Management of allergic conjunctivitis and dry eye

Ocular allergy is a common eye condition encountered in clinical practice. However, little is known how seasonal allergic conjunctivitis (SAC), the most common subtype, is managed in clinical practice. Further, dry eye, another common eye condition, may be misdiagnosed as SAC and vice-versa as they share similar signs and symptoms. In addition, despite the frequent recommendation of non-pharmacological treatments for SAC, evidenceto support their use has not been identified in the scientific literature. The aim of this thesis was therefore to determine the actual diagnosis and management of SAC and dry eye in clinical practice and investigate the efficacy of non-pharmacological treatments for these conditions. The diagnostic and management strategies for SAC and dry eye employed by pharmacy staff are found to be inconsistent with current guidelines and scientific evidence based upon a mystery shopper design. Cluster analysis of tear film metrics in normal and dry eye patients identified several clinically relevant groups of patients that may allow for targeted treatment recommendations. Using a novel environmental chamber model of SAC, the use of artificial tears and cold compresses, either alone or combined is an effective treatment modality for acute and symptomatic SAC, on a par with topical anti-allergic medication, and has been demonstrated for the first time. In addition, eyelid warming therapy with a simple, readily available, seed filled device is an effective method of treating meibomian gland dysfunction (MGD) related evaporative dry eye, perhaps the most common dry eye subtype. A greater focus on ophthalmology must be implemented as part of the formal education and training of pharmacy staff, while greater professional communication between community pharmacists, optometrists and the population they serve is required. Artificial tears and cold compresses may be considered as front line agents for acute SAC by pharmacy staff and optometrists, to whom pharmacological treatment options are limited.

Management of dry eye in UK pharmacies

Purpose - To investigate the ability of pharmacy staff in the United Kingdom (UK) to diagnose and treat dry eye. Methods - A mystery shopper technique to simulate a patient with presumed dry eye was used in 50 pharmacy practices in major towns and cities across the UK. Pharmacies were unaware of their involvement in the study. With the exception of a predetermined opening statement to initiate the consultation, no further information was volunteered. Questions asked, diagnoses given, management strategy advised and staff type was recorded immediately after the consultation. Results - The mean number of questions was 4.5 (SD 1.7; range 1–10). The most common question was the duration of symptoms (56%) and the least common was whether the patient had a history of headaches (2%). All pharmacy staff gave a diagnosis, but the majority were incorrect (58%), with only 42% correctly identifying dry eye. Treatment was advised by 92% of pharmacy staff, with the remaining 8% advising referral directly to the patient's GP or optometrist. Dry eye treatments involved topical ocular lubrication via eye drops (90%) and lipid based sprays (10%). However, only 10% gave administration advice, 10% gave dosage advice, 9% asked about contact lens wear, and none offered follow up although 15% also advised GP or optometrist referral. Conclusions - There is a need for improved ophthalmological training amongst pharmacists and pharmacy staff and establishment of cross referral relationships between pharmacies and optometry practices.

Narrative pace control practices in the digital age:how do people consume television (tv) series?

Digital devices are profoundly changing the way individuals consume media entertainment, and in particular television (TV). Our research contributes to prior work on narrative processing by advancing a more comprehensive theorization of narrative pace when control is in the hands of story receivers as opposed to storytellers. Using the empirical context of TV series viewing we draw on in-depth interviews to uncover 1) consumer narrative pace control practices such as multi-episode viewing sometimes colloquially called “binge-watching” or replaying specific scenes, and 2) the factors that drive the adoption of such practices, including the countervailing forces of narrative satiation and need for closure, as well as curiosity and enjoyment of mystery.

Anthocyanins in Autumn Leaf Senescence

Anthocyanins are synthesized during leaf senescence in certain plants across virtually all biomes, but are most spectacular in the autumn foliage of temperate deciduous forests. The patterns of color production in senescing foliage depend at least partly upon species composition and their phenology. Both ecological and physiological explanations have been raised to explain why plants produce this pigment just before leaf fall. Physiological explanations, as photoprotection, predict that cyanic leaves would be better able to resorb nitrogen during the process of chlorophyll degradation. Ecological explanations predict better dispersal of propagules advertised by association with the brilliantly colored leaves (plausible for only a minority of species), or warning against egg-laying activity of herbivorous insects, as aphids. These hypotheses make predictions that we now can test, to help us understand this old mystery - and majestic phenomenon.

Unravelling the evolution of autumn colours: an interdisciplinary approach.

Leaf colour change is commonly observed in temperate deciduous forests in autumn. This is not simply a side effect of leaf senescence, and, in the past decade, several hypotheses have emerged to explain the evolution of autumn colours. Yet a lack of crosstalk between plant physiologists and evolutionary ecologists has resulted in slow progress, and so the adaptive value of this colour change remains a mystery. Here we provide an interdisciplinary summary of the current body of knowledge on autumn colours, and discuss unresolved issues and future avenues of research that might help reveal the evolutionary meaning of this spectacle of nature.

A multi-faceted diagnostic approach to lung infections in patients with cystic fibrosis

One in 3,000 people in the US are born with cystic fibrosis (CF), a genetic disorder affecting the reproductive system, pancreas, and lungs. Lung disease caused by chronic bacterial and fungal infections is the leading cause of morbidity and mortality in CF. Identities of the microbes are traditionally determined by culturing followed by phenotypic and biochemical assays. It was first thought that the bacterial infections were caused by a select handful of bacteria such as S. aureus, H. influenzae, B. cenocepacia, and P. aeruginosa. With the advent of PCR and molecular techniques, the polymicrobial nature of the CF lung became evident. The CF lung contains numerous bacteria and the communities are diverse and unique to each patient. The total complexity of the bacterial infections is still being determined. In addition, only a few members of the fungal communities have been identified. Much of the fungal community composition is still a mystery. This dissertation addresses this gap in knowledge. A snap shot of CF sputa bacterial community was obtained using the length heterogeneity-PCR community profiling technique. The profiles show that south Florida CF patients have a unique, diverse, and dynamic bacterial community which changes over time. The identities of the bacteria and fungi present were determined using the state-of-the-art 454 sequencing. Sequencing results show that the CF lung microbiome contains commonly cultured pathogenic bacteria, organisms considered a part of the healthy core biome, and novel organisms. Understanding the dynamic changes of these identified microbes will ultimately lead to better therapeutical interventions. Early detection is key in reducing the lung damage caused by chronic infections. Thus, there is a need for accurate and sensitive diagnostic tests. This issue was addressed by designing a bacterial diagnostic tool targeted towards CF pathogens using SPR. By identifying the organisms associated with the CF lung and understanding their community interactions, patients can receive better treatment and live longer.

Measuring Hotel Service Quality: Tools for Gaining the Competitive Edge

As the hotel industry grows more competitive, quality guest service becomes an increasingly important part of managers' responsibility measuring the quality of service delivery is facilitated when managers know what types of assessment methods are available to them. The authors present and discuss the following available measurement techniques and describe the situations where they best meet the needs of hotel managers: management observation, employee feedback programs, comment cards, mailed surveys, personal and telephone interviews, focus groups, and mystery shopping.

Examining the Impact of Service Times on Overall Guest Satisfaction Perception in the Casual Dining Environment

A mystery shopper study was used to examine the influence of service times on customer satisfaction. The impact of management emphasis on service quality was also examined. In the restaurants studied, service time influenced customer satisfaction. Management attention to service time improved performance in direct relationship to the level of emphasis.

Post-revolutionary post-modernism: Central American detective fiction by the turn of the 21st century

Contemporary Central American fiction has become a vital project of revision of the tragic events and the social conditions in the recent history of the countries from which they emerge. The literary projects of Sergio Ramirez (Nicaragua), Dante Liano (Guatemala), Horacio Castellanos Moya (El Salvador), and Ramon Fonseca Mora (Panama), are representative of the latest trends in Central American narrative. These trends conform to a new literary paradigm that consists of an amalgam of styles and discourses, which combine the testimonial, the historical, and the political with the mystery and suspense of noir thrillers. Contemporary Central American noir narrative depicts the persistent war against social injustice, violence, criminal activities, as well as the new technological advances and economic challenges of the post-war neo-liberal order that still prevails throughout the region. ^ Drawing on postmodernism theory proposed by Ihab Hassan, Linda Hutcheon and Brian MacHale, I argued that the new Central American literary paradigm exemplified by Sergio Ramirez's El cielo llora por mí, Dante Liano's El hombre de Montserrat, Horacio Castellanos Moya's El arma en el hombre and La diabla en el espejo , and Ramon Fonseca Mora's El desenterrador, are highly structured novels that display the characteristic marks of postmodern cultural expression through their ambivalence, which results from the coexistence of multiple styles and conflicting ideologies and narrative trends. The novels analyzed in this dissertation make use of a noir sensitivity in which corruption, decay and disillusionment are at their core to portray the events that shaped the modern history of the countries from which they emerge. The revolutionary armed struggle, the state of terror imposed by military regimes and the fight against drug trafficking and organized crime, are among the major themes of these contemporary works of fiction, which I have categorized as perfect examples of the post-revolutionary post-modernism Central American detective fiction at the turn of the 21st century.^

Grey Slate

GREY SLATE is a collection of poems that focuses on the natural world in order to explore the mysteries of life with the intent to create a meditation on what it means to be a human being interacting with this world. Inspired by John Keats’ theory of Negative Capability, GREY SLATE does not seek to explain, but to dwell in the mysteries it explores. The poems are tied together through similar images or ideas in order to mimic the way the mind works as it jumps from thought to thought. GREY SLATE also mixes different types of poems: from haiku to sonnet to paradelle, and from lyric to narrative to prose poem. GREY SLATE hopes to inspire readers to take a break from searching for truths and indulge in the beautiful mystery that is life with no need for answers.

Using secret shopping to assess student assistant training

This paper aims to describe the results of three rounds of secret shopping conducted at the Hubert Library of Florida International University, and how the results affected and were affected by changes made to circulation desk student training programs.

The Mysteries of Secret Shopping and Student Training!

In 2011 the Reference Department at the Glenn Hubert Library (HL), Biscayne Bay Campus, Florida International University (FIU) moved to a joint ser-vice desk with the circulation desk. Shortly after the move reference librarians became concerned with the misinformation that the circulation department’s work-study students sometimes provided to patrons. As a result, we felt a Secret Shopping program would be a good method to evaluate the information provided. Furthermore, it was seen as a method of improving customer service and com-paring the self-perceptions of service to patrons’ perceptions.

Asterisms

ASTERISMS is a collection of lyric poetry that seeks to express a sense of awe for the natural world by exploring themes of science, art, and the self. By combining physics and metaphysics, scientific terminology and musings on love, ASTERISMS argues that these seemingly-disparate fields of knowledge can harmonize in unexpected ways. In its style, the collection draws from the works of Dorianne Laux, Pablo Neruda, and Annie Dillard. Most of the poems are written in free-version and are tied together by images of astronomy and wilderness, both modern and prehistoric. Poems about classical music appear as interludes meant to complement others concerned with science and technology, as music too has its own invented language. Like asterisms - ancient inventions meant to personalize the expansive mystery of the night sky - this collection seeks to admire, if not completely understand, our place in the natural world and cosmos beyond.

A Body Outside the Kremlin

A BODY OUTSIDE THE KREMLIN is a historical mystery novel set in the Northern Camps of Special Significance, a Soviet Russian penal institution based in the Solovetsky Archipelago during the 1920s. The protagonist, working first with the camp authorities, then in spite of their disapproval, solves the murder of a fellow prisoner. In the process he improves his position within the camp, while also becoming hardened to the brutal necessities of camp life. Prior to the establishment of the penal camp, the Solovetsky Archipelago was the site of an important Russian Orthodox monastery, and the mystery proves to involve valuables, particularly icons, seized from the monks by the Soviet secret police. Thus the novel treats themes not only of statist repression, but also religious epiphany and the problems of true perception in a world of symbols.