A solute gradient in the tear meniscus I. A hypothesis to explain Marx's line

Marx's line is a line of mucosal staining behind the mucocutaneous junction. It can be demonstrated throughout life in all normal lids by staining with lissamine green and related dyes. Of all the body orifices, only the mucosae of the eye and mouth are directly exposed to the atmosphere. In this paper, we suggest that for the eye, this exposure leads to the formation of Marx's line. The tear meniscus thins progressively toward its apex, where it is pinned at the mucocutaneous junction of the lid. It also thins toward the black line, which segregates the meniscus from the tear film after the blink. We predict that, because of the geometry of the tear meniscus, evaporation generates a solute gradient across the meniscus profile in the anteroposterior plane, which peaks at the meniscus apices at the end of the interblink. One outcome would be to amplify the level of tear molarity at these sites so that they reach hyperosmolar proportions. Preliminary mathematical modeling suggests that dilution of this effect by advection and diffusion of solute away from the meniscus apex at the mucocutaneous junction will be restricted by spatial constraints, the presence of tear and surface mucins at this site, and limited fluid flow. We conclude that evaporative water loss from the tear meniscus may result in a physiological zone of hyperosmolar and related stresses to the occlusal conjunctiva, directly behind the mucocutaneous junction. We hypothesize that this stimulates a high epithelial cell turnover at this site, incomplete epithelial maturation, and a failure to express key molecules such as MUC 16 and galectin-3, which, with the tight junctions between surface epithelial cells, are necessary to seal the ocular surface and prevent penetration of dyes and other molecules into the epithelium. This is proposed as the basis for Marx's line. In Part II of this paper (also published in this issue of The Ocular Surface), we address additional pathophysiological consequences of this mechanism, affecting lid margins

A solute gradient in the tear meniscus II. implications for lid margin disease, including meibomian gland dysfunction

We have hypothesized previously that evaporation from the tears generates a solute gradient across the tear meniscus, which delivers hyperosmolar stress to the mucocutaneous junction (MCJ) of the lid margin. This is proposed as the basis for Marx's line, a line of staining with topically applied dyes that lies directly behind the MCJ. In this article, we consider the implications of this hypothesis for progressive damage to the lid margin as an age-related phenomenon, its amplification in dry eye states, and its possible role in the etiology of meibomian gland dysfunction (MGD). It is suggested that a hyperosmolar or related stimulus, acting behind the MCJ over a lifetime, promotes the anterior migration of the MCJ, which is a feature of the aging lid margin. This mechanism would be amplified in dry eye states, not only by reason of increased tear molarity at the meniscus apex but also by raising the concentration of inflammatory peptides at this site. This could explain the increased width and irregularity of Marx's line in dry eye. While the presence of stem cells at the lid margin may equip this region to respond to such stress, their depletion could be the basis of irreversible lid margin damage. It is further proposed, given the proximity of the MCJ to the meibomian gland orifices, that the solute gradient mechanism could play a role in the initiation of MGD by delivering hyperosmolar and inflammatory stresses to the terminal ducts and orifices of the glands. By the same token, the presence of a zone of increased epithelial permeability in this region may provide a back door route for the delivery of drugs in the treatment of MGD

A mass and solute balance model for tear volume & osmolarity in the normal and the dry eye

Tear hyperosmolarity is thought to play a key role in the mechanism of dry eye, a common symptomatic condition accompanied by visual disturbance, tear film instability, inflammation and damage to the ocular surface. We have constructed a model for the mass and solute balance of the tears, with parameter estimation based on extensive data from the literature which permits the influence of tear evaporation, lacrimal flux and blink rate on tear osmolarity to be explored. In particular the nature of compensatory events has been estimated in aqueous-deficient (ADDE) and evaporative (EDE) dry eye.\ud \ud The model reproduces observed osmolarities of the tear meniscus for the healthy eye and predicts a higher concentration in the tear film than meniscus in normal and dry eye states. The differential is small in the normal eye, but is significantly increased in dry eye, especially for the simultaneous presence of high meniscus concentration and low meniscus radius. This may influence the interpretation of osmolarity values obtained from meniscus samples since they need not fully reflect potential damage to the ocular surface caused by tear film hyperosmolarity.\ud \ud Interrogation of the model suggests that increases in blink rate may play a limited role in compensating for a rise in tear osmolarity in ADDE but that an increase in lacrimal flux, together with an increase in blink rate, may delay the development of hyperosmolarity in EDE. Nonetheless, it is predicted that tear osmolarity may rise to much higher levels in EDE than ADDE before the onset of tear film breakup, in the absence of events at the ocular surface which would independently compromise tear film stability. Differences in the predicted responses of the pre-ocular tears in ADDE compared to EDE or hybrid disease to defined conditions suggest that no single, empirically-accessible variable can act as a surrogate for tear film concentration and the potential for ocular surface damage. This emphasises the need to measure and integrate multiple diagnostic indicators to determine outcomes and prognosis. Modelling predictions in addition show that further studies concerning the possibility of a high lacrimal flux phenotype in EDE are likely to be profitable

Gender differences in expressed interests in engineering-related fields over a 30-year span

Journal ArticleThis study examines gender differences and historical trends of high school student interest in engineering based on ACT data on expressed interest compared with that of students' and ability. Changes have been observed in the interest in engineering fields over time most likely because of societal influences. These influences are especially seen in computer related fields causing speculation that both males and females were influenced by the dot com era but that only male interest was piqued due to the rise of computer games in the late 1990's. Another interesting observation is the number of students stating they are interested in engineering careers but who minimally or poorly prepared based on their ACT math scores. This raises the question of whether these students understand what engineering is, and whether they have been informed of the demands of the major. These students are likely to face retention issues in engineering fields and are often candidates for math remediation. By better understanding the societal influences as well as gender and ability disparities we will have a better understanding of what needs to be done in order to reverse the current trends of gender disparity and lack of interest in engineering fields

AOTA Continuing Education: Occupational Therapy’s Role in Addressing Sexuality and Intimacy

The purpose of this capstone project was to create a continuing education course for the American Occupational Therapy Association (AOTA) on the topic of OT’s role in addressing sexuality and intimacy. The topic of sexuality and intimacy is often under-addressed by healthcare professionals, despite its importance to clients. According to the Occupational Therapy Practice Framework, engagement in sexual activity is not only an ADL, but can be a key aspect of social participation in the context of familial and peer/ friend roles. Therefore, it is well within OT’s scope of practice to address sexuality and intimacy with clients. However, there has been a disconnect in practice as well as formal education for practitioners. This happens for a variety of reasons including attitudes and bias, cultural/ religious barriers, fear of offending the client, therapist perceived lack of knowledge, and therapist discomfort. The purpose of the continuing education course was to provide an opportunity for OT practitioners to increase their knowledge and confidence when advocating for an occupation that is often overlooked. During the development of this course, the authors conducted an informal needs assessment in order to assist with curriculum development. Artifacts of this capstone product include: 1 hour CEU with knowledge checks, 12 question exam and a resource guide accessible on AOTA’s learn platform

Early Successional Microhabitats Allow the Persistence of Endangered Plants in Coastal Sand Dunes

Many species are adapted to disturbance and occur within dynamic, mosaic landscapes that contain early and late successional microhabitats. Human modification of disturbance regimes alters the availability of microhabitats and may affect the viability of species in these ecosystems. Because restoring historical disturbance regimes is typically expensive and requires action at large spatial scales, such restoration projects must be justified by linking the persistence of species with successional microhabitats. Coastal sand dune ecosystems worldwide are characterized by their endemic biodiversity and frequent disturbance. Dune-stabilizing invasive plants alter successional dynamics and may threaten species in these ecosystems. We examined the distribution and population dynamics of two federally endangered plant species, the annual Layia carnosa and the perennial Lupinus tidestromii, within a dune ecosystem in northern California, USA. We parameterized a matrix population model for L. tidestromii and examined the magnitude by which the successional stage of the habitat (early or late) influenced population dynamics. Both species had higher frequencies and L. tidestromii had higher frequency of seedlings in early successional habitats. Lupinus tidestromii plants in early successional microhabitats had higher projected rates of population growth than those associated with stabilized, late successional habitats, due primarily to higher rates of recruitment in early successional microhabitats. These results support the idea that restoration of disturbance is critical in historically dynamic landscapes. Our results suggest that large-scale restorations are necessary to allow persistence of the endemic plant species that characterize these ecosystems

Phonological and lexical influences on phonological awareness in children with specific language impairment and dyslexia

Children with dyslexia and/or specific language impairment have marked deficits in phonological processing, putting them at an increased risk for reading deficits. The current study sought to examine the influence of word-level phonological and lexical characteristics on phonological awareness. Children with dyslexia and/or specific language impairment were tested using a phoneme deletion task in which stimuli differed orthogonally by sound similarity and neighborhood density. Phonological and lexical factors influenced performance differently across groups. Children with dyslexia appeared to have a more immature and aberrant pattern of phonological and lexical influence (e.g., favoring sparse and similar features). Children with SLI performed less well than children who were typically developing, but followed a similar pattern of performance (e.g., favoring dense and dissimilar features). Collectively, our results point to both quantitative and qualitative differences in lexical organization and phonological representations in children with SLI and in children with dyslexia