The Only Eye Study (OnES): a qualitative study of surgeon experiences of only eye surgery and recommendations for patient safety

OBJECTIVE: Performing surgery on patients with only one seeing-eye, where complications may result in catastrophic vision loss, presents unique challenges for the ophthalmic care team. There is currently no evidence regarding how surgeons augment their care when treating only eye patients and no guidelines for how these patients should be managed in hospital eye services. This study aimed to explore ophthalmic surgeons' experiences of only eye surgery and perceptions of current practice. DESIGN AND PARTICIPANTS: Ten ophthalmic surgeons were asked to relate their experiences and views on performing only eye surgery in indepth, semistructured interviews. Interviews were audio-recorded and transcribed. Qualitative data were subjected to thematic analysis to identify key themes. SETTING: Hospital eye service. RESULTS: Five key themes emerged relating to surgeons' experiences and perceptions of only eye surgery: (1) differences in approach to consent, (2) strategies for risk reduction, (3) unmet training needs, (4) value of surgical mentor and (5) emotional impact of unsuccessful outcomes. Recommendations for improving the surgical journey for both the patient and the surgeon related primarily to better recognition and understanding of the complexities inherent with only eye surgery. CONCLUSIONS: Outcomes of only eye surgery may be improved through a number of methods, including development of purpose-designed training fellowships, adoption of stress-reducing strategies and enhancement of available support services. The findings identify emerging themes unique to only eye surgery and the need for guidelines on the provision of care for these high-stakes surgical patients

Healthy shopper? Blood pressure testing in a shopping centre Pop-Up in England

Background: Improving detection of elevated blood pressure (BP) remains a public health need. We present results from a Pop-Up health check stationed in shopping centres in England. We hypothesise the rate of case detection is related to measurable ‘unhealthiness’ of the shopping centres. Methods: A Pop-Up health check was sited in four and three shopping centres sampled from the top ten unhealthiest and top 15 healthiest shopping regions respectively, following a report ranking towns/cities based on their unhealthy and healthy retail outlets. On one day in each shopping centre, people were approached and consented to BP testing. Outcome measure was people flagged with BP ≥ 140/90 mmHg (cases). Results: We detected 45 (22.6%) and 20 (13.1%) cases from testing 199 and 152 adults in the unhealthy and healthy locations respectively (relative risk 1.72; 95% confidence interval: 1.06 to 2.78). A measure of unhealthy retail outlets (e.g. fast-food outlets) within each shopping centre was associated with detection rate (R2 = 0.61; p = 0.04). Conclusion: An association exists between cases of suspect hypertension found in a health check Pop-Up and measured ‘unhealthiness’ of the shopping centre site. Results hint at strategies for public testing of BP, potentially in the context of reducing health inequalities

Feeling the pressure: a cross-sectional study exploring feasibility of a healthcare Pop-Up for intraocular pressure measurements in shopping centres in England

OBJECTIVES: To test the hypothesis that a shopping centre Pop-Up health check combining an intraocular pressure (IOP) check with a general health check (blood pressure (BP)) is more readily accepted by the general public than an IOP check only. We investigate public awareness of IOP compared with BP and the feasibility of measuring IOP in large numbers in a Pop-Up. DESIGN: A cross-sectional study using a tailor-made healthcare Pop-Up. SETTING: The 'Feeling the Pressure' Pop-Up was sited in eight regionally-different shopping centres in England. PARTICIPANTS: Adult members of the public in shopping centres. METHODS: On one day we measured IOP only and on another measured BP and IOP. IOP was measured by Icare IC100 tonometer (Helsinki, Finland). Potential participants were asked about their awareness of IOP and BP and when they last visited their optometrist. RESULTS: More people attended the combined BP + IOP days (461; 60%; 95% CI 56% to 64%) than IOP-only days (307; 40%, 95% CI 37% to 43%) over 16 days of testing. We recorded IOP in 652 participants (median (IQR) age and IOP of 54 (42 to 68) years and 13 (11 to 15) mm Hg, respectively). Fewer people reported awareness about IOP (19%, 95% CI 16% to 23%) compared with BP (71%, 95% CI 66% to 75%). Of 768 participants, 60 (8%) reported no previous optometric eye examination and 185 (24%) reported >2 years since their most recent examination. CONCLUSIONS: Measuring IOP in large numbers of the public via a shopping centre Pop-Up is feasible. Public engagement was greater when a BP check was offered alongside an IOP check, suggesting unfamiliar health checks can be promoted by aligning them with a more familiar check. Our findings hint at strategies for public health schemes that engage the public with their eye health

In search of phylogenetic congruence between molecular and morphological data in bryozoans with extreme adult skeletal heteromorphy

peerreview_statement: The publishing and review policy for this title is described in its Aims & Scope. aims_and_scope_url: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=tsab20© Crown Copyright 2015. This document is the author's final accepted/submitted version of the journal article. You are advised to consult the publisher's version if you wish to cite from it

Energy benchmarks for water clusters and ice structures from an embedded many-body expansion

We show how an embedded many-body expansion (EMBE) can be used to calculate accurate \emph{ab initio} energies of water clusters and ice structures using wavefunction-based methods. We use the EMBE described recently by Bygrave \emph{et al.} (J. Chem. Phys. \textbf{137}, 164102 (2012)), in which the terms in the expansion are obtained from calculations on monomers, dimers, etc. acted on by an approximate representation of the embedding field due to all other molecules in the system, this field being a sum of Coulomb and exchange-repulsion fields. Our strategy is to separate the total energy of the system into Hartree-Fock and correlation parts, using the EMBE only for the correlation energy, with the Hartree-Fock energy calculated using standard molecular quantum chemistry for clusters and plane-wave methods for crystals. Our tests on a range of different water clusters up to the 16-mer show that for the second-order M\o{}ller-Plesset (MP2) method the EMBE truncated at 2-body level reproduces to better than 0.1 m$E_{\rm h}$/monomer the correlation energy from standard methods. The use of EMBE for computing coupled-cluster energies of clusters is also discussed. For the ice structures Ih, II and VIII, we find that MP2 energies near the complete basis-set limit reproduce very well the experimental values of the absolute and relative binding energies, but that the use of coupled-cluster methods for many-body correlation (non-additive dispersion) is essential for a full description. Possible future applications of the EMBE approach are suggested

Mapping the 3-D Dark Matter potential with weak shear

We investigate the practical implementation of Taylor's (2002) 3-dimensional gravitational potential reconstruction method using weak gravitational lensing, together with the requisite reconstruction of the lensing potential. This methodology calculates the 3-D gravitational potential given a knowledge of shear estimates and redshifts for a set of galaxies. We analytically estimate the noise expected in the reconstructed gravitational field, taking into account the uncertainties associated with a finite survey, photometric redshift uncertainty, redshift-space distortions, and multiple scattering events. In order to implement this approach for future data analysis, we simulate the lensing distortion fields due to various mass distributions. We create catalogues of galaxies sampling this distortion in three dimensions, with realistic spatial distribution and intrinsic ellipticity for both ground-based and space-based surveys. Using the resulting catalogues of galaxy position and shear, we demonstrate that it is possible to reconstruct the lensing and gravitational potentials with our method. For example, we demonstrate that a typical ground-based shear survey with redshift limit z=1 and photometric redshifts with error Delta z=0.05 is directly able to measure the 3-D gravitational potential for mass concentrations >10^14 M_\odot between 0.1<z<0.5, and can statistically measure the potential at much lower mass limits. The intrinsic ellipticity of objects is found to be a serious source of noise for the gravitational potential, which can be overcome by Wiener filtering or examining the potential statistically over many fields. We examine the use of the 3-D lensing potential to measure mass and position of clusters in 3-D, and to detect clusters behind clusters.Comment: 21 pages, including 24 figures, submitted to MNRA

The Spatial Distribution of Atomic Carbon Emission in the Giant Molecular Cloud NGC 604-2

We have mapped a giant molecular cloud in the giant HII region NGC 604 in M33 in the 492 GHz ^3P_1 -- ^3P_0 transition of neutral atomic carbon using the James Clerk Maxwell Telescope. We find the distribution of the [CI] emission to be asymmetric with respect to the CO J=1--0 emission, with the peak of the [CI] emission offset towards the direction of the center of the HII region. In addition, the line ratio I_{[CI]}/I_{CO} is highest (~ 0.2) facing the HII region and lowest (< 0.1) away from it. These asymmetries indicate an edge-on morphology where the [CI] emission is strongest on the side of the cloud facing the center of the HII region, and not detected at all on the opposite side This suggests that the sources of the incident flux creating C from the dissociation of CO are the massive stars of the HII region. The lowest line ratios are similar to what is observed in Galactic molecular clouds, while the highest are similar to starburst galaxies and other regions of intense star formation. The column density ratio, N(C)/N(H_2) is a few times 10^{-6}, in general agreement with models of photodissociation regions.Comment: Accepted for publication in ApJ. 8 pages, 5 figures, 3 table

Self-Monitoring Symptoms in Glaucoma: A Feasibility Study of a Web-Based Diary Tool

Purpose: Glaucoma patients annually spend only a few hours in an eye clinic but spend more than 5000 waking hours engaged in everything else. We propose that patients could self-monitor changes in visual symptoms providing valuable between clinic information; we test the hypothesis that this is feasible using a web-based diary tool. Methods: Ten glaucoma patients with a range of visual field loss took part in an eight-week pilot study. After completing a series of baseline tests, volunteers were prompted to monitor symptoms every three days and complete a diary about their vision during daily life using a bespoke web-based diary tool. Response to an end of a study questionnaire about the usefulness of the exercise was a main outcome measure. Results: Eight of the 10 patients rated the monitoring scheme to be “valuable” or “very valuable.” Completion rate to items was excellent (96%). Themes from a qualitative synthesis of the diary entries related to behavioural aspects of glaucoma. One patient concluded that a constant focus on monitoring symptoms led to negative feelings. Conclusions: A web-based diary tool for monitoring self-reported glaucoma symptoms is practically feasible. The tool must be carefully designed to ensure participants are benefitting, and it is not increasing anxiety