Eye-related photophobia

This article provides an overview of the various eye-related causes of photophobia and the likely mechanisms responsible. Photophobia is an experience of discomfort affecting the eyes due to exposure to light. It has a variety of causes including the result of eye or brain disease, or it can be a side effect of various drugs or laser surgery. Photophobia can also be a symptom of a more serious disorder such as meningitis and therefore, requires appropriate investigation, diagnosis, and treatment. Trauma or disease affecting several structures of the eye are a common cause of photophobia and can be associated with: (1) the ocular adnexia, such as blepharitis and blepharospasm, (2) the cornea, including abrasion, ulcerative keratitis, and corneal dystrophy, (3) problems in eye development, such as aniridia, buphthalmos, coloboma, and aphakia, (4) various eye inflammations, including uveitis, and (5) retinal disorders, such as achromatopsia, retinal detachment, and retinal dystrophy. There may be two main explanations for eye-related photophobia: (1) direct stimulation of the trigeminal nerve due to damage, disease, or excessive light entering the eye and (2) overstimulation of the retina including a specific population of light-sensitive ganglion cells.

Clinical significance of medication reconciliation in children admitted to a UK pediatric hospital:observational study of neurosurgical patients

Background: In December 2007, the National Institute for Health and Clinical Excellence and the National Patient Safety Agency in the UK (NICE-NPSA) published guidance that recommends all adults admitted to hospital receive medication reconciliation, usually by pharmacy staff. A costing and report tool was provided indicating a resource requirement of d12.9 million for England per year. Pediatric patients are excluded from this guidance. Objective: To determine the clinical significance of medication reconciliation in children on admission to hospital. Methods: A prospective observational study included pediatric patients admitted to a neurosurgical ward at Birmingham Childrens Hospital, Birmingham, England, between September 2006 and March 2007. Medication reconciliation was conducted by a pharmacist after the admission of each of 100 consecutive eligible patients aged 4 months to 16 years. The clinical significance of prescribing disparities between pre-admission medications and initial admission medication orders was determined by an expert multidisciplinary panel and quantified using an analog scale. The main outcome measure was the clinical signficance of unintentional variations between hospital admission medication orders and physician-prescribed pre-admission medication for repeat (continuing) medications. Results: Initial admission medication orders for children differed from prescribed pre-admission medication in 39%of cases. Half of all resulting prescribing variations in this setting had the potential to cause moderate or severe discomfort or clinical deterioration. These results mirror findings for adults. Conclusions: The introduction of medication reconciliation in children on admission to hospital has the potential to reduce discomfort or clinical deterioration by reducing unintentional changes to repeat prescribed medication. Consequently, there is no justification for the omission of children from the NICENPSA guidance concerning medication reconciliation in hospitals, and costing tools should include pediatric patients. © 2010 Adis Data Information BV. All rights reserved.

Processo de cuidar de um centro de tratamento oncológico

The objective was to understand the process of caring for a center for cancer treatment from the perspective of nurses and patients. This is a qualitative research, xploratory and descriptive, performed in a cancer treatment center in Natal / RN / Brazil. Data collection occurred between August 2013 and February 2014, being effected by means of two techniques: photographic record and projective interviews with nurses and patients. Social actors included in the study were ten professional nursing and ten patients admitted to the surgical department of the institution. The criteria used for inclusion of professionals were: be professional in the field of nursing, being an employee of the hospital, to be inserted in the scale of nurses of the institution at the time of data collection. For the patients were included who had preserved their cognitive abilities and who were hospitalized and at any stage of treatment. We used content analysis proposed by Bardin, for the analysis of material collected during projective interview. The research followed the ethical and legal principles that govern scientific research on human beings, being conducted by the project approval by the Research Ethics Committee of the Northern League Against Cancer Riograndense with 295 673 and look CAAE 16104313.0.0000.5293. Referring to nurses, they demonstrated different views about care, which sprouted from a holistic, multidisciplinary approach and welcoming, as well as linked to the performance of procedures and compliance with the requirements technicality. Furthermore, these subjects also showed that care unfolds through the actions of management in carrying out the records in the humanization of care by meeting the needs of the patient and ambience. Front of patients, it is noteworthy that, for them, care happens through attitudes of caring and professional approach, and by performing procedures, being mentioned as a careless lack of structure of the institution and the discomfort caused by this condition factors. It was evident also that the actors involved in the care, the perception of professionals and patients, are represented by nurses, doctors, psychologists, nutritionists, as well as kitchen assistants and cleaners; beyond family companion, the individual himself as responsible for their care and volunteer caregiver. In this opportunity, it is concluded 9 that an understanding of care from the perspective of nurses and patients involves broad issues ranging from perceptions of care that embraces a dynamic complex elements and attitudes imbued with meanings, in which those involved can assume both the role of carers as care beings, even a carefully tied to prescribed routines and performing procedures. Thus, the findings described refer to reflections on the care provided to cancer patients and whether this, in fact, translates principles of a humane practice

Das palavras à vida: o prazer em Max Weber

The thesis has as its goal the discussion over the pleasure as an intellectual and personal subject for Max Weber. The main references are The Sociology of Religion, Science as a Vocation and Politics as a Vocation, Bureaucracy, The sense of "Axiological Neutrality" in Social and Economic Sciences. Many authors were researched for information about his life, with a highlight to the biography written by his wife Marianne Weber, for its great number of excerpts from letters and informal conversations. The subject "pleasure" was developed by taking into consideration the complexity of this phenomenon which happens in an ambivalent and multiple ways. In order to do that, we started from the paradigm of the complexity according to Edgar Morin's view, Georges Bataille's discussions on erotism and the antinomic comprehension of Lepegneur and Onfray, who define pleasure as a phenomenon with ambiguities, and the historical references of Peter Gay, Nobert Elias, Wolf Lepenies. In Max Weber, pleasure presents, also, this ambiguity, as his scientific approach is registering the absence of pleasure for the rise of a protestant ethic and, besides that, to support with a process of disenchantment of the world which leads us to a meaningless life. Weber goes through great changes in the last years of his life. In this period he includes in his comments the subjects "erotism" and "arts" with the possibility of escaping from modem everyday routine that affects the individual's existential freedom. However, his ambiguous position about these possibilities take him to consider that a situation o f personal confrontation, considered heroical, once, in his opinion, each one accepts the consequences o f their acts and builds their values to give a meaning to their own existence. The pleasure in Weber is, above ali aspects, intellectual and existential: side by side with the routine, bureaucracy and disenchantment ofthe world was the possibility of charisma, vocation and passion. However, always he related these characteristics to the discomfort that the modem world presented to men, he, as a scientist, was ethical. This is the main argument ofthis thesis

Simulação de desempenho luminoso para salas de aula em Natal-RN

The city of Natal has a significant daylight availability, although it use isn’t systematically explored in schools architecture. In this context, this research aims to determine procedures for the analysis of the daylight performance in school design in Natal-RN. The method of analysis is divided in Visible Sky Factor (VSF), simulating and analyzing the results. The annual variation of the daylight behavior requires the adoption of dynamic simulation as data procedure. The classrooms were modelled in SketchUp, simulated in Daysim program and the results were assessed by means of spreadsheets in Microsoft Excel. The classrooms dimensions are 7.20mx 7.20m, with windows-to-wall-ratio (WWR) of 20%, 40% and 50%, and with different shading devices, such as standard horizontal overhang, sloped overhang, standard horizontal overhang with side view protection, standard horizontal overhang with a dropped edge, standard horizontal overhang with three horizontal louvers, double standard horizontal overhang, double standard horizontal overhang with three horizontal louvers, plus the use of shelf light in half the models with WWR of 40% and 50%. The data was organized in spreadsheets, with two intervals of UDI: between 300lux and 2000 lux and between 300lux and 3000lux. The simulation was performed with the weather file of 2009 to the city of NatalRN. The graphical outputs are illuminance curves, isolines of UDI among 300lux and 2000 lux and tables with index of occurrences of glare and to an UDI among 300lux 3000lux. The best UDI300-2000lux performance was evidenced to: Phase 1 (models with WWR of 20%), Phase 2 (models with WWR of 40% and 50% with light shelf). The best UDI300-3000lux performance was evidenced to: Phase 1 (models with WWR of 20% and 40% with light shelf) and Phase 2 (models with WWR of 40% and 50% with light shelf). The outputs prove that the daylight quality mainly depends on the shading system efficacy to avoid the glare occurrence, which determines the daylight discomfort. The bioclimatic recommendations of big openings with partial shading (with an opening with direct sunlight) resulted in illuminances level higher than the acceptable upper threshold. The improvement of the shading system percentage (from 73% to 91%) in medium-size of openings (WWR 40% and 50%) reduced or eliminate the glare occurrence without compromising the daylight zone depth (7.20m). The passive zone was determined for classrooms with satisfactory daylight performance, it was calculated the daylight zone depth rule-of-thumb with the ratio between daylight zone depth and the height of the window for different size of openings. The ratio ranged from 1.54 to 2.57 for WWR of 20%, 40% and 50% respectively. There was a reduction or elimination of glare in the passive area with light shelf, or with awning window shading.

História oral de vida de pessoas com úlcera venosa nos serviços de atenção primária à saúde

The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

Percepção da equipe de saúde, discentes e usuários sobre a comunicação com indivíduos surdos na atenção primária

The study aimed to identify in the professionals and students of health courses that work in a health Basic Unit in the city of Natal/RN their perceptions of the care of deaf patients, and with the population's needs with hearing loss in relation to health care. This is a cross-sectional, exploratory, descriptive study, conducted between April to July 2014, with a population composed of 21 health professionals, 17 students and 8 deaf users. For data collection, we used a structured questionnaire with open and closed questions applied to groups composed of health professionals (doctors, dentists, nurses and health workers) and students of medical schools, nursing, physical education, nutrition and social service. The professionals/students answered a semi-structured questionnaire with open and closed questions concerning the possible difficulties the care of the deaf and hearing impaired. Data collection with deaf users was conducted through filmed interview for the Brazilian Sign Language (Libras) could be interpreted as to the Portuguese by the researcher. With the latter it was conducted a survey of their reactions when looking for a care in the health service. Regarding the profile of identification of the subjects, it was analyzed by simple descriptive statistics (absolute and relative frequencies). The open questions were analyzed through the content analysis technique which allowed the categorization process preserving all the points raised in the discussion so that the lines were representative of the whole. When asked about the professionals and students attitude used to communicate with deaf patients possible the following categories emerged: the "writing", the "gestures" and the "third party assistance". With regard of the deaf, when asked about their experiences in seeking care in health, the elucidated categories were: "quality of care to the hearing impaired", "communication with the hearing impaired adequacy" and "dependence on third parties." The closed questions were measured and adapted to the 5 degrees of variation Likert Scale, which comprised three of these issues: degree of difficulty in communication to meet a patient with hearing loss (minimum to great difficulty); feeling of comfort while using sign language (minimum to severe discomfort); and knowledge of the Law 10.436, which provides for the Brazilian Sign Language (Libras) (low knowledge to entirely clear). The data collected with professionals and students revealed some misunderstanding and discomfort in health care for deaf patients, reality also evidenced in the opinion of the deaf participants. This study revealed problems in communication, resulting in negative consequences in serving this population. This diagnosis may be relevant to public policy development and curriculum guidelines essential to the training of health professionals, inclusion and improving assistance to deaf.

Gravidade do olho seco em pacientes internados em unidade de terapia intensiva: análise de conceito e construção de definições

Dry eye syndrome is a multifactorial disease of the tear film, resulting from the instability of the lacrimal functional unit that produces volume change, up or tear distribution. In patients in intensive care the cause is enhanced due to various risk factors, such as mechanical ventilation, sedation, lagophthalmos, low temperatures, among others. The study's purpose is to build an assessment tool of Dry Eye Severity in patients in intensive care units based on the systematization of nursing care and their classification systems. The aim of this study is to build an assessment tool of Dry Eye Severity in hospitalized patients in Care Unit Intensiva.Trata is a methodological study conducted in three stages, namely: context analysis, concept analysis, construction of operational definitions and magnitudes of nursing outcome. For the first step we used the methodological framework for Hinds, Chaves and Cypress (1992). For the second step we used the model of Walker and Avant and an integrative review Whitemore seconds, Knalf (2005). This step enabled the identification of the concept of attributes, background and consequent ground and the construction of the settings for the result of nursing severity of dry eye. For the construction of settings and operational magnitudes, it was used Psicometria proposed by Pasquali (1999). As a result of context analysis, visualized from the reflection that the matter should be discussed and that nursing needs to pay attention to the problem of eye injury, so minimizing strategies are created this event with a high prevalence. With the integrative review were located from the crosses 19 853 titles, selected 215, and from the abstracts 96 articles were read in full. From reading 10 were excluded culminating in the sample of 86 articles that were used to analyze the concept and construction of settings. Selected articles were found in greater numbers in the Scopus database (55.82%), performed in the United States (39.53%), and published mainly in the last five years (48.82). Regarding the concept of analysis were identified as antecedents: age, lagophthalmos, environmental factors, medication use, systemic diseases, mechanical ventilation and ophthalmic surgery. As attributes: TBUT <10s, Schimer I test <5 mm in Schimer II test <10mm, reduced osmolarity. As consequential: the ocular surface damage, ocular discomfort, visual instability. The settings were built and added indicators such as: decreased blink mechanism and eyestrain.

Does a mandibular RDP and new maxillary CD improve masticatory efficiency and quality of life in patients with a mandibular Kennedy class I arch?

Objectives To evaluate the change in masticatory efficiency and quality of life of patients treated with mandibular Kennedy class I removable partial dentures (RPDs) and maxillary complete dentures at the Department of Dentistry of the Federal University of Rio Grande do Norte. Materials and methods A total of 33 Kennedy class I patients were rehabilitated with maxillary complete dentures, and mandibular RPDs were selected for this non-randomized prospective intervention study. The patients had a mean age of 59.1 years. Masticatory efficiency was evaluated by colorimetric assay using fuchsin capsules. The measurements were conducted at baseline and 2 and 6 months after prosthesis insertion. Quality of life was evaluated using the Oral Health Impact Profile (OHIP-14) at baseline and 6 months after denture insertion. The Kolmogorov-Smirnov normality test was applied. Masticatory efficiency was evaluated by repeated measures ANOVA. Oral health-related quality of life was compared using the paired t test. Results There was no statistically significant difference in masticatory efficiency after denture insertion (p = 0.101). Significant differences were found (p = 0.010) for oral health-related quality of life. A significant improvement in psychological discomfort (p < 0.01) and psychological disability (p < 0.01) was observed. Mean difference value (95 % confidence interval) was 6.8 (3.8 to 9.7) points, reflecting a low impact of oral health on quality of life, considering the 0–56 range of variation of the OHIP-14 and a Cohen’s d of 1.13. Conclusion According to the results of the present study, rehabilitation with Kennedy class I RPDs and complete dentures did not influence masticatory efficiency but improved oral health-related quality of life. Clinical relevance The association between the patient’s quality of life and the masticatory efficiency is important for treatment predictability.

Vernaculares: a casa de fazenda seridoense do século XIX como exemplo de adaptação ao clima semiárido

The farm’s rural dwellings of creation from the Seridó Potiguar microregion, built in the nineteenth century, became a reference by its vernacular character, i.e. these buildings, besides having recognized relevance to the identity of the region, they are adapted to the conditions of the place in many aspects (economic, cultural, construction, physical, et.) and consist in protective spaces in relation to hostile characteristics of Seridó’s climate. Considering the above premise, the following question arises: What characteristics of the nineteenth century Seridó Potiguar’s cattle farms are crucial for them to be a protective space in relation to the semiarid climate? In order to answer the question, this research aim to identify which particularities of the Seridó’s farmhouses that contribute to adaptability in these buildings to semiarid climate, as protection environments; and contribute to the stock valuation of the architectural heritage concerned. Therefore, procedures were adopted divided into two stages. Were first identified the recurring characteristics in the studied buildings, through typological study performed from existing inventories (DINIZ, 2008; FEIJÓ, 2002; IPHAN, 2012). To define the type it worked up with the concept that merges Durand’s analytical typology that identifies the similarities and differences to classify buildings, having the character of historical survey and architectural documentation, with the definition proposed by Argan (1963) that the type is not defined a priory, but the deduction from a number of illustrative cases which have formal and functional similarity with each other. Then worked up in a sample of five different types with each other, defined by the possibility of access to the interior of the houses, proximity to other copies, good state of conservation and preservation. The contemplated farms were: Pitombeiras, Agenus e Garrotes in Acari’s town, and the municipality of Caicó, Palma and Penedo. The second stage consists of the architectural survey, photographic record, digital three-dimensional modeling (aiming to expand the existing documentation and registration) and thermal monitoring over approximately a representative day in five farmhouses, relating the thermal performance of the houses with their individual characteristics. The selected variables for analysis monitoring are based on the thermal comfort adaptive model (SPAGNOLO and DE DEAR, 2003 apud NEGREIROS, 2010). The characteristics of the houses were analyzed as meeting the passive thermal conditioning strategies recommended by NBR 15220 (ABNT, 2005), for the bioclimatic zone 7 where the municipalities of Caicó and Acari are located. The house’s analysis of the operating temperatures revealed that 90% of the times of day the environments are within the comfort range. The farmhouses, which had a higher degree of compliance with recommended bioclimatic strategies, had the best thermal performance. In environments (usually the kitchen and rooms with low ceiling heights, exposed to west radiation) which still had discomfort hours, the thermal comfort can be reached with air movement approximately 1,0 m/s.

Vernaculares: a casa de fazenda seridoense do século XIX como exemplo de adaptação ao clima semiárido

The farm’s rural dwellings of creation from the Seridó Potiguar microregion, built in the nineteenth century, became a reference by its vernacular character, i.e. these buildings, besides having recognized relevance to the identity of the region, they are adapted to the conditions of the place in many aspects (economic, cultural, construction, physical, et.) and consist in protective spaces in relation to hostile characteristics of Seridó’s climate. Considering the above premise, the following question arises: What characteristics of the nineteenth century Seridó Potiguar’s cattle farms are crucial for them to be a protective space in relation to the semiarid climate? In order to answer the question, this research aim to identify which particularities of the Seridó’s farmhouses that contribute to adaptability in these buildings to semiarid climate, as protection environments; and contribute to the stock valuation of the architectural heritage concerned. Therefore, procedures were adopted divided into two stages. Were first identified the recurring characteristics in the studied buildings, through typological study performed from existing inventories (DINIZ, 2008; FEIJÓ, 2002; IPHAN, 2012). To define the type it worked up with the concept that merges Durand’s analytical typology that identifies the similarities and differences to classify buildings, having the character of historical survey and architectural documentation, with the definition proposed by Argan (1963) that the type is not defined a priory, but the deduction from a number of illustrative cases which have formal and functional similarity with each other. Then worked up in a sample of five different types with each other, defined by the possibility of access to the interior of the houses, proximity to other copies, good state of conservation and preservation. The contemplated farms were: Pitombeiras, Agenus e Garrotes in Acari’s town, and the municipality of Caicó, Palma and Penedo. The second stage consists of the architectural survey, photographic record, digital three-dimensional modeling (aiming to expand the existing documentation and registration) and thermal monitoring over approximately a representative day in five farmhouses, relating the thermal performance of the houses with their individual characteristics. The selected variables for analysis monitoring are based on the thermal comfort adaptive model (SPAGNOLO and DE DEAR, 2003 apud NEGREIROS, 2010). The characteristics of the houses were analyzed as meeting the passive thermal conditioning strategies recommended by NBR 15220 (ABNT, 2005), for the bioclimatic zone 7 where the municipalities of Caicó and Acari are located. The house’s analysis of the operating temperatures revealed that 90% of the times of day the environments are within the comfort range. The farmhouses, which had a higher degree of compliance with recommended bioclimatic strategies, had the best thermal performance. In environments (usually the kitchen and rooms with low ceiling heights, exposed to west radiation) which still had discomfort hours, the thermal comfort can be reached with air movement approximately 1,0 m/s.

A docência na educação superior: narrativas das diferenças políticas de sujeitos surdos

Deaf teachers presence at superior education triggers a series of reactions due to cultural differences. They feel the discomfort. The cultural difference defies the established power relations. From that emerge the trading spaces with their constant shocks about problems that affect the deaf teacher participation. The thesis goes through practice, resistance, resilience and political thinking of the deaf teacher at the Superior Education. Authors like: Foucault (2004), Hall (2009), Bhabha (1998), Touraine (2009) and Veiga-Netto (2010) underlie the concept of power relations that permeate this study. Perlin (2003); Ladd (2002) subsidize with the cultural focus. The investigation came from the question: How deaf teachers make their political stands in power relations established to the construction of their narratives at Superior Education? It had the goal of identify and chart the deaf teachers narratives at Superior Education. Leaving from the interview-narrative qualitative approach it was constituted a corpus with the collected narratives. These narratives were identified in order to achieve a thematic map express in the last chapter where the constant facts of the trading spaces of Superior Education shocks unfolds. The results point to an infinity of debates. The deaf teachers do not only present initial conditions of distress, doubt and difficulty at Superior Education, but also the disposition to discuss more the everyday power chains, waged by trading spaces. The identification of the narratives was vitally important to confirm the value of cultural and linguistic recognition as strategy for new politics to the structural power relations at the university context.

Diadenosine polyphosphates after laser in situ keratomileusis and photorefractive keratectomy refractive techniques

Purpose:  To study the concentrations of diadenosine polyphosphates in the ocular surface after PRK and LASIK. Methods:  Sixty-one patients (30 males and 31 females) with ages ranging from 20 to 63 (34.04 ± 9.13 years) were recruited in Balear Institute of Ophthalmology, Palma de Mallorca, Spain. LASIK was performed in 92 eyes of 46 patients and PRK in 25 eyes of 15 patients. Variations in the levels of diadenosine polyphosphate (Ap4A and Ap5A), Schirmer I (Jones test), TBUT, corneal staining together with the Dry Eye Questionnaire to evaluate discomfort and dryness were studied. All tests were performed at the preoperative visit and at 1-day, 2-week, 1-month and 3-month postoperative visits. Results:  Ap4A showed a 5 and 3.5 fold increase at the 1-day visit for LASIK and PRK, respectively. LASIK patients continued having higher statistically significant concentrations (p = 0.01) all over the follow-up. Ap5A showed no significant differences at any visit. Tear volume decreased during the 3 months in LASIK. The PRK cases had a normal volume at 1 month. TBUT in LASIK increased at the 1-day visit (p = 0,002) and decreased from the 2 weeks onwards and for the PRK, decreased by a 35% at the 1-day visit and kept reduced for a month. Discomfort only increased at the 1-day visit (p = 0.007). Dryness frequency was similar in all visits. Conclusions:  Ap4A levels only are increased in refractive surgery patients during the first day after the surgery. This increasing suggests that Ap4A may help accelerating the healing process.

"I’m complicit and I’m ambivalent and that’s crazy":care-less spaces for women in the academy

This paper is about three working class women academics in their 40s, who are at different phases in their career. I take a reflexive, feminist, (Reay 2000, 2004, Ribbens and Edwards 1998) life story approach (Plummer, 2001) in order to understand their particular narratives about identity, complicity, relationships and discomfort within the academy, and then how they inhabit care-less spaces. However unique their narratives, I am able to explore an aspect of higher education – women and their working relationships – through a lens of care-less spaces, and argue that care-less-ness in the academy, can create and reproduce animosity and collusion. Notably, this is damaging for intellectual pursuits, knowledge production and markedly, the identity of woman academics. In introducing this work, I first contextualise women in the academy and define the term care-less spaces, then move onto discuss feminist methods. I then explore and critique in some detail, the substantive findings under the headings of ‘complicity and ‘faking’ it’ and ‘publishing and collaboration’. The final section concludes the paper by drawing on Herring’s (2013) legal premise, in the context of care ethics, as a way to interrogate particular care-less spaces within higher education.

Epidemiology of medication discrepancies upon hospital admission in children - a systematic review

Objectives: NICE/NPSA excluded children under 16 from their guidance concerning medicines reconciliation (MR) upon admission.1 Our aims and objectives of conducting the literature review was to identify the epidemiology of medication discrepancies upon admission, transfer and discharge in children, and if they require MR. Method: Six bibliographical databases (Medline, Embase, CINAHL, International Pharmaceutical Abstracts, Web of Science and Biosis Previews) and selected key words were used to find epidemiological studies on medication discrepancies in children upon hospital admission, transfer and discharge (key words included ‘medication discrepancy’; ‘medication reconciliation’; ‘hospital admission’; ‘hospital discharge’; ‘hospital transfer’); studies where the data for children could be extracted were included. Results: From the 1239 articles found (in May 2011), eight of the articles had extractable paediatric information, (five from Canada, two from USA, one from UK). Five of the studies involved discrepancies on admission, one involved discrepancies on admission and transfer, one involved discrepancies at transfer and one considered discharge. The reference point used to compare against the admission, transfer and the discharge order differed in each of the studies. Four studies used a rating scale to assess the clinical significance of the discrepancies to demonstrate the potential adverse clinical outcome of patients in the absence of clinical intervention. Two studies2 3 used a rating scale that was used in adults.4 A study of paediatric neurosurgical patients found that initial hospital prescriptions for children differed from the preadmission prescriptions in 39% of occasions and 50% of all prescribing variations had the potential to cause moderate or severe discomfort or clinical deterioration.2 A study by Coffey et al in general paediatric admissions in Canada showed 22% of patients experienced at least one discrepancy and 29% of the discrepancies had the potential to cause moderate or severe discomfort or clinical deterioration.3 By comparison an epidemiological study in discrepancies in adults on admission had 38.6% of the discrepancies identified with a potential to cause moderate or severe discomfort or clinical deterioration.4 All the studies involved small samples or specific patient groups such as medically complex patients. However all of the studies demonstrated that discrepancies occurred among paediatric populations during transitions in care settings and mentioned MR as an intervention. Conclusion: The results have shown that discrepancies of medication upon hospital admission, transfer and discharge occur regularly in children. With only one published study in the UK looking at hospital admission in children, and no published articles on the incidence and epidemiology of medication discrepancies upon hospital transfer or discharge further research is required in a wider paediatric population. Further work is also required to define the required interventions to improve practice.