Ear care: an update for nurses (part 2)

Impacted cerumen can cause problems ranging from general discomfort to loss of hearing function. In the second of two articles, Kat Millward examines the best methods for softening and removing cerumen from the ear without causing any damage Our ears are essential for both hearing and balance. Up to 4% of the population will have difficulties with their ears relating to impacted cerumen and many of them will present in primary care with ear discomfort or hearing difficulties. In the second of two articles, we review the evidence and recommended best practice for managing impacted cerumen, including ear drops, irrigation, microsuction and instrumentation

The revised short-form of the Eating Beliefs Questionnaire: Measuring positive, negative, and permissive beliefs about binge eating.

BACKGROUND: The Eating Beliefs Questionnaire (EBQ) is a self-report assessment tool that measures positive and negative beliefs about food and eating that are believed to play a key role in maintaining binge eating behaviour that occurs in individuals with Bulimia Nervosa, Binge Eating Disorder and other atypical eating disorders. The present study aimed to further refine this measure with the addition of a third scale to assess permissive beliefs about eating, also thought to play a crucial role in the maintenance of binge eating. Permissive beliefs are defined as beliefs about eating that provide justification for the individual to engage in a binge eating episode. METHODS: After consultation with the literature and endorsement from 10 experts in eating disorders, 19 permissive belief items were generated. Eight hundred eighty-three participants were recruited to complete a test battery online that included the EBQ and the new permissive items. RESULTS: An exploratory factor analysis (n = 441) found a three-factor solution (positive, negative and permissive beliefs) explaining 63.4% of variance. A confirmatory factor analysis (n = 442) provided support for the three-factor model, with the data best supporting a shorter 18-item questionnaire. The revised scale demonstrated good internal consistency, as well as good convergent validity with measures of related eating disorder symptoms, emotional regulation, mood and anxiety. CONCLUSIONS: With the addition of a third scale to measure permissive beliefs, the revised short-form of the EBQ offers clinicians and researchers a brief comprehensive tool for the measurement of positive, negative and permissive beliefs about binge eating

Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating.

Background:There are a number of factors commonly believed to be important to the development and maintenance of binge eating that have been identified across multiple models and theories in the psychological literature. In the present study, we sought to develop and test a psychological model for binge eating that incorporated the main variables identified in the literature to drive binge eating behaviour; specifically, core low self-esteem, negative affect, difficulty with emotional regulation, restricted eating and beliefs about eating. Methods:Questionnaire data was collected from 760 unselected participants. The proposed model of binge eating was developed, bivariate relationships between the included variables were assessed, and the goodness-of-fit of this new model was evaluated using structural equations modelling. Result:The results identified significant bivariate relationships between all the included variables. While the originally proposed model did not provide a good fit to the data, the revised version of the model provided a good fit to the data. Conclusions:Supporting, integrating and building upon the current existing psychological models of binge eating, this study presents a new integrated cognitive and behavioural model of binge eating. The dual-pathway to binge eating identified in the new model provides a different way to understand transdiagnostic binge eating

Fibroblasts profiling in scarring trachoma identifies IL-6 as a functional component of a fibroblast-macrophage pro-fibrotic and pro-inflammatory feedback loop

Trachoma is a conjunctiva scarring disease, which is the leading infectious cause of blindness worldwide. Yet, the molecular mechanisms underlying progressive fibrosis in trachoma are unknown. To investigate the contribution of local resident fibroblasts to disease progression, we isolated conjunctival fibroblasts from patients with scarring trachoma and matching control individuals, and compared their gene expression profiles and functional properties in vitro. We show that scarring trachoma fibroblasts substantially differ from control counterparts, displaying pro-fibrotic and pro-inflammatory features matched by an altered gene expression profile. This pro-inflammatory signature was exemplified by increased IL-6 expression and secretion, and a stronger response to macrophage-mediated stimulation of contraction. We further demonstrate that scarring trachoma fibroblasts can promote Akt phosphorylation in macrophages in an IL-6 –dependent manner. Overall this work has uncovered a distinctive molecular fingerprint for scarring trachoma fibroblasts, and identified IL-6- as a potential contributor to the chronic conjunctival fibrosis, mediating reciprocal pro-fibrotic/pro-inflammatory interactions between macrophages and fibroblasts

What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise.

PURPOSE: The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (<6/60) often comprise 20% in published case series. This Delphi exercise aimed to identify and prioritise potential interventions for improving the quality of cataract surgery in SSA to guide research and eye health programme development. METHODS: An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking. RESULTS: Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases). CONCLUSION: Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated

The Use of a Numerical Weather Prediction Model to Simulate Near-Field Volcanic Plumes

In this paper, a state-of the art numerical weather prediction (NWP) model is used to simulate the near-field plume of a Plinian-type volcanic eruption. The NWP model is run at very high resolution (of the order of 100 m) and includes a representation of physical processes, including turbulence and buoyancy, that are essential components of eruption column dynamics. Results are shown that illustrate buoyant gas plume dynamics in an atmosphere at rest and in an atmosphere with background wind, and we show that these results agree well with those from theoretical models in the quiescent atmosphere. For wind-blown plumes, we show that features observed in experimental and natural settings are reproduced in our model. However, when comparing with predictions from an integral model using existing entrainment closures there are marked differences. We speculate that these are signatures of a difference in turbulent mixing for uniform and shear flow profiles in a stratified atmosphere. A more complex implementation is given to show that the model may also be used to examine the dispersion of heavy volcanic gases such as sulphur dioxide. Starting from the standard version of the weather research and forecasting (WRF) model, we show that minimal modifications are needed in order to model volcanic plumes. This suggests that the modified NWP model can be used in the forecasting of plume evolution during future volcanic events, in addition to providing a virtual laboratory for the testing of hypotheses regarding plume behaviour

Increased Epithelial Expression of CTGF and S100A7 with Elevated Subepithelial Expression of IL-1 beta in Trachomatous Trichiasis

Purpose: To characterize the histological appearance and expression of pro-inflammatory mediators, growth factors, matrix metalloproteinases and biomarkers of epithelial-mesenchymal transition (EMT) in healthy control and trachomatous trichiasis (TT) conjunctival tissue. Methods: Conjunctival biopsies were taken from 20 individuals with TT and from 16 individuals with healthy conjunctiva, which served as controls. Study participants were of varying ethnicity and were living in a trachoma-endemic region of northern Tanzania. Formalin-fixed paraffin-embedded tissue sections were stained using hematoxylin and eosin or by immunohistochemistry using antibodies against: IL-1β, IL-6, IL-17A, IL-22, CXCL5, S100A7, cleaved caspase 1 (CC1), PDGF, CTGF, TGFβ2, MMP7, MMP9, E-cadherin, vimentin, and αSMA. Results: Tissue from TT cases had a greater inflammatory cell infiltrate relative to controls and greater disruption of collagen structure. CTGF and S100A7 were more highly expressed in the epithelium and IL-1β was more highly expressed in the substantia propria of TT cases relative to controls. Latent TGFβ2 was slightly more abundant in the substantia propria of control tissue. No differences were detected between TT cases and controls in the degree of epithelial atrophy, the number of myofibroblasts or expression of EMT biomarkers. Conclusions: These data indicate that the innate immune system is active in the immunopathology of trachoma, even in the absence of clinical inflammation. CTGF might provide a direct link between inflammation and fibrosis and could be a suitable target for therapeutic treatment to halt the progression of trachomatous scarring

Altered Patterns of Fungal Keratitis at a London Ophthalmic Referral Hospital: An Eight-Year Retrospective Observational Study

PURPOSE: In previous studies of fungal keratitis (FK) from temperate countries, yeasts were the predominant isolates, with ocular surface disease (OSD) being the leading risk factor. Since the 2005–2006 outbreak of contact lens (CL)-associated Fusarium keratitis, there may have been a rise in CL-associated filamentary FK in the United Kingdom. This retrospective case series investigated the patterns of FK from 2007 to 2014. We compared these to 1994–2006 data from the same hospital. DESIGN: Retrospective observational study. METHODS: All cases of FK presenting to Moorfields Eye Hospital between 2007 and 2014 were identified. The definition of FK was either a fungal organism isolated by culture or fungal structures identified by light microscopy (LM) of scrape material, histopathology, or in vivo corneal confocal microscopy (IVCM). Main outcome measure was cases of FK per year. RESULTS: A total of 112 patients had confirmed FK. Median age was 47.2 years. Between 2007 and 2014, there was an increase in annual numbers of FK (Poisson regression, P [ .0001). FK was confirmed using various modalities: 79 (70.5%) by positive culture, 16 (14.3%) by LM, and 61 (54.5%) by IVCM. Seventy-eight patients (69.6%) were diagnosed with filamentary fungus alone, 28 (25%) with yeast alone, and 6 (5.4%) with mixed filamentary and yeast infections. This represents an increase in the proportion of filamentary fungal infections from the pre-2007 data. Filamentary fungal and yeast infections were associated with CL use and OSD, respectively. CONCLUSIONS: The number of FK cases has increased. This increase is due to CL-associated filamentary FK. Clinicians should be aware of these changes, which warrant epidemiologic investigations to identify modifiable risk factors

Single-beam three-dimensional optical trapping at extremely low insertion angles via optical fiber optimization

Employing optical fiber to deliver the trapping laser to the sample chamber significantly reduces the size and costs of optical tweezers (OT). The utilization of fiber decouples the OT from the microscope, providing scope for system portability, and the potential for uncomplicated integration with other advanced microscopy systems. For use with an atomic force microscope, the fiber must be inserted at an angle of 10 deg to the plane of the sample chamber floor. However, the literature states that optical trapping with a single fiber inserted at an angle ≤20 deg is not possible. This paper investigates this limitation and proposes a hypothesis that explains it. Based on this explanation, a tapered-fiber optical tweezer system is developed. This system demonstrates that such traps can indeed be made to function in three-dimensions (3-D) at insertion angles of ≤10 deg using relatively low optical powers, provided the fiber taper is optimized. Three such optimized tapered fiber tips are presented, and their ability to optically trap both organic and inanimate material in 3-D is demonstrated. The near-horizontal insertion angle introduced a maximum trapping range (MTR). The MTR of the three tips is determined empirically, evaluated against simulated data, and found to be tunable through taper optimization

Full Thermoelectric Characterization of Stoichiometric Electrodeposited Thin Film Tin Selenide (SnSe)

Tin selenide (SnSe) has attracted much attention in the thermoelectric community since the discovery of the record figure of merit (ZT) of 2.6 in single crystal tin selenide in 2014. There have been many reports since of the thermoelectric characterization of SnSe synthesized or manufactured by several methods, but so far none of these have concerned the electrodeposition of SnSe. In this work, stoichiometric SnSe was successfully electrodeposited at −0.50 V vs SCE as shown by EDX, XPS, UPS, and XRD. The full ZT of the electrodeposits were then measured. This was done by both a delamination technique to measure the Seebeck coefficient and electrical conductivity which showed a peak power factor of 4.2 and 5.8 μW m–1 K–2 for the as deposited and heat-treated films, respectively. A novel modified transient 3ω method was used to measure the thermal conductivity of the deposited films on the deposition substrate. This revealed the thermal conductivity to be similar to the ultralow thermal conductivity of single crystal SnSe, with a value of 0.34 W m–1 K–1 being observed at 313 K