Perimetric progression in open angle glaucoma and the Visual Field Index (VFI)

PURPOSE: To evaluate the changes in the Visual Field Index (VFI) in eyes with perimetric glaucomatous progression, and to compare these against stable glaucoma patients.

PATIENTS AND METHODS: Consecutive patients with open angle glaucoma with a minimum of 6 reliable visual fields and 2 years of follow-up were identified. Perimetric progression was assessed by 4 masked glaucoma experts from different units, and classified into 3 categories: "definite progression," "suspected progression," or "no progression." This was compared with the Glaucoma Progression Analysis (GPA) II and VFI linear regression analysis, where progression was defined as a negative slope with significance of <5%.

RESULTS: Three hundred ninety-seven visual fields from 51 eyes of 39 patients were assessed. The mean number of visual fields was 7.8 (SD 1.1) per eye, and the mean follow-up duration was 63.7 (SD 13.4) months. The mean VFI linear regression slope showed an overall statistically significant difference (P<0.001, analysis of variance) for each category of progression. Using expert consensus opinion as the reference standard, both VFI analysis and GPA II had high specificity (0.93 and 0.90, respectively), but relatively low sensitivity (0.45 and 0.41, respectively).

CONCLUSIONS: The mean VFI regression slope in our cohort of eyes without perimetric progression showed a statistically significant difference compared with those with suspected and definite progression. VFI analysis and GPA II both had similarly high specificity but low sensitivity when compared with expert consensus opinion.

'"These schemes will win for themselves the confidence of the people": Irish independence, poor law reform and hospital provision'

This article examines hospital provision in Ireland during the early twentieth century. It examines attempts by the newly independent Irish Free State to reform and de-stigmatise medical relief in former workhouse infirmaries. Such reforms were designed to move away from nineteenth century welfare regimes which were underpinned by principles of deterrence. The reform initiated in independent Ireland - the first attempted break-up of the New Poor Law in Great Britain or Ireland - was partly successful. Many of the newly named County and District Hospitals provided solely for medical cases and managed to dissociate such health care provision from the relief of poverty. However, some hospitals continued to act as multifunctional institutions and provided for various categories including the sick, the aged and infirm, 'unmarried mothers' and 'harmless lunatics'. Such institutions often remained associated with the relief of poverty. This article also examines patient fee-payment and outlines how fresh terms of entitlement and means-testing were established. Such developments were even more pronounced in voluntary hospitals where the majority of patients made a financial contribution to their treatment. The article argues that the ability to pay at times determined the type of provision, either voluntary or rate-aided, available to the sick. However, it concludes that the clinical condition of patients often determined whether they entered a more prestigious voluntary hospital or the former workhouse. Although this article concentrates on two Irish case studies, County Kerry and Cork City; it is conceptualised within wider developments with particular reference to the British context.

Access to a Car and the Self-Reported Health and Mental Health of People Aged 65 and Older in Northern Ireland

This article examines relationships between access to a car and the self- reported health and mental health of older people. The analysis is based on a sample of N 1⁄4 65,601 individuals aged 65 years and older from the Northern Ireland Longitudinal Study linked to 2001 and 2011 census returns. The findings from hierarchical linear and binary logistic multilevel path models indicate that having no access to a car is related to a considerable health and mental health disadvantage particularly for older people who live alone. Rural–urban health and mental health differences are mediated by access to a car. The findings support approaches that emphasize the importance of autonomy and independence for the well-being of older people and indicate that not having access to a car can be a problem for older people not only in rural but also in intermediate and urban areas, if no sufficient alternative forms of mobility are provided.

The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK).

Background
The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention.

Methods
Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff.

Results
Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision.

Conclusions
We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes.

Out on the Inside: The Rights, Experiences and Needs of LGBT People in Prison

Lesbian, Gay, Bisexual and Transgender (LGBT) people have long been a ‘hidden’ or overlooked population in prisons. In recent years, however, international research and policy has begun to focus on the experiences and needs of this group. This research has revealed a range of issues that affect LGBT individuals in prison. This includes heteronormativity, homophobia and transphobia both within and outside prison, the threat of physical and sexual violence within prison, institutional discrimination and neglect, health needs, and social isolation. Based on a review of international literature and primary research with representatives from the LGBT and criminal justice sectors, prisoners and former prisoners, this report represents the first study of the needs and experiences of LGBT prisoners within the Irish context.

Holding the Door Half (?) Open: the EU and Turkey 10 years on

A decade of accession negotiations with the EU has not brought Turkey significantly closer to EU membership. In part the reasons lie with Turkey. This article, however, explores the position of the EU and the ‘supply-side’ of enlargement. It reflects on developments in how the EU has engaged with Turkey on the question of membership, situating Turkey’s candidacy and the EU’s position within the broader comparative context of how the process and politics of EU enlargement have evolved over the last ten years. It focuses on a set of supply-side variables that are key to determining the progress that applicants can make towards membership: member state preferences, the activism of supranational institutional actors, the EU’s integration capacity, public opinion in the EU towards enlargement, and the narratives deployed in justification of enlargement. The article also considers the state of Turkey’s accession negotiations and how they have been and potentially will be affected, assuming they are meaningfully revived, by the evolving nature and substance of EU accession negotiations more generally and EU’s approach to conditionality.

An appeal to the people ; being a review of the late correspondence and documents, relating to the rejection of the British Minister : including an examination of the "arrangement" of April last /

Introduction "To the people of the United States" signed Wm. Coleman.

At a special session of the General Assembly of the State of Connecticut, held at Hartford, on the twenty third day of February, A.D. 1809 ... An address of the General Assembly, to the people of Connecticut. --

Caption title.

Letter to S.D. Woodruff from George H. Gillespie who says that Mackenzie has left many books and papers in the office

Letter to S.D. Woodruff from George H. Gillespie who says that Mackenzie has left many books and papers in the office. Mr. Gillespie makes inquiries about the purchase and license of Long Point. The letterhead on this document is “Gillespie and Powis, Commission Merchants, Brokers and Co., Hamilton, Ont.” (3 pages, handwritten), Apr. 30, 1878.

Books and reading; by Brother Azarias of the Brothers of the Christian schools

UANL

Vascular and morphological changes of the optic nerve head following therapeutic intraocular pressure reduction in open angle glaucoma and ocular hypertension

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Ancient civilizations : discovering the people and places of long ago.

Para que una civilización pueda considerarse como tal, debe reunir todas ó algunas de estas características: una escritura desarrollada, un sistema de gobierno, una religión organizada y capacidad para construir edificios y monumentos a gran escala. Se describe el desarrollo de antiguas civilizaciones en varios continentes. En Asia: las culturas de Mesopotamia, del valle del Indo, de China, Japón y Camboya y los imperios persa e islámico. En Europa sobresalen: Creta, Micenas, Etruria, Grecia y Roma; en África: además de la gran civilización egipcia al norte, se encuentran otras al sur del Sahara. Y, por último, en América, civilizaciones desarrolladas en Estados Unidos, y las más importantes de los mayas en Centroamérica y de los pueblos andinos, al sur.