Transcameral suture to prevent tube-corneal touch after glaucoma drainage device implantation: a new surgical technique

PURPOSE: To report a new technique to correct tube position in anterior chamber after glaucoma drainage device implantation.

PATIENT AND METHODS: A patient who underwent a glaucoma drainage device implantation was noted to have the tube touching the corneal endothelium. A 10/0 polypropylene suture with double-armed 3-inch long straight needle was placed transcamerally from limbus to limbus, in the superior part of the eye, passing the needle in front of the tube.

RESULTS: The position of the tube in the anterior chamber was corrected with optimal distance from corneal endothelium and iris surface. The position remained satisfactory after 20 months of follow-up.

CONCLUSIONS: The placement of a transcameral suture offers a safe, quick, and minimal invasive intervention for the correction of the position of a glaucoma drainage device tube in the anterior chamber.

Recurrent vitreous occlusion of glaucoma drainage device tube in a patient with glaucoma in aphakia:A case report

Patients with spontaneous lens dislocation and glaucoma can be challenging to manage. We present a forty-six year old Caucasian lady who was referred with bilateral high intraocular pressure, and was subsequently diagnosed with glaucoma in association with lens dislocation and Marfan syndrome. Baerveldt glaucoma drainage device tubes were inserted in both eyes due to poor response to medical therapy. However, this was complicated by recurrent vitreous occlusion of both glaucoma drainage tubes requiring further multiple surgical interventions. There have not been any further recurrences of vitreous incarceration or posterior segment complications since, but the patient remains under close follow-up. © 2010 Ang et al; licensee BioMed Central Ltd.

Surgical technique:Complex glaucoma case requiring molteno drainage tube extension

A 42-year-old man has been under long-term follow-up since he was a child for congenital glaucoma and buphthalmos in both eyes. His left eye best corrected visual acuity (BCVA) was counting fingers, due to end-stage glaucoma. He was on maximal medical therapy with an intraocular pressure (IOP) maintained at mid to low twenties. His right eye, the only seeing eye, had a BCVA of 6/9. This eye had undergone multiple glaucoma laser and surgical procedures, including an initial first Molteno drainage device inserted superonasally that failed in April 2003 due to fibrotic membrane over the tube opening. As a result, he subsequently had a second Molteno drainage device inserted inferotemporally. To further maximize his vision he had an uncomplicated cataract extraction and intraocular lens implant in December 2004, after which he developed postoperative cystoid macular edema and corneal endothelial failure. He underwent a penetrating keratoplasty in the right eye thereafter in March 2007. After approximately a year, the second Molteno device developed drainage tube retraction, which was managed surgically to maintain optimum IOP in the right eye. His right eye vision to date is maintained at 6/12. © 2011 Mustafa and Azuara-Blanco.

Energy balance of SRC willow used for managing farmyard washings - how does it compare to a conventional wastewater treatment works?

The water and wastewater industry in the UK accounts for around 3% of total energy use and just over 1% of total UK greenhouse gas emissions. Targets for greenhouse gas emissions reduction and higher renewable energy penetration, coupled with rising energy costs, growing demand for wastewater services and tightening EU water quality requirements, have led to an increased interest in alternative wastewater treatment methods. The use of short rotation coppice (SRC) willow for the treatment of wastewater effluent is one such alternative, which brings with it the dual benefits of wastewater treatment and production of biomass for energy. In order to assess the effectiveness of SRC willow, it is important to analyse the overall energy balance in terms of energy input versus energy output. This paper carries out an energy life cycle analysis of a specific SRC willow plantation in Northern Ireland to which farmyard washings (dirty water) are applied. The system boundaries include the establishment, maintenance, and harvesting of the plantation, along with the transport and drying of the wood for biomass combustion. The analysis shows that the overall energy balance is positive, and that the direct and indirect energy demands are 12% and 8% of gross energy production respectively. The energy demands of the plantation are compared with the energy required to treat an equivalent nutrient load in a conventional wastewater treatment plant. While a conventional plant consumes 2.6 MJ/m3 , the irrigation system consumes 1.6 MJ/m3 and the net energy production of the scenario is 48 MJ/m3 .

The Political Economy of Swift's Satires and other Prose Works

Jonathan Swift wrote perceptively about the emerging commercial society
in Britain in the early eighteenth century. His particular focus was on the
financial revolution and its implications for economic and political stability
as well as for shifts of power between the landed and commercial
classes. Following his return to Ireland Swift’s focus shifted to the developmental
problems of his native country. In several pamphlets he advocated
consumption of domestic products, challenged existing political
structures and made trenchant criticisms of absenteeism and other dysfunctional
aspects of the land tenure system. Swift’s politico-economic
concerns are fully reflected in his best known work, Gulliver’s Travels but
his most pointed criticism of the emerging commercial system is contained
in A Modest Proposal. Written in the form of an economic pamphlet, A
Modest Proposal is ostensibly designed to address the problem of poverty
in Ireland. In addition to its implicit criticism of economic policy in Ireland,
the pamphlet challenges the separation of economics and morality as
evidenced in the writings of William Petty and Bernard Mandeville. Swift
parodies Petty’s political arithmetic but it is suggested here that he also
had in his sights the consequentialist reasoning present in the work of
both authors but explicitly so in Mandeville.
Keywords: financial revolution, public debt, paper credit, rationality, political
arithmetic, consequentialism, Petty (William), Mandeville (Bernard)

Listening to the World Through New Ears:Reinvention of the soundtrack in the works of Lucrecia Martel and Sofia Coppola

This paper explores the production and post-production techniques and tensions in designing sound for film. Considering the films of Lucrecia Martel and Sofia Coppola, amongst others, Greene and Yang will discuss how the soundtrack takes on a primary role in these films and becomes a medium for symbolism, reflection, characterisation, as well as storytelling. There will be a close examination of the processes involved in creating character-orientated soundscapes. These processes are sensitive to the effects sound has on an audience. Exploring how these filmmakers (with their sound teams) utilise the listening experience, including attention to point of audition and sound perception, this paper will critically unpick how such creative decisions are arrived at during various stages of the production process. Outlining the use of diegetic and non-diegetic sound and the potential musicality of sound effect design, issues of reverberation, noise and intent are discussed to highlight the sonic framing of these creative teams. Greene will approach these soundtracks from a production/post-production perspective, while Yang will explore the composer’s/designer’s ear.

The Complete Works of John Milton: Volume III: The Shorter Poems (826pp.)

Stephen B. Dobranski, Milton Quarterly 49.3 (October, 2015), 181-4:

'By addressing classical and neo-Latin works with which Milton's poems appear to engage, Haan has pursued something unattempted yet. Her erudite and engaging commentary on the Poemata is the most extensive and impressive that I have encountered in any edition ... Haan's discussion of Milton's Poemata - including the Testimonia, the one Italian and four Latin encomia by the poet's acquaintances published in 1645 and 1673 - is remarkably detailed and well-researched. In these sections, readers learn, for example, how Milton's Epitaphium Damonis borrows from both classical writers (Theocritus, Moschus) and contemporary models (Castiglione, Zanchi) while transcending all of them through a pattern of resurrection motifs. Or, readers can discover affinities between Milton's lament on the death of the Bishop of Ely and a poem by the Italian humanist Hieronymo Aleander, Jr., or learn about the connections between Milton's Elegia Quinta and George Buchanan's Maiae Calendae ... The Shorter Poems is a scholarly achievement of the highest order.'

Noam Reisner, Review of English Studies 65 (2014), 744-5:
‘Haan shines with her Neo-Latinist expertise by offering a vivid separate introduction to the Latin poems, which sets up Milton’s poemata specifically within the Neo-Latin contexts of the seventeenth century, thereby dispelling any remaining view of these poems as juvenilia (a view which results from reading the poems chronologically). … The present volume will instantly establish itself as the definitive resource for any reader interested in Milton’s shorter poems, and it is scarcely imaginable that it will ever be eclipsed or be in need of replacing. Its contribution is important in all areas, especially in providing for the first time in a single volume truly valuable documents which can teach us a lot more about Milton’s poetic development than simply reading the poems in chronological sequence. But perhaps, this edition’s greatest achievement is the way in which it succeeds in giving Milton’s Latin poems the pride of place they have long deserved as fully integral to Milton’s complete poetic imagination. Haan’s specific achievement in this regard is less in updating the translations than in providing a different context through which to look at the Latin poems themselves. Haan’s detailed commentaries set the Latin poems in a completely fresh light which looks beyond the obvious classical references and allusions, noted by Carey and many other editors, to Milton’s complex engagement with the Neo-Latin literary culture of his time. It is this aspect of the volume, more than anything else, which vindicates its essentialness.'

Power Capping: What Works, What Does Not

Peak power consumption is the first order design constraint of data centers. Though peak power consumption is rarely, if ever, observed, the entire data center facility must prepare for it, leading to inefficient usage of its resources. The most prominent way for addressing this issue is to limit the power consumption of the data center IT facility far below its theoretical peak value. Many approaches have been proposed to achieve that, based on the same small set of enforcement mechanisms, but there has been no corresponding work on systematically examining the advantages and disadvantages of each such mechanism. In the absence of such a study,it is unclear what is the optimal mechanism for a given computing environment, which can lead to unnecessarily poor performance if an inappropriate scheme is used. This paper fills this gap by comparing for the first time five widely used power capping mechanisms under the same hardware/software setting. We also explore possible alternative power capping mechanisms beyond what has been previously proposed and evaluate them under the same setup. We systematically analyze the strengths and weaknesses of each mechanism, in terms of energy efficiency, overhead, and predictable behavior. We show how these mechanisms can be combined in order to implement an optimal power capping mechanism which reduces the slow down compared to the most widely used mechanism by up to 88%. Our results provide interesting insights regarding the different trade-offs of power capping techniques, which will be useful for designing and implementing highly efficient power capping in the future. 

Managing patient deterioration: evaluation of what works.

Background: Rapid Response Systems (RRS) have been implemented nationally and internationally to improve patient safety in hospital. However, to date the majority of the RRS research evidence has focused on measuring the effectiveness of the intervention on patient outcomes. To evaluate RRS it has been recommended that a multimodal approach is required to address the broad range of process and outcome measures required to determine the effectiveness of the RRS concept. Aim: The aim of this paper is to evaluate the official RRS programme theoretical assumptions regarding how the programme is meant to work against actual practice in order to determine what works. Methods: The research design was a multiple case study approach of four wards in two hospitals in Northern Ireland. It followed the principles of realist evaluation research which allowed empirical data to be gathered to test and refine RRS programme theory [1]. This approach used a variety of mixed methods to test the programme theories including individual and focus group interviews with a purposive sample of 75 nurses and doctors, observation of ward practices and documentary analysis. The findings from the case studies were analysed and compared within and across cases to identify what works for whom and in what circumstances. Results: The RRS programme theories were critically evaluated and compared with study findings to develop a mid-range theory to explain what works, for whom in what circumstances. The findings of what works suggests that clinical experience, established working relationships, flexible implementation of protocols, ongoing experiential learning, empowerment and pre-emptive management are key to the success of RRS implementation.  Conclusion:These findings highlight the combination of factors that can improve the implementation of RRS and in light of this evidence several recommendations are made to provide policymakers with guidance and direction for their success and sustainability.References: 1.Pawson R and Tilley N. (1997) Realistic Evaluation. Sage Publications; LondonType of submission: Concurrent session Source of funding: Sandra Ryan Fellowship funded by the School of Nursing & Midwifery, Queen’s University of Belfast

“They should stay at their desk until the work’s done”: a qualitative study examining perceptions of sedentary behaviour in a desk-based occupational setting

Background: Workplace sedentary behaviour is a priority target for health promotion. However, little is known about how to effect change. We aimed to explore desk-based office workers’ perceptions of factors that influenced sedentary behaviour at work and to explore the feasibility of using a novel mobile phone application to track their behaviours.

Methods: We invited office employees (n = 12) and managers (n = 2) in a software engineering company to participate in semi-structured interviews to explore perceived barriers and facilitators affecting workplace sedentary behaviour. We assessed participants’ sedentary behaviours using an accelerometer before and after they used a mobile phone application to record their activities at self-selected time intervals daily for 2 weeks. Interviews were analysed using a thematic framework.

Results: Software engineers (5 employees; 2 managers) were interviewed; 13 tested the mobile phone application; 8 returned feedback. Major barriers to reducing workplace sedentary behaviour included the pressure of ‘getting the job done’, the nature of their work requiring sitting at a computer, personal preferences for the use of time at and after work, and a lack of facilities, such as a canteen, to encourage moving from their desks. Facilitators for reduced sedentariness included having a definite reason to leave their desks, social interaction and relief of physical and mental symptoms of prolonged sitting. The findings were similar for participants with different levels of overall physical activity. Valid accelerometer data were tracked for four participants: all reduced their sedentary behaviour. Participants stated that recording data using the phone application added to their day’s work but the extent to which individuals perceived this as a burden varied and was counter-balanced by its perceived value in increasing awareness of sedentary behaviour. Individuals expressed a wish for flexibility in its configuration.

Conclusions: These findings indicate that employers’ and employees’ perceptions of the cultural context and physical environment of their work, as well as personal factors, must be considered in attempting to effect changes that reduce workplace sedentary behaviour. Further research should investigate appropriate individually tailored approaches to this challenge, using a framework of behaviour change theory which takes account of specific work practices, preferences and settings.

Hotel Brand Conversions: What Works and What Doesn’t

As many as one-third of U.S. hotels have been converted from one brand to another in recent years, a process that frequently improves the hotel’s financial performance—although that is not always the case. Using data collected between 1994 and 2012 from PKF Hospitality Research, an analysis of brand conversions by 260 hotels shows that hotels moving downscale generally improved their occupancy, and thus their top-line revenue and profit ratios, compared to a control group of 2,750 hotels that did not change brands. However, hotels that moved upscale did not see notable changes in revenue or profit, nor did hotels that moved across their tier, especially when they stayed within their brand family. Two factors seem to drive the financial results for converted hotels—the relative strength of the brand and the fit between the brand and the property.