the parents. No intra/post-operative complications were noted.Discussion: Irreversible or intractable amblyopia secondary to severe anisometropic myopia is a serious medical concern in the pediatric population. Failure of compliance with contact lens therapy consistently leads to visual loss. Anterior chamber phakic IOLs may provide a safe alternative in treatment of noncompliant anisometropic myopic patients who do not accept spectacle wear or contact lens therapy.Conclusion: To reduce or eliminate highly significant anisometropic myopia in children who are noncompliant with traditional medical treatment, phakic anterior chamber IOL implantation may be considered as an alternative modality of treatment. Keywords: amblyopia, anisometropia, myopia, intraocular lens implan

Contribution of the cyclic nucleotide gated channel subunit, CNG-3, to olfactory plasticity in Caenorhabditis elegans.

In Caenorhabditis elegans, the AWC neurons are thought to deploy a cGMP signaling cascade in the detection of and response to AWC sensed odors. Prolonged exposure to an AWC sensed odor in the absence of food leads to reversible decreases in the animal's attraction to that odor. This adaptation exhibits two stages referred to as short-term and long-term adaptation. Previously, the protein kinase G (PKG), EGL-4/PKG-1, was shown necessary for both stages of adaptation and phosphorylation of its target, the beta-type cyclic nucleotide gated (CNG) channel subunit, TAX-2, was implicated in the short term stage. Here we uncover a novel role for the CNG channel subunit, CNG-3, in short term adaptation. We demonstrate that CNG-3 is required in the AWC for adaptation to short (thirty minute) exposures of odor, and contains a candidate PKG phosphorylation site required to tune odor sensitivity. We also provide in vivo data suggesting that CNG-3 forms a complex with both TAX-2 and TAX-4 CNG channel subunits in AWC. Finally, we examine the physiology of different CNG channel subunit combinations

Advance care planning for patients with end-stage kidney disease on dialysis: narrative review of the current evidence, and future considerations

Patients with end-stage kidney disease (ESKD) have a high symptom-burden and high rates of morbidity and mortality. Despite this, evidence has shown that this patient group does not have timely discussions to plan for deterioration and death, and at the end of life there are unmet palliative care needs. Advance care planning is a process that can help patients share their personal values and preferences for their future care and prepare for declining health. Earlier, more integrated and holistic advance care planning has the potential to improve access to care services, communication, and preparedness for future decision-making and changing circumstances. However, there are many barriers to successful implementation of advance care planning in this population. In this narrative review we discuss the current evidence for advance care planning in patients on dialysis, the data around the barriers to advance care planning implementation, and interventions that have been trialled. The review explores whether the concepts and approaches to advance care planning in this population need to be updated to encompass current and future care. It suggests that a shift from a problem-orientated approach to a goal-orientated approach may lead to better engagement, with more patient-centred and satisfying outcomes

Online leadership discourse in higher education: a digital multimodal discourse perspective

As leadership discourses in higher education are increasingly being mediated online, texts previously reserved for staff are now being made available in the public domain. As such, these texts become accessible for study, critique and evaluation. Additionally, discourses previously confined to the written domain are now increasingly multimodal. Thus, an approach is required that is capable of relating detailed, complex multimodal discourse analyses to broader sociocultural perspectives to account for the complex meaning-making practices that operate in online leadership discourses. For this purpose, a digital multimodal discourse approach is proposed and illustrated via a small-scale case study of the online leadership discourse of an Australian university. The analysis of two short video texts demonstrates how a digital multimodal discourse perspective facilitates the identification of key multimodal systems used for meaning-making in online communication, how meaning arises through combinations of semiotic choices (not individual choices), and how the results of multimodal discourse analysis using digital technology can reveal larger sociocultural patterns – in this case, divergent leadership styles and approaches as reflected in online discourse, at a time of immense change within the higher education sector

Barriers and facilitators to physical activity among children, adolescents, and young adults with cystic fibrosis: A systematic review and thematic synthesis of qualitative of research

This is the final version. Available from BMJ Publishing Group via the DOI in this record.Availability of data and material: All data relevant to the study are included in the article or uploaded as supplementary information.Objectives: Physical activity is widely recommended in the treatment and management of cystic fibrosis (CF). Despite the numerous physical and psychological benefits, many young people with CF are not achieving the recommended levels of physical activity. The aim of this systematic review was to identify and synthesise available qualitative investigations exploring the motives for, barriers to and facilitators of physical activity among young people with CF. Methods: The following six electronic databases were systematically searched: ASSIA, CINAH, EMBASE, MEDLINE, MEDLINE-in-process, PsycINFO up to August 2019. Keywords were used to identify qualitative research that explored engagement in physical activity among young people with CF. Titles and abstracts were screened by two independent reviewers, and potentially relevant articles were retrieved in full. Articles were eligible for inclusion if they employed any qualitative method and recruited participants under the age of 24 years with CF. Risk of bias of included studies were assessed via the Critical Appraisal Skills Program. Results were synthesised using a thematic approach. Results: Seven studies met our inclusion criteria and were included in the review. Overall, studies were of moderate to high quality. Thematic synthesis identified nine main themes that encompass motives for, barriers to and facilitators of physical activity among young people with CF. These were 1) perceptions of physical activity, 2) value attributed to physical activity, 3) social influences, 4) competing priorities, 5) fluctuating health, 6) normality, 7) control beliefs, 8) coping strategies, and 9) availability of facilities. Previous reviews have been unable to identify intervention characteristics that influence physical activity behaviour. Conclusions: This review provides detailed information on the physical (biological – clinical), psychological, social, and environmental influences on physical activity behaviour, thus providing numerous targets for future interventions. This in turn could facilitate promotion of physical activity among young people with CF.Cystic Fibrosis TrustVertex Pharmaceutical

Spitzer-IRS Spectroscopy of the Prototypical Starburst Galaxy NGC7714

We present observations of the starburst galaxy NGC 7714 with the Infrared Spectrograph IRS on board the Spitzer Space Telescope. The spectra yield a wealth of ionic and molecular features that allow a detailed characterization of its properties. NGC 7714 has an HII region-like spectrum with strong PAH emission features. We find no evidence for an obscured active galactic nucleus, and with [NeIII]/[NeII]~0.73, NGC7714 lies near the upper end of normal-metallicity starburst galaxies. With very little slicate absorption and a temperature of the hottest dust component of 340K, NGC 7714 is the perfect template for a young, unobscured starburstComment: To appear in the special ApJSS issue on early results from Spitze

Tense and aspect in word problems about motion: diagram, gesture, and the felt experience of time

© 2014, Mathematics Education Research Group of Australasia, Inc. Word problems about motion contain various conjugated verb forms. As students and teachers grapple with such word problems, they jointly operationalize diagrams, gestures, and language. Drawing on findings from a 3-year research project examining the social semiotics of classroom interaction, we show how teachers and students use gesture and diagram to make sense of complex verb forms in such word problems. We focus on the grammatical category of “aspect” for how it broadens the concept of verb tense. Aspect conveys duration and completion or frequency of an event. The aspect of a verb defines its temporal flow (or lack thereof) and the location of a vantage point for making sense of this durational process

Reviews of theoretical frameworks: challenges and judging the quality of theory application.

Background Rigorous reviews of available information, from a range of resources, is required to support medical and health educators in their decision making related to their educational practice. Aim The aim of the paper is to highlight the importance of a review of theoretical frameworks specifically to supplement reviews that focus on a synthesis of the empirical evidence alone. Establishing a shared understanding of theory as a concept is highlighted as a challenge to these types of review and some practical strategies to achieving this are presented. The paper also introduces the concept of theoretical quality to the methodology of literature reviews, arguing that a critique of how theory is applied should complement the methodological appraisal of the literature in a review. Method We illustrate the challenge of establishing a shared meaning of theory through reference to experiences of an on-going review of this kind conducted in the field of interprofessional education (IPE) and use a high scoring paper selected in this review to illustrate how theoretical quality can be assessed. We focus on theories that apply to IPE curriculum design but the findings are transferable to all reviews of theoretical frameworks. Findings In reaching a shared understanding of theory as a concept, practical strategies that promote experiential and practical ways of knowing (e.g. small group work and piloting of all phases of the review protocol) are required in addition to more propositional ways of sharing knowledge. Concepts of parsimony, testability, operational adequacy and empirical adequacy are explored as concepts that establish theoretical quality. Conclusions Reviews of theoretical frameworks used in medical education are required to inform educational practice. Review teams should make time and effort to reach a shared understanding of the term theory. Theory reviews, and reviews more widely, should add an assessment of theory application to the protocol of their review method.

The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK)

Background: The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention. Methods: Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff. Results: Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision. Conclusions: We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes

New Observations of Extra-Disk Molecular Gas in Interacting Galaxy Systems, Including a Two-Component System in Stephan's Quintet

We present new CO (1 - 0) observations of eleven extragalactic tails and bridges in nine interacting galaxy systems, almost doubling the number of such features with sensitive CO measurements. Eight of these eleven features were undetected in CO to very low CO/HI limits, with the most extreme case being the NGC 7714/5 bridge. This bridge contains luminous H II regions and has a very high HI column density (1.6 X 10^21 cm^-2 in the 55" CO beam), yet was undetected in CO to rms T(R)* = 2.4 mK. The HI column density is higher than standard H2 and CO self-shielding limits for solar-metallicity gas, suggesting that the gas in this bridge is metal-poor and has an enhanced N(H2)/I(CO) ratio compared to the Galactic value. Only one of the eleven features in our sample was unambiguously detected in CO, a luminous HI-rich star formation region near an optical tail in the compact group Stephan's Quintet. We detect CO at two widely separated velocities in this feature, at ~6000 km/s and ~6700 km/s. Both of these components have HI and H-alpha counterparts. These velocities correspond to those of galaxies in the group, suggesting that this gas is material that has been removed from two galaxies in the group. The CO/HI/H-alpha ratios for both components are similar to global values for spiral galaxies.Comment: 39 pages, Latex, 15 figures, Astronomical Journal, in pres