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Andrew M Williams,* Benjamin Botsford,* Peter Mortensen, Daniel Park, Evan L Waxman Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA *These authors contributed equally to this work Objective: The objective of the study was to characterize the population served by the student-led Guerrilla Eye Service (GES), a mobile outreach program that delivers comprehensive ophthalmic care to underserved communities in the greater Pittsburgh area.Patients and methods: Patients attending GES missions at a single urban free clinic from 2012 through 2017 were included in this retrospective case series. All patients underwent a comprehensive eye examination at no cost, with referral to a university eye clinic if necessary. Demographic characteristics, past ocular history, reasons for attendance, and ophthalmic diagnoses were recorded. Attendance rates and treatment outcomes of patients referred to the university eye clinic were also reviewed.Results: We reviewed records of 360 GES patients (mean age 43 years, age range 1–79 years; 56% [200] male; 37% [133] non-English speakers). The most common reasons for attending were blurry vision (28% [101]), need for new glasses (22% [80]), and referral for a diabetic eye exam (18% [63]). The most common diagnosis made was refractive error (59% [214]), and vouchers for free spectacles were provided. One-third of diabetic patients had retinopathy (32% [38]). Glaucoma suspect (11% [40]), narrow angles (4% [13]), treatment-requiring diabetic eye disease (4% [14]), and visually-significant cataract (3% [11]) were diagnoses that most often prompted referral to the university clinic. In all, 114 patients were referred (32%), of whom 82 (72%) attended the follow-up visit. Other patients continued to receive longitudinal care through GES.Conclusion: Medical student-led outreach programs under the supervision of an attending ophthalmologist can deliver regular eye care to underserved communities while providing referrals to a university clinic for those with advanced disease. Keywords: vision health, public health, mobile medical care, eye care, education, community engagement

Andrew M Williams,1 Kelly W Muir2,3 1Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; 3Durham VA Medical Center, Health Services Research and Development, Durham, NC, USA Abstract: There is a severe shortage of donor corneas available worldwide for transplantation, with the number of patients in need of transplant greatly exceeding the number of cornea tissues available. Understanding awareness and attitudes about corneal donation worldwide is a critical step toward addressing this shortage. In this review, awareness of corneal donation and reported willingness to donate are summarized from 55 published studies across 13 countries. In general, many more respondents indicated positive attitudes toward eye donation and willingness to donate their eyes than the number of respondents who have pledged their eyes for donation, suggesting an unrealized potential of additional donors. Specifically, of 38,851 respondents across all included studies, 52% endorsed a willingness to donate their eyes after death, yet only 5% reported being a pledged donor. The most commonly cited reason for not being a registered eye donor was lack of awareness about eye donation. The disconnection between the large number of people who expressed willingness to donate and the scarcity of individuals who have pledged their eyes for donation could be addressed through educational media campaigns, collaborations with medical personnel, partnerships with grief counselors and religious leaders, use of social media, and educational sessions with medical students and staff. Keywords: eye donation, corneal transplantation, attitudes, eye bank, organ donation

Andrew M Williams,1 Wei Huang,2 Kelly W Muir,3,4 Sandra S Stinnett,3 Jordan S Stone,5 Jullia A Rosdahl3 1Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Charlotte Eye Ear Nose & Throat Associates, Charlotte, NC, USA; 3Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA; 4Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA; 5School of Medicine, University of California San Diego, La Jolla, CA, USA Purpose: To examine the factors associated with blindness from primary open-angle glaucoma (POAG) among black and white patients at our institution.Patients and methods: For this retrospective, case–control study, patients legally blind from POAG (“cases”) were matched on age, race, and gender with non-blind POAG patients (“controls”). Thirty-seven black case–control pairs and 19 white case–control pairs were included in this study. Clinical variables were compared at initial presentation and over the course of follow-up.Results: Black case–control pairs and white case–control pairs had similar characteristics at presentation, including cup-to-disc ratio and number of glaucoma medications. However, over the course of follow-up, black cases underwent significantly more glaucoma surgeries than matched controls (2.4 versus 1.2, p=0.001), whereas white cases and controls had no significant difference in glaucoma operations (0.9 versus 0.6, p=0.139). Our analysis found that glaucoma surgery is associated with blindness in black patients (odds ratio [OR] 1.6, 95% CI 1.1–2.2) but not in white patients (OR 1.5, 95% CI 0.7–3.2).Conclusion: Black and white case–control pairs with POAG shared similar risk factors for blindness at presentation. However, over the follow-up period, black cases required significantly more glaucoma surgeries compared to black controls, whereas there was no significant difference in surgery between white cases and controls. There was no difference in medication changes in either case–control set. Keywords: health disparities, glaucoma surgery, glaucoma treatment, glaucoma medications

Energetic films were synthesized using stress altered nano-aluminum particles (nAl). The nAl powder was pre-stressed to examine how modified mechanical properties of the fuel particles influenced film reactivity. Pre-stressing conditions varied by quenching rate. Slow and rapid quenching rates induced elevated dilatational strain within the nAl particles that was measured using synchrotron X-ray diffraction (XRD). An analytical model for stress and strain in a nAl core-Al2O3 shell particle that includes creep in the shell and delamination at the core-shell boundary, was developed and used for interpretation of strain measurements. Results show rapid quenching induced 81% delamination at the particle core-shell interface also observed with Transmission Electron Microscopy (TEM). Slower quenching elevated dilatational strain without delamination. All films were prepared at approximately a 75 : 25 Al : poly(vinylidene fluoride) PVDF weight ratio and were 1 mm thick. A drop weight impact test was performed to assess ignition sensitivity and combustion. Stress altered nAl exhibited greater energy release rates and more complete combustion than untreated nAl, but reaction dynamics and kinetics proceeded in two different ways depending on the nAl quenching rate during pre-stressing.

Turbo-discharging is a novel approach that can better utilize the energy recoverable by a turbine (or series of turbines) mounted in the exhaust flow of internal combustion engines. The recovery of blowdown pulse energy in isolation of displacement pulse energy allows the discharging (depressurization) of the exhaust system to reduce engine pumping work and improve engine fuel economy. This is a novel approach to air system optimization that has previously been studied for naturally aspirated engines. However, to be successful, turbo-discharging should be applicable to turbocharged engines, as downsizing is a promising direction for future powertrain systems.This study uses one-dimensional gas dynamics modelling to explore the effect of turbo-discharging on a turbocharged gasoline engine, particularly focusing on the interaction with the turbocharging system. The results show that the peak engine torque is increased at low to mid speeds with high speed torque slightly reduced due to restrictions in engine breathing with low lift exhaust valves. The engine peak torque as a function of speed with a larger turbocharger and turbo-discharging was comparable to that of the smaller turbocharger without turbo-discharging. Fuel economy improvements were evident over most part-load regions of the engine map, with peak values varying from 2 to 7% depending on the baseline engine air system strategy. Hot trapped residual mass was consistently reduced across a large fraction of the engine map, with the exception of high power conditions, where the valve pressure drop effect dominated. This is expected to enable spark advance and further fuel economy benefit.The results from this study are promising and show that the use of some of the available exhaust gas energy for turbo-discharging in preference to turbocharging can have a positive effect on both part-load and full-load engine performance. There remains significant potential for further optimization with application of variable valve actuation and turbocharger control systems (for example, variable geometry turbines). [ABSTRACT FROM AUTHOR]

Thomas de Quincey, a British writer of 19th century, suffered insomnia from the age of 17 years. In his famous "Confessions of an English-Opium Eater" (1822), he described a symptomatology that could concord with restless legs syndrome long before he became addicted to opium. In this report, we analyze his clinical description and the circumstances leading to his opium addiction. [ABSTRACT FROM AUTHOR]

The experiences of living renal donors in Western Australia were explored using the qualitative method of grounded theory. Data were collected through 18 tape-recorded interviews with donors. Two main categories were identified that related to the physical and psychological reactions that occurred following surgery. This study provides insights (both positive and negative) into the donation experience. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper describes the development and preliminary psychometric testing of an instrument that evaluates the emotional care experienced by patients during hospitalisation. Background. Previous qualitative work using the Grounded Theory method identified the characteristics of interpersonal interactions that hospitalised patients perceived to be therapeutic. Three conditions were associated with the patient's experience of emotional comfort: the patient's perceived Level of Security, Level of Knowing and Level of Personal Value. Questions relating to each of these conditions were included in this new instrument. Design. Instrument development and psychometric testing. Method. Preliminary psychometric testing was carried out in four phases: construction of the instrument; assessment of face and content validity; testing for clarity and feasibility for use with hospitalised patients; assessment of reliability, construct validity of the tool and assessment of the internal structure. Conclusions. A hospital-wide survey was carried out and the instrument was completed by a total sample of 132 patients. Two of the three sub-scales achieved an internal consistency estimate of at least 0·70. The construct validity of the tool confirmed the previously identified characteristics of patients in need of additional emotional care. Exploratory factor analysis established two of the sub-scales and identified a fourth sub-scale which was named 'Level of Connection'. Encouraging reliability and validity estimates were obtained and the instrument was improved. Further testing with larger samples is recommended. Relevance to clinical practice. This questionnaire, which is completed by hospitalised patients, differs from other instruments because it evaluates the interactions of all hospital staff rather than only nursing staff. This instrument can be used to identify patients who may be in need of additional emotional care and to evaluate the effectiveness of interventions directed at improving the emotional well-being of patients. [ABSTRACT FROM AUTHOR]

Background: Decision making in the context of palliative care is particularly complex given the unpredictable illness trajectories experienced by patients and the number of individuals who may be part of decision-making processes. This study aimed to describe the significant issues that influence the processes of care decision making, from the perspective of patients with advanced illness.Methods: Patients (14), family members (7) and health professionals (18) were interviewed and field observations (100 h) of decision-making practices were undertaken in two Australian palliative care services. A systematic approach using grounded theory to collect and analyse the data was used to develop a theory of decision making from the patient's perspective.Results: The main issue experienced by palliative care patients was identified as a lack of involvement in decision making. One of the significant factors affecting the decision process is the type of relationship with health professionals that patients believe enhances their involvement in decision making. This was determined by the manner and focus of the health professional, their trustworthiness as well as the healthcare culture and environment. This paper provides a greater understanding of the perspective of patients in relation to their involvement in decisions related to palliative care. [ABSTRACT FROM AUTHOR]

International mobility provides opportunities for learning and knowledge transfer by health care workers, with significant potential benefits for countries of destination and, in the case of returned migration, countries of origin. This is examined using a typology that recognizes four types of tacit knowledge: embrained, embodied, embedded, and encultured. There are, however, constraints to learning and knowledge transfer in the form of professional and social recognition as well as language barriers and power relationships. These theoretical ideas are explored through a case study of internationally mobile Slovak doctors after their return to Slovakia. Individual learning and knowledge sharing with colleagues, both abroad and after return, are analysed through in-depth interviews. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This paper describes a translational project that explored the feasibility and effect of introducing a coordinated approach to emotional care. METHODS: The project was undertaken using Action Research on one ward at St John of God Hospital Subiaco, Western Australia. A senior Registered Nurse was appointed to provide the leadership and direction to staff regarding emotional care and an education program for staff was provided. The project was evaluated using both quantitative and qualitative data. RESULTS: Data demonstrated an increase in the patient's evaluation of emotional care, although levels were found to fluctuate throughout the project. Factors such as the emotional distress of the staff were hypothesised as impacting on the delivery of emotional care. CONCLUSION: The approach used in this project was found to be a useful method of improving emotional care. However, the data collected in this study revealed the complexity of emotional care delivery and the possible impact of a number of factors within the environment. PRACTICE IMPLICATIONS: Emotional care delivery can be improved by using a coordinated research-based educational approach led by a clinical champion. However, the impact of other factors within the hospital environment needs to be considered and more research is required. [ABSTRACT FROM AUTHOR]