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

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

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

Controls on mangrove forest-atmosphere carbon dioxide exchanges in western Everglades National Park

We report on net ecosystem production (NEP) and key environmental controls on net ecosystem exchange (NEE) of carbon dioxide (CO2) between a mangrove forest and the atmosphere in the coastal Florida Everglades. An eddy covariance system deployed above the canopy was used to determine NEE during January 2004 through August 2005. Maximum daytime NEE ranged from −20 to −25 mmol (CO2) m−2 s−1 between March and May. Respiration (Rd) was highly variable (2.81 ± 2.41 mmol (CO2) m−2 s−1), reaching peak values during the summer wet season. During the winter dry season, forest CO2 assimilation increased with the proportion of diffuse solar irradiance in response to greater radiative transfer in the forest canopy. Surface water salinity and tidal activity were also important controls on NEE. Daily light use efficiency was reduced at high (\u3e34 parts per thousand (ppt)) compared to low (ppt) salinity by 46%. Tidal inundation lowered daytime Rd by ∼0.9 mmol (CO2) m−2 s−1 and nighttime Rd by ∼0.5 mmol (CO2) m−2 s−1. The forest was a sink for atmospheric CO2, with an annual NEP of 1170 ± 127 g C m−2 during 2004. This unusually high NEP was attributed to year‐round productivity and low ecosystem respiration which reached a maximum of only 3 g C m−2 d−1. Tidal export of dissolved inorganic carbon derived from belowground respiration likely lowered the estimates of mangrove forest respiration. These results suggest that carbon balance in mangrove coastal systems will change in response to variable salinity and inundation patterns, possibly resulting from secular sea level rise and climate change. Citation: Barr, J. G., V. Engel, J. D. Fuentes

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

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

Development of an Anthropomorphic Phantom of the Axillary Region for Microwave Imaging Assessment

We produced an anatomically and dielectrically realistic phantom of the axillary region to enable the experimental assessment of Axillary Lymph Node (ALN) imaging using microwave imaging technology. We segmented a thoracic Computed Tomography (CT) scan and created a computer-aided designed file containing the anatomical configuration of the axillary region. The phantom comprises five 3D-printed parts representing the main tissues of interest of the axillary region for the purpose of microwave imaging: fat, muscle, bone, ALNs, and lung. The phantom allows the experimental assessment of multiple anatomical configurations, by including ALNs of different size, shape, and number in several locations. Except for the bone mimicking organ, which is made of solid conductive polymer, we 3D-printed cavities to represent the fat, muscle, ALN, and lung and filled them with appropriate tissue-mimicking liquids. Existing studies about complex permittivity of ALNs have reported limitations. To address these, we measured the complex permittivity of both human and animal lymph nodes using the standard open-ended coaxial-probe technique, over the 0.5 GHz-8.5 GHz frequency band, thus extending current knowledge on dielectric properties of ALNs. Lastly, we numerically evaluated the effect of the polymer which constitutes the cavities of the phantom and compared it to the realistic axillary region. The results showed a maximum difference of 7 dB at 4 GHz in the electric field magnitude coupled to the tissues and a maximum of 10 dB difference in the ALN response. Our results showed that the phantom is a good representation of the axillary region and a viable tool for pre-clinical assessment of microwave imaging technology.info:eu-repo/semantics/publishedVersio

Are there missed opportunities for vaccinating against hepatitis B among people who inject drugs in the United Kingdom?

Sustaining the impact of hepatitis B virus (HBV) vaccination on incidence and prevalence of HBV infection requires increasing and maintaining the uptake of vaccine among those at risk. In recent years, the level of vaccine uptake among people who inject drugs (PWID) in the United Kingdom (UK) has levelled-off. Data (2015-16) from the national unlinked anonymous monitoring survey of PWID an annual survey that collects data from PWID across England, Wales and Northern Ireland was used to examine HBV vaccine uptake. Data from participants who had injected drugs during the previous year was used to investigate sources of hepatitis B vaccine doses as well as factors associated with vaccine uptake. Among the 3175 anti-HBc negative participants, 3138 (99%) reported their vaccination status; 23% (714) reported no vaccine uptake. Among those not vaccinated, 447 (63%) reported being sexually active and 116 (16%) reported sharing needles and syringes. Majority of those not vaccinated reported accessing services in the previous year that could have provided hepatitis B vaccine doses. These missed opportunities for vaccinating of PWID indicate a need for additional targeted interventions