The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma

Aim: To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of glaucoma and the decision to treat with that of routine hospital eye care, against a reference standard of expert opinion (a consultant ophthalmologist with a special interest in glaucoma). Methods: A directly comparative, masked, performance study was undertaken in Grampian, Scotland. Of 165 people invited to participate, 100 (61%) were examined. People suspected of having glaucoma underwent, within one month, a full ophthalmic assessment in both a newly established community optometry led glaucoma management scheme and a consultant led hospital eye service. Results: Agreement between the AGO and the consultant ophthalmologist in diagnosing glaucoma was substantial (89%; ? = 0.703, SE = 0.083). Agreement over the need for treatment was also substantial (88%; ? = 0.716, SE = 0.076). The agreement between the trainee ophthalmologists and the consultant ophthalmologist in the diagnosis of glaucoma and treatment recommendation was moderate (83%, ? = 0.541, SE = 0.098, SE = 0.98; and 81%, ? = 0.553, SE = 0.90, respectively). The diagnostic accuracy of the optometrists in detecting glaucoma in this population was high for specificity (0.93 (95% confidence interval, 0.85 to 0.97)) but lower for sensitivity (0.76 (0.57 to 0.89)). Performance was similar when accuracy was assessed for treatment recommendation (sensitivity 0.73 (0.57 to 0.85); specificity 0.96 (0.88 to 0.99)). The differences in sensitivity and specificity between AGO and junior ophthalmologist were not statistically significant. Conclusions: Community optometrists trained in glaucoma provided satisfactory decisions regarding diagnosis and initiation of treatment for glaucoma. With such additional training in glaucoma, optometrists are at least as accurate as junior ophthalmologists but some cases of glaucoma are missed.

Effects of confining pressure and water content on performance of unsaturated compacted clay under repeated loading

This paper examines the performance of unsaturated soils under repeated loading. As part of the research, a triaxial system was developed that incorporates small-strain measurements using Hall effect transducers, in addition to suction measurements taken using a psychrometer. Tests were conducted on samples of kaolin under constant water mass conditions. The results address the effects of compaction effort and water content at the time of compaction on the overall performance of unsaturated soils, under different amplitudes of loading and different confining pressures. The results show that suction in the sample reduced with increasing number of loading cycles of the same magnitude. The resilient modulus initially increased with increasing water content up to approximately optimum water content, and then reduced substantially with further increase in water content.

Reasoning on the basis of fantasy content:two studies with high-functioning autistic adolescents

Reasoning about problems with empirically false content can be hard, as the inferences that people draw are heavily influenced by their background knowledge. However, presenting empirically false premises in a fantasy context helps children and adolescents to disregard their beliefs, and to reason on the basis of the premises. The aim of the present experiments was to see if high-functioning adolescents with autism are able to utilize fantasy context to the same extent as typically developing adolescents when they reason about empirically false premises. The results indicate that problems with engaging in pretence in autism persist into adolescence, and this hinders the ability of autistic individuals to disregard their beliefs when empirical knowledge is irrelevant.

You have free access to this content 5.8 GHz full duplex amplitude shift keying retrodirective interrogator array

This article describes a practical demonstration of a complete full-duplex “amplitude shift keying (ASK)” retrodirective radio frequency identification (RFID) transceiver array.The interrogator incorporates a “retrodirective array (RDA)” with a dual-conversion phase conjugating architecture in order to achieve better performance than is possible with conventional RFID solutions. Here mixers phase conjugate the incoming signal and a carrier recovery circuit recovers incoming angle of arrival phase information of an encoded amplitude shift keyed signal. The resulting interrogator provides a receiver sensitivity level of -109 dBm. A four element square patch RDA gives a 3 dB automatic beam steering angle of acceptance of ±45°. When compared to an RFID system operating by conventional (non-retrodirective) means retrodirective action leads to improved range extension of up to 16 times at ±45°. Operator pointing accuracy requirements are also reduced due to automatic retrodirective self-pointing. These features significantly enhance deployment opportunities requiring long range low equivalent isotropic radiation power (EIRP) and/or RFID tagging of moving platforms. © 2012 Wiley Periodicals, Inc. Microwave Opt Technol Lett 55:160–164, 2013; View this article online at wileyonlinelibrary.com. DOI 10.1002/mop.27258

Increased methionine sulfoxide content of apoA-I in type 1 diabetes

Cardiovascular disease is a major cause of morbidity and premature mortality in diabetes. HDL plays an important role in limiting vascular damage by removing cholesterol and cholesteryl ester hydroperoxides from oxidized low density lipoprotein and foam cells. Methionine (Met) residues in apolipoprotein A-I (apoA-I), the major apolipoprotein of HDL, reduce peroxides in HDL lipids, forming methionine sulfoxide [Met(O)]. We examined the extent and sites of Met(O) formation in apoA-I of HDL isolated from plasma of healthy control and type 1 diabetic subjects to assess apoA-I exposure to lipid peroxides and the status of oxidative stress in the vascular compartment in diabetes. Three tryptic peptides of apoA-I contain Met residues: Q(84)-M(86)-K(88), W(108)-M(112)-R(116), and L(144)-M(148)-R(149). These peptides and their Met(O) analogs were identified and quantified by mass spectrometry. Relative to controls, Met(O) formation was significantly increased at all three locations (Met(86), Met(112), and Met(148)) in diabetic patients. The increase in Met(O) in the diabetic group did not correlate with other biomarkers of oxidative stress, such as N(epsilon)-malondialdehyde-lysine or N(epsilon)-(carboxymethyl)lysine, in plasma or lipoproteins. The higher Met(O) content in apoA-I from diabetic patients is consistent with increased levels of lipid peroxidation products in plasma in diabetes. Using the methods developed here, future studies can address the relationship between Met(O) in apoA-I and the risk, development, or progression of the vascular complications of diabetes.

Content of Museum display and objects, Gozo

2007- present- National Museum of Archaeology, Gozo- text, display, academic input

Hagar Qim and Mnajdra Visitor Centre, Ggantija Visitor Centre:Prehistoric World Heritage Sites visitor centre media and academic content

2010-12 Expert Assistance with research material, digital illustration and text for Visitor Centres in Malta and Gozo (Heritage Malta) and National Museum

Water Content Determinations for Peat and Other Organic Soils Using the Oven-Drying Method

There has been much debate in the literature over the past 60 years regarding an appropriate oven-drying temperature for water content determinations in peat and other organic soils. For inorganic soils, the water content is usually based on the equilibrium dry mass corresponding to drying temperatures in the range 100-110°C. However, for peat and other organic soils, several researchers have recommended lower drying temperatures in the range 60-90°C in an attempt to prevent possible charring, oxidation, and/or vaporization of substances other than pore water. However, all of the relevant water is not fully evaporated at too low a temperature, and because specimen dry mass is a function of drying temperature, the resulting water content values are lower than those determined for the temperature range 100-110°C. Experimental data reported in this article show that oven drying of peat and other organic soils at 100-110°C using either gravity-convection or forced-draft ovens is acceptable for routine water content determinations. Because a standardized oven temperature is desirable when correlating water content with other material properties, it is recommended that oven drying of peat and other organic soils be performed over temperature ranges of either 105-110°C or 105 ± 5°C, in line with standardized ranges for inorganic soils. © 2014 Copyright Taylor & Francis Group, LLC.

Arsenic removal from soil with high iron content using a natural surfactant and phosphate

An environment friendly arsenic removal technique from contaminated soil with high iron content has been studied. A natural surfactant extracted from soapnut fruit, phosphate solution and their mixture was used separately as extractants. The mixture was most effective in desorbing arsenic, attaining above 70 % efficiency in the pH range of 4–5. Desorption kinetics followed Elovich model. Micellar solubilization by soapnut and arsenic exchange mechanism by phosphate are the probable mechanisms behind arsenic desorption. Sequential extraction reveals that the mixed soapnut–phosphate system is effective in desorbing arsenic associated with amphoteric–Fe-oxide forms. No chemical change to the wash solutions was observed by Fourier transform-infrared spectra. Soil:solution ratio, surfactant and phosphate concentrations were found to affect the arsenic desorption process. Addition of phosphate boosted the performance of soapnut solution considerably. Response surface methodology approach predicted up to 80 % desorption of arsenic from soil when treated with a mixture of ≈1.5 % soapnut, ≈100 mM phosphate at a soil:solution ratio of 1:30.

Physician recommendation for invasive prenatal testing: the case of the 'precious baby'

Do clinicians manage pregnancies conceived by assisted reproductive technologies (ART) differently from spontaneous pregnancies?

Clinicians decisions about prenatal testing during pregnancy depend, at least partially, on the method of conception.

Research thus far has shown that patients decisions regarding prenatal screening are different in ART pregnancies compared with spontaneous ones, such that ART pregnancies may be considered more valuable or precious than pregnancies conceived without treatment.

In this cross-sectional study, preformed during the year 2011, 163 obstetricians and gynecologists in Israel completed an anonymous online questionnaire.

Clinicians were randomly assigned to read one of two versions of a vignette describing the case of a pregnant woman. The two versions differed only with regard to the method of conception (ART; n 78 versus spontaneous; n 85). Clinicians were asked to provide their recommendations regarding amniocentesis.

The response rate among all clinicians invited to complete the questionnaire was 16.7. Of the 85 clinicians presented with the spontaneous pregnancy scenario, 37 (43.5) recommended amniocentesis. In contrast, of the 78 clinicians presented with the ART pregnancy scenario, only 15 (19.2) recommended the test. Clinicians were 3.2 (95 confidence interval [CI]: 1.66.6) times more likely to recommend amniocentesis for a spontaneous pregnancy than for an ART pregnancy.

The study is limited by a low response rate, the relatively small sample and the hypothetical nature of the decision, as clinician recommendations may have differed in an actual clinical setting.

Our findings show that fertility history and use of ART may affect clinicians recommendations regarding amniocentesis following receipt of screening test results. This raises the question of how subjective factors influence clinicians decisions regarding other aspects of pregnancy management.

There was no funding source to this study. The authors declare no conflicts of interest.

What the newspapers say about medication adherence: a content analysis

Background: This study investigates the coverage of adherence to medicine by the UK and US newsprint media. Adherence to medicine is recognised as an important issue facing healthcare professionals and the newsprint media is a key source of health information, however, little is known about newspaper coverage of medication adherence.

Methods. A search of the newspaper database Nexis®UK from 2004-2011 was performed. Content analysis of newspaper articles which referenced medication adherence from the twelve highest circulating UK and US daily newspapers and their Sunday equivalents was carried out. A second researcher coded a 15% sample of newspaper articles to establish the inter-rater reliability of coding.

Results: Searches of newspaper coverage of medication adherence in the UK and US yielded 181 relevant articles for each country. There was a large increase in the number of scientific articles on medication adherence in PubMed® over the study period, however, this was not reflected in the frequency of newspaper articles published on medication adherence. UK newspaper articles were significantly more likely to report the benefits of adherence (p = 0.005), whereas US newspaper articles were significantly more likely to report adherence issues in the elderly population (p = 0.004) and adherence associated with diseases of the central nervous system (p = 0.046). The most commonly reported barriers to adherence were patient factors e.g. poor memory, beliefs and age, whereas, the most commonly reported facilitators to adherence were medication factors including simplified regimens, shorter treatment duration and combination tablets. HIV/AIDS was the single most frequently cited disease (reported in 20% of newspaper articles). Poor quality reporting of medication adherence was identified in 62% of newspaper articles.

Conclusion: Adherence is not well covered in the newspaper media despite a significant presence in the medical literature. The mass media have the potential to help educate and shape the public's knowledge regarding the importance of medication adherence; this potential is not being realised at present. © 2013 Goodfellow et al.; licensee BioMed Central Ltd.

Development of a method to quantify the DNA content in DNA- cationic peptide nanoparticles

Gene therapy has the potential to provide safe and targeted therapies for a variety of diseases. A range of intracellular gene delivery vehicles have been proposed for this purpose. Non-viral vectors are a particularly attractive option and among them cationic peptides have emerged as promising candidates. For the pharmaceutical formulation and application to clinical studies it is necessary to quantify the amount of pDNA condensed with the delivery system. There is a severe deficiency in this area, thus far no methods have been reported specifically for pDNA condensed with cationic peptide to form nanoparticles. The current study seeks to address this and describes the evaluation of a range of disruption agents to extract DNA from nanoparticles formed by condensation with cationic fusogenic peptides RALA and KALA. Only proteinase K exhibited efficient and reproducible results and compatibility with the PicoGreen reagent based quantification assay. Thus we report for the first time a simple and reliable method that can quantify the pDNA content in pDNA cationic peptide nanoparticles.