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.

University Competition, Grading Standards, and Grade Inflation

We develop a model of strategic grade determination by universities distinguished by their distributions of student academic abilities. Universities choose grading standards to maximize the total wages of graduates, taking into account how the grading standards affect firms' productivity assessment and job placement. We identify conditions under which better universities set lower grading standards, exploiting the fact that firms cannot distinguish between good and badA''s. In contrast, a social planner sets stricter standards at better universities. We show how increases in skilled jobs drive grade inflation, and determine when grading standards fall faster at better schools. (JEL I21)

Use and views on social networking sites of pharmacy students in the United Kingdom

Objective. To investigate students' use and views on social networking sites and assess differences in attitudes between genders and years in the program.

Methods. All pharmacy undergraduate students were invited via e-mail to complete an electronic questionnaire consisting of 21 questions relating to social networking.

Results. Most (91.8%) of the 377 respondents reported using social networking Web sites, with 98.6% using Facebook and 33.7% using Twitter. Female students were more likely than male students to agree that they had been made sufficiently aware of the professional behavior expected of them when using social networking sites (76.6% vs 58.1% p=0.002) and to agree that students should have the same professional standards whether on placement or using social networking sites (76.3% vs 61.6%; p<0.001).

Conclusions. A high level of social networking use and potentially inappropriate attitudes towards professionalism were found among pharmacy students. Further training may be useful to ensure pharmacy students are aware of how to apply codes of conduct when using social networking sites.

Optimising the locations of thermally sensitive equipment in an aircraft crown compartment

A Design of Experiments (DoE) analysis was undertaken to generate a list of configurations for CFD numerical simulation of an aircraft crown compartment. Fitted regression models were built to predict the convective heat transfer coefficients of thermally sensitive dissipating elements located inside this compartment. These are namely the SEPDC and the Route G. Currently they are positioned close to the fuselage and it is of interest to optimise the heat transfer for reliability and performance purposes. Their locations and the external fuselage surface temperature were selected as input variables for the DoE. The models fit the CFD data with values ranging from 0.878 to 0.978, and predict that the optimum locations in terms of heat transfer are when the elements are positioned as close to the crown floor as possible ( and ?min. limits), where they come in direct contact with the air flow from the cabin ventilation system, and when they are positioned close to the centreline ( and ?CL). The methodology employed allows aircraft thermal designers to optimise equipment placement in confined areas of an aircraft during the design phase. The determined models should be incorporated into global aircraft numerical models to improve accuracy and reduce model size and computational time. © 2012 Elsevier Masson SAS. All rights reserved.

Learning fluid prescription skills: why is it so challenging?

IIt is well recognised that medical students and junior doctors find fluid prescription a challenging topic. This study was designed to gain a greater understanding of the experiences that medical students face related to learning about fluid prescribing. Methods: A qualitative approach, using focus groups, was employed in this research. Final-year medical students in academic year 2011-12 at Queen's University Belfast were invited to participate during their 'Assistantship' placement in March 2012. Discussions in focus groups, consisting of between six and eight students, were recorded and transcribed verbatim. The research team, consisting of three separate investigators, conducted thematic analysis independently. A final consensus regarding emerging themes was reached by discussion within the whole research team. Medical students and junior doctors find fluid prescription a challenging topic Results: Five prominent themes emerged: 'Teaching experience: a disruptive variation'; 'Curricular disconnections'; 'The driving test: Theory-practice transformation'; 'Role modelling: which standard to aspire to?'; and finally 'Reconciling the perceived risk'. Discussion: This re search provided insights into medical students' opinions of the teaching practices and learning experiences related to fluid prescribing. The learning of prescribing skills is complex andcontextual. In the development of such skills, medical students are often exposed to conflicting educational experiences that challenge the novicelearner in making judgements on best prescribing practice. This study adds to the body of evidence that fluid prescription is a difficult topic, and has generated a number of multifaceted and strategic recommendations to potentially improve fluid prescription teaching.

Young people, crime and justice in Northern Ireland

Many children and young people in conflict with the law in Northern Ireland have experienced living in poverty, truancy or exclusion from school, limited educational attainment, neglect or abuse within their families, placement in alternative care, drug or alcohol misuse, physical and mental ill-health. However, their lives are also affected by the legacy and particular circumstances of a society in transition from conflict. In addition to historical under-investment in services for children and their families, this includes discriminatory policing alongside informal regulation by ‘paramilitaries’ or members of ‘the community’ and community-based restorative justice schemes as an alternative way of dealing with low-level crime and ‘anti-social’ behaviour.

Following a Criminal Justice Review, the 2002 Justice (Northern Ireland) Act affirmed that the principal aim of the youth justice system is to protect the public by preventing offending by children’. Youth justice initiatives therefore encompass a range of responses: early intervention to prevent offending and the application of civil Anti-Social Behaviour Orders, diversionary measures (including community-based restorative justice schemes), non-custodial disposals for those found guilty of offences, and custodial sentences. While ‘policy transfer’ prevailed during periods of ‘direct rule’ from Westminster, the punitive responses to ‘sub-criminal’ and ‘anti-social’ behaviour introduced by the 1998 Crime and Disorder Act in England and Wales were resisted or not implemented in the same way in Northern Ireland.

This Chapter will critically analyse the debates informing recent developments, noting key issues raised by the 2011 review of youth justice initiated as a priority following the devolution of justice and policing to the Northern Ireland Assembly. It will focus on promotion and protection of the rights of children and young people in conflict with the law.

Development of a Temperature-Recording Vaginal Ring for Monitoring User Adherence

Background: Vaginal ring devices are being actively developed for controlled delivery of HIV microbicides and as multi-purpose prevention technology (MPT) products combining hormonal contraception with prevention of HIV and other sexually transmitted diseases. Presently, there is no reliable method for monitoring user adherence in HIV vaginal ring trials; previous acceptability studies have included some type of participant self-reporting mechanism, which have often been unreliable. More objective, quantitative and accurate methods for assessing adherence are needed.
Methods: A silicone elastomer vaginal ring containing an encapsulated miniature temperature recording device has been developed that can capture and store real-time temperature data during the period of designated use. Devices were tested in both simulated vaginal environments and following vaginal placement in cynomolgus macaques. Various use protocols and data sampling rates were tested to simulate typical patient usage scenarios. Results: The temperature logging devices accurately recorded vaginal temperature in macaques, clearly showing the regular diurnal temperature cycle. When environmental temperature and vaginal temperature was significantly different, the device was able to accurately pinpoint the insertion and removal times. Based on the data collected it was possible to infer removal periods as short as 5 min when the external environmental temperature was 25 °C. Accuracy increased with data sampling rate. Conclusions: This work provides proof-of-concept for monitoring adherence using a vaginal ring device containing an encapsulated temperature logger. The addition of one or more active agents into the ring body is not anticipated to affect the temperature monitoring function. A clinical study to compare self- reported user adherence data with that obtained by the device would be highly informative.

Tales Out of School – The ‘Hidden Curriculum’ in National Schools in the North of Ireland During the Nineteenth and Early Twentieth Centuries

The paper addresses the possibility of the existence of a ‘hidden curriculum’ in nineteenth- and early twentieth-century National Schools by comparing working practices evident from an analysis of a sample of schools from two case study areas in the north of Ireland – Derry City and the rural area of Boho/Derrygonnelly in western County Fermanagh. The relationship between the placement of the school buildings and variations in their external appearances are examined in respect to their relationships with different churches. The possible significance of this relationship is scrutinised given that the primary aim of the National School system was joint secular education in a religiously divided society. Both the external and internal architecture of the buildings are also examined for the purposes of reconstructing aspects of the intentions and practices that governed their use. In particular, the relationship between allocated space and the categories of age and gender are studied by means of an access analysis of the floor plans of a representative sample of primary schools from both case study areas. Information derived from oral history accounts, archived material from the Public Record Office of Northern Ireland (PRONI) and school registers is used to supplement the findings obtained from the architectural analyses.

At Home in Care: Children living with birth parents on a Care Order

This study explored the processes, background information, and perceived reasons why children and young people returned home while remaining in care, in the five HSC Trusts in Northern Ireland. The research also focused on understanding the functions the Care Order had for social services, the birth parents, and young people involved.
It was found that on 31st March 2009, there were 193 children/young people living with their birth parents on a Care Order in Northern Ireland. This is eight per cent of the total population of Looked After children, and is lower than had been anticipated from governmental statistics. In total, the case files of 47 of these young people (24% of them) were reviewed, and interviews were conducted with ten of them and their birth parent/s.
The analysis revealed that the majority of them had in common a parental background history of alcohol abuse and domestic violence, and most return breakdowns in the study were related to continuing parental alcohol and/or drugs misuse. While some children had a planned return home after parents had engaged in supports and completed assessments, many young people had returns that were not planned, as they initiated the move themselves, or previous foster placements had broken down and there were no alternative placements identified for them. Many of these young people essentially ‘voted with their feet’, and social services were required to ensure that they remained safe in often less than optimal circumstances.
After returning home, for many, Care Orders remained for initially unintended lengthy periods because of the risks posed by parents’ intermittent alcohol abuse and their lifestyle, contact issues, and parents’ desire to ensure that their children were able to access the supports that they needed. Thus, Care Orders at home tended to serve two main functions: to either monitor and/or support the placement.

Make the most of clinical placements

While nurse mentors are responsible and accountable for the assessment of students during practice placements, students are responsible for ensuring they learn as much as possible during this time

Middleware mechanisms for agent mobility in wireless sensor and actuator networks

This paper describes middleware-level support for agent mobility, targeted at hierarchically structured wireless sensor and actuator network applications. Agent mobility enables a dynamic deployment and adaptation of the application on top of the wireless network at runtime, while allowing the middleware to optimize the placement of agents, e.g., to reduce wireless network traffic, transparently to the application programmer. The paper presents the design of the mechanisms and protocols employed to instantiate agents on nodes and to move agents between nodes. It also gives an evaluation of a middleware prototype running on Imote2 nodes that communicate over ZigBee. The results show that our implementation is reasonably efficient and fast enough to support the envisioned functionality on top of a commodity multi-hop wireless technology. Our work is to a large extent platform-neutral, thus it can inform the design of other systems that adopt a hierarchical structuring of mobile components. © 2012 ICST Institute for Computer Science, Social Informatics and Telecommunications Engineering.

Wetting of compacted clays under laterally restrained conditions: Initial state, overburden pressure and mineralogy

Compacted clay fills are generally placed at the optimum value of water content and, immediately after placement, they are unsaturated. Wetting might subsequently occur due, for example, to rainfall infiltration, which can cause volumetric deformation of the fill (either swell or collapse) with associated loss of shear strength and structural integrity. If swelling takes place under partially restrained deformation, due for example to the presence of a buried rigid structure or a retaining wall, additional stresses will develop in the soil and these can be detrimental to the stability of walling elements and other building assets. Factors such as dry density, overburden pressure, compaction water content and type of clay are known to influence the development of stresses. This paper investigates these factors by means of an advanced stress path testing programme performed on four different clays with different mineralogy, index properties and geological histories. Specimens of kaolin clay, London Clay, Belfast Clay and Ampthill Clay were prepared at different initial states and subjected to ‘controlled’ wetting, whereby the suction was reduced gradually to zero under laterally restrainedconditions (i.e. K0 conditions). The results showed that the magnitude of the increase in horizontal stresses (and therefore the increase of K0) is influenced by the overburden pressure, compaction water content, dry density at the time of compaction and mineralogy.

Tracking smart grid hackers

The next-generation smart grid will rely highly on telecommunications infrastructure for data transfer between various systems. Anywhere we have data transfer in a system is a potential security threat. When we consider the possibility of smart grid data being at the heart of our critical systems infrastructure it is imperative that we do all we can to ensure the confidentiality, availability and integrity of the data. A discussion on security itself is outside the scope of this paper, but if we assume the network to be as secure as possible we must consider what we can do to detect when that security fails, or when the attacks comes from the inside of the network. One way to do this is to setup a hacker-trap, or honeypot. A honeypot is a device or service on a network which appears legitimate, but is in-fact a trap setup to catch breech attempts. This paper identifies the different types of honeypot and describes where each may be used. The authors have setup a test honeypot system which has been live for some time. The test system has been setup to emulate a device on a utility network. The system has had many hits, which are described in detail by the authors. Finally, the authors discuss how larger-scale systems in utilities may benefit from honeypot placement.

Cadaveric fascia lata pubovaginal slings:early results on safety, efficacy and patient satisfaction

Objective To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI).

Patients and methods Thirty-one women with SUI (25 type II and six type III; mean age 63 years, range 40-75) had a CFL pubovaginal sling placed transvaginally. The operative time, blood loss, surgical complications and mean hospital stay were all documented. Before and at 4 months and 1 year after surgery each patient completed a 3-day voiding diary and validated voiding questionnaires (functional inquiry into voiding habits, Urogenital Distress Inventory and Incontinence Impact Questionnaire, including visual analogue scales).

Results The mean (range) operative time was 71 (50-120) min, blood loss 78.7 (20-250) mL and hospital stay 1.2 (1-2) days; there were no surgical complications. Over the mean follow-up of 13.5 months, complete resolution of SUI was reported by 29 (93%) patients. Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (<15 cmH (2) O) voiding pressures before surgery required self-catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty-four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use (P <0.05). The severity of leak and storage symptoms was also significantly less (P <0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, approximate to 80% of the patients said they would undergo the procedure again and/or recommend it to a friend.

Conclusion Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.