Barriers to sight impairment certification in the UK:the example of a population with diabetes in East London

BACKGROUND: This study assessed the barriers to sight impairment certification in the East London Borough of Tower Hamlets amongst patients attending the Diabetic Retinopathy Screening Service (DRSS). METHODS: All patients who attended DRSS between 1(st)April 2009 and 31st of March 2010 and whose recorded best corrected visual acuity (BCVA) at DRSS fulfilled the requirements for sight impairment in the UK were included. An additional 24 patients whose general practitioners (GPs) reported them to be certified blind due to no perception of light (NPL) vision were re-examined to ascertain the reason for certification, and their potential social and visual aids needs. RESULTS: 78 patients were identified with certifiable vision and were reviewed: 10 deceased in the preceding 12 months; 60 were not known to be certified. Of these, 57 attended further assessment, 27 were found to have non-certifiable vision, 9 were referred for further interventions, 9 were certified and 9 were found to be eligible, but declined certification. Five patients were registered due to diabetic eye disease. Of those 24 reported by the GP of NPL vision, only 4 had true NPL, the rest had usable vision. Only two of them were certified blind due to diabetes. CONCLUSIONS: Our data shows that sight certification in patients with diabetes might be underestimated and these patients often have non-diabetes related visual loss. We propose that data on certifiable visual impairment could serve, along with existing certification databases, as a resource for quality of care standards assessment and service provision for patients with diabetes

Development of a Whole Body Atlas for Radiation Therapy Planning and Treatment Optimization

The main objective of radiation therapy is to obtain the highest possible probability of tumor cure while minimizing adverse reactions in healthy tissues. A crucial step in the treatment process is to determine the location and extent of the primary tumor and its loco regional lymphatic spread in relation to adjacent radiosensitive anatomical structures and organs at risk. These volumes must also be accurately delineated with respect to external anatomic reference points, preferably on surrounding bony structures. At the same time, it is essential to have the best possible physical and radiobiological knowledge about the radiation responsiveness of the target tissues and organs at risk in order to achieve a more accurate optimization of the treatment outcome. A computerized whole body Atlas has therefore been developed to serve as a dynamic database, with systematically integrated knowledge, comprising all necessary physical and radiobiological information about common target volumes and normal tissues. The Atlas also contains a database of segmented organs and a lymph node topography, which was based on the Visible Human dataset, to form standard reference geometry of organ systems. The reference knowledgebase and the standard organ dataset can be utilized for Atlas-based image processing and analysis in radiation therapy planning and for biological optimization of the treatment outcome. Atlas-based segmentation procedures were utilized to transform the reference organ dataset of the Atlas into the geometry of individual patients. The anatomic organs and target volumes of the database can be converted by elastic transformation into those of the individual patient for final treatment planning. Furthermore, a database of reference treatment plans was started by implementing state-of-the-art biologically based radiation therapy planning techniques such as conformal, intensity modulated, and radiobiologically optimized treatment planning. The computerized Atlas can be viewed as a central framework that contains different forms of optimal treatment plans linked to all the essential information needed in treatment planning, which can be adapted to a given patient, in order to speed up treatment plan convergence. The Atlas also offers a platform to synthesize the results of imaging studies through its advanced geometric transformation and segmentation procedures. The whole body Atlas is anticipated to become a physical and biological knowledgebase that can facilitate, speed up and increase the accuracy in radiation therapy planning and treatment optimization

Impact of climate change on water resources in Jordan: a case study of Azraq basin

Abstract Azraq basin is one of the most important groundwater basins in Jordan. Trend analysis using RClimDex for six rainfall stations and two metrological stations was performed to detect and predict climate change impacts on the Azraq basin until the year 2030. Three absolute homogeneity tests were used to detect any variation in the data time series. The results showed that monthly max value of daily mean temp, tropical night, monthly maximum value of daily maximum temp, monthly maximum value of daily minimum temp and cool days were found to be statistically significant climate change indices. The trend of the max temperature during July is significant, while insignificant trend for the minimum temperature in the same month was noticed. The frequency of days in which the maximum temperature exceeded 38 °C increased and there was increase in the minimum temperature count of values that are exceeding 20 °C in the last 46 years. Regarding the rainfall, there is no change in total annual precipitation over the study area during the studied period. The results of simulating climate change impact into the evaporation showed expected increase by 4.74 and 5.32% for Al Butum and El Janab wadis, respectively, during the period of 2013–2030. Streamflow analysis showed slight decrease by 1.51 and 1.02% for both wadis, respectively

The economic cost of posterior capsule tear at cataract surgery

PURPOSE: To estimate the direct financial burden to healthcare purchasers of a posterior capsule tear (PCT) during cataract surgery. METHODS: A retrospective data analysis of cataract surgeries was performed. Patients who had surgery in the 2-year period from April 2005, with a maximum follow-up, to April 2009 were identified. Patients previously under review for ocular comorbidity apart from cataract were excluded. Each case with PCT was matched with an uncomplicated cataract operation performed on the same list by the same grade of surgeon. For both groups, we extracted details of all additional subsequent visits and interventions. Data on the cost of visits and procedures were provided by the Department of Health. We then compared this data between groups. RESULTS: A total of 100 patients with PCT were matched with 100 controls. The preoperative parameters of the two groups were similar. The cases required a median of 3 (mean 3.6, range 0-24) additional postoperative visits compared with 0 (mean 0.19, range 0-8) for controls, with a median duration of follow-up of 74 (mean 129.5, range 6-1316) days for cases compared to 21 (mean 26.1, range 0-308) days for controls (p=0.000). The average cost of extra visits was £ 475.0 (SD £ 697.8) for cases and £ 69.2 (SD £ 51.0) for controls (p<0.001). CONCLUSIONS: Based on the National Health Service national tariff, a PCT during cataract surgery results in significant additional financial cost to healthcare purchasers. A full cost analysis would be required to estimate the additional cost of a PCT for the healthcare provider

River driftwood pretreated via hydrothermal carbonization as a sustainable source of hard carbon for Na-ion battery anodes

International audienceProducing hard carbon from lignocellulosic biomass has been the focus of recent studies as a promising source of anode material for Na-ion batteries. Woody biomass is a potential source, but it is already well valorized. Consequently, river driftwood can be an excellent alternative, especially since it is a disturbing waste for dam regulators. It can jeopardize dam safety, damage intake works, and sink in reservoirs, lowering water quality and decreasing reservoir volume. We examine the potential of river driftwood as a source of hard carbon for Na-ion batteries. Hydrothermal carbonization (HTC) was carried out at temperatures between 180 and 220 • C as the first step to produce hydrochar followed by an upgrading pyrolysis step at 1400 • C under an inert atmosphere to obtain hard carbon. We investigated the effect of HTC operational conditions and driftwood biomass (genera) on hydrochar and hard carbon properties, as well as the latter's impact on Na-ion batteries. The produced carbon electrodes delivered a reversible capacity of 270-300 mAh⋅g-1 for the first cycle and showed high coulombic efficiencies of 77-83%. We also observed promising cyclability of a maximum 2% loss after 100 cycles. Moreover, results suggest that obtained hard carbon can compete with commercial materials and is capable to supply large battery factories with anode material