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The Arbuckle Group aquifer is the principal disposal zone for oil and gas field brines and hazardous/nonhazardous wastewater across the U.S. midcontinent and is traditionally viewed as an infinite capacity aquifer. Thousands of wells annually dispose hundreds of millions of barrels of wastewater into the aquifer across Kansas and Oklahoma, but direct links between injection and recent increases in seismicity have been hindered by a lack of pressure data for the Arbuckle Group. Here we present a newly compiled data set for 49 wells across Kansas that provides a unique perspective on the aquifer's performance over two decades. Statistical analysis of falloff test pressures, static fluid levels, and injection volumes shows that Arbuckle pressures and fluid levels are rising, recently at faster rates, likely associated with increased wastewater injection. The new data also suggest that the pressure diffusion, the primary driver of induced seismicity, can reach distances up to 25 km from an injection point and is connected to static fluid level rises. The compiled dataset explains the recent surge in midcontinent seismicity. The data set also suggests that the Arbuckle has finite storage capacity and that wastewater disposal across parts of the midcontinent may soon require alternatives. Key Points: Two decades worth of pressure and static fluid level data are compiled from legacy reports for Arbuckle Group injection wells in KansasArbuckle Group pressures and fluid levels are rising, recently at faster rates, likely associated with increased wastewater injectionDocumented pressure increases explain the recent surge in US midcontinent seismicity [ABSTRACT FROM AUTHOR]

Purpose Addressing the need for increased capacity in glaucoma follow‐up clinics by delegating resposibility to a trained nurse practitioner. A specialist hospital‐based study. Methods A senior nurse practitioner (NP) was trained by a glaucoma specialist in the management of glaucoma follow‐ups. Once training was completed, glaucoma cases were transferred to NP‐led clinic for follow‐up alongside consultant clinic. Certain criteria had to be met for inclusion in NP clinic: 1.Good compliance and control on topical treatment+/‐laser 2.Stability of visual fields over previous 3 years 3.No post‐surgical cases 4.No complex cases or co‐morbidities Results 200 follow‐up cases were accomodated in NP clinic over a period of 3 years, thus adding capacity to an increasingly overburdened service.There were no cases lost to follow‐up, a non‐attendance rate of 2% and no cases had a progression of visual fields MD>0.75dB/year. The most frequent reasons for seeking advise of the specialist were the need to change treatment regime due to increasing IOP (10%),or poor comliance/tolerability to treatment (10%). Conclusion 1.NP‐led clinics add capacity without compromising on standard of care 2.NP skills and confidence improved with regular practice 3.Patients' experience was excellent 4.Capacity was freed up in consultant clinic to see more complex cases in a timely manner 5.Training does take a long time 6.In order to run smoothly and safely the NP‐led clinic had to be alongside the consultant clinic 7.There is a limit to the number of cases that can be seen in NP clinic without compromising on quality of care. [ABSTRACT FROM AUTHOR]

Purpose To assess outcomes of trabeculectomy surgery augmented with Mitomycin C (MMC) applied trans‐conjunctivally. Methods An MMC applicator (Duckworth and Kent, UK) was developed for drug delivery. Fornix‐based conjunctival flap dissection was performed in each trabeculectomy case after trans‐consjunctival MMC application for 3 min. A retrospective, case‐note study was conducted. Records of patients who underwent the procedure over a one‐year period, were analysed. Duration of follow‐up, intraocular pressure (IOP) at last follow‐up, and complications were noted. Results 33 eyes of 28 patients were included. 23 eyes had primary open angle glaucoma, 5 had chronic narrow angle glaucoma, 2 had ocular hypertension and 3 had secondary open angle glaucoma. Mean follow‐up duration was 8.4 months (range 3‐15 months). Mean IOP at last follow‐up was 11.9 mm Hg (range 2 to 21). Proportions of patients achieving IOPs at last follow‐up of less than or equal to 12, 15, 18 and 21 mm Hg were 66.7%, 72.7%, 93.9% and 100% respectively. Two eyes (6.1%) had an IOP of 6 or below at last follow‐up. Eight eyes (25%) required further needling or antimetabolite injection (2 of these underwent bleb revision). Other complications included choroidal effusions (4 eyes, 12.1%), transient bleb leakage (2 eyes, 6.1%) and corneal decompensation (1 eye, 3.0%). Conclusion IOP outcomes in this preliminary study of trans‐conjunctival MMC application are comparable to those reported using the more conventional subconjunctival application of MMC (WuDunn et al. Am J Ophthalmol. 2002;134:521‐8; Wilkins et al. Cochrane Database Syst Rev. 2005;4:CD002897). Thus trans‐conjunctival application may be a viable alternative. A larger study is underway comparing the two methods. [ABSTRACT FROM AUTHOR]

Purpose We tested eye protection used for phototherapy patients. The study also established current practice concerning eye protection in a sample of UK phototherapy units. Methods The ultraviolet (UV) transmission spectra of 30 'UV protective' contact lenses were measured at 5 nm intervals between 290 and 400 nm. Sunglasses, small UV goggles and UV visors were tested between 270 and 420 nm. We surveyed the use of eye protection during phototherapy in 78 UK phototherapy units. Results All samples of sunglasses, eye protection goggles, visors and sunglasses comfortably passed previously published arbitrary limits of acceptability. Most contact lenses showed some protection in the UVB, but most had little or no UVA protection. Of 78 UK phototherapy units 21 (33%) use tinted goggles during UV exposures, two (3%) use a visor only, 28 (43%) use both and nine (14%) use clear plastic (probably polycarbonate) goggles. Conclusion UV transmission for sunglasses and contact lenses is lower compared with samples tested 10 years ago. All samples of glasses, goggles and visors tested provided adequate protection in the UV range according to published arbitrary limits of acceptability. Most contact lenses did not provide significant UV protection in the UVA range. [ABSTRACT FROM AUTHOR]

Purpose Glaucoma has received very little attention in terms of how the internet influences patient behaviour. We assessed the quality of information accessed by sufferers from glaucoma using the internet. Methods The word 'glaucoma' was subjected to an advanced keyword search. This analyses average monthly search volumes over a 12 month period using the Google search engine. The search term 'glaucoma' was then inputted into Google and the first 5 pages of websites studied using a validated instrument. The 4 criteria published in the Journal of the American Medical Association (JAMA) for qualifying information from the internet were used in the analysis, yielding a possible score of between 0 and 4. Results 50 websites were studied. All 4 criteria were satisfied by 4% of sites; 3 criteria were met by 38%; 2 criteria by 6%; 1 criterion by 24%. 28% of sites scored zero for objective quality of information on glaucoma. Superior scores were achieved by peer‐reviewed journals and medipedias (online medical encyclopedias). Counter‐intuitively the websites of professional bodies including academic institutions scored poorly (mean 0.3, median 0, mode 0). Information provided by charities scored poorly also (mean 0.25, median 0, mode 0). The websites of public hospitals scored above average (mean of 3 (mode 3, median 3). This is different from the quality of information available in other fields such as retinopathy of prematurity, though is, overall, superior to the quality of information found recently in areas of oculoplastic surgery. Conclusion The quality of information accessed by patients on glaucoma is in need of improvement. This data is topical and of relevance to both clinicians and their patients in an age where more and more patients use the internet as a resource for healthcare information and misinformation. [ABSTRACT FROM AUTHOR]

Several centers turn patients down for long-term ventricular assist devices (VADs) once they have received extracorporeal life support (ECLS) due to the expected poor outcome in these patients. The aim of this study was to identify survival predictors in this cohort of patients. Data of patients undergoing VAD support between January 2010 and November 2013 were retrospectively reviewed. Patients on ECLS support before implantation were considered eligible for inclusion. Outcome in survivors following long-term VAD support was compared with outcomes in nonsurvivors. Student's t-test and χ(2)-test were used as applicable. A total of 65 long-term VADs were implanted. The inclusion criteria were met by 24 patients. Eight patients did not survive the first 30 days. All preoperative characteristics were comparable between the two groups except for statistically higher Model for End-stage Liver Disease (MELD) score, bilirubin, white blood cell count, and blood urea nitrogen in nonsurvivors (P = 0.002, 0.01, 0.01, and 0.003, respectively). Stepwise discriminant analysis revealed MELD score as the most important survival predictor. Based on this analysis, an outcome predictor formula was generated. The 30-day and 1-year survival rates were 67% and 54%, respectively. In this study, we were able to determine survival predictors in VAD patients with prior ECLS support. The outcome in these patients is limited and associated with higher postoperative complications, particularly right ventricular and respiratory failure. The pre-VAD MELD score is an important predictor of poor outcome., (Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)