The content of optometric eye examinations for a presbyopic patient presenting with symptoms of flashing lights

Background:  Standardised patients (SPs) are the gold standard methodology for evaluating clinical care. This approach was used to investigate the content of optometric eyecare for a presbyopic patient who presented with recent photopsia. Methods:  A total of 102 community optometrists consented to be visited by an actor for a recorded eye examination. This actor received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. The actor presented unannounced (incognito) as a 59-year-old patient seeking a private eye examination and complaining of recent onset flashing lights. The results of each clinical encounter were recorded on a pre-designed checklist based on evidence-based reviews on photopsia, clinical guidelines and the views of an expert panel. Results:  The presence of the symptom of photopsia was proactively detected in 87% of cases. Although none of the optometrists visited asked all seven gold standard questions relating to the presenting symptoms of flashing lights, 35% asked four of the seven questions. A total of 85% of optometrists asked the patient if he noticed any floaters in his vision and 36% of optometrists asked if he had noticed any shadows in his vision. The proportion of the tests recommended by the expert panel that were carried out varied from 33 to 100% with a mean of 67%. Specifically, 66% recommended dilated fundoscopy to be carried out either by themselves or by another eyecare practitioner, and 29% of optometrists asked the patient to seek a second opinion regarding the photopsia. Of those who referred, 70% asked for the referral to be on the same day or within a week. Conclusion:  SP encounters are an effective way of measuring clinical care within optometry and should be considered for further comparative measurements of quality of care. As in research using SPs in other healthcare disciplines, our study has highlighted substantial differences between different practitioners in the duration and depth of their clinical investigations. This highlights the fact that not all eye examinations are the same but inherently different and that there is no such thing as a ‘standard sight test’. Future optometric continuing education could focus on history taking, examination techniques and referral guidelines for patients presenting with symptoms of posterior vitreous detachment, retinal breaks and secondary retinal detachment

Leukocyte trafficking in experimental autoimmune uveitis in vivo

Leukocyte trafficking from blood into tissue is a fundamental process in immune surveillance and the immune response to stimuli. Experimental autoimmune uveitis (EAU) is an animal model for posterior uveitis and is mediated by T lymphocytes and macrophages that infiltrate the posterior segment of the eye. To analyze leukocyte migration into retinal tissue during the course of EAU, labeled cells were identified in vivo by scanning laser ophthalmoscopy and in retinal flatmounts by confocal microscopy. Adhesion of blood leukocytes to retinal endothelial cells in vivo was significantly raised 48 h before the appearance of clinical disease, and this correlated with the increased expression of CD54 on retinal vessels. Mitogen-activated spleen cells and CD4+ T cells only entered into retinal tissue in animals with clinical disease and not naive recipients. The disease status of the donor animal had no effect on leukocyte trafficking. These results, which identify leukocyte-endothelial cell interactions in vivo, suggest that the activation of the retinal endothelium is a prerequisite to leukocyte adhesion and extravasation into ocular tissue during EAU

Leukocyte trafficking in experimental autoimmune uveitis in vivo

Leukocyte trafficking from blood into tissue is a fundamental process in immune surveillance and the immune response to stimuli. Experimental autoimmune uveitis (EAU) is an animal model for posterior uveitis and is mediated by T lymphocytes and macrophages that infiltrate the posterior segment of the eye. To analyze leukocyte migration into retinal tissue during the course of EAU, labeled cells were identified in vivo by scanning laser ophthalmoscopy and in retinal flatmounts by confocal microscopy. Adhesion of blood leukocytes to retinal endothelial cells in vivo was significantly raised 48 h before the appearance of clinical disease, and this correlated with the increased expression of CD54 on retinal vessels. Mitogen-activated spleen cells and CD4+ T cells only entered into retinal tissue in animals with clinical disease and not naive recipients. The disease status of the donor animal had no effect on leukocyte trafficking. These results, which identify leukocyte-endothelial cell interactions in vivo, suggest that the activation of the retinal endothelium is a prerequisite to leukocyte adhesion and extravasation into ocular tissue during EAU

The remaining koalas (Phascolarctos cinereus) of the Pilliga forests, north-west New South Wales: Refugial persistence or a population on the road to extinction?

In the 1990s, the Pilliga forests were carrying the largest population of koalas west of the Great Dividing Range in New South Wales (NSW). Whereas the NSW koala population in its entirety was thought to be in decline, the Pilliga population stood out as potentially increasing. By 2007, anecdotal evidence suggested that the population was in decline. We undertook surveys of koalas in the Pilliga forests that repeated surveys undertaken between 1991 and 2011. We found that koalas had declined and were found in only 21% of sites in which they were observed in the initial surveys-by any measure, a 5-fold drop in occupancy in less than two decades is severe. Declines occurred evenly across the Pilliga, with persistence at a site seemingly related to a high initial density of koalas rather than to a slower rate of decline. Sites where koalas persisted were characterised as having higher temperatures and lower rainfall relative to other sites, being close to drainage lines with deeper soils and having a lower occurrence of fire. This pattern fits with the observation in the recent surveys that koalas were next to drainage lines in the western half of the Pilliga and fits with the suggestion that koalas show refugial persistence. Recovery from this point is not assured and will depend on how we manage the landscape, particularly with the threat of climate change. This will likely require active management within an adaptive management framework, such as restoration of refuges, and not simply habitat reservation

A genealogy of calculations at an early Queensland sugar mill

This study of a unique historic situation is sociologically framed and politically contextualized. It examines the technical and persuasive rhetorical dimensions of calculations employed at a nineteenth-century Queensland sugar plantation and mill in relation to the employment of indentured labour. Historical archival data is interpreted through the lens of the rhetoric of rationality. Queensland legislation permitted the employment of indentured Pacific islanders to assist in the development of its sugar industry. Accounting practices employed at the Colonial Sugar Refinery (CSR) Company’s Goondi Plantation and Mill focused on recording and controlling labour costs to maximize profits and maintain a healthy dividend to shareholders. The use of this single perspective, while it provides a restricted interpretation of events, nevertheless enables some unique insights about the practice of accounting in this historic context