Screening, Diagnosis, and Management of Open Angle Glaucoma: An Evidence-Based Guideline for Canadian Optometrists

Glaucoma is the most common form of irreversible blindness in the world, and second only to cataract among all causes of blindness. There is still no universally agreed-upon definition of glaucoma, and as such, it remains a condition for which there are differing views on the classification of individuals within the continuum of suspicion through diagnosis. Regardless, there appears to be consensus that glaucoma refers to a group of diseases that manifest as a characteristic progressive optic neuropathy and retinal ganglion cell loss that eventually leads to a permanent loss of visual field. Glaucoma is a major public health issue because individuals are typically asymptomatic until end stages of the disease when the associated vision loss is significant and irreversible. Studies have shown that the prevalence of undetected glaucoma is as high as 50% even in high income areas including North America and Australia, increasing to 90% in middle and low income areas such as Asia and Africa. This is at least in part a result of inadequate screening tools and strategies to detect this asymptomatic disease: without more individuals accessing routine eye examinations, glaucoma will continue to go undetected. Vision loss from glaucoma imposes significant societal and economic burdens that increase with disease severity: the direct costs of vision loss from glaucoma exceed $300 million annually in Canada, and approach$2 billion across North America

Maternal and infant food insecurity in the UK: a problem hiding in plain sight?

Lone parents with children under five are amongst the most food insecure in the UK (Cheong et al, 2021; Tobi et al, 2022). Yet maternal and infant food insecurity experience remains poorly understood in the UK. Drawing on findings from qualitative research conducted with parents of infants and young children, and early years health professionals, this paper highlights the hidden nature of poverty and food insecurity amongst young mothers and asks questions about the extent to which this problem is recognised and understood within health care. Two interview studies were conducted during 2020 and 2021 with 22 participants in north-east Scotland, including pregnant women and mothers with at least one child under five. One study included interviews with 18 midwives, health visitors and family nurses (HCP). The studies investigated experiences of parenting on a low income, and health professional support related to financial hardship challenges during pregnancy and early infancy. health professionals' perceptions of poverty within caseloads and experiences of raising financial issues during practice were also investigated. Data were thematically analysed using Grounded Theory principles. Key parent themes included: inadequate social security income co-existing with restricted access to paid employment; anxieties around food and other resource provision for their children; going without food themselves; and relying on charity or extended family for help with feeding. Fear of raising child protection concerns, shame and embarrassment, and exacerbating partner abuse prevented parents disclosing financial hardship and food insecurity to health professionals. Health professionals themselves were aware of poverty within some households, but not universally confident they could recognise the problem. They were also inhibited from raising the issue both because of poverty stigma, and further because of a lack of time and knowledge regarding how to do so effectively. Our findings point to the economic, nutritional and social vulnerability of lone parents that existed before the current cost-of-living crisis. As mothers continue to remain responsible for infant feeding - either as food producers themselves or through infant formula procurement from commercial sources (Frank, 2018; Doonan, 2018) - there is an urgent need to develop a better understanding of the nature and extent of maternal and infant food security in the UK, to develop more effective public policy and health care practice

Modeling active electrolocation in weakly electric fish

In this paper, we provide a mathematical model for the electrolocation in weakly electric fishes. We first investigate the forward complex conductivity problem and derive the approximate boundary conditions on the skin of the fish. Then we provide a dipole approximation for small targets away from the fish. Based on this approximation, we obtain a non-iterative location search algorithm using multi-frequency measurements. We present numerical experiments to illustrate the performance and the stability of the proposed multi-frequency location search algorithm. Finally, in the case of disk- and ellipse-shaped targets, we provide a method to reconstruct separately the conductivity, the permittivity, and the size of the targets from multi-frequency measurements.Comment: 37 pages, 11 figure

Optioneering analysis for connecting Dogger Bank offshore wind farms to the GB electricity network

This paper outlines possibilities for connecting 2.4 GW of power from two separate wind farms at Dogger Bank in the North Sea to the GB transmission system in Great Britain. Three options based on HVDC with Voltage Source Converters (VSC HVDC) are investigated: two separate point-to-point connections, a four-terminal multi-terminal network and a four-terminal network with the addition of an AC auxiliary cable between the two wind farms. Each option is investigated in terms of investment cost, controllability and reliability against expected fault scenarios. The paper concludes that a VSC-HVDC point-to-point connection is the cheapest option in terms of capital cost and has the additional advantage that it uses technology that is commercially available. However, while multi-terminal connections are more expensive to build it is found that they can offer significant advantages over point to point systems in terms of security of supply and so could offer better value for money overall. A multi-terminal option with an auxiliary AC connection between wind farms is found to be lower cost than a full multi-terminal DC grid option although the latter network would offer ability to operate at greater connection distances between substations

Adenosine-mono-phosphate-activated protein kinase-independent effects of metformin in T cells

The anti-diabetic drug metformin regulates T-cell responses to immune activation and is proposed to function by regulating the energy-stress-sensing adenosine-monophosphate-activated protein kinase (AMPK). However, the molecular details of how metformin controls T cell immune responses have not been studied nor is there any direct evidence that metformin acts on T cells via AMPK. Here, we report that metformin regulates cell growth and proliferation of antigen-activated T cells by modulating the metabolic reprogramming that is required for effector T cell differentiation. Metformin thus inhibits the mammalian target of rapamycin complex I signalling pathway and prevents the expression of the transcription factors c-Myc and hypoxia-inducible factor 1 alpha. However, the inhibitory effects of metformin on T cells did not depend on the expression of AMPK in T cells. Accordingly, experiments with metformin inform about the importance of metabolic reprogramming for T cell immune responses but do not inform about the importance of AMPK

The end of the unique myocardial band: Part I. Anatomical considerations

The concept of the ‘unique myocardial band’, which proposes that the ventricular myocardial cone is arranged like skeletal muscle, provides an attractive framework for understanding haemodynamics. The original idea was developed by Francisco Torrent-Guasp. Using boiled hearts and blunt dissection, Torrent-Guasp created a single band of ventricular myocardium extending from the pulmonary trunk to the aortic root, with the band thus constructed encircling both ventricular cavities. Cooked hearts can, however, be dissected in many ways. In this review, we show that the band does not exist as an anatomical entity with defined borders. On the contrary, the ventricular cardiomyocytes are aggregated end to end and by their branching produce an intricate meshwork. Across the thickness of the left ventricular wall, the chains of cardiomyocytes exhibit a gradually changing helical angle, with a circumferential zone formed in the middle. There is no abrupt change in helical angle, as could be expected if the wall was constructed of opposing limbs of a single wrapped band, nor does the long axis of the cardiomyocytes consistently match with the long axis of the unique myocardial band. There are, furthermore, no connective tissue structures that could be considered to demarcate its purported boundaries. The unique myocardial band should be consistent with evolution, and although the ventricular wall of fish and reptiles has one or several distinct layers, a single band is not found. In 1965, Lev and Simpkins cautioned that the ventricular muscle mass of a cooked heart can be dissected almost at the whim of the anatomist. We suggest that the unique myocardial band should have ended there

Locating hydrogen positions in the autunite mineral metatorbernite [Cu(UO₂)₂(PO₄)₂·8H₂O]:A combined approach using neutron powder diffraction and computational modelling

Metatorbernite [Cu(UO(2))(2)(PO(4))(2)·8H(2)O] is a promising remediation material for environmental uranium contamination. Previous X-ray diffraction studies have been unable to definitively locate hydrogen positions within metatorbernite, which are key to determining the hydrogen-bond network that helps to stabilize the structure. Here, hydrogen positions have been determined using a combination of neutron powder diffraction and the computational modelling technique ab initio random structure searching (AIRSS). Atomic coordinates determined through Rietveld analysis of neutron powder diffraction data are in excellent agreement with the minimum energy configuration predicted by AIRSS; thus, simulations confirm that our proposed model likely represents the global minimum configuration. Two groups of water molecules exist within the metatorbernite structure: free water and copper-coordinating water. Free water molecules are held within the structure by hydrogen bonding only, whilst the coordinating water molecules bond to copper in the equatorial positions to produce a 4 + 2 Jahn–Teller octahedra. The successful agreement between neutron powder diffraction data and AIRSS suggests that this combined approach has excellent potential for the study of other (trans)uranium materials in which hydrogen bonding plays a key role in phase stability

MRI: how to understand it

MRI is a staple of the neurologist’s armoury when facing diagnostic challenges. At times, it can reveal or confirm the diagnosis with clarity, at others it brings us no further forwards, or even muddies the water. We rely on the expertise of neuroradiology colleagues to interpret MR images, but the choice of protocol for MR acquisition and its interpretation hinge crucially on the clinical information we provide. Having a degree of understanding about how MRI works, its limitations and pitfalls, can help to optimise what we learn from a scan