High speed synchrotron x-ray phase contrast imaging of dynamic material response to split Hopkinson bar loading.

The successful process of amalgamating both the time-resolved imaging capabilities present at the Advanced Photon Source beamline 32ID-B and the proficiency of high-rate loading offered by the split Hopkinson or Kolsky compression/tension bar apparatus is discussed and verification of system effectiveness is expressed via dynamic experiments on various material systems. Single particle sand interaction along with glass cracking during dynamic compression, and fiber-epoxy interfacial failure, ligament-bone debonding, and single-crystal silicon fragmentation due to dynamic tension, were imaged with 0.5 µs temporal resolution and µm-level spatial resolution. Synchrotron x-ray phase contrast imaging of said material systems being loaded with the Kolsky bar apparatus demonstratively depicts the effectiveness of the novel union between these two powerful techniques, thereby allowing for in situ analysis of the interior of the material system during high-rate loading for a variety of applications.

Assisted conception and retinopathy of prematurity: 8-year follow-up study.

AIMS: To assess the effect of assisted conception (AC) on retinopathy of prematurity (ROP) and ROP screening. Follow-up to the study by McKibbin et al. METHODS: Retrospective study utilising computerised databases of ROP screening, live births, AC and multiple births between 1st April 2000 and 31st August 2003 at St James's Hospital (SJUH) Leeds. chi(2) tests of significance were used. RESULTS: ROP screening was undertaken in 11/265 (4.2%) of AC births versus 1.6% of all SJUH births. This is significantly less than the 20.3% of AC babies screened in McKibbin et al study (P=<0.01). There was no ROP detected in the 11 AC babies. Of all AC births, 36.9% were one of twins and 1.5% from triplet births compared to 46.0% one of twins and 18.6% one of triplets in McKibbin's study. CONCLUSIONS: The percentage of AC babies requiring ROP screening has fallen since McKibbin et al study which was performed between August 1991 and December 1994. This appears to be at least partially due to the reduced multiple birth rates. This reduction in the multiple birth rates follows evidence that reducing the number of embryos transferred does not reduce the number of couples taking home a baby and Human Fertility and Embryology Association guidelines recommending 'no more than two embryos should be transferred in an IVF cycle'. Changes in clinical practice at SJUH have significantly reduced the likelihood of AC babies requiring ROP screening and developing ROP.

Comparative cohort study of the outcomes of deep lamellar keratoplasty and penetrating keratoplasty for keratoconus.

AIM: To compare the outcomes and complications of deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) for keratoconus. METHODS: A cohort of 20 consecutive PKs, for keratoconus, was compared with 20 consecutive DLKs, for keratoconus. The PKs were performed between June 2000 and July 2001, the DLKs between October 2001 and October 2002. Surgery was performed by one surgeon. Best-corrected visual acuities (BCVA), refraction and complications were recorded at the time of surgery, 6 and 12 months postoperatively. chi(2)-tests were used to compare visual acuity outcomes and independent t-tests in the analysis of astigmatism. RESULTS: Groups were comparable for age, sex, and ethnicity. All PKs were uncomplicated. Two of the DLK group had microperforations of Descemet's membrane. There was no significant difference in the proportion of patients achieving 6/9 or better between the PK and DLK groups (85 vs 78%, P=0.54). PK patients were, however, more likely than the DLKs to achieve 6/6 at 1 year; 70% (14/20) of PKs compared to 22% of (4/18) DLKs (P=0.04). Astigmatism was significantly higher in the PKs compared to the DLKs (P=0.022). There were two cases of graft rejection in the PK group, while none in the DLKs. CONCLUSIONS: This study confirms good visual results from both PK and DLK in keratoconus with similarly high percentages reaching 6/9 BCVA. DLK appears to cause less astigmatism and also has the advantage of no endothelial graft rejection. The apparent cost, however, is a reduction in the likelihood of achieving 6/6 BCVA.

Combined cataract and glaucoma surgery with mitomycin C: phacoemulsification-trabeculectomy compared to phacoemulsification-deep sclerectomy.

AIMS: To compare outcomes of phacoemulsification combined with trabeculectomy (PT) or deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) application. METHODS: Non-randomised, consecutive, retrospective comparative study. 97 eyes of 97 patients (59 PDS, 38 PT) undergoing combined surgery with intraoperative MMC (0.1-0.4 mg/ml for 1-3 minutes) were identified for inclusion in the study. RESULTS: The probability of maintaining intraocular pressure (IOP) below 19 mm Hg and 15 mm Hg, with a 30% drop from preoperative IOP and without additional medication, 1 year after surgery were 77.6% (95% CI: 67 to 90) and 71.5% (60 to 85) for the PDS group and 89.5% (80 to 99) and 89.5 (80 to 99) for the PT group, respectively, and these differences were not statistically significant (p>0.05, log rank test). After excluding ocular co-morbidity no differences were observed in the improvement of visual acuity between the two groups. There were no major differences in the complication rates except that delayed bleb leaks were seen in seven eyes (18.4%) of the PT group (p = 0.004). CONCLUSION: In this study, no statistically significant difference was found in the IOP and visual outcomes between PDS and PT. A significantly higher frequency of late bleb leaks after PT was observed.

Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asians and white patients.

PURPOSE: To investigate the influence of ethnic origin on the incidence of keratoconus and the association of atopic diseases in patients with keratoconus. METHODS: Retrospective study of new patients referred to Dewsbury District General Hospital and diagnosed with keratoconus in a 6-year period between 1994 and 2000. The ethnic origin of the patient was defined as white, Asian, or other. Incidence was calculated from the catchment population of 176 774 (82% white people, 17% Asians, 1% others). t-Test, confidence intervals and chi2 tests were used to show statistical significance. RESULTS: A total of 74 cases of keratoconus were diagnosed over this period. Of these patients 29 (39%) were white and 45 (61%) were Asian. This equated to an incidence of keratoconus of 25 per 100 000 (1 in 4000) per year for Asians, compared with 3.3 per 100 000 (1 in 30 000) per year for white people (P<0.001). Asians presented significantly younger than white patients. The incidence of atopic disease was found to be significantly higher in white compared to Asian keratoconic patients. CONCLUSIONS: Asians were significantly more likely to present with keratoconus. The Asian patients were mostly of Northern Pakistani origin. This community has a tradition of consanguineous, especially first-cousin marriages. The higher incidence in this population was highly suggestive of a genetic factor being significant in the aetiology. The incidence was higher than revealed by previous studies. Atopic disease was significantly less common in Asians compared to white people, supporting the theory of a different aetiology in these patients.

Ethics, the health assessment interview, and the older patient.

As a requirement for the first year nursing subject 'Health Assessment' at Flinders University of South Australia, the task was given of examining Ethics and how this relates to the health assessment interview. Due to the negative stereotypes of older people and the subsequent treatment of the older patient, focus is placed on this particular age group. A definition of Ethics is given, with further discussion relating specifically to autonomy, respect and justice. This paper is not intended to be a major dissertation on Ethics and the Four Principles, because at the time of writing this the author had not studied ethics. Instead, it is hoped that other nurses and nursing students may learn as much about the difficulties of the older patient as the author has herself, and examine possible prejudices towards patients of any age, particularly the vulnerable older patient.

Empathy in the clinical context.

As a requirement for the first year nursing subject "Foundations of Nursing", we were given the opportunity to examine the complex dimensions of Nursing culture and Nursing care. To apply the learned theory to practice, the author undertook a three-day clinical placement in a major metropolitan hospital. Negative and positive experiences while on clinical placement led to the use of exemplars to describe these experiences. These exemplars have been graded according to the levels of empathy observed and experienced by the author. This paper describes the author's reflections of nursing practice using empathy as the specific focus. A significant amount of emotional catharsis was felt by the author on completion of this paper; it is hoped that other nurses and nursing students may learn from and reflect from their own experiences of empathy in the clinical context.

What do members of the National Eczema Society really want?

In order to assess the impact of eczema on the lives of affected individuals a postal questionnaire was sent to all members of the National Eczema Society (NES). The survey also sought to ascertain their expectations of their initial consultation with general practitioners and hospital doctors; to assess their satisfaction with these consultations; to obtain their views on the treatment prescribed, and their reasons for joining the NES. Information on 1972 adults (614 male, 1358 female) and from 1944 parents of affected children was received, representing an overall response rate of 29%. The work of 1061 (54%) adults, and the choice of career of 391 (20%) had been affected. Eczema affected the ability to perform domestic duties in 1128 (83%) women compared with 439 (71%) men. Social and leisure activities were affected in 1269 (64%) of adults. The development of personal relationships had been impaired in 273 (14%), and the sex lives of 373 (19%) had been affected. In children sleep (60%) was the most commonly affected activity. The expectations of the initial consultation with their general practitioner of 659 (17%) had not at all been met, of 2528 (65%) partly met, and of only 483 (12%) completely met; 2638 patients had seen a hospital specialist. The expectations of 478 (18%) had not at all been met, of 1164 (62%) partly met, and of only 512 (19%) completely met. Forty-four per cent (1713) were either 'extremely satisfied' or 'satisfied' with the treatments they had been given, 1529 (40%) were 'neutral', 480 (12%) were dissatisfied, and 103 (2.6%) were extremely dissatisfied.(ABSTRACT TRUNCATED AT 250 WORDS)

Normal infant after combination chemotherapy including teniposide for Burkitt's lymphoma in pregnancy.

A 32-year-old woman was treated for Burkitt's lymphoma diagnosed during the 22nd week of pregnancy. Chemotherapy consisting of doxorubicin (Adriamycin), vincristine, teniposide (VM-26), cyclophosphamide, and prednisolone (AVTEP) was given each 2.5 to 3 weeks from the time of the diagnosis until delivery in the 37th week. Bleomycin and intrathecal methotrexate were also given from the 35th week. The infant was born after an assisted vaginal delivery and was fully developed and normal in all respects. This paper confirms prior reports that cytotoxic chemotherapy may safely be given during the second and third trimesters of pregnancy without adverse effects on the fetus. To our knowledge it is the first report of the use of teniposide, a new podophyllin derivative, during pregnancy.