Blood-oxygen-level-dependent (BOLD) signal changes in total cortex and subcortex, pain, reward, and vigilance regions during mechanical pressure pain after morphine administration

Morphine is the most common clinical choice in the management of severe pain. Although the molecular mechanisms of morphine have already been characterized, the cerebral circuits by which it attenuates the sensation of pain have not yet been studied in humans. The objective of this two-arm (morphine versus placebo), between-subjects study was to examine whether morphine affects pain via pain-related cortical circuits, but also via reward regions that relate to the motivational state, as well as prefrontal regions that relate to vigilance as a result of morphine's sedative effects. Cortical activity was measured by the blood-oxygen-level-dependent (BOLD) signal changes using functional magnetic resonance imaging (fMRI). ^ The novelty of this study is at three levels: (i) to develop a methodology that will assess the average BOLD signal across subjects for the pain, reward, and vigilance cortical systems; (ii) to examine whether the reward and/or sedative effects of morphine are contributing factors to cortical regions associated with the motivational state and vigilance; and (iii) to propose a neuroanatomical model related to the opioid-sensitive effects of reward and sedation as a function of cortical activity related to pain in an effort to assess future analgesics. ^ Consistent with our hypotheses, our findings showed that the decrease in total pain-related volume activated between the post- and the pre-treatment morphine group was about 78%, while the post-treatment placebo group displayed only a 5% decrease when compared to pre-treatment levels of activation. The volume increase in reward regions was 451% in the post-treatment compared to the pre-treatment morphine condition. Finally, the volumetric decrease in vigilance regions was 63% in the posttreatment compared to the pre-treatment morphine condition. ^ These findings imply that changes in the blood flow of the reward and vigilance regions may be contributing factors in producing the analgesic effect under morphine administration. Future studies need to replicate this study in a higher resolution fMRI environment and to assess the proposed neuroanatomical model in patient populations. The necessity of pain research is apparent, since pain cuts across different diseases especially chronic ones, and thus, is recognized as a vital public health developing area. ^

A qualitative assessment of multi-level nutrition strategies for reducing racial and ethnic disparities in diabetes

The purpose of this study is to examine the stages of program realization of the interventions that the Bronx Health REACH program initiated at various levels to improve nutrition as a means for reducing racial and ethnic disparities in diabetes. This study was based on secondary analyses of qualitative data collected through the Bronx Health REACH Nutrition Project, a project conducted under the auspices of the Institute on Urban Family Health, with support from the Centers for Disease Control and Prevention (CDC). Local human subjects' review and approval through the Institute on Urban Family Health was required and obtained in order to conduct the Bronx Health REACH Nutrition Project. ^ The study drew from two theoretical models—Glanz and colleagues' nutrition environments model and Shediac-Rizkallah and Bone's sustainability model. The specific study objectives were two-fold: (1) to categorize each nutrition activity to a specific dimension (i.e. consumer, organizational or community nutrition environment); and (2) to evaluate the stage at which the program has been realized (i.e. development, implementation or sustainability). ^ A case study approach was applied and a constant comparative method was used to analyze the data. Triangulation of data based was also conducted. Qualitative data from this study revealed the following principal findings: (1) communities of color are disproportionately experiencing numerous individual and environmental factors contributing to the disparities in diabetes; (2) multi-level strategies that targeted the individual, organizational and community nutrition environments can appropriately address these contributing factors; (3) the nutrition strategies greatly varied in their ability to appropriately meet criteria for the three program stages; and (4) those nutrition strategies most likely to succeed (a) conveyed consistent and culturally relevant messages, (b) had continued involvement from program staff and partners, (c) were able to adapt over time or setting, (d) had a program champion and a training component, (e) were integrated into partnering organizations, and (f) were perceived to be successful by program staff and partners in their efforts to create individual, organizational and community/policy change. As a result of the criteria-based assessment and qualitative findings, an ecological framework elaborating on Glanz and colleagues model was developed. The qualitative findings and the resulting ecological framework developed from this study will help public health professionals and community leaders to develop and implement sustainable multi-level nutrition strategies for addressing racial and ethnic disparities in diabetes. ^

Comparing experience of diabetes care with chronic illness care in the primary care clinic using the Patient Assessment of Chronic Illness Care (PACIC)

Purpose. The overall purpose of the study was to evaluate the patient experience relevant to the Chronic Care Model as measured by the PACIC. Chronic illness care of patients with diabetes was compared to those with other chronic illnesses. In addition, chronic illness care of Hispanics was compared to those of other race/ethnicity. ^ Methods. The setting of this study was 20 primary care practices located in San Antonio, TX. The subjects in this study were consecutive adult patients age >18 yrs. Data was collected via a survey (PACIC) administered to 40-60 consecutive adult patients in each primary care clinic who presented for a scheduled appointment. ^ Results. Patient experience of the Chronic Care Model is different among those with diabetes than those with other chronic diseases: those with diabetes report a higher PACIC score. (P = 0.012) Although Hispanic patients report a higher PACIC score, patient experience of the Chronic Care Model among Hispanic patients is not significantly different than that of patients of other race/ethnicity regardless of chronic disease. (P = 0.053) After controlling for the patient characteristics of age, education, health status, and race/ethnicity, the diabetes status of the patient remains significantly associated with the outcome, the PACIC score. (P = 0.033) ^ Conclusions. Diabetes is associated with a greater experience of the Chronic Care model. Contributing factors to diabetes patients’ greater experience of the Chronic Care Model include the greater heath care use and higher self-care needs unique to individuals with diabetes. Special consideration must be given to the specific needs diabetic patients to ensure effective interventions, higher patient education, greater patient compliance, and lower health care costs. ^

Relationship between parental feeding practices and weight status in a lower socioeconomic pre-school population

High prevalence of overweight and obesity among preschool children in the low income population is consistently documented in research with one of every seven low-income, preschool-aged children classified as obese. Parental feeding practices have the potential to be contributing factors to the obesity epidemic. However, the impact of parental feeding practices on obesity in preschool age children has not been well explored. The purpose of this study was to determine relationships between the parental feeding practices of using dessert, sweets or candy as a reward for finishing foods, restricting dessert if the child does not finish their plate at dinner, asking the child to consume everything on their plate at dinner, and having family dinners to obesity in low income, preschool age children.^ A cross-sectional secondary data analysis was completed using the STATA 11 statistical software. Descriptive statistics were completed to summarize demographic and BMI data of participants, as well as parental feeding behavior variables. Pearson’s correlation was implemented to determine a correlation between parental feeding behavior variables and BMI z scores. Predictive relationships between the variables were explored through multivariable linear regression analysis. Regression analyses were also completed factoring in the confounders of gender, age, and ethnicity.^ Results revealed (1) no significant correlations or predictive trends between the use of rewards, forced consumption, or family dinner and BMI in low income preschool age children, and (2) a significant negative correlation and predictive trend between restriction of desserts and BMI in low income preschool age children. Since the analysis supported the null hypothesis for the practices of reward use, forced consumption, and family dinner, these practices are not considered risk factors for obese level BMIs. The inverse association found for practice of restriction and BMI suggests it is unnecessary to discourage parents from using restriction. Limitations of the study included the sample size, reliability of the answers provided on the Healthy Home Survey by participant guardians, and generalizability of the sample to the larger population.^

Relating one's social support network to one's mid term grade

Much has been written about the relation of social support to health outcomes. Support networks were found to be predictive of health status. Not so clear was the manner in which social support helped the individual to avoid health complications. Whereas some aspects of the support network were protective, others were burdensome. Duties to one's network could serve as a stressor and duties outside one's network might stress the support system itself. Exposure to one's network was associated with certain health risks while disruption in one's social support network was associated with other health risks.^ Many factors contributed to the impact of a social support network upon the individual member: the characteristics of the individual, the individual's role or position within the network, qualities of the network and duties or indebtedness of the individual to the network. This investigation considered the possibility that performance could serve as a stressor in a fashion similar to an exposure to a health hazard.^ Because the literature includes many examples of studies in which the subjects were college students, academic progress is a performance common to most subjects. A profile of the support networks of successful students was contrasted with those of less successful students in this correlational study.^ What was uncovered in this investigation was a very complex web of interrelated constructs. Most aspects of the social support network did not significantly predict academic performance. Only a limited number of characteristics were associated with academic success: the frequency of support, student age, the existence of a 'mentor' within one' s network, and the extent to which one received a predominant source of support. Other factors had a tendency to be negatively correlated with midterm grade, suggesting those factors may impede academic performance.^ Medical status did not predict grades, but was correlated with many aspects of the network. Disruptions in particular parts of one's network were correlated with particular health categories. In fact, disruption in social support was more predictive of academic outcomes than medical complications. Whereas the individual's values were related to the contributing factors, only the individual's satisfaction with certain aspects of the support network were predictive of higher midterm grades in a psychology class. Dissatisfaction was associated with lower grades, suggesting a disruptive effect within the network. Associations among the features of support networks which predicted academic progress were considered. ^

Data mining applied to the cognitive rehabilitation of patients with acquired brain injury

Acquired brain injury (ABI) is one of the leading causes of death and disability in the world and is associated with high health care costs as a result of the acute treatment and long term rehabilitation involved. Different algorithms and methods have been proposed to predict the effectiveness of rehabilitation programs. In general, research has focused on predicting the overall improvement of patients with ABI. The purpose of this study is the novel application of data mining (DM) techniques to predict the outcomes of cognitive rehabilitation in patients with ABI. We generate three predictive models that allow us to obtain new knowledge to evaluate and improve the effectiveness of the cognitive rehabilitation process. Decision tree (DT), multilayer perceptron (MLP) and general regression neural network (GRNN) have been used to construct the prediction models. 10-fold cross validation was carried out in order to test the algorithms, using the Institut Guttmann Neurorehabilitation Hospital (IG) patients database. Performance of the models was tested through specificity, sensitivity and accuracy analysis and confusion matrix analysis. The experimental results obtained by DT are clearly superior with a prediction average accuracy of 90.38%, while MLP and GRRN obtained a 78.7% and 75.96%, respectively. This study allows to increase the knowledge about the contributing factors of an ABI patient recovery and to estimate treatment efficacy in individual patients.

Güímar and La Orotava mega-landslides (Tenerife) and tsunamis deposits in Canary Islands

More than 20 mega-landslides have been described in the Canary Islands affecting the flanks of the volcanic edifices. Gliimar and La Orotava landslides, in Tenerife, are two exceptional cases due to their huge dimensions and outstanding geomorphological features. The estimated volume of these landslides exceed tens of cubic km. Tsunami deposits have been also identified in some of the islands of the archipelago probably associated to the large landslides of the islands flanks. An investigation has been carried out to explain the causes of these large instability processes and their failure mechanisms. One of the main aspects investigated was the geomechanical characteristics of the volcanic rock masses, specially the hyaloclastite rocks forming the substratum underlying the emerged volcanic building. The low strength and high deformability properties of these rocks have played a fundamental role on the stability of the island flanks. The results have shown the gravitational origin of these instability processes as the main failure mechanism. Volcanic eruptions or large earthquakes could be contributing factors to the instability, but according with the data obtained in Gliimar and La Orotava cases they are not necessary as triggering factors. As a result of the field work carried out in the frame of the project, three large tsunami deposits have been identified in the islands of Lanzarote, Tenerifc and Gran Canaria attributed to rnega-Iandslides, possibly related to Guimar and La Orotava. A Sumrnary of their main features is described.

Artificial metaplasticity prediction model for cognitive rehabilitation outcome in acquired brain injury patients

Objective The main purpose of this research is the novel use of artificial metaplasticity on multilayer perceptron (AMMLP) as a data mining tool for prediction the outcome of patients with acquired brain injury (ABI) after cognitive rehabilitation. The final goal aims at increasing knowledge in the field of rehabilitation theory based on cognitive affectation. Methods and materials The data set used in this study contains records belonging to 123 ABI patients with moderate to severe cognitive affectation (according to Glasgow Coma Scale) that underwent rehabilitation at Institut Guttmann Neurorehabilitation Hospital (IG) using the tele-rehabilitation platform PREVIRNEC©. The variables included in the analysis comprise the neuropsychological initial evaluation of the patient (cognitive affectation profile), the results of the rehabilitation tasks performed by the patient in PREVIRNEC© and the outcome of the patient after a 3–5 months treatment. To achieve the treatment outcome prediction, we apply and compare three different data mining techniques: the AMMLP model, a backpropagation neural network (BPNN) and a C4.5 decision tree. Results The prediction performance of the models was measured by ten-fold cross validation and several architectures were tested. The results obtained by the AMMLP model are clearly superior, with an average predictive performance of 91.56%. BPNN and C4.5 models have a prediction average accuracy of 80.18% and 89.91% respectively. The best single AMMLP model provided a specificity of 92.38%, a sensitivity of 91.76% and a prediction accuracy of 92.07%. Conclusions The proposed prediction model presented in this study allows to increase the knowledge about the contributing factors of an ABI patient recovery and to estimate treatment efficacy in individual patients. The ability to predict treatment outcomes may provide new insights toward improving effectiveness and creating personalized therapeutic interventions based on clinical evidence.

Energy-based Fair Queuing: Energy-centric Processor Scheduling Algorithm for Battery-limited Mobile Systems

Los dispositivos móviles modernos disponen cada vez de más funcionalidad debido al rápido avance de las tecnologías de las comunicaciones y computaciones móviles. Sin embargo, la capacidad de la batería no ha experimentado un aumento equivalente. Por ello, la experiencia de usuario en los sistemas móviles modernos se ve muy afectada por la vida de la batería, que es un factor inestable de difícil de control. Para abordar este problema, investigaciones anteriores han propuesto un esquema de gestion del consumo (PM) centrada en la energía y que proporciona una garantía sobre la vida operativa de la batería mediante la gestión de la energía como un recurso de primera clase en el sistema. Como el planificador juega un papel fundamental en la administración del consumo de energía y en la garantía del rendimiento de las aplicaciones, esta tesis explora la optimización de la experiencia de usuario para sistemas móviles con energía limitada desde la perspectiva de un planificador que tiene en cuenta el consumo de energía en un contexto en el que ésta es un recurso de primera clase. En esta tesis se analiza en primer lugar los factores que contribuyen de forma general a la experiencia de usuario en un sistema móvil. Después se determinan los requisitos esenciales que afectan a la experiencia de usuario en la planificación centrada en el consumo de energía, que son el reparto proporcional de la potencia, el cumplimiento de las restricciones temporales, y cuando sea necesario, el compromiso entre la cuota de potencia y las restricciones temporales. Para cumplir con los requisitos, el algoritmo clásico de fair queueing y su modelo de referencia se extienden desde los dominios de las comunicaciones y ancho de banda de CPU hacia el dominio de la energía, y en base a ésto, se propone el algoritmo energy-based fair queueing (EFQ) para proporcionar una planificación basada en la energía. El algoritmo EFQ está diseñado para compartir la potencia consumida entre las tareas mediante su planificación en función de la energía consumida y de la cuota reservada. La cuota de consumo de cada tarea con restricciones temporales está protegida frente a diversos cambios que puedan ocurrir en el sistema. Además, para dar mejor soporte a las tareas en tiempo real y multimedia, se propone un mecanismo para combinar con el algoritmo EFQ para dar preferencia en la planificación durante breves intervalos de tiempo a las tareas más urgentes con restricciones temporales.Las propiedades del algoritmo EFQ se evaluan a través del modelado de alto nivel y la simulación. Los resultados de las simulaciones indican que los requisitos esenciales de la planificación centrada en la energía pueden lograrse. El algoritmo EFQ se implementa más tarde en el kernel de Linux. Para evaluar las propiedades del planificador EFQ basado en Linux, se desarrolló un banco de pruebas experimental basado en una sitema empotrado, un programa de banco de pruebas multihilo, y un conjunto de pruebas de código abierto. A través de experimentos específicamente diseñados, esta tesis verifica primero las propiedades de EFQ en la gestión de la cuota de consumo de potencia y la planificación en tiempo real y, a continuación, explora los beneficios potenciales de emplear la planificación EFQ en la optimización de la experiencia de usuario para sistemas móviles con energía limitada. Los resultados experimentales sobre la gestión de la cuota de energía muestran que EFQ es más eficaz que el planificador de Linux-CFS en la gestión de energía, logrando un reparto proporcional de la energía del sistema independientemente de en qué dispositivo se consume la energía. Los resultados experimentales en la planificación en tiempo real demuestran que EFQ puede lograr de forma eficaz, flexible y robusta el cumplimiento de las restricciones temporales aunque se dé el caso de aumento del el número de tareas o del error en la estimación de energía. Por último, un análisis comparativo de los resultados experimentales sobre la optimización de la experiencia del usuario demuestra que, primero, EFQ es más eficaz y flexible que los algoritmos tradicionales de planificación del procesador, como el que se encuentra por defecto en el planificador de Linux y, segundo, que proporciona la posibilidad de optimizar y preservar la experiencia de usuario para los sistemas móviles con energía limitada. Abstract Modern mobiledevices have been becoming increasingly powerful in functionality and entertainment as the next-generation mobile computing and communication technologies are rapidly advanced. However, the battery capacity has not experienced anequivalent increase. The user experience of modern mobile systems is therefore greatly affected by the battery lifetime,which is an unstable factor that is hard to control. To address this problem, previous works proposed energy-centric power management (PM) schemes to provide strong guarantee on the battery lifetime by globally managing energy as the first-class resource in the system. As the processor scheduler plays a pivotal role in power management and application performance guarantee, this thesis explores the user experience optimization of energy-limited mobile systemsfrom the perspective of energy-centric processor scheduling in an energy-centric context. This thesis first analyzes the general contributing factors of the mobile system user experience.Then itdetermines the essential requirements on the energy-centric processor scheduling for user experience optimization, which are proportional power sharing, time-constraint compliance, and when necessary, a tradeoff between the power share and the time-constraint compliance. To meet the requirements, the classical fair queuing algorithm and its reference model are extended from the network and CPU bandwidth sharing domain to the energy sharing domain, and based on that, the energy-based fair queuing (EFQ) algorithm is proposed for performing energy-centric processor scheduling. The EFQ algorithm is designed to provide proportional power shares to tasks by scheduling the tasks based on their energy consumption and weights. The power share of each time-sensitive task is protected upon the change of the scheduling environment to guarantee a stable performance, and any instantaneous power share that is overly allocated to one time-sensitive task can be fairly re-allocated to the other tasks. In addition, to better support real-time and multimedia scheduling, certain real-time friendly mechanism is combined into the EFQ algorithm to give time-limited scheduling preference to the time-sensitive tasks. Through high-level modelling and simulation, the properties of the EFQ algorithm are evaluated. The simulation results indicate that the essential requirements of energy-centric processor scheduling can be achieved. The EFQ algorithm is later implemented in the Linux kernel. To assess the properties of the Linux-based EFQ scheduler, an experimental test-bench based on an embedded platform, a multithreading test-bench program, and an open-source benchmark suite is developed. Through specifically-designed experiments, this thesis first verifies the properties of EFQ in power share management and real-time scheduling, and then, explores the potential benefits of employing EFQ scheduling in the user experience optimization for energy-limited mobile systems. Experimental results on power share management show that EFQ is more effective than the Linux-CFS scheduler in managing power shares and it can achieve a proportional sharing of the system power regardless of on which device the energy is spent. Experimental results on real-time scheduling demonstrate that EFQ can achieve effective, flexible and robust time-constraint compliance upon the increase of energy estimation error and task number. Finally, a comparative analysis of the experimental results on user experience optimization demonstrates that EFQ is more effective and flexible than traditional processor scheduling algorithms, such as those of the default Linux scheduler, in optimizing and preserving the user experience of energy-limited mobile systems.

Metodologias utilizadas no estudo do escoamento em aquíferos cársicos e o caso prático da captação do Olho de Mira (Maciço Calcário Estremenho)

Tese de mestrado em Geologia Aplicada, apresentada à Universidade de Lisboa, através da Faculdade de Ciências, 2016

Fatigue, physical performance, and systemic inflammation in patients with chronic obstructive pulmonary disease

Thesis (Ph.D.)--University of Washington, 2016-06

Incorporating nerve-gliding techniques in the conservative treatment of cubital Tunnel syndrome

Objective: To discuss the diagnosis and treatment of a patient with cubital tunnel syndrome and to illustrate novel treatment modalities for the ulnar nerve and its surrounding structures and target tissues. The rationale for the addition of nerve-gliding techniques will be highlighted. Clinical Features: Two months after onset, a 17-year-old female nursing student who had a traumatic onset of cubital tunnel syndrome still experienced pain around the elbow and paresthesia in the ulnar nerve distribution. Electrodiagnostic tests were negative. Segmental cervicothoracic motion dysfunctions were present which were regarded as contributing factors hindering natural recovery. Intervention and Outcomes: After 6 sessions consisting of nerve-gliding techniques and segmental joint manipulation and a home exercise program consisting of nerve gliding and light free-weight exercises, a substantial improvement was recorded on both the impairment and functional level (pain scales, clinical tests, and Northwick Park Questionnaire). Symptoms did not recur within a 10-month follow-up period, and pain and disability had completely resolved. Conclusions: Movement-based management may be beneficial in the conservative management of cubital tunnel syndrome. As this intervention is in contrast with the traditional recommendation of immobilization, comparing the effects of both interventions in a systematic way is an essential next step to determine the optimal treatment of patients with cubital tunnel syndrome.

How is leflunomide prescribed and used in Australia? analysis of prescribing and adverse effect reporting

Purpose To evaluate the use of leflunomide in the Australian community since introduction in 2000. Trends in adverse drug reaction (ADR) reporting were also studied. Methods Annual Australian prescription and dispensing statistics were analysed. Drug utilisation was estimated as defined daily doses (DDD)/1000 inhabitants/day. ADR data from the Therapeutic Goods Administration's Adverse Drug Reactions Advisory Committee (ADRAC) national monitoring system were compared with the World Health Organisation (WHO) Vigibase records. Results Leflunomide use in Australia (dispensing data) increased from 0.2 in 2000 to 0.4 DDD/1000 inhabitants/day in 2002. The same overall pattern was observed in the 'authority to prescribe' data. From 2000-2002, prescribing of the starter pack (3 x 100 mg loading dose plus 30 x 20 mg tablets) declined (down 74%); likewise for the 20mg (30 tablets) pack. Gradual increases were noted for the 10 mg (30 tablets) pack (up 40%). Approximately 135 reports, detailing about 370 individual ADR, were generated annually. Gastro-intestinal disorders predominated, accounting for 24% of reactions reported to ADRAC. Skin and appendages disorders constituted 14% of reported reactions. Deaths in leflunomide users were attributed to a combination of haematological and gastro-intestinal complications, but it was not possible to ascertain other medication usage or contributing factors. Trends observed with the ADRAC reports were consistent with the WHO database. Conclusions Leflunomide was the first registered DMARD in Australia in over a decade and its use has increased within the community. The ADR reports might have contributed to Australian rheumatologists gradually abandoning loading patients with high doses of leflunomide in favour of starting therapy at lower doses. Copyright (c) 2006 John Wiley & Sons, Ltd.

Earnings behaviour of financially distressed firms:The role of institutional ownership

Using a sample of 859 U.S. bankruptcy-filing firms over the period 1986-2004, we examine the earnings behaviour of managers during the distressed period by looking at sources of abnormal accruals prior to the bankruptcy-filing year. Results show that managers of highly distressed firms shift earnings downwards prior to the bankruptcy filing. We test and provide evidence in support of two potential contributing factors. First, top-level management turnover among distressed firms leads new managers to earnings bath choices during the distressed period. Second, qualified audit opinions exert pressure on managers to follow more conservative earnings behaviour during the distressed period. Evidence is also provided that the management of distressed firms with lower (higher) institutional ownership has greater (lesser) tendency to manage earnings downwards. Results also show that higher institutional ownership mitigates the negative abnormal returns of firms with top management turnover. To the authors' knowledge, this is the first study that attempts to examine whether institutional ownership relates to market reaction in conjunction with a top management turnover or a qualified audit opinion during the distressed period. Prior studies focused on the investigation of earnings management or institutional ownership (separately) during the distressed period, but did not examine if the effect of institutional ownership on earnings behaviour also influences subsequent returns. Thus, the results of this study should be of interest to analysts, standard setters and regulatory bodies since our results show that management turnover, qualified audit opinions and firm governance mechanisms affect the quality of earnings and the level of abnormal returns. © 2007 Accounting Foundation, The University of Sydney.

CLAE to move to online format

Editorial: The 2015 BCLA annual conference was another fantastic affair. It was the first time the conference was held in the beautiful city of Liverpool. The venue was great and the programme was excellent. The venue overlooked the River Mersey and many of the hotels were local boutique hotels. I stayed in one which was formerly the offices of White Star Liners—where the RMS Titanic was originally registered. The hotel decor was consistent with its historic significance. The BCLA gala dinner was held in the hugely impressive Anglican Cathedral with entertainment from a Beatles tribute band. That will certainly be a hard act to follow at the next conference in 2017. Brian Tompkins took the reigns as the new BCLA president. Professor Fiona Stapleton was the recipient of the BCLA Gold Medal Award. The winner of the poster competition was Dorota Szczesna-Iskander with a poster entitled ‘Dry Contact lens poor wettability and visual performance’. Second place was Renee Reeder with her poster entitled ‘Abnormal Rosacea as a differential diagnosis in corneal scarring’. And third place was Maria Jesus Gonzalez-Garcia with her poster entitled ‘Dry Effect of the Environmental Conditions on Tear Inflammatory Mediators Concentration in Contact Lens Wearers’. The photographic competition winner was Professor Wolfgang Sickenberger from Jena in Germany. The Editorial Panel of CLAE met at the BCLA conference for their first biannual meeting. The journal metrics were discussed. In terms of number of submissions of new papers CLAE seems to have plateaued after seeing a rapid growth in the number of submissions over the last few years. The increase over the last few years could be attributed to the fact that CLAE was awarded an impact factor for the first time in 2012. This year it seems that impact factors across nearly all ophthalmic related journals has dropped. This could in part be due to the fact that last year was a ‘Research Exercise Framework (REF) year for UK universities, where they are judged on quality of their research output. The next REF is in 2020 so we may see changes nearing that time. Looking at article downloads, there seems to be a continued rise in figures. Currently CLAE attracts around 85,000 downloads per year (this is an increase of around 10,000 per year for the last few years) and the 2015 prediction is 120,000! With this in mind and with other contributing factors too, the BCLA has decided to move to online delivery of CLAE to its members starting from issue 5 of 2015. Some members do like to flick through the pages of a hard copy of the journal so members will still have the option of receiving a hard copy through the post but the default journal delivery method will now be online. The BCLA office will send various alerts and content details to members email addresses. To access CLAE online you will need to log in via the BCLA web page, currently you then click on ‘Resources’ and then under ‘Free and Discounted Publications’ you will see CLAE. This actually takes you to CLAE’s own webpage (www.contactlensjournal.com) but you need to log in via the BCLA web page. The BCLA plans to change these weblinks so that from the BCLA web page you can link to the journal website much more easily and you have the choice of going directly into the general website for CLAE or straight to the current issue. In 2016 you will see an even easier way of accessing CLAE online as the BCLA will launch a CLAE application for mobile devices where the journal can be downloaded as a ‘flick-book’. This is a great way of bringing CLAE into the modern era where people access their information in newer ways. For many the BCLA conference was part of a very busy conference week as it was preceded by the International Association of Contact Lens Educators’ (IACLE) Third World Congress, held in Manchester on the 4 days before the BCLA conference. The first and second IACE World Congresses were held in Waterloo, Canada in 1994 and 2000 respectively and hosted by Professor Des Fonn. Professor Fonn was the recipient of the first ever IACLE lifetime achievement award. The Third IACLE World Congress saw more than 100 contact lens educators and industry representatives from around 30 countries gather in the UK for the four-day event, hosted by The University of Manchester. Delegates gained hands-on experience of innovations in teaching, such as learning delivery systems, the use of iPads in the classroom and for creating ePub content, and augmented and virtual reality technologies. IACLE members around the world also took part via a live online broadcast. The Third IACLE World Congress was made possible by the generous support of Sponsors Alcon, CooperVision and Johnson & Johnson Vision Care., for more information look at the IACLE web page (www.iacle.org).