Comparison of Outcomes between Endoscopic and Transcleral Cyclophotocoagulation.

Importance: Traditionally cyclophotocoagulation has been reserved as a treatment of last resort for eyes with advanced stage glaucoma, but increasingly it is offered to eyes with less severe disease. Endoscopic approaches in particular are utilized in increasing numbers of patients despite only a small number of publications on its results. Objective: The purpose of this study was to compare the efficacy and safety of endoscopic and transcleral cyclophotocoagulation (ECP and TCP) procedures in eyes with refractory glaucomas. Design, Setting, and Participants: A chart review was performed on consecutive patients who underwent ECP and TCP at a tertiary ophthalmology care center between January 2000 and December 2010. Cases with fewer than 3 months of follow-up or that had concurrent pressure reducing procedures were excluded. The main outcome measures examined were intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), additional glaucoma procedure required, and complications. Main Outcomes and Measures: Forty-two eyes (42 patients) that underwent ECP and forty-four eyes (44 patients) that underwent TCP were identified. The TCP group had a statistically higher mean age (71.2 ± 16.7 vs. 58.1 ± 22.9 years, respectively), larger proportion of neovascular glaucoma (40.9% vs. 16.7%), worse initial BCVA (logMAR 2.86 vs. 1.81), and higher preoperative IOP (45.3 vs. 26.6 mmHg) than the ECP group. At 12 months follow-up, the mean IOP difference between groups was not statistically significant, although the change in IOP from baseline to 12 months was greater for the TCP group (p = 0.006). The rates of progression to no light perception (NLP) and phthisis bulbi were significantly higher amongst TCP eyes than ECP eyes (27.2% vs. 4.8%, p = 0.017, and 20.5% vs. 0%, p = 0.003, respectively). Of these eyes that progressed, a majority had neovascular glaucoma (NVG). Corneal decompensation was the most frequent complication following ECP (11.9%). Conclusions and Relevance: In patients with preoperative BCVA of 20/400 or better, overall complication rates (cystoid macular edema, exudative retinal detachment, inflammation, cornea decompensation) were higher after ECP than with TCP. In refractory glaucomas in a real world setting (not a trial), TCP was more frequently used in ischemic eyes. TCP was associated with a higher rate of progression to phthisis bulbi and loss of light perception than ECP. However, ECP was associated with a clinically significant rate of corneal decompensation. These outcomes likely were related to the severity of underlying ocular diseases found in these eyes

Local Youth Groups in Georgia Working Towards Policy, Systems, and Environmental Changes

Background: The Georgia Youth Tobacco Survey (YTS) is a survey of public middle school (MS) and high school (HS) students. The Georgia YTS was first conducted in 2001. According to YTS, students who attended a tobacco free schools’ youth summit were significantly more likely to be aware of students who use tobacco products (MS: 21% for smoking and 20% for smokeless tobacco; HS: 42% for smoking and 39% for smokeless tobacco) on school property than students who did not attend a tobacco free schools’ youth summit (MS: 10 % for smoking and 9 % for smokeless tobacco; HS: 32 % for smoking and 35 % for smokeless tobacco. Methods: During the fall of 2014, the Chronic Disease Prevention Section of the Georgia Department of Public Health (DPH) hosted a youth summit for youth groups across the state. In total, 149 youth and 49 adult leaders attended the summit. The youth summit provided training for middle and high school youth to become tobacco use control advocates in their communities. The youth were involved in creating the messages they would deliver to their school boards. Results: The local youth groups who attended the summit in 2014 were instrumental in four school districts adopting the model 100% Tobacco-Free Schools policy: Lowndes County Schools and Irwin County Schools (Valdosta, GA); Emanuel County Schools and Jenkins County Schools (Augusta, GA). Conclusions: These findings support the growing literature on youth involvement in advocacy work towards policy change. Youth should be recruited to work with public health professionals in building coalitions to change community norms

Partnership Approach to Establishing Tobacco-Free Colleges and Universities in Georgia

Background: Smoking rates in young adults ages 18-24 have been steadily declining since 2011 (2011:25.0%, 2012:22.3%, 2013:16.5% (BRFSS). The Georgia Department of Public Health (GDPH) partnered with the Georgia Board of Regents to adopt the 100% Tobacco Free Colleges/Universities policy. Methods: The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based surveillance system, administered by the GDPH in collaboration with the CDC. The survey began in 1984 with 15 states participating, including Georgia. The data from this survey were used to inform key shareholders of smoking prevalence to encourage policy adoption as a method of decreasing tobacco use. The GDPH used the CDC’s Partnership Toolkit to recruit and retain partnerships with various multi-sector organizations in working towards systems change. Results: The Georgia Board of Regents—the governing body for the state’s system of colleges and universities –adopted the model 100% tobacco free colleges/universities policy resulting in a systems change of 31 campuses now having the model policy in place. The policy not only impacted the students who fall in the 18-24 age group, but the staff and visitors as well. Conclusions: Partnerships play a key role in creating systems changes. The partnership between the Georgia Board of Regents and the Georgia Department of Public Health contributed to the growing number of colleges and universities who are now 100% Tobacco Free. Using the CDC’s Partnership Toolkit allowed for sustainable partnerships leading to positive social change

Critical and Tricritical Points for the Massless 2d Gross-Neveu Model Beyond Large N

Using optimized perturbation theory, we evaluate the effective potential for the massless two dimensional Gross-Neveu model at finite temperature and density containing corrections beyond the leading large-N contribution. For large-N, our results exactly reproduce the well known 1/N leading order results for the critical temperature, chemical potential and tricritical points. For finite N, our critical values are smaller than the ones predicted by the large-N approximation and seem to observe Landau's theorem for phase transitions in one space dimension. New analytical results are presented for the tricritical points that include 1/N corrections. The easiness with which the calculations and renormalization are carried out allied to the seemingly convergent optimized results displayed, in this particular application, show the robustness of this method and allows us to obtain neat analytical expressions for the critical as well as tricritical values beyond the results currently known.Comment: 29 pages, 14 figure

Community social network pattern analysis: Development of a novel methodology using a complex, multi-level health intervention

Community social networks (CSN) include individuals and groups, and those with strong partnerships and relationships are well situated for implementing community-based interventions. However, information on the nature of CSN relationships required for multilevel community-based interventions is not present in the literature. Using data from the multi-level Children’s Healthy Living (CHL) trial to reduce child obesity in nine Pacific communities, this study aimed to develop a methodology based on Social Network Analysis (SNA) to understand how CSN evolved over the course of a two-year trial, as well as the characteristics of CSN most successful in impacting indicators of childhood obesity. The two-year trial was considered in four six-month intervals. Within each interval, implemented activities, as recorded in CHL monthly reports, were coded by activity implementer(s), e.g. government agency, school, or community-based group, as well as for collective efficacy impact of the activity, e.g. to leverage resources from outside the CSN or to facilitate civic engagement. Coded data were used to create CSN maps for the four time intervals, and SNA techniques examined the CSN characteristics. CSN density increased over time, as measured by the number of ties within the network. Schools, community-based groups and large organizations were identified as the primary implementers of the CHL intervention and formed a community implementer backbone. Social leveraging, i.e. linking local groups to people with authority over outside resources, was shown to be a central component in intervention success. It took time to develop strong CSN, and stronger (denser) CSN were more successful in building social cohesion and enacting community change. Findings illustrate a methodology that can be useful for tracking the development and impact of CSN

A Lower Limit on Omega-Lambda Using Gravitational Lensing in the Hubble Deep Field

We calculate the expected number of multiply-imaged galaxies in the Hubble Deep Field (HDF), using photometric redshift information for galaxies with $m_I < 27$ that were detected in all four HDF passbands. A comparison of these expectations with the observed number of strongly lensed galaxies places a lower limit on the current value of $\Omega_m-\Omega_{\Lambda}$, where $\Omega_m$ is the cosmological mass density of the universe and $\Omega_\Lambda$ is the normalized cosmological constant. Based on current estimates of the HDF luminosity function and associated uncertainties in individual parameters, our 95% confidence lower limit on $\Omega_m-\Omega_{\Lambda}$ is between -0.44, if there are no strongly lensed galaxies in the HDF, and -0.73, if there are two strongly lensed galaxies in the HDF. If the only lensed galaxy in the HDF is the one presently viable candidate, then, in a flat universe ($\Omega_m+\Omega_\Lambda=1$), $\Omega_{\Lambda} < 0.79$ (95% C.L.). These lower limits are compatible with estimates based on high-redshift supernovae and with previous limits based on gravitational lensing.Comment: 18 pages, 3 figures and 2 tables. Final proof version, to appear in The Astrophysical Journal, Vol 511, February 1, 199

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

Collective Decision Dynamics in the Presence of External Drivers

We develop a sequence of models describing information transmission and decision dynamics for a network of individual agents subject to multiple sources of influence. Our general framework is set in the context of an impending natural disaster, where individuals, represented by nodes on the network, must decide whether or not to evacuate. Sources of influence include a one-to-many externally driven global broadcast as well as pairwise interactions, across links in the network, in which agents transmit either continuous opinions or binary actions. We consider both uniform and variable threshold rules on the individual opinion as baseline models for decision-making. Our results indicate that 1) social networks lead to clustering and cohesive action among individuals, 2) binary information introduces high temporal variability and stagnation, and 3) information transmission over the network can either facilitate or hinder action adoption, depending on the influence of the global broadcast relative to the social network. Our framework highlights the essential role of local interactions between agents in predicting collective behavior of the population as a whole.Comment: 14 pages, 7 figure