Treatment of ocular allergies:nonpharmacologic, pharmacologic and immunotherapy

Ocular allergy is a significant and growing issue worldwide but for many patients, it is often not differentiated from systemic conditions, such as hay fever. Management of seasonal and perennial allergic conjunctivitis is often poor. Management is principally through avoidance measures (blocking or hygiene), nonpharmaceutical (such as artificial tears and cold compresses) and pharmaceutical (such as topical antihistamines and prophylactic mast cell stabilizers). Vernal and atopic keratoconjunctivitis are more severe and generally need treatment with NSAIDs, steroids and immunomodulators. Giant papillary conjunctivitis can be related to allergy but also is often contact lens related and in such cases can be managed by a period of abstinence and replacement of the lens or a change in lens material and/or design. Immunotherapy can be efficacious in severe, persistent cases of contact lens or allergic conjunctivitis.

Femmes, mères et prêtres dans l’église d’Angleterre:quels sacerdoces

Cet article entend analyser la façon dont les femmes prêtres ayant des enfants ont été intégrées dans l'Église d'Angleterre. C'est en 1992 qu’a été autorisée l'ordination des femmes et en 1994 que les premières ont été prononcées. Comme cet article le montrera, les femmes prêtres sont confrontées à de multiples discriminations dans l’Église d’Angleterre, qui est structurellement réticente à la féminisation. Notre étude se concentre plus particulièrement sur la situation des mères, qui sont encore plus rudement mises à l’épreuve. La question du corps, celui de la femme enceinte comme celui de la mère qui allaite, apparaît très problématique au sein de l’Église. Les femmes prêtres ne sont en effet pas des professionnelles comme les autres, leur mission relève en même temps du domaine du sacré, ce qui complique le processus de féminisation, par rapport à d’autres univers professionnels.

De l'objectif au subjectif:le rapport du discours à la télévision

On s’interrogera ici sur les moyens pragmatiques et linguistiques télévisuels pour rapporter le discours d’autrui, s’en distancier ou se l’approprier. Le discours de l’information, supposé objectif, a déjà fait l’objet de multiples études (v. bibliographie). On souhaiterait donc élargir l’analyse au talk show (TS), genre explicitement subjectif – même si, comme le journal télévisé (JT), il plonge ses racines dans le réel.

Premium e-grocery:exploring value in logistics integrated service solutions

E-grocery is gradually becoming viable or a necessity for many families. Yet, most e-supermarkets are seen as providers of low value "staple" and bulky goods mainly. While each store has a large number of SKU available, these products are mainly necessity goods with low marginal value for hedonistic consumption. A need to acquire diverse products (e.g., organic), premium priced products (e.g., wine) for special occasions (e.g., anniversary, birthday), or products just for health related reasons (e.g., allergies, diabetes) are yet to be served via one-stop e-tailers. In this paper, we design a mathematical model that takes into account consumers' geo-demographics and multi-product sourcing capacity for creating critical mass and profit. Our mathematical model is a variant of Capacitated Vehicle Routing Problem with Time Windows (CVRPTW), which we extend by adding intermediate locations for trucks to meet and exchange goods. We illustrate our model for the city of Istanbul using GIS maps, and discuss its various extensions as well as managerial implications.

Source of legitimacy in M-government initiatives in Turkey:concerns human vs. technical resource management

Emerging markets have recently been experiencing a dramatic increased in the number of mobile phone per capita. M-government has, hence, been heralded as an opportunity to leap-frog the technology cycle and provide cheaper and more inclusive and services to all. This chapter explores, within an emerging market context, the legitimacy and resistance facing civil servants’ at the engagement stage with m-government activities and the direct implication for resource management. Thirty in depth interview, in Turkey, are drawn-upon with key ICT civil servant in local organizations. The findings show that three types of resources are perceived as central namely: (i) diffusion of information management, (ii) operating system resource management and (iii) human resource management. The main evidence suggests that legitimacy for each resource management, at local level, is an ongoing struggle where all groups deploy multiples forms of resistance. Overall, greater attention in the resource management strategy for m-government application needs to be devoted to enablers such as civil servants rather than the final consumers or citizens.

Vibration in electromagnetically heated steel

When a ferromagnetic steel billet was heated by induction a large increase in the amplitude of longitudinal vibration frequently occurred as a result of resonance. This happened when a natural frequency of the bar coincided with twice the heating frequency or multiples thereof. The temperature at which resonance occurred depended on a number of factors including billet length and heating power. Resonance was most often observed when the surface temperature of the billet reached the Curie point. It is well established that magnetostrictive vibrations occur in a ferromagnetic material subjected to an alternating electromagnetic field, but existing data suggests that linear magnetostriction decreases towards the Curie point. Linear magnetostriction was measured in a sample of mild steel up to 800ºC using a high temperature strain gauge. The magnetostriction constant 100 was calculated assuming an average grain orientation in mild steel. The data was found to be comparable to that published for single crystals of iron. It was discovered that linear magnetostriction was responsible for resonance below 600ºC but not for temperatures near the Curie point. Other possible causes of resonance such as forces produced by the interaction between eddy currents and the alternating electromagnetic field, the alpha to gamma phase transformation and the existence of a thin ferromagnetic layer were investigated. None were found to account for resonance in bars of mild steel heated by induction. Experimental work relating to the induction heating of steel is compared to previous work on the subject of electromagnetic generation of ultrasound where a similar increase of the amplitude of longitudinal waves in steel is reported at the Curie point. It is concluded that the two phenomena are related as they show strong similarities.

May the contact lens force be with you

FULL TEXT: Like many people one of my favourite pastimes over the holiday season is to watch the great movies that are offered on the television channels and new releases in the movie theatres or catching up on those DVDs that you have been wanting to watch all year. Recently we had the new ‘Star Wars’ movie, ‘The Force Awakens’, which is reckoned to become the highest grossing movie of all time, and the latest offering from James Bond, ‘Spectre’ (which included, for the car aficionados amongst you, the gorgeous new Aston Martin DB10). It is always amusing to see how vision correction or eye injury is dealt with by movie makers. Spy movies and science fiction movies have a freehand to design aliens with multiples eyes on stalks or retina scanning door locks or goggles that can see through walls. Eye surgery is usually shown in some kind of day case simplified laser treatment that gives instant results, apart from the great scene in the original ‘Terminator’ movie where Arnold Schwarzenegger's android character encounters an injury to one eye and then proceeds to remove the humanoid covering to this mechanical eye over a bathroom sink. I suppose it is much more difficult to try and include contact lenses in such movies. Although you may recall the film ‘Charlie's Angels’, which did have a scene where one of the Angels wore a contact lens that had a retinal image imprinted on it so she could by-pass a retinal scan door lock and an Eddy Murphy spy movie ‘I-Spy’, where he wore contact lenses that had electronic gadgetry that allowed whatever he was looking at to be beamed back to someone else, a kind of remote video camera device. Maybe we aren’t quite there in terms of devices available but these things are probably not the behest of science fiction anymore as the technology does exist to put these things together. The technology to incorporate electronics into contact lenses is being developed and I am sure we will be reporting on it in the near future. In the meantime we can continue to enjoy the unrealistic scenes of eye swapping as in the film ‘Minority Report’ (with Tom Cruise). Much more closely to home, than in a galaxy far far away, in this issue you can find articles on topics much nearer to the closer future. More and more optometrists in the UK are becoming registered for therapeutic work as independent prescribers and the number is likely to rise in the near future. These practitioners will be interested in the review paper by Michael Doughty, who is a member of the CLAE editorial panel (soon to be renamed the Jedi Council!), on prescribing drugs as part of the management of chronic meibomian gland dysfunction. Contact lenses play an active role in myopia control and orthokeratology has been used not only to help provide refractive correction but also in the retardation of myopia. In this issue there are three articles related to this topic. Firstly, an excellent paper looking at the link between higher spherical equivalent refractive errors and the association with slower axial elongation. Secondly, a paper that discusses the effectiveness and safety of overnight orthokeratology with high-permeability lens material. Finally, a paper that looks at the stabilisation of early adult-onset myopia. Whilst we are always eager for new and exciting developments in contact lenses and related instrumentation in this issue of CLAE there is a demonstration of a novel and practical use of a smartphone to assisted anterior segment imaging and suggestions of this may be used in telemedicine. It is not hard to imagine someone taking an image remotely and transmitting that back to a central diagnostic centre with the relevant expertise housed in one place where the information can be interpreted and instruction given back to the remote site. Back to ‘Star Wars’ and you will recall in the film ‘The Phantom Menace’ when Qui-Gon Jinn first meets Anakin Skywalker on Tatooine he takes a sample of his blood and sends a scan of it back to Obi-Wan Kenobi to send for analysis and they find that the boy has the highest midichlorian count ever seen. On behalf of the CLAE Editorial board (or Jedi Council) and the BCLA Council (the Senate of the Republic) we wish for you a great 2016 and ‘may the contact lens force be with you’. Or let me put that another way ‘the CLAE Editorial Board and BCLA Council, on behalf of, a great 2016, we wish for you!’

Community pharmacy in a commissioning-led NHS:can pharmacy compete effectively?

Introduction – The commissioning of services has been a core responsibility of English Primary Care Trusts (PCTs) since 2002. Primary care organisations (PCOs) in Scotland, Wales and Northern Ireland have also increased their commissioning activities but with, arguably, less fervour than their English counterparts. The commissioning function of English PCTs has been reinforced by the introduction of new contractual frameworks across primary care – for medical services, dentistry and pharmacy. The new pharmaceutical services contract for England and Wales introduced an “enhanced” category of services, the provision of which is dependent on the commissioning decisions of local PCTs. As the NHS, most pertinently in England, continues its transformation from a provider to a commissioner of healthcare, the ability of pharmacy to compete effectively for funding is likely to become increasingly important. Method - After piloting, in August 2006 a self-completion postal questionnaire was sent to a random sample of practising community pharmacists, stratified for country and sex, within Great Britain (n=1998), with a follow-up to non-responders 4 weeks later. Data were analysed using SPSS (v12.0). A final response rate of 51% (n=1023/1998) was achieved. Within the section of the questionnaire relating to service provision, respondents were asked “do you believe that pharmacy will be able to compete effectively with other healthcare providers for access to additional funding to develop services that address a public health need identified by your local Primary Care Organisation (PCO), e.g. PCT/LHB etc.?”. Answers were recorded on a three-point scale; pharmacy “will”, “may”, or “will not” be able to compete effectively for funding. Results - The attitudes of pharmacists showed variation depending on the type of pharmacy they worked in (supermarket, multiple (outlets (n)=200), large chain (200>n>20), small chain (20=n>5), or independent (n=5)) (?2 test with p=0.001). Over a third of survey pharmacists working in small chains and independents (37% (n=21/57) and 33% (n=113/341) respectively) believed that pharmacy would not be able to compete effectively for funding compared to 23% (n=15/65) for supermarket pharmacists, 22% (n=21/97) for pharmacists employed by large chains and just 18% (n=62/353) for pharmacists employed most regularly in multiples. Furthermore, attitudes also varied between the countries of residence of respondents (?2 test with p<0.05). 27% (n=242/893) of pharmacists resident in England and Wales believed that pharmacy would not be able to compete compared to 16% (n=18/116) of pharmacists resident in Scotland. Conclusions – It would appear that community pharmacists believe that the larger pharmacy chains and supermarkets will occupy an advantageous position in terms of attracting finance to develop services. This could have notable implications for service provision across the sector. If corporate pharmacy chains were to monopolise commissioning monies then the proportion of funding available to independents will be diminished; arguably further hastening their demise, as well as stifling the professional development of pharmacists employed within the independent sector. These findings, when combined with the variation observed between UK pharmacists operating under different contractual frameworks, may be a reflection of the divergent policy in the different administrations with developments in England, including the new pharmacy contract, reflecting a market-based approach with Scotland taking a near opposite stance with service integration and a commitment to new public health. However, it should be acknowledged that the questionnaire did not allow for detection of ambiguities in, or misunderstandings of, the survey question and this should be considered as a limitation of the research.

Health promotion for chronic obstructive pulmonary disease

Peter, a 45 year old male, enters the pharmacy and asks, 'do you have something to stop a cough?' On questioning you find out that Peter has an irritating cough that has been off and on for the past few weeks since winter started. He coughs up phlegm every now and then, mostly upon waking. He has tried some cough mixture that he bought at the supermarket but is looking for something stronger. He states that he does not have any medical history or allergies and does not take any medication. He does feel that he can't exercise as much as he used to as he gets more breathless these days.

Discriminating behaviors through value added premium online grocery offering

Despite many interest in e-grocery, little has changed, over the years, in the offering that is often geared only towards low value staple products. Yet, from an e-supermarket perspective, the number of sourcing stores is increasing regularly providing an illusion of service improvement. This situation, we argue is leading e-grocery providers to forego profits as consumers need to look both at the competition online and offline to satisfy their overall regular grocery needs. Expansion of e-grocery operations could be better achieved, we argue, by serving diverse and premium priced products (e.g. organic, limited production, regional items; special occasions items and products related to health e.g. allergies, diabetes) and utilizing more efficiently modern logistic techniques. A framework is offered presenting a model including the delivery of premium products from various suppliers and providing an integrated service solution to e-grocery customers that complete traditional supermarket ranges, creating potential high value added products niches. In this context, the objective was to understand the consumer discrimination factors (ie: range of product, delivery timing, location, service quality) leading to intentions towards purchasing more items from e-grocery retailers. Data are derived from a survey of 356 respondents in Turkey’s three biggest metropolitan areas. The relationship between consumer attitudes and demographic characteristics are also analyzed. Factor and SEM analyses are used to discriminate within the sample (n=356, no of items=150). Results, future research and policy implications are discussed.

The feasibility of hybrid solar-biomass power plants in India

We assess the feasibility of hybrid solar-biomass power plants for use in India in various applications including tri-generation, electricity generation and process heat. To cover this breadth of scenarios we analyse, with the help of simulation models, case studies with peak thermal capacities ranging from 2 to 10 MW. Evaluations are made against technical, financial and environmental criteria. Suitable solar multiples, based on the trade-offs among the various criteria, range from 1 to 2.5. Compared to conventional energy sources, levelised energy costs are high - but competitive in comparison to other renewables such as photovoltaic and wind. Long payback periods for hybrid plants mean that they cannot compete directly with biomass-only systems. However, a 1.2-3.2 times increase in feedstock price will result in hybrid systems becoming cost competitive. Furthermore, in comparison to biomass-only, hybrid operation saves up to 29% biomass and land with an 8.3-24.8 $/GJ/a and 1.8-5.2 ¢/kWh increase in cost per exergy loss and levelised energy cost. Hybrid plants will become an increasingly attractive option as the cost of solar thermal falls and feedstock, fossil fuel and land prices continue to rise. In the foreseeable future, solar will continue to rely on subsidies and it is recommended to subsidise preferentially tri-generation plants. © 2012 Elsevier Ltd.

The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy

Background - Twenty percent of children outgrow peanut allergy and 10% outgrow tree nut allergy. Resolution can be confirmed by a food challenge. Little is known about the psychosocial impact of the challenge. We aimed to investigate effects of a food challenge on anxiety, stress and quality of life (QoL) in children and their mothers on the day of a food challenge to peanuts or nuts, and in the months following the challenge. Methods - One hundred and three families participated. Forty children undergoing food challenges to access resolution of allergy, and their mothers, completed validated questionnaires to measure generic and food specific quality of life, stress and anxiety prior to challenge, on the day of investigation and 3–6 months later. Sixty-three children with no clinical indication to challenge (i.e. in the opinion of the allergist had persistent allergy) acted as comparison group completing questionnaires 3–6 months apart. Results - Mothers reported raised anxiety on the day of challenge (P = 0.007), but children were less anxious. The children (P = 0.01) and mothers (P = 0.01) had improved food-related, but not general, QoL 3–6 months following challenge. Children reported lower anxiety levels following the challenge (P = 0.02), but anxiety remained unchanged in mothers. The improvements in maternal and children's QoL and anxiety levels were irrespective of the challenge outcome and despite co-existing food allergies in 50% of children. Conclusions - Mothers experienced increased anxiety on the day of food challenge, unlike the children, perhaps reflecting the differences in their perceived risks. Food challenges are associated with improved food-related QoL in the following months even in those with a positive challenge.

The management of ocular allergy in community pharmacies in the United Kingdom

Background Ocular allergies frequently present in pharmacy practices. However, research into the actual management of ocular allergy in pharmacies is lacking. Objective To determine and quantify history and symptom questioning of a patient with presumed allergic conjunctivitis and management strategies employed by pharmacy staff in the UK. Method A mystery shopper technique was used to simulate an episode of allergic conjunctivitis in 100 community pharmacies across the UK. Results The mean number of questions asked by pharmacy staff to the patient was 3.5 ± 2.6, with a range of 0-10. The most common question was whether the patient had a history of allergies (45 %).Ninety-one percent advised on treatment, with the remaining 9 % directly referring to the patient's general practitioner (n = 4) or pharmacist(n = 4), but only two to their optometrist. The most common treatment suggested was sodium cromoglycate 2 % (50 %). However, many pharmacies advising treatment did not ask the patient's age (37 %), if they wore contact lenses (43 %), or gave dosage advice (43 %). Only 5 % of pharmacies advised follow up and 14 % suggested visiting a general practitioner and 1 % an optometrist if symptoms did not resolve with treatment. Conclusion There is a need for improved ophthalmological training for pharmacy staff with respect to the management of allergic conjunctivitis. © Springer Science+Business Media Dordrecht 2012.

Specialist contact lens fitting

What is meant by the term ‘specialist contact lens fitting’? Or put another way, what would be considered non-specialist contact lens fitting? Is there such a thing as routine contact lens fitting? Soft or silicone hydrogel fitting for daily wear would probably be considered as routine contact lens fitting, but would extended or flexible wear remain in the same category or would they be considered a specialist fit? Different eras will classify different products as being ‘specialist’. Certainly twenty years ago soft toric contact lenses were considered as being speciality lenses but today would be thought of as routine lenses. Conversely, gas permeable lenses were thought of as mainstream twenty years ago but now are considered as speciality lenses. Although this would not be the same globally, as in some countries (such as Netherlands, France and Japan) gas permeable lens fitting remains popular and is not on the decline as in other countries (Canada, Australia and Sweden) [1]. Bandage soft lenses applied after surface laser refractive procedures would be considered as therapeutic lenses but in reality they are just plano thin hydrogel lenses worn constantly for 3–4 days to allow the underlying epithelium to convalesce and are then removed [2]. Some patients find that wearing hydrogel lenses during periods when they suffer from seasonal allergies actually improves their ocular comfort as the contact lens acts as a barrier to the allergen [3] and [4]. Scleral lenses have long been considered speciality lenses, apart from a time when they were the only lenses available but at that time all contact lens work would have been considered speciality practice! Nowadays we see the advent of mini-scleral designs and we see large diameter gas permeable lenses too. It is possible that these lenses increase the popularity of gas permeable lenses again and they become more main stream. So it would seem that the lines between routine and speciality contact lens fitting are not clear. Whether a lens is classed a specialist fit or not would depend on the lens type, why it was fitted, where in the world the fitting was being done and even the era in which it was fitted. This begs the question as to what would be considered entry level knowledge in contact lens fitting. This may not be an issue for most BCLA members or CLAE readers but certainly would be for bodies such as the College of Optometrists (UK) or the Association of British Dispensing Opticians when they are planning the final registration examinations for budding practitioners or when planning the level of higher level qualifications such as College Certificates or Diplomas. Similarly for training institutions when they are planning their course content. This becomes even trickier when trying to devise a qualification that spans across many countries, like the European Diploma in Optometry and Optics. How do we know if the training and examination level is correct? One way would be to analyse things when they go wrong and if patterns of malpractice are seen then maybe that could be used as an indicator to more training being needed. There were 162 Fitness to Practice Hearing at the General Optical Council between 2001 and 2010. Forty-seven of these were clinically related case, 39 fraud related, and 76 others. Of the clinical ones only 3 were contact lens related. So it would appear that as whole, in the profession, contact lens clinical skills are not being questioned too often (although it seems a few of us can’t keep our hands out the cookie jar!).

Exploring quality of life in families of children living with and without a severe food allergy

This study aimed to explore the impact of food allergy on quality of life in children with food allergy and their primary caregivers, compared to a healthy non-food allergy comparison group. Food allergy children (n = 34) and control children (n = 15), aged 8–12, and their respective primary caregivers (n = 30/n = 13), completed generic quality of life scales (PedsQL™ and WHOQOLBREF) and were asked to take photographs and keep a diary about factors that they believed enhanced and/or limited their quality of life, over a one-week period. Questionnaire analysis showed that parents of children with food allergy had significantly lower quality of life in the social relationships domain and lower overall quality of life than the comparison parents. In contrast, children with food allergy had similar or higher quality of life scores compared to comparison children. Content analysis of photograph and diary data identified ten themes that influenced both child and parental quality of life. It was concluded that although food allergy influenced quality of life for some children, their parent's quality of life was hindered to a greater extent. The variability in findings highlights the importance of assessing quality of life in individual families, considering both children with allergies and their primary caregivers.