Ivermectin for onchocercal eye disease (river blindness).

BACKGROUND: It is believed that ivermectin (a microfilaricide) could prevent blindness due to onchocerciasis. However, when given to everyone in communities where onchocerciasis is common, the effects of ivermectin on lesions affecting the eye are uncertain and data on whether the drug prevents visual loss are unclear. OBJECTIVES: The aim of this review was to assess the effectiveness of ivermectin in preventing visual impairment and visual field loss in onchocercal eye disease. The secondary aim was to assess the effects of ivermectin on lesions affecting the eye in onchocerciasis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 3), MEDLINE (January 1950 to April 2012), EMBASE (January 1980 to April 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 April 2012. SELECTION CRITERIA: We included randomised controlled trials with at least one year of follow-up comparing ivermectin with placebo or no treatment. Participants in the trials were people normally resident in endemic onchocercal communities with or without one or more characteristic signs of ocular onchocerciasis. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. We contacted study authors for additional information. As trials varied in design and setting, we were unable to perform a meta-analysis. MAIN RESULTS: The review included four trials: two small studies (n = 398) in which people with onchocercal infection were given one dose of ivermectin or placebo and followed up for one year; and two larger community-based studies (n = 4941) whereby all individuals in selected communities were treated every six or 12 months with ivermectin or placebo, whether or not they were infected, and followed for two to three years. The studies provide evidence that treating people who have onchocerciasis with ivermectin reduces the number of microfilariae in their skin and eye(s) and reduces the number of punctate opacities. There was weaker evidence that ivermectin reduced the risk of chorioretinitis. The studies were too small and of too short a duration to provide evidence for an effect on sclerosing keratitis, iridocyclitis, optic nerve disease or visual loss. One community-based study in communities mesoendemic for the savannah strain of O.volvulus provided evidence that annual mass treatment with ivermectin reduces the risk of new cases of optic nerve disease and visual field loss. The other community-based study of mass biannual treatment of ivermectin in communities affected by the forest strain of O.volvulus demonstrated reductions in microfilarial load, punctate keratitis and iridocyclitis but not sclerosing keratitis, chorioretinitis, optic atrophy or visual impairment. The study was underpowered to estimate the effect of ivermectin on visual impairment and other less frequent clinical signs. The studies included in this review reported some adverse effects, in particular an increased risk of postural hypotension in people treated with ivermectin. AUTHORS' CONCLUSIONS: The lack of evidence for prevention of visual impairment and blindness should not be interpreted to mean that ivermectin is not effective, however, clearly this is a key question that remains unanswered. The main evidence for a protective effect of mass treatment with ivermectin on visual field loss and optic nerve disease comes from communities mesoendemic for the savannah strain of O.volvulus. Whether these findings can be applied to communities with different endemicity and affected by the forest strain is unclear. Serious adverse effects were rarely reported. None of the studies, however, were conducted in areas where people are infected with Loa loa (loiasis)

Maturity effects in concrete dams

Model equations for determining the coupled heat, moisture and maturity changes within a concrete block are introduced and briefly examined. Preliminary results are obtained for the heat exchange between concrete slabs in contact driven by maturity differences

Impact of Program Review on IPE Programming and Assessment

Purpose: Efforts to measure the effectiveness of Interprofessional Practice and Education (IPE) are challenging. We will present how formal program review can measure IPE effectiveness and lead to improvements in programming and assessment. Background: Western University of Health Sciences requires program review of curricular programs. The IPE curriculum recently underwent program review. External reviewers shared the results of their evaluations with university administration and deans. Their specific recommendations led to a retreat and development of a vision statement for IPE and the development of a new clinical assessment tool. Description of Intervention: After program review and receipt of the reviewers’ recommendations a full day retreat was held with senior administration and Deans from all health professions programs. Through these efforts a new IPE program vision statement was re-stated with reaffirmed commitments from all present. Preliminary Results: A shared vision statement was developed and finalized, which led to re-prioritizing core and key competencies to be used in the IPE curriculum. The revised core competencies were circulated via electronic survey to clinical practice sites where preceptors provided feedback and comments so that the competencies adequately defined measurable skills and behaviors could be used as assessment tools during clinical rotations. Relevance to Interprofessional Education or Practice: Program review can have an impact on the development of a shared university IPE vision and the identification of measurable IPE behaviors and skills important to the field. Recommendation for future investigation or incorporation into education: Outcomes from the new assessment tool will be compiled and analyzed with respect to use in clinical education across health professions. Learning Objectives: 1) Describe how formal university program review can used to renew senior administration commitment to IPE and to improve assessment practices. 2) Reflect on how program review can be instituted in any institution with an IPE program

JERZY TOPOLSKI - IN MEMORIAM

JERZY TOPOLSKI - IN MEMORIA

Optimal attentional focus during exposure therapy in specific phobia: a meta-analysis

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Interprofessional Healthcare as a Catalyst for Better Education

Abstract: Interprofessional healthcare was introduced as a concept to enhance quality of patient care. Its application involves a team of different healthcare professionals working together to deliver excellence in patient care. This is presupposed by an understanding of one another’s professions and its relation to best practices in patient care. Through the early adoption of this concept, enhanced interprofessional communication and patient education techniques have been developed and have been proven to show an enhanced quality of patient care. Concurrently, there has been an explosion of new health professional schools in university settings that have the potential to better promote inter professional education through innovative and creative ideas. Rightly so, interprofessional healthcare perspectives are serving as a catalyst for health professional education. The benefits to inter professional education are unarguable. Professions and education administrators must evaluate its current accreditation standards to ensure that they best prepare health professional students to meet societal demands. Thus far, several health professional accreditation associations have added or revised educational standards to include the need for interprofessional education. This paper will provide a review of the recent changes in accreditation standards across health professions as it relates to the inclusion of interprofessional education. Further, it will provide future recommendations for how educational institutions can best meet these standards to ensure quality education and patient care. Learning Objectives: • to show the impact that healthcare and society have on education • to provide a review of educational accreditation standards across professions, specifically those related to inter professional education • to provide recommendations to assist stand alone and university educational settings to meet these standards • to provide an overview of the barriers and challenges related to interprofessional education in various setting

Controlled interfacial assembly of 2D curved colloidal crystals and jammed shells

Assembly of colloidal particles on fluid interfaces is a promising technique for synthesizing two-dimensional micro-crystalline materials useful in fields as diverse as biomedicine1, materials science2, mineral flotation3 and food processing4. Current approaches rely on bulk emulsification methods, require further chemical and thermal treatments, and are restrictive with respect to the materials employed5-9. The development of methods that exploit the great potential of interfacial assembly for producing tailored materials have been hampered by the lack of understanding of the assembly process. Here we report a microfluidic method that allows direct visualization and understanding of the dynamics of colloidal crystal growth on curved interfaces. The crystals are periodically ejected to form stable jammed shells, which we refer to as colloidal armour. We propose that the energetic barriers to interfacial crystal growth and organization can be overcome by targeted delivery of colloidal particles through hydrodynamic flows. Our method allows an unprecedented degree of control over armour composition, size and stability.Comment: 18 pages, 5 figure