Systematized stenting of Baerveldt shunts: techniques to reduce early post-operative hypotony

Purpose: To investigate the effect of the systematized use of intraluminal stents in Baerveldt shunts (BS) on early postoperative IOP control and complication rates. Methods: One hundred and twenty eyes with medically uncontrolled glaucoma were prospectively recruited to undergo BS implantation at Jules Gonin Eye Hospital, Switzerland. Baerveldt shunts were stented (full-length of the intraluminal tube) using a Supramid® 3.0 suture. A minority of shunts (37%) were also ligated intraoperatively and laser suture lysis performed postoperatively. Stent removals, either partial (retraction of 5mm) or complete, were carried out according to a predetermined protocol. Surgery was considered a success when IOP was ≤ 21mmHg and a minimum of 20% reduction from baseline was achieved with/without glaucoma medication (GMs). Hypotony related complications were defined as: choroidal effusions, shallow AC, hypotonous maculopathy or IOP≤5mmHg for over 2 weeks. Results: Mean age was 61.8 years (± standard deviation; ±21.5). Mean follow-up was 17.1 (±7.9) months. Mean preoperative IOP was 26.9 mmHg; mean IOP on the last visit 13.2 mmHg (p<0.001). At year one, the success rate was 87%. In 90% of eyes, IOP was ≤18 mmHg at last visit. Mean number of preoperatively GMs was 3.1; postoperatively 1.4 (p<0.001). Stent removals were performed in 87% of eyes (24% partial; 61% complete). 13% of eyes required no stent removal to reach target IOP. Complications were minor and infrequent (16%) and only 7% were hypotony related. Conclusions: Systematized use of intraluminal stents with Baerveldt aqueous shunts resulted in gradual and controlled IOP lowering with minimal hypotony-related complications. This may have important implications on clinical practice, given the rising rates of aqueous shunt implantation.

PHA Corporate business plan 2011-2012

The PHA Corporate Business Plan 2011-2012 is based on the four core goals and the common themes from the Corporate Strategy 2011-2015 and sets out a corporate picture of how the goals will be taken forward in year one (2011-2012) in line with existing AMT and board direction.�All Directorates were involved in developing the Corporate Business Plan and it reflects the content of each of the Directorate business plans.�It identifies a number of measurable indicators taken from the DHSSPS Commissioning Directions 2011-2012, as well as from each of the Directorate business plans.The Corporate Business Plan was approved by AMT on 1 November and by the PHA board on 17 November. Quarterly monitoring reports on progress against the indicators will be brought to the PHA board.

Project AWARE Scrapbook, 2005-7

Iowa has nearly 72,000 miles of streams. With one week of camping, miles of paddling, on-going educational opportunities, and hundreds of dedicated and hard-working Iowans, Project AWARE can make a difference – one stretch of river, one week a year, one piece of trash at a time. If it seems like a vacation to the participants…it is. They just learn and improve the river as they go.

Fish Tissue Monitoring in Iowa, 2006

Iowa has nearly 72,000 miles of streams. With one week of camping, miles of paddling, on-going educational opportunities, and hundreds of dedicated and hard-working Iowans, Project AWARE can make a difference – one stretch of river, one week a year, one piece of trash at a time. If it seems like a vacation to the participants…it is. They just learn and improve the river as they go.

Project AWARE Scrapbook, 2005

Iowa has nearly 72,000 miles of streams. With one week of camping, miles of paddling, on-going educational opportunities, and hundreds of dedicated and hard-working Iowans, Project AWARE can make a difference – one stretch of river, one week a year, one piece of trash at a time. If it seems like a vacation to the participants…it is. They just learn and improve the river as they go.

Highlights, 2005

Iowa has nearly 72,000 miles of streams. With one week of camping, miles of paddling, on-going educational opportunities, and hundreds of dedicated and hard-working Iowans, Project AWARE can make a difference – one stretch of river, one week a year, one piece of trash at a time. If it seems like a vacation to the participants…it is. They just learn and improve the river as they go.

Why a Water Quality Index?, 2005

Iowa has nearly 72,000 miles of streams. With one week of camping, miles of paddling, on-going educational opportunities, and hundreds of dedicated and hard-working Iowans, Project AWARE can make a difference – one stretch of river, one week a year, one piece of trash at a time. If it seems like a vacation to the participants…it is. They just learn and improve the river as they go.

Why Monitor Wetlands?, 2005

Iowa has nearly 72,000 miles of streams. With one week of camping, miles of paddling, on-going educational opportunities, and hundreds of dedicated and hard-working Iowans, Project AWARE can make a difference – one stretch of river, one week a year, one piece of trash at a time. If it seems like a vacation to the participants…it is. They just learn and improve the river as they go.

Water Quality Summary 2000-2005, 2006

Iowa has nearly 72,000 miles of streams. With one week of camping, miles of paddling, on-going educational opportunities, and hundreds of dedicated and hard-working Iowans, Project AWARE can make a difference – one stretch of river, one week a year, one piece of trash at a time. If it seems like a vacation to the participants…it is. They just learn and improve the river as they go.

Long diagnostic delay in Crohn's disease is associated with complicated disease course and increased operation rate

Background: We have recently shown that the median diagnostic delay to establish Crohn's disease (CD) diagnosis (i.e. the period from first symptom onset to diagnosis) in the Swiss IBD Cohort (SIBDC) was 9 months. Seventy five percent of all CD patients were diagnosed within 24 months. The clinical impact of a long diagnostic delay on the natural history of CD is unknown. Aim: To compare the frequency and type of CD-related complications in the patient groups with long diagnostic delay (>24 months) vs. the ones diagnosed within 24 months. Methods: Retrospective analysis of data from the SIBDCS, comprising a large sample of CD patients followed in hospitals and private practices across Switzerland. The proportions of the following outcomes were compared between groups of patients diagnosed 1, 2-5, 6-10, 11-15, and ≥ 16 years ago and stratified according to the length of diagnostic delay: bowel stenoses, internal fistulas, perianal fistulas, CD-related surgical interventions, and extraintestinal manifestations. Results: Two hundred CD patients (121 female, mean age 44.9 ± 15.0 years, 38% smokers, 71% ever treated with immunomodulators and 35% with anti-TNF) with long diagnostic delay were compared to 697 CD patients (358 female, mean age 39.1 ± 14.9 years, 33% smokers, 74% ever treated with immunomodulators and 33% with anti-TNF) diagnosed within 24 months. No differences in the outcomes were observed between the two patient groups within year one after CD diagnosis. Among those diagnosed 2-5 years ago, CD patients with long diagnostic delay (n = 45) presented more frequently with internal fistulas (11.1% vs. 3.1%, p = 0.03) and bowel stenoses (28.9% vs. 15.7%, p = 0.05), and they more frequently underwent CD-related operations (15.6% vs. 5.0%, p = 0.02) compared to the patients diagnosed within 24 months (n = 159). Among those diagnosed 6-10 years ago, CD patients with long diagnostic delay (n = 48) presented more frequently with extraintestinal manifestations (60.4% vs. 34.6%, p = 0.001) than those diagnosed within 24 months (n = 182). For the patients diagnosed 11-15 years ago, no differences in outcomes were found between the long diagnostic delay group (n = 106) and the one diagnosed within 24 months (n = 32). Among those diagnosed ≥ 16 years ago, the group with long diagnostic delay (n = 71) more frequently underwent CD-related operations (63.4% vs. 46.5%, p = 0.01) compared to the group diagnosed with CD within 24 months (n = 241). Conclusions: A long diagnostic delay in CD patients is associated with a more complicated disease course and higher number of CD-related operations in the years following the diagnosis. Our results indicate that efforts should be undertaken to shorten the diagnostic delay in CD patients in order to reduce the risk for progression towards a complicated disease phenotype.

Effect of fertilizer-N application and seed coating with rhizobial inoculants on soybean yield in eastern Paraguay

Nitrogen removal in soybean grains at harvest may exceed biological N2 fixation, particularly if grain yields are as high as typically achieved on "Terra Rossa" soils of Eastern Paraguay. Applying N fertilizer or coating seeds with rhizobial inoculants that enhance nodulation may represent a way of balancing the N budget. However, the effects of such treatments appear to be highly site-specific. The objective of this study was to examine the effects of N application (N) and rhizobial inoculation (I) on nodulation, N accumulation and soybean yields in Eastern Paraguay. Field experiments were conducted in two consecutive soybean seasons. Dry conditions in the first year delayed sowing and reduced plant number m-2 and pod number plant-1. Grain yields were generally below 2 t ha-1 but the +N+I treatment increased yields by about 75%. In the second year favorable conditions resulted in yields of around 4 t ha-1 and the treatments had no effect. Nitrogen accumulation was higher in the first year and could therefore not explain the observed yield differences between years and treatment combinations. The positive effect of the +N+I treatment in year one was associated with a more rapid root growth which could have reduced susceptibility to intermittent drought stress. Nodule biomass decreased between flowering and pod setting stages in the +I treatment whereas further increases in nodule biomass in the -I treatment may have led to competition for assimilates between nodules and developing pods. Based on these preliminary results we conclude that N application and seed inoculation can offer short-term benefits in unfavorable years without negative effects on yield in favorable years.

Surgical outcomes of Baerveldt aqueous shunt implantation versus combined phacoemulsification and Baerveldt aqueous shunt implantation

Purpose: To examine the efficacy and safety of Baerveldt shunt (BS) implantation compared to combined phacoemulsification and Baerveldt shunt implantation (PBS). This study was designed to detect a difference in IOP reduction of 20% (~4mmHg) between groups with 90% power. Methods: Sixty patients with medically uncontrolled glaucoma, prospectively underwent either or BS implantation with phacoemulsification (Group PBS; n=30) or BS implantation alone (group BS; n=30, pseudophakic eyes only). Groups were matched for age, glaucoma subtype and length of follow-up. Pre and post-operative measures recorded included patient demographics, visual acuity, IOP, number of glaucoma medications (GMs) and all complications. Success was defined as IOP≤21mmHg and 20% reduction in IOP from baseline with or without GMs. Results: Age of PBS and BS groups was 61 vs 62 years respectively (p=0.72*). There were no significant differences in preoperative baseline characteristics: PBS vs PB, mean IOP =25.5mmHg (standard deviation (SD); ±10.3mmHg) vs 26.1mmHg (SD ±10.6mmHg), p=0.81*; mean GMs=3.0 (SD ±1.1) vs 3.1 (SD ±1.0), p=0.83*; mean VA=0.3 vs 0.3, p=0.89*. At year one there were no significant differences observed between groups in post-operative IOP, GMs or VA, mean IOP =14.1mmHg (SD ±5.4mmHg) vs 11.5 mmHg (SD ±4.2mmHg), p=0.12*; mean GMs=1.6 (SD ±1.4) vs 1.1 (SD ±1.1), p=0.23*; mean VA=0.5 vs 0.4, p=0.46*. Complication rates were similar between the two groups (7% vs 14%). Success rate was lower in eyes with PBS (71%) than with BS (88%), however this did not reach statistical significance (p=0.95, log-rank test). * two-sample t-test Conclusions: There were no significant differences at year one in success or complication rates between PBS and BS groups suggesting that simultaneous phacoemulsification does not have a marked (difference of >4mmHg) effect on tube function. IOP reduction and success were less in the PBS group, a larger sample (n=120) would be required to investigate if there is a 10% difference in IOP reduction between groups, however it is unclear if this would be a clinically significant difference to justify separate surgeries.

Surgical outcomes of deep sclerectomy versus Baerveldt aqueous shunt implantation following initial failed deep sclerectomy

Purpose: To examine the efficacy and safety of repeat deep sclerectomy (DS) versus Baerveldt shunt (BS) implantation as second line surgery following failed primary DS. Methods: Fifty one patients were prospectively recruited to undergo BS implantation following failed DS and 51 patients underwent repeat DS, for which data was collected retrospectively. All eyes had at least one failed DS. Surgical success was defined as IOP≤21mmHg and 20% reduction in IOP from baseline. Success rates, number of glaucoma medications (GMs), IOP, and complication rates were compared between the two groups at year 1, post-operatively. Results: Mean age, sex and the proportion of glaucoma subtypes were similar between groups. Preoperatively IOP was significantly lower in DS group vs BS group (18.8mmHg vs 23.8mmHg, p<0.01, two sample t-test). Postoperatively IOP was significantly higher in DS group than BS group (14.6mmHg vs 12.0mmHg, p<0.01, two-sample t-test). In the DS group, 47% of eyes did not achieve 20% reduction in IOP from baseline, as a result the success rates were significantly lower in eyes with DS (51%) than in eyes with BS (88%) (p=0.02, log-rank test). Preoperatively the number of GMs used in DS and BS groups were similar (2.2 vs 2.7 p=0.02, two sample t-test). Postoperatively there remained no significant difference in GMs between groups (0.9 vs 1.1, p= 0.58, two sample t-test). Complication rates were similar between the two groups (12% vs 10%). Conclusions: Baerveldt tube implantation was more effective in lowering IOP than repeat deep sclerectomy in eyes with failed primary DS, at year one. Complications were minor and infrequent in both groups

Long diagnostic delay in Crohn's disease is associated with complicated disease course and increased operation rate

Background: We have recently shown that the median diagnostic delay to establish Crohn's disease (CD) diagnosis in the Swiss IBD Cohort (SIBDC) was 9 months. Seventy five percent of all CD patients were diagnosed within 24 months. The clinical impact of a long diagnostic delay on the natural history of CD is unknown. Aim: To compare the frequency and type of CD-related complications in the patient groups with long diagnostic delay (>24 months) vs. the ones diagnosed within 24 months. Methods: Retrospective analysis of data from the SIBDCS, comprising a large sample of CD patients followed in hospitals and private practices across Switzerland. Results: Two hundred CD patients (121 female, mean age 44.9 ± 15.0 years, 38% smokers, 71% ever treated with immunomodulators and 35% with anti-TNF) with long diagnostic delay were compared to 697 CD patients (358 female, mean age 39.1 ± 14.9 years, 33% smokers, 74% ever treated with immunomodulators and 33% with anti-TNF) diagnosed within 24 months. No differences in the outcomes were observed between the two patient groups within year one after CD diagnosis. Among those diagnosed 2-5 years ago, CD patients with long diagnostic delay (n = 45) presented more frequently with internal fistulas (11.1% vs. 3.1%, p = 0.03) and bowel stenoses (28.9% vs. 15.7%, p = 0.05), and they more frequently underwent CD-related operations (15.6% vs. 5.0%, p = 0.02) compared to the patients diagnosed within 24 months (n = 159). Among those diagnosed 6-10 years ago, CD patients with long diagnostic delay (n = 48) presented more frequently with extraintestinal manifestations (60.4% vs. 34.6%, p = 0.001) than those diagnosed within 24 months (n = 182). For the patients diagnosed 11-15 years ago, no differences in outcomes were found between the long diagnostic delay group (n = 106) and the one diagnosed within 24 months (n = 32). Among those diagnosed >= 16 years ago, the group with long diagnostic delay (n = 71) more frequently underwent CD-related operations (63.4% vs. 46.5%, p = 0.01) compared to the group diagnosed with CD within 24 months (n = 241). Conclusions: A long diagnostic delay in CD patients is associated with a more complicated disease course and higher number of CD-related operations in the years following the diagnosis. Our results indicate that efforts should be undertaken to shorten the diagnostic delay in CD patients in order to reduce the risk for progression towards a complicated disease phenotype.

Koulutuskuntayhtymän hankintalogistiikan nykytilan selvitys ja kehittäminen

Työn tavoitteena oli kartoittaa Etelä-Karjalan koulutuskuntayhtymän hankintaprosessin nykytila, analysoida saatuja tuloksia ja pohtia menetelmiä hankintatoimintaan liittyvien prosessien parantamiseksi. Päähuomio kohdistettiin materiaalihankintoihin. Julkisia hankintoja ohjaavat lait ja asetukset, joiden keskeisimmät tavoitteet ovat avoimuus, tasapuolisuus ja syrjimättömyys. Lisäksi laki viranomaisen toiminnan julkisuudesta vaikuttaa asiakirjojen julkisuuteen hankintaprosessin aikana.Tutkimuksessa havaittiin, että erittäin suuri osa ostoista on markkamääräisesti pieniä ostoja, jotka aiheuttavat hintaansa nähden suuret hankintakustannukset. Toimittajia on paljon ja rahallisesti pienten toimittajien määrä on erittäin suuri. Tästä on seurauksena se, että toimittajayhteistyö on useiden toimittajien kanssa hyvin satunnaista ja toimitusten valvonta ja toimittajaseuranta vaikeutuu. Toimittajien kehittämiseen ei tästä johtuen enää riitä resursseja. Toimittajayhteistyö julkisiin hankintoihin erikoistuneen kauppatalon kanssa on vasta alullaan ja yhteistyön määrä vaihtelee paljon eri koulutusyksiköissä. Yllättäviä tuloksia tuotti toimittajan hintojen kehitys sopimuskauden aikana. Hinnoissa oli tapahtunut kaikissa tuoteryhmissä huomattavaa nousua vuoden aikana.Hankintatoimintaa voidaan kehittää nopeuttamalla nykyisiä prosesseja hyväksikäyttäen olemassa olevaa Intranet-tekniikkaa. Samoin sähköinen kaupankäynti on useissa tuoteryhmissä varteenotettava ja tulevaisuudessa edelleen kehittyvä vaihtoehto. Toimittajaseurantaa tulee tehostaa ja toimittajien kanssa tulee pyrkiä avoimeen ja jatkuvaan yhteistyöhön.Hankintayhteistyön kehittäminen omistajakuntien kanssa ja Etelä-Karjalan julkisen sektorin yhteishankintoihin sitoutuminen olisivat tehokas tapa säästää hankintakustannuksissa.