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The Self-Medication Hypothesis (SMH) theorizes that alcohol is used to alleviate negative states. We assessed whether an acute social stressor (Trier Social Stress Test, TSST), a priming dose of alcohol, and participant sex impacted 90-min ad libitum drinking. We expected exposure to stress to be associated with increased consumption, and this effect to be stronger following an alcohol priming dose; we also explored whether participant sex moderated these effects.Using a 2×2 experimental design, we randomized groups of two to three drinkers to stress (TSST vs. no TSST) and priming beverage (alcohol vs. placebo) conditions. All participants subsequently completed the 90-min ad libitum drinking period and were instructed not to exceed more than one alcoholic beverage per hour for optimal performance to model behavioral impaired control. We examined (a) number of drinks ordered, (b) violations of the drink limit, (c) change in breath alcohol concentration (BAC), and (d) peak BAC.Analyses showed that exposure to stress was associated with heavier ad libitum drinking. This effect was qualified by a three-way interaction; women who received a stressor and no prime dose (placebo) reached higher BACs, whereas men who received a stressor and a prime reached higher BACs.The hypothesized interaction between an alcohol priming dose and social stress was only evident among men, whereas women drank more under social stress in the absence of a priming dose. Findings suggest the importance of exploring sex differences in future studies of the SMH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The COVID-19 pandemic has resulted in pronounced changes for college students, including shifts in living situations and engagement in virtual environments. Although college drinking decreased at the onset of the pandemic, a nuanced understanding of pandemic-related changes in drinking contexts and the risks conferred by each context on alcohol use and related consequences have yet to be assessed.Secondary data analyses were conducted on screening data from a large parent clinical trial assessing a college student drinking intervention (N = 1669). Participants across six cohorts (from Spring 2020 to Summer 2021) reported on the frequency of drinking in each context (i.e., outside the home, home alone, home with others in-person, and home with others virtually), typical amount of drinking, and seven alcohol-related consequence subscales.Descriptive statistics and negative binomial regressions indicated that the proportion and frequency of drinking at home virtually with others decreased, while drinking outside the home increased from Spring 2020 to Summer 2021. Limited differences were observed in the proportion or frequency of individuals drinking at home alone or at home with others in-person. Negative binomial and logistic regressions indicated that the frequency of drinking outside the home was most consistently associated with more alcohol-related consequences (i.e., six of the seven subscales). However, drinking at home was not without risks; drinking home alone was associated with abuse/dependence, personal, social, hangover, and social media consequences; drinking home with others virtually was associated with abuse/dependence and social consequences; drinking home with others in-person was associated with drunk texting/dialing.The proportion and frequency of drinking in certain contexts changed during the COVID-19 pandemic, although drinking outside the home represented the highest risk drinking context across the pandemic. Future prevention and intervention efforts may benefit from considering approaches specific to different drinking contexts.

Risk-taking propensity has been crucial to the investigation of alcohol use and consequences. One measure, the balloon analogue risk task (BART), has been used consistently over the past two decades. However, it is unclear how this measure is related to alcohol outcomes. This paper systematically reviews the literature on the BART and alcohol outcomes. First, direct associations between the BART and alcohol use are reviewed including correlations, group comparisons, the BART’s prediction of alcohol outcomes and BART performance after consuming alcohol. Then, potential moderators that explain when and for whom the BART is related to alcohol outcomes are reviewed. Finally, potential mechanisms that explain how the BART and alcohol outcomes are related are reviewed. This review reveals patterns in the BART suggesting risk-taking propensity may be related to changes in alcohol use over time; however, there is little evidence to suggest BART scores increase after consuming alcohol. Yet, additional research suggests adjusted average pump scores may be too simplistic for the amount of information the BART captures and understanding individual’s patterns of responses on the BART is important for investigating its relation to alcohol outcomes. Finally, this review opens up several future directions for research to understand how risk-taking propensity is related to alcohol outcomes.

Self-regulation is studied across various disciplines, including personality, social, cognitive, health, developmental, and clinical psychology; psychiatry; neuroscience; medicine; pharmacology; and economics. Widespread interest in self-regulation has led to confusion regarding both the constructs within the nomological network of self-regulation and the measures used to assess these constructs. To facilitate the integration of cross-disciplinary measures of self-regulation, we estimated product-moment and distance correlations among 60 cross-disciplinary measures of self-regulation (23 self-report surveys, 37 cognitive tasks) and measures of health and substance use based on 522 participants. The correlations showed substantial variability, though the surveys demonstrated greater convergent validity than did the cognitive tasks. Variables derived from the surveys only weakly correlated with variables derived from the cognitive tasks (M = .049, range = .000 to .271 for the absolute value of the product-moment correlation; M = .085, range = .028 to .241 for the distance correlation), thus challenging the notion that these surveys and cognitive tasks measure the same construct. We conclude by outlining several potential uses for this publicly available database of correlations.

BACKGROUND: Previous research indicates college students report heavier drinking on certain events (e.g., 21(st) birthday). While past research has identified heavier drinking events, students’ own reports of what events are associated with elevated drinking remains understudied. The current study utilized mixed methods to explore potential high-risk drinking events for college student drinkers and how these events differed from typical drinking and each other. METHODS: College student drinkers (N=204) reported number of drinks consumed on nine predetermined events (e.g., Halloween). Students also responded to open-ended questions listing five events during which they had elevated drinking, and indicating amount consumed on each event. Open-ended responses were coded into similar event categories. Descriptive statistics for drinks consumed were calculated for predetermined and coded open-ended events. Chi-square analyses assessed differences in endorsement of open-ended events by birth sex, age, and Greek membership. Two multilevel count regressions assessed within-person differences in number of drinks consumed between participants’ typical drinking occasions and 1) highly endorsed open-ended events and 2) predetermined events. RESULTS: For all open-ended event categories, average number of drinks consumed exceeded heavy episodic drinking thresholds; however, there was substantial variability. Comparing predetermined events to participants’ typical drinking indicated elevated drinking on participants’ birthdays, New Year’s Eve, Halloween, Finals, and Spring Break; significant differences between events also emerged. Comparison of open-ended categories to participants’ typical drinking indicated elevated drinking on birthdays, celebrations, parties, and holidays; however, there were no significant differences between open-ended events. CONCLUSIONS: Students who drink alcohol report heavier drinking on specific calendar-based events (e.g., Spring Break). However, students also report non-calendar related events (e.g., non-specific parties) as some of their highest drinking events. More research is needed to understand how intervention and prevention programs can be adapted to target both known calendar-based high-risk drinking events, and unknown, idiosyncratic high-risk drinking events.

Somboonpanyakul et al., We present the results of an analysis of Wide-field Infrared Survey Explorer (WISE) observations of the full 2500 deg2 South Pole Telescope (SPT)-Sunyaev–Zel'dovich cluster sample. We describe a process for identifying active galactic nuclei (AGN) in brightest cluster galaxies (BCGs) based on WISE mid-IR color and redshift. Applying this technique to the BCGs of the SPT-SZ sample, we calculate the AGN-hosting BCG fraction, which is defined as the fraction of BCGs hosting bright central AGNs over all possible BCGs. Assuming an evolving single-burst stellar population model, we find statistically significant evidence (>99.9%) for a mid-IR excess at high redshift compared to low redshift, suggesting that the fraction of AGN-hosting BCGs increases with redshift over the range of 0 < z < 1.3. The best-fit redshift trend of the AGN-hosting BCG fraction has the form (1 + z)4.1±1.0. These results are consistent with previous studies in galaxy clusters as well as as in field galaxies. One way to explain this result is that member galaxies at high redshift tend to have more cold gas. While BCGs in nearby galaxy clusters grow mostly by dry mergers with cluster members, leading to no increase in AGN activity, BCGs at high redshift could primarily merge with gas-rich satellites, providing fuel for feeding AGNs. If this observed increase in AGN activity is linked to gas-rich mergers rather than ICM cooling, we would expect to see an increase in scatter in the Pcav versus Lcool relation at z > 1. Last, this work confirms that the runaway cooling phase, as predicted by the classical cooling-flow model, in the Phoenix cluster is extremely rare and most BCGs have low (relative to Eddington) black hole accretion rates., T.S. and M.M. acknowledge support from the Kavli Research Investment Fund at MIT, and from NASA through Chandra grant GO5-16143. F.R. acknowledges financial support provided by NASA through SAO Award Number SV2-82023 issued by the Chandra X-Ray Observatory Center, which is operated by the Smithsonian Astrophysical Observatory for and on behalf of NASA under contract NAS8-03060. This publication makes use of data products from the Wide-field Infrared Survey Explorer, which is a joint project of the University of California, Los Angeles, and the Jet Propulsion Laboratory/California Institute of Technology, funded by the National Aeronautics and Space Administration. The South Pole Telescope is supported by the National Science Foundation through grant PLR-1248097. Partial support is also provided by the NSF Physics Frontier Center grant PHY-1125897 to the Kavli Institute of Cosmological Physics at the University of Chicago, the Kavli Foundation, and the Gordon and Betty Moore Foundation grant GBMF 947. Funding for the DES Projects has been provided by the U.S. Department of Energy, the U.S. National Science Foundation, the Ministry of Science and Education of Spain, the Science and Technology Facilities Council of the United Kingdom, the Higher Education Funding Council for England, the National Center for Supercomputing Applications at the University of Illinois at Urbana-Champaign, the Kavli Institute of Cosmological Physics at the University of Chicago, the Center for Cosmology and Astro-Particle Physics at the Ohio State University, the Mitchell Institute for Fundamental Physics and Astronomy at Texas A&M University, Financiadora de Estudos e Projetos, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Conselho Nacional de Desenvolvimento Cientìfico e Tecnológico and the Ministério da Ciência, Tecnologia e Inovação, the Deutsche Forschungsgemeinschaft and the Collaborating Institutions in the Dark Energy Survey. The Collaborating Institutions are Argonne National Laboratory, the University of California at Santa Cruz, the University of Cambridge, Centro de Investigaciones Enérgeticas, Medioambientales y Tecnológicas-Madrid, the University of Chicago, University College London, the DES-Brazil Consortium, the University of Edinburgh, the Eidgenössische Technische Hochschule (ETH) Zürich, Fermi National Accelerator Laboratory, the University of Illinois at Urbana-Champaign, the Institut de Ciències de l'Espai (IEEC/CSIC), the Institut de Fìsica d'Altes Energies, Lawrence Berkeley National Laboratory, the Ludwig-Maximilians-Universität München and the associated Excellence Cluster Universe, the University of Michigan, the National Optical Astronomy Observatory, the University of Nottingham, The Ohio State University, the OzDES Membership Consortium, the University of Pennsylvania, the University of Portsmouth, SLAC National Accelerator Laboratory, Stanford University, the University of Sussex, and Texas A&M University.

Self-Discrepancy Theory (Higgins, 1987) predicts that the difference between the ideal and the actual self will be associated with impaired-control-over-drinking (IC; dysregulated drinking beyond one's own limits) as well as alcohol-related-problems. According to Slaney et al. (2001) perfectionism is a multi-faceted personality trait which represents both adaptive (e.g. high-standards) and maladaptive (e.g. discrepancy) aspects. In particular, discrepancy has been associated with poorer coping approaches, which may suggest a Self-Medication route to IC. Yet, to date, no one has examined whether drinking-motives (e.g., social, enhancement, coping and conformity) mediate the relations between discrepancy and high standards and alcohol-outcomes such as IC. We used a structural equation model to test indirect associations of discrepancy and high-standards to both heavy-episodic-drinking and alcohol-related-problems through the mediating mechanisms of drinking-motives and IC. Results supported the distinction between discrepancy and high-standards consistent with the Self-Medication Hypothesis (Hersh & Hussong, 2009). Discrepancy was associated with poorer alcohol-outcomes through greater coping-motives, conformity-motives and IC. In contrast, higher-standards were associated with fewer alcohol-outcomes through less coping-motives, conformity-motives, and IC. This study illustrates the importance of personality factors such as discrepancy in the development of problematic alcohol-use suggesting that it might be a good target for intervention.

Tension Reduction Theory (Kushner, Sher, Wood, & Wood, 1994) suggests alcohol is used as a means to alleviate negative affect (NA) such as shame and guilt. Shame is an internalized response in which blame is placed on the self, while guilt is not internalized and the blame is placed on the situation (Dearing, Stuewig, & Tangney, 2005). This study aims to investigate relationships of shame and guilt to alcohol use and problems through the mechanisms of multiple facets of impulsivity (i.e. UPPS) and impaired control over drinking (IC), which reflect behavioral control processes. The sample consisted of 419 college students (53% female). We examined direct and indirect relationships of shame and guilt on alcohol use and related problems through facets of impulsivity and IC. Shame and guilt were found to diverge (Woien, Ernst, Patock-Peckham, & Nagoshi, 2003). We found that those higher on shame-proneness used more alcohol and experienced more alcohol-related problems through increased negative urgency and IC. Conversely, guilt-prone individuals used less alcohol and experienced fewer alcohol-related problems through less negative urgency and IC. Our findings suggest that guilt is an adaptive form of negative affect, particularly when it comes to alcohol-related outcomes.

Abstract. Grit, the passion and perseverance for long-term goals, has received attention from personality psychologists because it predicts success and academic achievement. Grit has also been criticized as simply another measure of self-control or conscientiousness. A precise psychometric representation of grit is needed to understand how the construct is unique and how it overlaps with other constructs. Previous research suggests that the Short Grit Scale (Grit-S) has several psychometric limitations, such as uncertain factor structure within and across populations, uncertainty about reporting total or subscale scores, and different assessment precision at low and high levels on the construct. We conducted modern psychometric techniques including parallel analysis, measurement invariance, extrinsic convergent validity, and Item Response Theory models on two American samples. Our results suggest that the Grit-S is essentially unidimensional and that there is construct overlap with the self-control construct. Subscale factors were the result of an item doublet, where two items had highly correlated uniquenesses, showed similar item information, and were more likely to exhibit measurement bias. Findings replicated across samples. Finally, we discuss recommendations for the use of the Grit-S based on the theoretical interpretation of the unidimensional factor and our empirical findings.

Self-regulation is a broad construct representing the general ability to recruit cognitive, motivational and emotional resources to achieve long-term goals. This construct has been implicated in a host of health-risk behaviors, and is a promising target for fostering beneficial behavior change. Despite its clear importance, the behavioral, psychological and neural components of self-regulation remain poorly understood, which contributes to theoretical inconsistencies and hinders maximally effective intervention development. We outline a research program that seeks to define a neuropsychological ontology of self-regulation, articulating the cognitive components that compose self-regulation, their relationships, and their associated measurements. The ontology will be informed by two large-scale approaches to assessing individual differences: first purely behaviorally using data collected via Amazon's Mechanical Turk, then coupled with neuroimaging data collected from a separate population. To validate the ontology and demonstrate its utility, we will then use it to contextualize health risk behaviors in two exemplar behavioral groups: overweight/obese adults who binge eat and smokers. After identifying ontological targets that precipitate maladaptive behavior, we will craft interventions that engage these targets. If successful, this work will provide a structured, holistic account of self-regulation in the form of an explicit ontology, which will better clarify the pattern of deficits related to maladaptive health behavior, and provide direction for more effective behavior change interventions.

The nervous system of vertebrates is derived from an early embryonic region referred to as the neural plate. In the chick embryo, the neural plate is populated by neural stem cells specified from the epiblast shortly after the onset of gastrulation. Accompanying the formation of the plate, chondroitin sulfate glycosaminoglycans are expressed in the basal extracellular matrix. We describe in vitro experiments measuring cell adhesion of epiblast cells during the formation of the neural plate. Our findings may suggest that neural stem cells are set apart from non-neural epiblast by changes in relative cell-cell and cell-substrate adhesion. Specifically, changes in cell adhesion separating neural stem cells from the non-neural epiblast may be augmented by the presence of exogenous chondroitin-6-sulfate in the epiblast basal lamina at the time neural progenitors are specified in the epiblast.

This paper summarises the current status of the use of vascular endothelial growth factor (VEGF) blocking agents in retinal vein occlusion. There have been no randomised controlled trials comparing this treatment with the current standard treatment (largely laser) so the lower grade evidence of single treatment case series and anecdotal reports are discussed. VEGF blockers are good at reducing macular oedema in the short term, do improve visual acuity in many cases, and do not seem to adversely affect the long term revascularisation that is necessary to overcome the vein occlusion. VEGF blocking agents are not used in isolation in this condition - they will remain an adjunct to systemic and other local treatments. The literature was reviewed in online searches of Embase and Ovid and the papers quoted are a representative sample of a larger body of publications.

To pilot the use of the Cataract National Dataset (CND) using multi-centre data from Electronic Patient Record (EPR) systems and to demonstrate the ability of the CND to deliver certain of its intended benefits, including detailed preoperative profiling of cataract surgery patients and updating of benchmark standards of care in the NHS and beyond. NHS departments using EPR systems to collect a minimum preoperative, anaesthetic, operative and postoperative data set, the CND, were invited to submit data, which were remotely extracted, anonymised, assessed for conformity and completeness, and analysed. Four-hundred and six surgeons from 12 NHS Trusts submitted data on 55 567 cataract operations between November 2001 and July 2006 (86% from January 2004). Mean age (SD) was 75.4 (10.4) years, 62.0% female. Surgery was for first eyes in 58.5%, under local anaesthesia in 95.5% and by phacoemulsification in 99.7%. Trainees performed 33.9% of operations. Preoperative visual acuity (VA) was 6/12 or better in 42.9% eyes overall, in 35.3% first eyes and in 55.3% second eyes. Complication rates included the following: posterior capsule rupture and/or vitreous loss of 1.92%, simple zonule dialysis of 0.46% and retained lens fragments of 0.18%. Postoperative VA of 6/12 or better (and 6/6 or better) was achieved for 91.0% (45.9%) of all eyes, 94.7% (51.0%) of eyes with no co-pathologies and 79.9% (30.2%) of eyes with one or more co-pathologies respectively. The CND is fit for purpose, is able to deliver useful benefits and can be collected as part of routine clinical care via EPR systems. This survey confirms shifts in practice since the 1997–1998 UK National Survey with full conversion to phacoemulsification, better preoperative acuity, a halving of the surgical ‘index’ benchmark complication of posterior capsule rupture and/or vitreous loss, and improved VA outcomes.

We have investigated the role chondroitin sulfate has on cell interactions during neural plate formation in the early chick embryo. Using tissue culture isolates from the prospective neural plate, we have measured neural gene expression profiles associated with neural stem cell differentiation. Removal of chondroitin sulfate from stage 4 neural plate tissue leads to altered associations of N-cadherin-positive neural progenitors and causes changes in the normal sequence of neural marker gene expression. Absence of chondroitin sulfate in the neural plate leads to reduced Sox2 expression and is accompanied by an increase in the expression of anterior markers of neural regionalization. Results obtained in this study suggest that the presence of chondroitin sulfate in the anterior chick embryo is instrumental in maintaining cells in the neural precursor state.

Local anaesthesia (LA) is increasingly common in vitreoretinal surgery. However, younger patients often have such surgery under general anaesthesia (GA). We reanalysed the anaesthetic practice for vitreoretinal surgery in our unit over a 19-month period. A total of 1003 patients undergoing vitreoretinal surgery between August 2000 and February 2002 were studied. Type of surgery, patient pain score to anaesthesia and surgery, need for sedation and incidence of complications related to the local anaesthetic were recorded. Comparisons were made between this case series and previous data from our unit. In total, 920/1003 (91.7%) patients had LA. Total operations comprised 418 vitrectomies, 518 retinopexies with or without vitrectomy and 67 buckling procedures. More patients under the age of 35 years had LA than previously (60.2 vs35.7%, P

Background The use of local anaesthesia (LA) for vitreoretinal (VR) surgery is growing although surgeons in the UK traditionally use general anaesthesia. Purpose To assess the use and attitudes towards local anaesthesia for VR surgery among the members of the British and Eire Association of Vitreo-retinal Surgeons (BEAVRS). Methods A questionnaire was sent to members of BEAVRS. Use of LA was assessed for the following procedures: macular hole; diabetic vitrectomy; vitrectomy; cryopexy and gas; buckling and re-buckling procedures. Attitudes of surgeons generally using LA for primary retinal detachment surgery (< 50% of cases) were compared with those generally using general anaesthesia (GA) (< 50% of cases). Results 33.6% of surgeons preferred LA for macular hole; 26.2% for diabetic vitrectomy; 23.3% for vitrectomy, cryopexy and gas; 21.4% for buckling procedures; and 9.35% for re-buckling procedures. When surgeons routinely using LA were compared with those regularly using GA they considered LA less stressful for patients and surgeon, patients tolerant to longer operations, and buckling or redo surgery no more difficult under LA. However, both groups considered surgery on young patients and teaching relatively more difficult under LA. Conclusion The use of LA may convey benefits for VR surgery and faster rehabilitation for patients. However, we identified wide variations in the use of and attitudes to LA for VR surgery in British surgeons.

BACKGROUND/AIMS—Digital imaging is widely used for diabetic retinopathy screening. The storage and transmission of digital images can be facilitated by image compression. The authors aimed to assess the effect of image compression on the accuracy of grading diabetic retinopathy. METHODS—Forty nine 35 mm transparencies (17 with no retinopathy, eight with background, five with preproliferative, and 19 with proliferative retinopathy) were digitised and subjected to JPEG compression by 90%, 80%, 70%, and 0%. The 196 images were randomised and graded on a portable computer. Two masked graders assessed the images for grade of retinopathy and image quality (0-10). The sensitivity and specificity of retinopathy grading were calculated with a weighted kappa for grading agreement between levels of compression. RESULTS—The sensitivity of retinopathy grading was reduced by JPEG compression. At 90%, 80%, 70%, and 0% compression the sensitivities were 0.38, 0.50, 0.65, and 0.72, respectively; the specificity results were 1.00, 1.00, 0.83, and 0.84, respectively; and the weighted kappa scores were 0.60, 0.75, 0.77, and 0.84, respectively. The quality scores for 90%, 80%, 70%, 0% compression were 2.9 (SD 1.1, 95% CI; 2.7-3.2), 4.6 (SD 1.1, 95% CI; 3.0-5.6), 5.8 (SD1.5, 95% CI 5.0-6.6), 6.3 (SD1.4, 95% CI; 5.4-7.2) (p

The use of molecular visualization software has made a tremendous impact in the biochemistry and cell biology classroom. Instructors no longer have to rely on static images in textbooks to teach the structural nature of biological molecules. The emergence of many different molecular graphics programs and technology-based classrooms has enhanced the ability of instructors to teach structural concepts such as noncovalent interactions and levels of organization in proteins. Many web-based tutorials are also available for instructors to use during lecture or for students to explore outside of the classroom. Students can also obtain hands-on experience with the graphics programs to explore the structural aspects of macromolecular systems. This report shows that students involved in visualization projects become skilled at identifying various structural motifs they have discussed in class or are discovering for the first time. This student-centered approach enhances the ability of students to comprehend structural concepts and to realize the importance of weak interactions in the structure of large molecules. [Chem. Educ. Res. Pract. Eur.: 2001, 2, 109-122]

This review highlights the history of the development of treatments for choroidal neovascularization (wct AMD). It examines how drug therapies have evolved for the management of age-related macular degeneration (AMD) and the value of randomised clinical trials in determining efficacy. Finally it examines the emerging practice of utilising bevacizumab for the treatment of choroidal neovascularization despite the lack of any phase III clinical trial data.

Highly sulfated proteoglycans are correlated with axon boundaries in the developing central nervous system which suggests that these molecules affect neural pattern formation. In the developing mammalian retina, gradual regression of chondroitin sulfate may help control the onset of ganglion cell differentiation and initial direction of their axons. Changes induced by the removal of chondroitin sulfate from intact retinas in culture confirm the function of chondroitin sulfate in retinal histogenesis.

Macular phototoxicity is known to occur with laser use, and there is evidence that the wavelength of the light used influences this effect. In this study, a computer based colour contrast sensitivity test was used to assess the immediate macular effects of photocoagulation of peripheral flat retinal holes in otherwise normal retinas, using blue-green (488 and 514 nm), yellow (577 nm), orange (595 nm) or red (647 nm) laser light. The laser aiming beam was not allowed to traverse the macula at any stage during treatment. No protan or deutan axis threshold changes were noted in the 17 patients tested irrespective of the laser wavelength used. Tritan axis sensitivity was significantly reduced one hour after treatment with the blue-green laser, but no tritan axis change was found after treatment with longer wavelength lasers. The effect was no longer present the day after treatment in the subjects tested. The results show that even peripheral retinal treatment with blue-green laser can cause acute macular phototoxicity.

Purpose To establish current opinion as to whether ophthalmologists with conjunctivitis are fit to work. Methods One hundred and sixty ophthalmology units in the United Kingdom were sent a postal survey enquiring about work practices when an ophthalmologist contracts conjunctivitis. Results One hundred and five replies were received. Twenty-nine per cent of respondents said the ophthalmologist should stay off work while 7% said he or she should continue as usual. There was no concordance as to whether viral or bacterial conjunctivitis posed a greater problem. There is evidence that ophthalmologists have been implicated in the spread of epidemics of viral conjunctivitis but also reports of ophthalmologists who have continued to work with no reported spread of infection. Conclusion In view of the lack of consensus the authors are unable to recommend evidence-based clinical guidelines, but would suggest that use of modern diagnostic laboratory techniques may help in making the decision as to whether to continue at work or not.

We report the results of a randomised treatment trial of macular grid photocoagulation in 91 eyes with diffuse diabetic macular oedema followed up for at least two years comparing Krypton red with Argon blue/green lasers. At two years, macular oedema had improved equally in both groups, and the visual acuity was unchanged or better in 85% of eyes treated with Argon and in 79.5% of eyes treated with Krypton laser. No statistically significant differences were observed between the two groups in terms of visual acuity or the degree of oedema. We conclude that the observed effect of grid laser treatment in diffuse diabetic macular oedema did not depend on the wavelength of the laser light used in this study.

Rectal involvement from prostate cancer occurs in 1.5-11% of cases. A rarer presentation is that of a separate metastasis to the high rectosigmoid colon causing an annular stricture. We present our experience with six such cases who presented with gastrointestinal symptoms. Two of the cases had undergone intestinal resections. All 6 patients had radiographic evidence of an annular stricture in the rectosigmoid area. Retrospective review revealed evidence of metastatic disease in all cases in the form of abnormalities in one or more of the following: intravenous urography, radionuclide bone scan, liver spleen scan, acid phosphatase, or alkaline phosphatase. The mean survival was 9.3 months. This rare presentation of prostate cancer may be difficult to distinguish from primary colorectal cancer and therefore needs to be ruled out to avoid intestinal resections.

The primary aim of this large pilot survey was to demonstrate the use and benefits of electronic data collection with respect to rapidly monitoring the access, delivery, and outcome of cataract surgery in the NHS and to update benchmark standards for these parameters of care. Eight NHS departments that currently use specialty-specific electronic clinical systems or Electronic Patient Records (EPR) to collect a minimum preoperative, operative, and anaesthetic data set for cataract surgery agreed to pool their data. A total of 162 surgeons from 50 consultant teams and eight NHS Trusts agreed to submit their data on a total of 16 541 operations for age-related cataract. This report describes the age, sex, and ethnic profiles of the patients, waiting time for surgery, ocular copathology causing a reason for a guarded visual prognosis, visual impairment on admission, visual acuity in the operated eye, and the characteristics of the anaesthetic and surgical procedures. This survey has raised the benchmark standards established by the last National Survey in 1997. There has been a near universal switch to day case, phacosurgery under local anaesthesia (all used in ≥99.1% of cases compared with 70, 77, and 86%, respectively in 1997). The visual impairment in the operated eye is lower with 45% having 6 / 12 or better compared with 27% in 1997. Waiting times and visual impairment in the fellow eye have probably improved although data collection for these variables was incomplete. All departments require specialty-specific clinical systems to efficiently collect and analyse these data and this survey proves their potential to form the basis for national electronic surveys in the future.

Purpose Digital images are increasingly being used in ophthalmology. These may be viewed either on thin-film transistor (TFT) or on cathode-ray tube (CRT) displays. However, there is little data showing which is superior. In this study, we compared the performance of CRT and TFT displays for grading of both compressed and uncompressed images of diabetic retinopathy. Methods A total of 49 35 mm transparencies of diabetic retinopathy were scanned and compressed. The images comprised 17 with no retinopathy, eight with background, five with preproliferative, and 19 with proliferative retinopathy. Four levels of compression were used: 0, 70, 80, and 90%. A total of 196 randomised images were presented to two masked graders using both TFT and CRT displays under uniform lighting conditions, 2 months apart. The grade of retinopathy was assessed. Statistical analysis of grading accuracy was performed using receiver operator characteristic curves of sensitivity and specificity and the Stuart–Maxwell test for paired, nonparametric data. Results Both displays showed high sensitivity and specificity for the detection of any retinopathy. For the specific grade of retinopathy, the CRT performed slightly better with a sensitivity of 0.80 for uncompressed images, compared with 0.75 using the TFT. Compression reduced these sensitivities to 0.73 on the CRT and 0.63 on the TFT. Grading of uncompressed images magnified to four times their original size was more accurate on the TFT. Conclusions Grading on both displays met sensitivity and specificity criteria proposed by Diabetes UK (formerly British Diabetic Association) for screening of diabetic retinopathy. The CRT generally performed slightly better than the TFT in relation to the detection of the specific grade of retinopathy.

BACKGROUND--Previous studies have shown that ophthalmologists using blue-green argon laser may suffer subtle defects in their colour vision. A reduction in colour contrast sensitivity in the tritan colour confusion axis, an early manifestation of blue cone photoreceptor injury by the high energy photons of the laser, has been demonstrated and has prompted a reappraisal of laser safety in ophthalmology. Argon laser is also frequently used in scientific research, often at higher power output and for longer periods than is used in clinical practice. The scientists operating these lasers are at risk of developing similar phototoxic retinal injury. METHODS--The colour contrast sensitivity of 18 scientists who regularly use short wavelength argon laser was investigated. RESULTS--Eye protection was infrequently used and individuals had been subjected to between 580 and 7200 hours of cumulative laser exposure during the course of their research. CONCLUSION--The use of blue-green argon laser by the scientists investigated was not associated with a significant reduction in colour contrast sensitivity.

With the objective of examining the structure, staffing and policies for screening in diabetes miniclinics in general practices throughout a health region in the United Kingdom, a telephone study was conducted of 296 practices which had applied for permission from the local Family Health Servic Authority (FHSA) to conduct a diabetes clinic. All the clinics offered services to people with diabetes within the five FHSAs which comprise the region of Wessex. Of the practices contacted, 286 (97%) provided information. Of these, 249 (84%) were conducting diabetes clinics which covered 65.4% of the Wessex population; 207 (83%) of the clinics were run in practices with a computerised record system. The most common model of care in 120 clinics (48%) was one in which each GP reviewed his or her own diabetic patients. The types of diabetic patients reviewed showed that 55% of the practices contacted saw both insulin-dependent (IDDMs) and non-insulin-dependent (NIDDMs) diabetics; 28% of the clinics saw mainly NIDDMs with few IDDMs; and 12% of the clinics reviewed solely NIDDMs. In all, 23% of the clinics contacted never checked visual acuity and 23% never examined the fundus. Fundal examination through a dilated pupil occurred in fewer than half of the clinics (47%) and only 35% performed a full screening of visual acuity and dilated fundal examination. It is concluded that the services offered to diabetic patients attending clinics in general practice are inadequate for the purpose of eye screening and will fail to detect much treatable pathology.

Objectives: (1) To measure the force required to perforate the globe with various retrobulbar needles. (2) To determine the effects of angle of penetration on the force required to penetrate the globe. (3) To compare the force required to penetrate the globe with the force required to penetrate the skin. Study Design: Cadaver eyes were perforated with ultra-sharp, blunt disposable and reusable retrobulbar needles. The force required for each perforation was measured using a Pioden UF1 solid state load transducer. Setting: A laboratory based study. Results: Compared with a sharp needle, twice the force is required to penetrate the globe with a blunt disposable needle, and four times the force with a reusable needle. The angle of penetration does not affect the penetration force. The force required to penetrate the sclera is approximately three times that needed to penetrate the skin, irrespective of the needle used. Conclusion: The benefit of using a blunt retrobulbar needle to reduce the risk of scleral perforation during retrobulbar injections has not been confirmed. Because sharp retrobulbar needles are less traumatic and minimal resistance to its passage through the skin allows greater control, we favour their use.

BACKGROUND—Vitreoretinal (VR) surgery has been increasingly performed under local anaesthesia (LA) in this unit. The results of an audit monitoring this change are presented. METHODS—Data were collected on 1497 patients including type, volume, and position of the anaesthetic block, type of surgery, complications, and patient reactions. RESULTS—1221/1479 (82%) patients had LA. They were older than those having general anaesthesia (GA) 63.5 years v 45.9 years; 146 (10.6%) blocks were intracone, 130 (10.6%) peribulbar, and 927 (75.9%) combined. Operations included 436 vitrectomies, 545 retinopexy with or without vitrectomy, and 238 buckling procedures. Some pain was felt by 9.4%, 8.8%, and 19.7% of patients during vitrectomy, retinopexy with or without vitrectomy, and buckling surgery respectively. CONCLUSION—Local anaesthesia for VR surgery is well tolerated by patients, being effective throughout longer and more stimulating ocular surgery.

Avian gastrulation is dependent on the ingression of outer layer cells into the interior of the embryo by means of a transient structure referred to as the primitive streak. As the growing streak progresses through the central area pellucida of the blastoderm, selective de-epithelialization of epiblast cells results in the initial migratory cells of the primitive mesoderm and endoderm. Here, we have examined the possibility that extracellular matrix molecules of the epiblast basal lamina influence the selection of streak-specific epiblast cells. By using whole embryo culture, we have found that removal of chondroitin sulfate glycosaminoglycans at gastrulation stages leads to defective streak formation. In situ hybridization with streak-specific markers in these embryos reveals ectopic patterns of gene expression, suggesting that differentiation of primitive streak precursors in the pregastrula epiblast is independent of normal streak morphogenesis. In addition, in vitro assays with chondroitin sulfate containing matrices suggest that specific cells of the epiblast are inhibited from joining the streak during gastrulation. Taken together, these results indicate that the presence of chondroitin sulfate in the epiblast basal lamina facilitates the allocation of cells to the primary germ layers by preventing ectopic axis formation. © 2000 Wiley-Liss, Inc.

The effect on macular function of the wavelength of laser light used to treat proliferative diabetic retinopathy was studied. Thirty-six eyes of 25 patients received panretinal photo-coagulation according to a standardised protocol and before and at intervals after the treatment were tested by a battery of macular function tests. Each eye was randomly assigned to treatment with blue-green, yellow, or orange laser. The tests included best corrected visual acuity, colour vision, contrast sensitivity, macular threshold, and central visual fields. There were no significant differences in the results of these tests between the three treatment groups, though there was wide scattering of baseline values within each group. Laser wavelength has not been shown to be an important determinant of central visual function following panretinal photo-coagulation in patients with proliferative diabetic retinopathy within the wavelengths tested.

The epidemiological research potential of such a resource is obvious A recent survey of ophthalmologists in the United Kingdom showed that 30% have access to electronic patient records (EPR), and about two thirds of these used the EPR for almost all of their cataract surgery.1 That shows great progress over the past few years—one wonders if they appreciate quite what they are achieving. They are building the most powerful database of cataract surgery the world has ever seen. Will it one day turn on them and devour them?—great good can come from the use of data, but also great evil. We stand at a crossroad right now and which road we take will shape our individual and collective destinies, our relationship with patients, and our standing in society. While patient records continue to be written on paper, individual surgeon performance is available in theory but in practice it is hidden. The sheer number of patient notes on those long shelves in the hospital basement is as good an impediment to casual scrutiny as any lock and key. Layer upon layer of obstacles lie in wait for any who dare audit the data—identifying the relevant records, locating them, deciphering them, abstracting necessary gems and collating these. At each obstacle a little integrity is lost such that the output is a subset of a subset of a temporal cross section of what …

Postoperative hematoma, edema, and ecchymosis are the most common complications in scrotal surgery. Without proper hemostasis intraoperatively or appropriate scrotal compression postoperatively, significant morbidity, including re-exploration and prolonged convalescence, can occur. The scrotal hitch provides hemostasis, minimizes edema and hematomas, and reaffirms other clinicians' findings.

In a model of astrogliosis in vitro, cultured cortical astrocytes were triggered into a functionally reactive state by an immobilized fragment of the β-amyloid peptide. Induced astrocytes produced an extracellular matrix that inhibited the outgrowth of embryonic CNS axons. Within the extracellular matrix deposited by reactive astrocytes, we found an overall increase in the deposition of chondroitin sulphate that accounted for the inhibition. Specifically, we have detected an increased biosynthesis of a small chondroitin/heparan sulphate proteoglycan that is a potent inhibitor of axon outgrowth. We further suggest that this proteoglycan, or related molecules yet to be discovered, may play a role in gliosis-mediated regenerative failure of CNS axons. Copyright © 1996 ISDN.

Encirclement of the eye as part of a retinal detachment repair is known to raise the post-operative intraocular pressure. We studied the effect of anticipating this pressure rise by giving perioperative acetazolamide to patients having vitrectomy and encirclement procedures. Two groups (9 with acetazolamide and 14 without) were matched for biographic variables, type of detachment and operation variables. The group given acetazolamide had lower day 1 post-operative intraocular pressures (mean 22.11 mmHg vs 36.36 mmHg, p = 0.002) and were able to go home sooner (mean 1.56 days vs 3.29 days, p = 0.001). No adverse effects of short-term acetazolamide use were noted in this study. We conclude that patients having extensive scleral buckling procedures should all receive prophylactic acetazolamide unless it is specifically contraindicated.

A variety of inflammatOry proteins has been identified, particularly in the vicinity of /3-amyloid plaques, in the brain of patients INith Alzheimer's disease. Current findings indicate that these molecules are involved in a num?er of key steps in the parbological cascade. Activation products of ClasSICal complement pathway Clq, C4 and C3, but not the alternative pathway factor properdin, have been demonstrated in diffuse and classical plaques. In addition, complement receptors (CR3 and CR4) bearing cells are found within classical plaques. There are contradictory findings about the question whether or not the late complement proteins that can form the membrane attack complex, are present in Alzheimer's disease brains. In this chapter we review the findings indicating that complement activation in amyloid plaques does not proceed further than C3. The idea is discussed that in Alzheimer's disease, complement does not function as an inflammatory mediator through membrane attack complex formation, but through the action of early complement activation products.