Is reduction in the risk of vision loss the only benefit of photodynamic therapy in predominantly classic subfoveal choroidal neovascularization?

Nicola G Ghazi, rian P Conway, James S Tiedeman, Steven J YoonUniversity of Virginia Health System, Department of Ophthalmology, Charlottesville, VA, USAPurpose: To emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV).Methods: A retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT.Results: After an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of fluorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was significantly larger than that post-PDT (p = 0.044). It was also significantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001).Conclusion: This study demonstrates a beneficial effect for PDT on the size of the NL and DS in SFCNV, which might be of great significance, particularly when PDT fails to prevent severe vision loss.Keywords: age-related macular degeneration, choroidal neovascularization, classic choroidal neovascularization, disciform scarring, fluorescein angiography, photodynamic therap

Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

<p>Abstract</p> <p>Background</p> <p>The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification).</p> <p>Methods</p> <p>In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution.</p> <p>Results</p> <p>The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample.</p> <p>Conclusions</p> <p>A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with the self-identification. This empirical classification is an objective approach to variable construction and can be generally applied across Norwegian hospitals. The classification procedure used in the study could be developed into a standardized method for classifying hospital wards across health systems and over time.</p

Downregulation of the Escherichia coli guaB promoter by FIS

The Escherichia coli guaB promoter (PguaB) regulates transcription of two genes, guaB and guaA, that are required for the synthesis of guanosine 5′-monophosphate (GMP), a precursor for the synthesis of guanine nucleoside triphosphates. Transcription from PguaB increases as a function of increasing cellular growth rate, and this is referred to as growth rate-dependent control (GRDC). Here we investigated the role of the factor for inversion stimulation (FIS) in the regulation of this promoter. The results showed that there are three binding sites for FIS centred near positions −11, +8 and +29 relative to the guaB transcription start site. Binding of FIS to these sites results in repression of PguaB in vitro but not in vivo. Deletion of the fis gene results in increased PguaB activity in vivo, but GRDC of PguaB is maintained

Aligning agri-environmental subsidies and environmental needs: A comparative analysis between the US and EU

The global recognition of modern agricultural practices' impact on the environment has fuelled policy responses to ameliorate environmental degradation in agricultural landscapes. In the US and the EU, agri-environmental subsidies (AES) promote widespread adoption of sustainable practices by compensating farmers who voluntarily implement them on working farmland. Previous studies, however, have suggested limitations of their spatial targeting, with funds not allocated towards areas of the greatest environmental need. We analysed AES in the US and EU –specifically through the Environmental Quality Incentives Program (EQIP) and selected measures of the European Agricultural Fund for Rural Development (EAFRD)– to identify if AES are going where they are most needed to achieve environmental goals, using a set of environmental need indicators, socio-economic variables moderating allocation patterns, and contextual variables describing agricultural systems. Using linear mixed models and linear models we explored the associations among AES allocation and these predictors at different scales. We found that higher AES spending was associated with areas of low soil organic carbon and high greenhouse gas emissions both in the US and EU, and nitrogen surplus in the EU. More so than successes, however, clear mismatches of funding and environmental need emerged – AES allocation did not successfully target areas of highest water stress, biodiversity loss, soil erosion, and nutrient runoff. Socio-economic and agricultural context variables may explain some of these mismatches; we show that AES were allocated to areas with higher proportions of female producers in the EU but not in the US, where funds were directed towards areas with less tenant farmers. Moreover, we suggest that the potential for AES to remediate environmental issues may be curtailed by limited participation in intensive agricultural landscapes. These findings can help inform refinements to EQIP and EAFRD allocation mechanisms and identify opportunities for improving future targeting of AES spending

Occurrence and Treatment of Bone Atrophic Non-Unions Investigated by an Integrative Approach

Recently developed atrophic non-union models are a good representation of the clinical situation in which many nonunions develop. Based on previous experimental studies with these atrophic non-union models, it was hypothesized that in order to obtain successful fracture healing, blood vessels, growth factors, and (proliferative) precursor cells all need to be present in the callus at the same time. This study uses a combined in vivo-in silico approach to investigate these different aspects (vasculature, growth factors, cell proliferation). The mathematical model, initially developed for the study of normal fracture healing, is able to capture essential aspects of the in vivo atrophic non-union model despite a number of deviations that are mainly due to simplifications in the in silico model. The mathematical model is subsequently used to test possible treatment strategies for atrophic non-unions (i.e. cell transplant at post-osteotomy, week 3). Preliminary in vivo experiments corroborate the numerical predictions. Finally, the mathematical model is applied to explain experimental observations and identify potentially crucial steps in the treatments and can thereby be used to optimize experimental and clinical studies in this area. This study demonstrates the potential of the combined in silico-in vivo approach and its clinical implications for the early treatment of patients with problematic fractures

Adaptive and Efficient Computing for Subsurface Simulation within ParFlow

This project is concerned with the PF.WRF model as a means to enable more accurate predictions of wind fluctuations and subsurface storage. As developed at LLNL, PF.WRF couples a groundwater (subsurface) and surface water flow model (ParFlow) to a mesoscale atmospheric model (WRF, Weather Research and Forecasting Model). It was developed as a unique tool to address coupled water balance and wind energy questions that occur across traditionally separated research regimes of the atmosphere, land surface, and subsurface. PF.WRF is capable of simulating fluid, mass, and energy transport processes in groundwater, vadose zone, root zone, and land surface systems, including overland flow, and allows for the WRF model to both directly drive and respond to surface and subsurface hydrologic processes and conditions. The current PF.WRF model is constrained to have uniform spatial gridding below the land surface and matching areal grids with the WRF model at the land surface. There are often cases where it is advantageous for land surface, overland flow and subsurface models to have finer gridding than their atmospheric counterparts. Finer vertical discretization is also advantageous near the land surface (to properly capture feedbacks) yet many applications have a large vertical extent. However, the surface flow is strongly dependent on topography leading to a need for greater lateral resolution in some regions and the subsurface flow is tightly coupled to the atmospheric model near the surface leading to a need for finer vertical resolution. In addition, the interactions (e.g. rain) will be highly variable in space and time across the problem domain so an adaptive scheme is preferred to a static strategy to efficiently use computing and memory resources. As a result, this project focussed on algorithmic research required for development of an adaptive simulation capability in the PF.WRF system and its subsequent use in an application problem in the Central Valley of California. This report documents schemes of use for a future implementation of an adaptive grid capability within the ParFlow subsurface flow simulator in PF.WRF. The methods describe specific handling of the coarse/fine boundaries within a cell-centered discretization of the nonlinear parabolic Richards equation model for variable saturated flow. In addition, we describe development of a spline fit and table lookup method implemented within ParFlow to enhance computational efficiency of variably saturated flow calculations

Sheep production on medic and weedy pasture in semi-arid Morocco

Most farms in the semi-arid region of Morocco are mixed cereal-livestock producers. Livestock, dominated by sheep, account for more than one third of farm income but production is far below potential. Low quality cereal straw and weeds from fallow land are the main sources of forage, but provide inadequate nutrition. Fall planted wheat is usually grown in rotation following a year of weedy fallow. The replacement of the weedy fallow by sowing a self regenerating annual Medicago spp., a system known as ley farming in Australia, was tested in Morocco to determine if it could increase livestock production. Ewe and lamb liveweight gain, wool yield, and forage standing crop during grazing were compared between medic and weedy fallow pastures. Large significant differences (P < 0.05) in forage standing crop and both lamb and ewe liveweight gain occurred in 1990/91 but no differences occurred the previous 2 years when medic was initially sown nor the following 2 years during severe drought. In 1991 lambs gained 67% and ewes gained 60% more liveweight, plus wool yield was 23% higher on medic as compared to weedy fallow. In addition, 3,000 kg ha-4 of forage remained after grazing medic as compared to 568 kg ha-1 after weedy fallow.The Journal of Range Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202