Pain response and follow-up of patients undergoing panretinal laser photocoagulation with reduced exposure times

Purpose - We performed a study of laser panretinal photocoagulation in 20 patients with proliferative retinopathy. We compared short exposure, high-energy laser settings with conventional settings, using a 532?nm, frequency doubled, Neodymium–Yag laser and assessed the patients in terms of pain experienced and effectiveness of treatment. Methods - Twenty patients having panretinal photocoagulation for the first time underwent random allocation to treatment of the superior and inferior hemi-retina. Treatment A used ‘conventional’ parameters: exposure time 0.1?s, power sufficient to produce a visible grey-white burns, spot size 300?µm. The other hemi- retina was treated with treatment B using exposure 0.02?s, 300?µm and sufficient power to have similar endpoint. All patients were asked to evaluate severity of pain on a visual analogue scale. (0=no pain, 10=most severe pain). All patients were masked as to the type of treatment and the order of carrying out the treatment on each patient was randomised. Patients underwent fundus photography and were followed up for 6–45 months. Results - Seventeen patients had proliferative diabetic retinopathy, two had ischaemic central retinal vein occlusion and one had ocular ischaemic syndrome. The mean response to treatment A was 5.11, compared to 1.40 treatment B, on the visual analogue scale, which was statistically significant (P=0.001). All patients preferred treatment B. Further treatments, if required, were performed with treatment B parameters and long-term follow-up has shown no evidence of undertreatment. Conclusions - Shortening exposure time of retinal laser is significantly less painful but equally effective as conventional parameters.

Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant

The efficacy of a new skin disinfectant, 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) isopropyl alcohol (IPA) (ChloraPrep®), was compared with five commonly used skin disinfectants against Staphylococcus epidermidis RP62A in the presence or absence of protein, utilizing quantitative time-kill suspension and carrier tests. All six disinfectants [70% (v/v) IPA, 0.5% (w/v) aqueous CHG, 2% (w/v) aqueous CHG, 0.5% (w/v) CHG in 70% (v/v) IPA and 10% (w/v) aqueous povidone iodine (PI)] achieved a log10 reduction factor of 5, in colony-forming units/mL, in a suspension test (exposure time 30 s) in the presence and absence of 10% human serum. Subsequent challenges of S. epidermidis RP62A in a biofilm (with and without human serum) demonstrated reduced bactericidal activity. Overall, the most effective skin disinfectants tested against S. epidermidis RP62A were 2% (w/v) CHG in 70% IPA and 10% (w/v) PI. These results suggest that enhanced skin antisepsis may be achieved with 2% (w/v) CHG in 70% (v/v) IPA compared with the three commonly used CHG preparations [0.5% (w/v) aqueous CHG, 2% (w/v) aqueous CHG and 0.5% (w/v) CHG in 70% (v/v) IPA]. © 2005 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Recognition times of different views of 56 depth-rotated objects: a note concerning Verfaillie and Boutsen (1995)

The present study examines the effect of the goodness of view on the minimal exposure time required to recognize depth-rotated objects. In a previous study, Verfaillie and Boutsen (1995) derived scales of goodness of view, using a new corpus of images of depth-rotated objects. In the present experiment, a subset of this corpus (five views of 56 objects) is used to determine the recognition exposure time for each view, by increasing exposure time across successive presentations until the object is recognized. The results indicate that, for two thirds of the objects, good views are recognized more frequently and have lower recognition exposure times than bad views.

Investigation of aspects of reactive gliosis in human astrocytoma cell lines:application for toxicity assessment

The process of astrogliosis, or reactive gliosis, is a typical response of astrocytes to a wide range of physical and chemical injuries. The up-regulation of the astrocyte specific glial fibrillary acidic protein (GFAP) is a hallmark of reactive gliosis and is widely used as a marker to identify the response. In order to develop a reliable, sensitive and high throughput astrocyte toxicity assay that is more relevant to the human response than existing animal cell based models, the U251-MG, U373-MG and CCF-STTG 1 human astrocytoma cell lines were investigated for their ability to exhibit reactive-like changes following exposure to ethanol, chloroquine diphosphate, trimethyltin chloride and acrylamide. Cytotoxicity analysis showed that the astrocytic cells were generally more resistant to the cytotoxic effects of the agents than the SH-SY5Y neuroblastoma cells. Retinoic acid induced differentiation of the SH-SY5Y line was also seen to confer some degree of resistance to toxicant exposure, particularly in the case of ethanol. Using a cell based ELISA for GFAP together with concurrent assays for metabolic activity and cell number, each of the three cell lines responded to toxicant exposure by an increase in GFAP immunoreactivity (GFAP-IR), or by increased metabolic activity. Ethanol, chloroquine diphosphate, trimethyltin chloride and bacterial lipopolysaccharide all induced either GFAP or MTT increases depending upon the cell line, dose and exposure time. Preliminary investigations of additional aspects of astrocytic injury indicated that IL-6, but not TNF-α. or nitric oxide, is released following exposure to each of the compounds, with the exception of acrylamide. It is clear that these human astrocytoma cell lines are capable of responding to toxicant exposure in a manner typical of reactive gliosis and are therefore a valuable cellular model in the assessment of in vitro neurotoxicity.

Hearing protectors: a dilemma involving acoustics and personal safety

This thesis is concerned with the optimising of hearing protector selection. A computer model was used to estimate the reduction in noise exposure and risk of occupational deafness provided by the wearing of hearing protectors in industrial noise spectra. The model was used to show that low attenuation hearing protectors con provide greater protection than high attenuation protectors if the high attenuation protectors ore not worn for the total duration of noise exposure; or not used by a small proportion of the population. The model was also used to show that high attenuation protectors will not necessarily provide significantly greater reduction in risk than low attenuation protectors if the population has been exposed to the noise for many years prior to the provision of hearing protectors. The effects of earplugs and earmuffs on the localisation of sounds were studied to determine whether high attenuation earmuffs are likely to have greater potential than the lower attenuation earplugs for affecting personal safety. Laboratory studies and experiments at a foundry with normal-hearing office employees and noise-exposed foundrymen who had some experience of wearing hearing protectors showed that although earplugs reduced the ability of the wearer to determine the direction of warning sounds, earmuffs produced more total angular error and more confusions between left and right. !t is concluded from the research findings that the key to the selection of hearing protectors is to be found in the provision of hearing protectors that can be worn for a very high percentage of the exposure time by a high percentage of the exposed population with the minimum effect on the personal safety of the wearers - the attenuation provided by the protection should be adequate but not a maximum value.

Coupled heat and mass transfer in concrete exposed to fire

The first investigation of this study is concerned with the reasonableness of the assumptions related to diffusion of water vapour in concrete and with the development of a diffusivity equation for heated concrete. It has been demonstrated that diffusion of water vapour does occur in concrete at all temperatures and that the type of diffusion is concrete is Knudsen diffusion. Neglecting diffusion leads to underestimating the pressure. It results in a maximum pore pressure of less than 1 MPa. It has also been shown that the assumption that diffusion in concrete is molecular is unreasonable even when the tortuosity is considered. Molecular diffusivity leads to overestimating the pressure. It results in a maximum pore pressure of 2.7 MPa of which the vapour pressure is 1.5 MPa while the air pressure is 1.2 MPa. Also, the first diffusivity equation, appropriately named 'concrete diffusivity', has been developed specifically for concrete that determines the effective diffusivity of any gas in concrete at any temperature. In thick walls and columns exposed to fire, concrete diffusivity leads to a maximum pore pressures of 1.5 and 2.2 MPa (along diagonals), respectively, that are almost entirely due to water vapour pressure. Also, spalling is exacerbated, and thus higher pressures may occur, in thin heated sections, since there is less of a cool reservoir towards which vapour can migrate. Furthermore, the reduction of the cool reservoir is affected not only by the thickness, but also by the time of exposure to fire and by the type of exposure, i.e. whether the concrete member is exposed to fire from one or more sides. The second investigation is concerned with examining the effects of thickness and exposure time and type. It has been demonstrated that the build up of pore pressure is low in thick members, since there is a substantial cool zone towards which water vapour can migrate. Thus, if surface and/or explosive spalling occur on a thick member, then such spalling must be due to high thermal stresses, but corner spalling is likely to be pore pressure spalling. However, depending on the exposure time and type, the pore pressures can be more than twice those occurring in thick members and thought to be the maximum that can occur so far, and thus the enhanced propensity of pore pressure spalling occurring on thin sections heated on opposite sides has been conclusively demonstrated to be due to the lack of a cool zone towards which moisture can migrate. Expressions were developed for the determination of the maximum pore pressures that can occur in different concrete walls and columns exposed to fire and of the corresponding times of exposure.

Reading without central vision:effects of text spacing on reading in patients with macular disease

Abstract: Loss of central vision caused by age-related macular degeneration (AMD) is a problem affecting increasingly large numbers of people within the ageing population. AMD is the leading cause of blindness in the developed world, with estimates of over 600,000 people affected in the UK . Central vision loss can be devastating for the sufferer, with vision loss impacting on the ability to carry out daily activities. In particular, inability to read is linked to higher rates of depression in AMD sufferers compared to age-matched controls. Methods to improve reading ability in the presence of central vision loss will help maintain independence and quality of life for those affected. Various attempts to improve reading with central vision loss have been made. Most textual manipulations, including font size, have led to only modest gains in reading speed. Previous experimental work and theoretical arguments on spatial integrative properties of the peripheral retina suggest that ‘visual crowding’ may be a major factor contributing to inefficient reading. Crowding refers to the phenomena in which juxtaposed targets viewed eccentrically may be difficult to identify. Manipulating text spacing of reading material may be a simple method that reduces crowding and benefits reading ability in macular disease patients. In this thesis the effect of textual manipulation on reading speed was investigated, firstly for normally sighted observers using eccentric viewing, and secondly for observers with central vision loss. Test stimuli mimicked normal reading conditions by using whole sentences that required normal saccadic eye movements and observer comprehension. Preliminary measures on normally-sighted observers (n = 2) used forced-choice procedures in conjunction with the method of constant stimuli. Psychometric functions relating the proportion of correct responses to exposure time were determined for text size, font type (Lucida Sans and Times New Roman) and text spacing, with threshold exposure time (75% correct responses) used as a measure of reading performance. The results of these initial measures were used to derive an appropriate search space, in terms of text spacing, for assessing reading performance in AMD patients. The main clinical measures were completed on a group of macular disease sufferers (n=24). Firstly, high and low contrast reading acuity and critical print size were measured using modified MNREAD test charts, and secondly, the effect of word and line spacing was investigated using a new test, designed specifically for this study, called the Equal Readability Passages (ERP) test. The results from normally-sighted observers were in close agreement with those from the group of macular disease sufferers. Results show that: (i) optimum reading performance was achieved when using both double line and double word spacing; (ii) the effect of line spacing was greater than the effect of word spacing (iii) a text size of approximately 0.85o is sufficiently large for reading at 5o eccentricity. In conclusion, the results suggest that crowding is detrimental to reading with peripheral vision, and its effects can be minimized with a modest increase in text spacing.

Breakage model development and application with CFD for predicting breakage of whey protein precipitate particles

Particle breakage due to fluid flow through various geometries can have a major influence on the performance of particle/fluid processes and on the product quality characteristics of particle/fluid products. In this study, whey protein precipitate dispersions were used as a case study to investigate the effect of flow intensity and exposure time on the breakage of these precipitate particles. Computational fluid dynamic (CFD) simulations were performed to evaluate the turbulent eddy dissipation rate (TED) and associated exposure time along various flow geometries. The focus of this work is on the predictive modelling of particle breakage in particle/fluid systems. A number of breakage models were developed to relate TED and exposure time to particle breakage. The suitability of these breakage models was evaluated for their ability to predict the experimentally determined breakage of the whey protein precipitate particles. A "power-law threshold" breakage model was found to provide a satisfactory capability for predicting the breakage of the whey protein precipitate particles. The whey protein precipitate dispersions were propelled through a number of different geometries such as bends, tees and elbows, and the model accurately predicted the mean particle size attained after flow through these geometries. © 2005 Elsevier Ltd. All rights reserved.

Influence of downstream processing on the breakage of whey protein precipitates

Whey proteins may be fractionated by isoelectric precipitation followed by centrifugal recovery of the precipitate phase. Transport and processing of protein precipitates may alter the precipitate particle properties, which may affect how they behave in subsequent processes. For example, the transport of precipitate solution through pumps, pipes and valves and into a centrifugal separator may cause changes in particle size and density, which may affect the performance of the separator. This work investigates the effect of fluid flow intensity, flow geometry and exposure time on the breakage of whey protein precipitates: Computational fluid dynamics (CFD) was used to quantify the flow intensity in different geometries. Flow geometry can have a critical impact on particle breakage. Sharp geometrical transitions induce large increases in turbulence that can result in substantial particle breakage. As protein precipitate particles break, they tend to form denser more compact structures. The reduction in particle size and increase in compaction is due to breakage. This makes the particles become more resistant to further breakage as particle compactness increases. The effect of flow intensity on particle breakage is coupled to exposure time, with greater exposure time producing more breakage. However, it is expected that the particles will attain an equilibrium particle size and density after prolonged exposure in a constant flow field where no further breakage will occur with exposure time. © 2005 Institution of Chemical Engineers.

Pain response in patients undergoing panretinal photocoagulation by continuos wave Nd-YAG laser

Purpose: Current panretinal laser photocoagulative parameters are based on the Diabetic Retinopathy Study, which used exposures of 0.1 - 0.5 second to achieve moderate intensity retinal burns. Unfortunately, many patients find these settings painful. We wanted to investigate whether reducing exposure time and increasing power to give the same endpoint, is more comfortable and effective. Methods: 20 patients having panretinal photocoagulation for the first time underwent random allocation to two forms of laser treatment: half of the retinal area scheduled for treatment was treated with Green Yag laser with conventional parameters {exposure time 0.1 second (treatment A), power density sufficient to produce a visible grey - white burns}. The other half treated with shorter exposure 0.02 second (treatment B). All patient were asked to evaluate severity of pain on a visual analogue scale ranging from 0 - 10 (0 = no pain, 10 = most severe pain). All patients were masked as to the type of treatment. The order of carrying out the treatment on each patient was randomised. Fundus photographs were taken of each hemifundus to confirm treatment. Results: Of the 20 patients, 17 had proliferative diabetic retinopathy, 2 had ischaemic central retinal vein occlusion and one had ocular ischaemic syndrome. The average pain response to treatment A was 5.11 on a visual analogue scale with a mean power of 0.178 Watt; the average pain response to treatment B was 1.40 with a mean power of 0.489 Watt. Short exposure laser burns were significantly less painful (P < 0.001). Conclusion: Shortening exposure time with increased power is more comfortable for patients undergoing panretinal photocoagulation than conventional parameters.

Apodisation of photo-induced waveguide gratings using double-exposure with complementary duty cycles

We present a novel apodisation scheme for photo-induced waveguide gratings. The apodisation is implemented with double exposures that have reversely varying duty cycles. We have successfully applied the proposed scheme to remove the sidelobes of long period gratings (LPGs). We also observed for the first time super strong sidelobes in LPGs when creating them with only a single varying-duty-cycle exposure. The strong sidelobes can be well explained with a Mach-Zehnder interference model.

Apodisation of photo-induced waveguide gratings using double-exposure with complementary duty cycles

We present a novel apodisation scheme for photo-induced waveguide gratings. The apodisation is implemented with double exposures that have reversely varying duty cycles. We have successfully applied the proposed scheme to remove the sidelobes of long period gratings (LPGs). We also observed for the first time super strong sidelobes in LPGs when creating them with only a single varying-duty-cycle exposure. The strong sidelobes can be well explained with a Mach-Zehnder interference model.

The development of chemical exposure limits for the workplace

The thesis examines and explains the development of occupational exposure limits (OELs) as a means of preventing work related disease and ill health. The research focuses on the USA and UK and sets the work within a certain historical and social context. A subsidiary aim of the thesis is to identify any short comings in OELs and the methods by which they are set and suggest alternatives. The research framework uses Thomas Kuhn's idea of science progressing by means of paradigms which he describes at one point, `lq ... universally recognised scientific achievements that for a time provide model problems and solutions to a community of practitioners. KUHN (1970). Once learned individuals in the community, `lq ... are committed to the same rules and standards for scientific practice. Ibid. Kuhn's ideas are adapted by combining them with a view of industrial hygiene as an applied science-based profession having many of the qualities of non-scientific professions. The great advantage of this approach to OELs is that it keeps the analysis grounded in the behaviour and priorities of the groups which have forged, propounded, used, benefited from, and defended, them. The development and use of OELs on a larger scale is shown to be connected to the growth of a new profession in the USA; industrial hygiene, with the assistance of another new profession; industrial toxicology. The origins of these professions, particularly industrial hygiene, are traced. By examining the growth of the professions and the writings of key individuals it is possible to show how technical, economic and social factors became embedded in the OEL paradigm which industrial hygienists and toxicologists forged. The origin, mission and needs of these professions and their clients made such influences almost inevitable. The use of the OEL paradigm in practice is examined by an analysis of the process of the American Conference of Governmental Industrial Hygienists, Threshold Limit Value (ACGIH, TLV) Committee via the Minutes from 1962-1984. A similar approach is taken with the development of OELs in the UK. Although the form and definition of TLVs has encouraged the belief that they are health-based OELs the conclusion is that they, and most other OELs, are, and always have been, reasonably practicable limits: the degree of risk posed by a substance is weighed against the feasibility and cost of controlling exposure to that substance. The confusion over the status of TLVs and other OELs is seen to be a confusion at the heart of the OEL paradigm and the historical perspective explains why this should be. The paradigm has prevented the creation of truly health-based and, conversely, truly reasonably practicable OELs. In the final part of the thesis the analysis of the development of OELs is set in a contemporary context and a proposal for a two-stage, two-committee procedure for producing sets of OELs is put forward. This approach is set within an alternative OEL paradigm. The advantages, benefits and likely obstacles to these proposals are discussed.

Placenta growth factor-1 exerts time-dependent stabilization of adherens junctions following VEGF-induced vascular permeability

Increased vascular permeability is an early event characteristic of tissue ischemia and angiogenesis. Although VEGF family members are potent promoters of endothelial permeability the role of placental growth factor (PlGF) is hotly debated. Here we investigated PlGF isoforms 1 and 2 and present in vitro and in vivo evidence that PlGF-1, but not PlGF-2, can inhibit VEGF-induced permeability but only during a critical window post-VEGF exposure. PlGF-1 promotes VE-cadherin expression via the trans-activating Sp1 and Sp3 interaction with the VE-cadherin promoter and subsequently stabilizes transendothelial junctions, but only after activation of endothelial cells by VEGF. PlGF-1 regulates vascular permeability associated with the rapid localization of VE-cadherin to the plasma membrane and dephosphorylation of tyrosine residues that precedes changes observed in claudin 5 tyrosine phosphorylation and membrane localization. The critical window during which PlGF-1 exerts its effect on VEGF-induced permeability highlights the importance of the translational significance of this work in that PLGF-1 likely serves as an endogenous anti-permeability factor whose effectiveness is limited to a precise time point following vascular injury. Clinical approaches that would pattern nature's approach would thus limit treatments to precise intervals following injury and bring attention to use of agents only during therapeutic windows.

Relaxing claims:coping with uncertainty while evaluating assumptions at run time

Self-adaptation enables software systems to respond to changing environmental contexts that may not be fully understood at design time. Designing a dynamically adaptive system (DAS) to cope with this uncertainty is challenging, as it is impractical during requirements analysis and design time to anticipate every environmental condition that the DAS may encounter. Previously, the RELAX language was proposed to make requirements more tolerant to environmental uncertainty, and Claims were applied as markers of uncertainty that document how design assumptions affect goals. This paper integrates these two techniques in order to assess the validity of Claims at run time while tolerating minor and unanticipated environmental conditions that can trigger adaptations. We apply the proposed approach to the dynamic reconfiguration of a remote data mirroring network that must diffuse data while minimizing costs and exposure to data loss. Results show RELAXing Claims enables a DAS to reduce adaptation costs. © 2012 Springer-Verlag.