Benefit of coloured lenses for age-related macular degeneration

Purpose: To evaluate and compare the functional and perceived benefits of wearing coloured lenses by patients with age-related macular degeneration (ARMD). Method: Ten subjects with early ARMD and five elderly controls wore a selection of NoIR wrap-around coloured lenses (yellow 29.7% light transmission, orange 22.9%, red 16.8% and grey 10.3%), each for a duration of 7 days. Contrast sensitivity, colour vision, visual acuity, the effect of glare and peripheral sensitivity were measured for each lens and compared with a control (no lens) condition. Subjective ratings of visual performance were also scored. Results: Compared with the no filter condition, red and grey lenses reduced contrast sensitivity whereas yellow and orange lenses increased contrast sensitivity. These objective changes were supported by subjective ratings in subjects with ARMD. Grey lenses reduced the loss of contrast sensitivity usually suffered in the presence of glare, whereas visual acuity and peripheral sensitivity decreased with red lenses. Colour vision became distorted with red lenses in control subjects, but was relatively unaffected by the use of coloured lenses in subjects with ARMD. Conclusions: The subjective benefit of coloured lenses appears to be due to a minor enhancement of contrast sensitivity. © 2002 The College of Optometrists.

Regarding the benefit of zero-dimensional noise

Baker and Meese (2012) (B&M) provided an empirically driven criticism of the use of two-dimensional (2D) pixel noise in equivalent noise (EN) experiments. Their main objection was that in addition to injecting variability into the contrast detecting mechanisms, 2D noise also invokes gain control processes from a widely tuned contrast gain pool (e.g., Foley, 1994). B&M also developed a zero-dimensional (0D) noise paradigm in which all of the variance is concentrated in the mechanisms involved in the detection process. They showed that this form of noise conformed much more closely to expectations than did a 2D variant.

The benefit of combining standard automated perimetry and multifocal visual evoked potential hemifield intersector analysis in suspecious glaucomatous visual field defects

Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard SAP visual field assessment, and others were not very informative and needed more adjustment and research work. In this study we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. The purpose of this study is to examine the benefit of adding mfVEP hemifield Intersector analysis protocol to the standard HFA test when there is suspicious glaucomatous visual field loss. 3 groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey visual field HFA test 24-2, optical coherence tomography of the optic nerve head, and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the Hemifield Sector Analysis HSA protocol. The retinal nerve fibre (RNFL) thickness was recorded to identify subjects with suspicious RNFL loss. The hemifield Intersector analysis of mfVEP results showed that signal to noise ratio (SNR) difference between superior and inferior hemifields was statistically significant between the 3 groups (ANOVA p<0.001 with a 95% CI). The difference between superior and inferior hemispheres in all subjects were all statistically significant in the glaucoma patient group 11/11 sectors (t-test p<0.001), partially significant 5/11 in glaucoma suspect group (t-test p<0.01) and no statistical difference between most sectors in normal group (only 1/11 was significant) (t-test p<0.9). Sensitivity and specificity of the HSA protocol in detecting glaucoma was 97% and 86% respectively, while for glaucoma suspect were 89% and 79%. The use of SAP and mfVEP results in subjects with suspicious glaucomatous visual field defects, identified by low RNFL thickness, is beneficial in confirming early visual field defects. The new HSA protocol used in the mfVEP testing can be used to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patient. Using this protocol in addition to SAP analysis can provide information about focal visual field differences across the horizontal midline, and confirm suspicious field defects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss. The Intersector analysis protocol can detect early field changes not detected by standard HFA test.

Clinical characteristics and benefit of cataract intervention amongst UK domiciliary eye care recipients

Purpose: Given the ageing UK population and the high prevalence of activity-limiting illness and disability in the over 65s, the demand for domiciliary eye care services is set to grow significantly. Over 400,000 NHS domiciliary eye examinations are conducted each year, yet minimal research attention has been directed to this mode of practice or patient needs amongst this group. The study aimed to compare clinical characteristics and benefits of cataract surgery between conventional in-practice patients and domiciliary service users. Methods: Clinical characteristics were compared between patients in North-West England receiving NHS domiciliary eye care services (n = 197; median age 76.5 years), and an age-matched group of conventional in-practice patients (n = 107; median age 74.6 years). Data including reason for visit; logMAR uncorrected and best corrected distance (UDVA and CDVA) and near acuities (UNVA and CNVA); presence of ocular pathology and examination outcome were documented retrospectively. To compare the benefit of cataract surgery in terms of functional capacity between the patient groups, individuals undergoing routine referral for first-eye surgery completed the VF-14 questionnaire pre-operatively, and at 6 weeks post-operatively. Results: UDVA was similar between the two groups (median 0.48 and 0.50 logMAR in the domiciliary and practice groups, P = 0.916); CDVA was significantly worse in the domiciliary group (median 0.18 vs 0.08 logMAR, P<0.001), who were more likely to have clinically-significant cataract. Both groups showed similar improvements in VF-14 scores following cataract surgery (mean gains 24.4 ± 11.7, and 31.5 ± 14.7 points in the in-practice and domiciliary groups, respectively. P = 0.312). Conclusions: Patients receiving domiciliary eye care services are more likely to have poorer corrected vision than in-practice patients of a similar age, partly due to a higher prevalence of significant cataract. Despite limitations in their activities due to illness and disability, domiciliary patients experience similar gains in self-reported functional capacity following cataract surgery

On the thermal stabilization of carbon-supported SiO2 catalysts by phosphorus:evaluation in the oxidative dehydrogenation of ethylbenzene to styrene and a comparison with relevant catalysts

A strategy to enhance the thermal stability of C/SiO2 hybrids for the O2-based oxidative dehydrogenation of ethylbenzene to styrene (ST) by P addition is proposed. The preparation consists of the polymerization of furfuryl alcohol (FA) on a mesoporous precipitated SiO2. The polymerization is catalyzed by oxalic acid (OA) at 160 °C (FA:OA = 250). Phosphorous was added as H3PO4 after the polymerization and before the pyrolysis that was carried out at 700 °C and will extend the overall activation procedure. Estimation of the apparent activation energies reveals that P enhances the thermal stability under air oxidation, which is a good indication for the ODH tests. Catalytic tests show that the P/C/SiO2 hybrids are readily active, selective and indeed stable in the applied reactions conditions for 60 h time on stream. Coke build-up during the reaction attributed to the P-based acidity is substantial, leading to a reduction of the surface area and pore volume. The comparison with a conventional MWCNT evidences that the P/C/SiO2 hybrids are more active and selective at high temperatures (450–475 °C) while the difference becomes negligible at lower temperature. However, the comparison with reference P/SiO2 counterparts shows a very similar yield than the hybrids but more selective to ST. The benefit of the P/C/SiO2 hybrid is the lack of stabilization period, which is observed for the P/SiO2 to create an active coke overlayer. For long term operation, P/SiO2 appears to be a better choice in terms of selectivity, which is crucial for commercialization.

An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital

Aims: To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm. Method: A 5 month prospective multisite study. Pharmacists at four English hospitals conducted admission medicines reconciliation in children using a standardised data collection form. A discrepancy was defined as a difference between the patient's preadmission medication (PAM), compared with the initial admission medication orders written by the hospital doctor. The discrepancies were classified into intentional and unintentional discrepancies. The unintentional discrepancies were assessed for potential clinical harm by a team of healthcare professionals, which included doctors, pharmacists and nurses. Results: Medicines reconciliation was conducted in 244 children admitted to hospital. 45% (109/244) of the children had at least one unintentional medication discrepancy between the PAM and admission medication order. The overall results indicated that 32% (78/244) of patients had at least one clinically significant unintentional medication discrepancy with potential to cause moderate 20% (50/244) or severe 11% (28/244) harm. No single source of information provided all the relevant details of a patient's medication history. Parents/carers provided the most accurate details of a patient's medication history in 81% of cases. Conclusions: This study demonstrates that in the absence of medicines reconciliation, children admitted to hospitals across England are at risk of harm from unintended medication discrepancies at the transition of care from the community to hospital. No single source of information provided a reliable medication history.

Increasing the use of simulation in business

The nature of Discrete-Event Simulation (DES) and the use of DES in organisations is changing. Two important developments are the use of Visual Interactive Modelling systems and the use of DES in Business Process Management (BPM) projects. Survey research is presented that shows that despite these developments usage of DES remains relatively low due to a lack of knowledge of the benefits of the technique. This paper considers two factors that could lead to a greater achievement and appreciation of the full benefit of DES and thus lead to greater usage. Firstly in relation to using DES to investigate social systems, both in the process of undertaking a simulation project and in the interpretation of the findings a 'soft' approach may generate more knowledge from the DES intervention and thus increase its benefit to businesses. Secondly in order to assess the full range of outcomes of DES the technique could be considered from the perspective of an information processing tool within the organisation. This will allow outcomes to be considered under the three modes of organisational information use of sense making, knowledge creating and decision making which relate to the theoretical areas of knowledge management, organisational learning and decision making respectively. The association of DES with these popular techniques could further increase its usage in business.

Do tinted lenses or filters improve visual performance in low vision? A review of the literature

This is a review of studies that have investigated the proposed rehabilitative benefit of tinted lenses and filters for people with low vision. Currently, eye care practitioners have to rely on marketing literature and anecdotal reports from users when making recommendations for tinted lens or filter use in low vision. Our main aim was to locate a prescribing protocol that was scientifically based and could assist low vision specialists with tinted lens prescribing decisions. We also wanted to determine if previous work had found any tinted lens/task or tinted lens/ocular condition relationships, i.e. were certain tints or filters of use for specific tasks or for specific eye conditions. Another aim was to provide a review of previous research in order to stimulate new work using modern experimental designs. Past studies of tinted lenses and low vision have assessed effects on visual acuity (VA), grating acuity, contrast sensitivity (CS), visual field, adaptation time, glare, photophobia and TV viewing. Objective and subjective outcome measures have been used. However, very little objective evidence has been provided to support anecdotal reports of improvements in visual performance. Many studies are flawed in that they lack controls for investigator bias, and placebo, learning and fatigue effects. Therefore, the use of tinted lenses in low vision remains controversial and eye care practitioners will have to continue to rely on anecdotal evidence to assist them in their prescribing decisions. Suggestions for future research, avoiding some of these experimental shortcomings, are made. © 2002 The College of Optometrists.

Transglutaminase treatment of wool fabrics leads to resistance to detergent damage

Biological detergents are now routinely used in domestic laundry because the enzymes they contain provide the added benefit of low temperature washes with improved cleaning performance. One of the key enzymes found in these detergents are proteases, which if exposed to natural protein fibres such as wool or silk can cause irreversible damage, leading to loss of fabric strength, shape and poor colour fastness. Transglutaminases (TGases) are protein cross-linking enzymes capable of adding tensile strength to wool proteins, and as a consequence are capable of remediating the damage caused by previous chemical treatments, and more importantly, by proteases. In this paper we treated dyed wool fabric with TGase and then washed the fabric with biological and non-biological detergents to investigate whether TGases would protect wool garments from damage by the undue use of biological detergents in domestic laundry. We demonstrate using different cycles of detergent washes containing biological and non-biological detergents and different TGase treatments, that wool fabric treated previously with TGase release less dye into the washing liquor and in addition maintain fabric strength at levels greater than the washed controls. As a consequence, wool garments previously treated with TGase are likely to have increased resistance to domestic washing and thus provide increased longevity. © 2005 Elsevier B.V. All rights reserved.

Administration routes affect the quality of immune responses:a cross-sectional evaluation of particulate antigen-delivery systems

Particulate delivery systems such as liposomes and polymeric nano- and microparticles are attracting great interest for developing new vaccines. Materials and formulation properties essential for this purpose have been extensively studied, but relatively little is known about the influence of the administration route of such delivery systems on the type and strength of immune response elicited. Thus, the present study aimed at elucidating the influence on the immune response when of immunising mice by different routes, such as the subcutaneous, intradermal, intramuscular, and intralymphatic routes with ovalbumin-loaded liposomes, N-trimethyl chitosan (TMC) nanoparticles, and poly(lactide-co-glycolide) (PLGA) microparticles, all with and without specifically selected immune-response modifiers. The results showed that the route of administration caused only minor differences in inducing an antibody response of the IgG1 subclass, and any such differences were abolished upon booster immunisation with the various adjuvanted and non-adjuvanted delivery systems. In contrast, the administration route strongly affected both the kinetics and magnitude of the IgG2a response. A single intralymphatic administration of all evaluated delivery systems induced a robust IgG2a response, whereas subcutaneous administration failed to elicit a substantial IgG2a response even after boosting, except with the adjuvanted nanoparticles. The intradermal and intramuscular routes generated intermediate IgG2a titers. The benefit of the intralymphatic administration route for eliciting a Th1-type response was confirmed in terms of IFN-gamma production of isolated and re-stimulated splenocytes from animals previously immunised with adjuvanted and non-adjuvanted liposomes as well as with adjuvanted microparticles. Altogether the results show that the IgG2a associated with Th1-type immune responses are sensitive to the route of administration, whereas IgG1 response associated with Th2-type immune responses were relatively insensitive to the administration route of the particulate delivery systems. The route of administration should therefore be considered when planning and interpreting pre-clinical research or development on vaccine delivery systems.

Plant ecology of lowland Alnus Glutinosa woodlands:The management implications of species composition, requirements and distribution

Wet woodlands have been recognised as a priority habitat and have featured in the UK BAP since 1994. Although this has been acknowledged in a number of UK policies and guidelines, there is little information relating to their detailed ecology and management. This research, focusing on lowland Alnus glutinosa woodlands, aimed to address this data paucity through the analysis of species requirements and to develop a methodology to guide appropriate management for this habitat for the benefit of wildlife. To achieve these aims data were collected from 64 lowland Alnus glutinosa woodlands and a review of the literature was undertaken to identify species associated with the target habitat. The groundflora species found to be associated with lowland Alnus glutinosa woodland were assessed in relation to their optimal environmental conditions (Ellenberg indicator values) and survival strategies (Grime CSR-Strategy) to determine the characteristics (Characters of a Habitat; CoaHs) and range of intra-site conditions (Niches of a Habitat; NoaH). The methodologies, using CSR and Ellenberg indicator values in combination, were developed to determine NoaHs and were tested both quantitatively and qualitatively at different lowland Alnus glutinosa sites. The existence of CoaHs and NoaHs in actual sites was verified by detailed quadrat data gathered at three Alnus glutinosa woodlands at Stonebridge Meadows, Warwickshire, UK and analysed using TWINSPAN and DCA ordination. The CoaHs and NoaHs and their component species were confirmed to have the potential to occur in a particular woodland. Following a literature search relating to the management of small wet woodlands within the UK, in conjunction with the current research, broad principles and strategies were identified for the management of lowland Alnus glutinosa woodland. Using the groundflora composition, an innovative procedure is developed and described for identifying the potential variation within a particular site and determining its appropriate management. Case studies were undertaken on distinct woodlands and the methodology proved effective.

TRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and outcome of Treatment with warfarin (TREAT)

Background Atrial fibrillation (AF) patients with a high risk of stroke are recommended anticoagulation with warfarin. However, the benefit of warfarin is dependent upon time spent within the target therapeutic range (TTR) of their international normalised ratio (INR) (2.0 to 3.0). AF patients possess limited knowledge of their disease and warfarin treatment and this can impact on INR control. Education can improve patients' understanding of warfarin therapy and factors which affect INR control. Methods/Design Randomised controlled trial of an intensive educational intervention will consist of group sessions (between 2-8 patients) containing standardised information about the risks and benefits associated with OAC therapy, lifestyle interactions and the importance of monitoring and control of their International Normalised Ratio (INR). Information will be presented within an 'expert-patient' focussed DVD, revised educational booklet and patient worksheets. 200 warfarin-naïve patients who are eligible for warfarin will be randomised to either the intervention or usual care groups. All patients must have ECG-documented AF and be eligible for warfarin (according to the NICE AF guidelines). Exclusion criteria include: aged < 18 years old, contraindication(s) to warfarin, history of warfarin USE, valvular heart disease, cognitive impairment, are unable to speak/read English and disease likely to cause death within 12 months. Primary endpoint is time spent in TTR. Secondary endpoints include measures of quality of life (AF-QoL-18), anxiety and depression (HADS), knowledge of AF and anticoagulation, beliefs about medication (BMQ) and illness representations (IPQ-R). Clinical outcomes, including bleeding, stroke and interruption to anticoagulation will be recorded. All outcome measures will be assessed at baseline and 1, 2, 6 and 12 months post-intervention. Discussion More data is needed on the clinical benefit of educational intervention with AF patients receiving warfarin. Trial registration ISRCTN93952605

Synthesis and characterisation of imprinted polymeric receptor mimics

Molecularly imprinted polymers (MIPs) are crosslinked polymers containing bespoke functionalised cavities arising from the inclusion of template molecules in the polymerisation mixture and their later extraction. When the polymers are prepared functional polymerisable monomers are included which become part of the polymer matrix and serve to decorate the cavities with functionality appropriate to the template molecules. Overall, binding sites are created which have a memory for the template both in terms of shape and matching functionality. Fluorescent molecularly imprinted polymers have the benefit of a fluorophore in their cavities that may respond to the presence of bound test compound by a change in their fluorescence output. The work presented falls into three main areas. A series of fluorescent MIPs was prepared with a view to generating material capable of mimicking the binding characteristics of the metabolically important cytochrome isoform CYP2D6. The MIPs re-bound their templates and various cross-reactivities were encountered for test compound/drug recognition. One MIP in particular exhibited a rational discrimination amongst the related synthetic templates and was reasonably successful in recognising CYP2D6 substrates from the drug set tested. In order to give some insights into binding modes in MIPs, attempts were made to produce functional monomers containing two or more fluorophores that could be interrogated independently. A model compound was prepared which fitted the dual-fluorophore criteria and which will be the basis for future incorporation into MIPs. A further strand to this thesis is the deliberate incorporation of hydrophobic moieties into fluorescent functional monomers so that the resulting imprinted cavities might be biomimetic in their impersonation of enzyme active sites. Thus the imprinted cavities had specific hydrophobic regions as well as the usual polar functionality with which to interact with binding test compounds.

The use of anticholinergic agents to treat excessive oropharyngeal and tracheal secretions in palliative care

Palliative care involves a multi-professional team approach to the provision of active, holistic care for patients and their families when the patient's disease is no longer responsive to curative treatment. Patient care encompasses medical and pharmacological intervention for symptom control, together with psychological, spiritual and social support for patients and families. Care is provided by teams in hospice, hospital or community environments. Although traditionally associated with providing care for cancer patients, palliative care services are increasingly providing for patients with non-malignant disease. Symptoms commonly associated with terminal phase of disease include pain, nausea, agitation, respiratory symptoms and general fatigue. During the last few days of life, patients may become weak, resulting in difficulty taking oral medication and have periods of unconsciousness. Some patients may require drug administration via subcutaneous infusion. A proportion of patients may develop difficulty clearing respiratory secretions causing a characteristic ‘death rattle’, which although not generally considered to be distressing for the patient, is often treated with a variety of anticholinergic drugs in an attempt to reduce the ‘noisy breathing’ for the benefit of relatives and others who may be closely associated with the patient.This study examined treatment of death rattle in two Hospices focusing on objective and subjective outcome measures in order to determine the efficacy of anticholinergic regimens in current use. Qualitative methods were employed to elicit attitudes of professionals and carers working closely with the patient. The number of patients recruited and monitored were small, many confounding factors were identified which questioned firstly the clinical rationale for administering anticholinergic drugs routinely to treat death rattle and secondly, the ethics of administering drug regimens to patients to treat death rattle with the primary aim of relieving distress for others. Ethnical issues, including those of consent are discussed in relation to their impact on the methodology of end of life studies in medicines management in palliative care.

The role of industrial design in technological innovation

This is an exploratory study in a field which previously was virtually unexplored. The aim is to identify, for the benefit of innovators, the influence of industrial design on the commercial success of new science-based products used for professional and industrial purposes. The study is a contribution to the theory of success and failure in industrial innovation. The study begins by defining the terminology. To place the investigation in context, there is then a review of past attempts by official policy-making bodies to improve the competitiveness of British products of manufacture through good design. To elucidate the meaning of good design, attempts to establish a coherent philosophy of style in British products of manufacture during the same period are also reviewed. Following these reviews, empirical evidence is presented to identify what actually takes place in successful firms when industrial design is allocated a role in the process of technological innovation. The evidence comprises seven case studies of new science-based products used for professional or industrial purposes which have received Design Council Awards. To facilitate an objective appraisal, evidence was obtained by conducting separate semi-structured interviews, the detail of which is described, with senior personnel in innovating firms, with industrial design consultants, and with professional users. The study suggests that the likelihood of commercial success in technological innovation is greater when the form, configuration, and the overall appearance of a new product, together with the detail which delineates them, are consciously and expertly controlled. Moreover, uncertainty in innovation is likely to be reduced if the appearance of a new product is consciously designed to facilitate recognition and comprehension. Industrial design is an especially significant factor when a firm innovates against a background of international competition and comparable levels of technological competence in rival firms. The likelihood of success in innovation is enhanced if design is allocated a role closely identified with the total needs of the user and discrete from the engineering function in company organisation. Recent government measures, initiated since this study began, are corroborative of the findings.