The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

Introduction
Standard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.

Methods
The Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.

Discussion
This trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.

“I just can’t, I am frightened for my safety, I don’t know how to work with her” Practitioners’ experiences of client violence and recommendations for future practice

To what extent is the therapist-client relationship damaged following client perpetuated violence and what steps can we take to diminish its impact? Much of the information we have on client violence comes from multiple mental health disciplines in the US and the UK over the last 20-30 years and has formed a useful, though sometimes dated and sporadic, quantitative baseline to delineate a range of issues. However, there is limited systematic research on how practitioner psychologists process the violence in the course of their everyday practice and how this impacts the therapist-client dynamic. Using Interpretative Phenomenological Analysis (IPA), we explored seven therapists’ experiences of client violence across a range of work sites – acute psychiatric hospital wards, forensic hospital wards and community mental health teams. Three main themes were documented: processing the moment-to-moment experience of client violence; professional vulnerabilities and needs as a result of client violence; and the ruptured therapeutic relationship. Strategies for supporting practicing psychologists and providing continuing professional care for clients include challenging self-doubt and re-energizing professional competencies as well as repairing ourselves and repairing the therapeutic relationship. Recommendations for credentialing and regulatory bodies in relation to client violence are also highlighted.

Let's go to work

This document communicates the mission of the Vocational Rehabilitation Department to create relationships among individuals, community partners, agencies, non-profits and businesses. It discusses client services, business services, disability determination services and partnerships. A directory of statewide offices is also provided.

A mediated moderation study to explain the negative relationship between job insecurity and employee supportive voice

Double degree

Translation of biomechanical concepts in bone tissue engineering: from animal study to revision knee arthroplasty.

Bone defects in revision knee arthroplasty are often located in load-bearing regions. The goal of this study was to determine whether a physiologic load could be used as an in situ osteogenic signal to the scaffolds filling the bone defects. In order to answer this question, we proposed a novel translation procedure having four steps: (1) determining the mechanical stimulus using finite element method, (2) designing an animal study to measure bone formation spatially and temporally using micro-CT imaging in the scaffold subjected to the estimated mechanical stimulus, (3) identifying bone formation parameters for the loaded and non-loaded cases appearing in a recently developed mathematical model for bone formation in the scaffold and (4) estimating the stiffness and the bone formation in the bone-scaffold construct. With this procedure, we estimated that after 3 years mechanical stimulation increases the bone volume fraction and the stiffness of scaffold by 1.5- and 2.7-fold, respectively, compared to a non-loaded situation.

Population pharmacokinetic study to evaluate dosing strategies of imipenem in neonates and infants

Objective: Imipenem is a broad spectrum antibiotic used to treat severe infections in critically ill patients. Imipenem pharmacokinetics (PK) was evaluated in a cohort of neonates treated in the Neonatal Intensive Care Unit of the Lausanne University Hospital. The objective of our study was to identify key demographic and clinical factors influencing imipenem exposure in this population. Method: PK data from neonates and infants with at least one imipenem concentration measured between 2002 and 2013 were analyzed applying population PK modeling methods. Measurement of plasma concentrations were performed upon the decision of the physician within the frame of a therapeutic drug monitoring (TDM) programme. Effects of demographic (sex, body weight, gestational age, postnatal age) and clinical factors (serum creatinine as a measure of kidney function; co-administration of furosemide, spironolactone, hydrochlorothiazide, vancomycin, metronidazole and erythromycin) on imipenem PK were explored. Model-based simulations were performed (with a median creatinine value of 46 μmol/l) to compare various dosing regimens with respect to their ability to maintain drug levels above predefined minimum inhibitory concentrations (MIC) for at least 40 % of the dosing interval. Results: A total of 144 plasma samples was collected in 68 neonates and infants, predominantly preterm newborns, with median gestational age of 27 weeks (24 - 41 weeks) and postnatal age of 21 days (2 - 153 days). A two-compartment model best characterized imipenem disposition. Actual body weight exhibited the greatest impact on PK parameters, followed by age (gestational age and postnatal age) and serum creatinine on clearance. They explain 19%, 9%, 14% and 9% of the interindividual variability in clearance respectively. Model-based simulations suggested that 15 mg/kg every 12 hours maintain drug concentrations over a MIC of 2 mg/l for at least 40% of the dosing interval during the first days of life, whereas neonates older than 14 days of life required a dose of 20 mg/kg every 12 hours. Conclusion: Dosing strategies based on body weight and post-natal age are recommended for imipenem in all critically ill neonates and infants. Most current guidelines seem adequate for newborns and TDM should be restricted to some particular clinical situations.

Leisure connections : a case study to understand facilitation techniques with survivors of trauma

Leisure-based therapy is a potentially effective approach to supporting survivors of trauma in their healing. The purpose ofthis qualitative case study was to describe the recreation therapist's facilitation techniques of Leisure Connections, a unique leisurebased psycho-educational group for survivors of trauma, and explore how the facilitation was experienced by participants. Qualitative case study design, following the methods of Yin (1994) was used. One two week, three session Leisure Connections group was observed. Six participants completed the Group· Therapy Alliance Scale (pinsof & Catherall, 1986) and reflection cards. In-depth, semi-structured interviews were conducted with the recreation therapist and four participants. Six themes emerged describing group leader interventions, recreation therapist's actions, recreation therapist's preparation and reflections, group members' experience of a therapeutic alliance, group cohesion, and prior influences and assumptions. Therapeutic alliance and group cohesion were influenced by the recreation therapist's group leader interventions (drawing out, processing, protecting) and actions. The context of the group within a therapeutic community milieu was an important influence.

Sex Talk: A Multiple Case Study to Explore and Understand Parent-Child Sexual Health Communication in Chinese Immigrant Families

Parent-child sexual health communication can be beneficial. Many factors affect such communication in Chinese immigrant families. This qualitative study explored the influences of acculturation, parenting, and parental participation in the Raising Sexually Healthy Children Program (RSHC) on such communication. With a hermeneutic framework, the purpose was to develop understanding based on the topic, context, and researcher interpretations. Twelve interviews elicited data from six parent-child dyads, three from the RSHC. Analysis involved coding processes; data were compared repeatedly and organized into themes. Perceived personality differences between generations were confounded with cultural communicative differences. Parents used implicitness observed in Chinese culture to establish "open" communication; children expected explicitness observed in Western culture. Post- RSHC, parents perceived themselves as more open to talking about sex; children did not perceive such parental changes. Future research should include joint interviews and longitudinal program evaluation. Future practice should focus on cross-cultural communication and involving children in RSHC.

From school to work. 'De la escuela al trabajo'.

Proyecto educativo indicado para el nivel de Educación Secundaria. El cuaderno propone conocer los vínculos entre la escuela y el mundo del trabajo para así facilitar la inserción laboral de los alumnos que acaban los estudios. Para ello se estructura en cinco fichas, que proponen a partir de unos objetivos a conseguir, unas actividades. Las fichas están orientadas a desarrollar la autoestima y la confianza en el alumnado. Este proyecto pone al alcance de los estudiantes unas herramientas básicas para enfrontarse al mundo laboral y les da la oportunidad de ponerlas en práctica, aunque sólo sea de manera fictícia.

Yecla : a gaze upon your town : (a sample of activities design to work and communicate in english on your town).

Subtítulo tomado de la cub