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Purpose To study the longitudinal effect of anterior chamber inflammation on the corneal endothelium in children. Methods In this prospective longitudinal observational study, children (aged Results Ninety-nine eyes of 99 children (mean age (±SD): 10.0±4.1 years) with a history of anterior chamber inflammation were recruited. Mean follow-up was 12.3±3.5 months. Eleven children, who were under surveillance but had not developed JIA-associated uveitis were included as controls. While there were no significant differences in mean ECD between controls and subjects without prior surgery (group 1) at all time points, those who had prior ophthalmic surgery (group 2) displayed significantly lower ECD than the controls at recruitment (p=0.002) and at follow-up (p=0.004). However, longitudinal ECD assessments did not show significant changes in either group (group 1, p=0.07, group 2, p=0.54). On regression analysis, once the patient’s age was adjusted for, only the occurrence of intraocular procedures during the study (r=0.43, adjusted p=0.03) was associated with a significant annual rate of ECD loss. Conclusion During the study period, longitudinal ECD changes among children with uveitis were associated with intraocular surgery for uveitis-related complications but not uveitis activity. By reducing the need for surgical intervention, the corneal endothelium in these children may be preserved.

PURPOSE To investigate whether the safety of intracameral moxifloxacin (IC-Mox) was equivalent to subconjunctival antibiotics (SC-Abs) in pediatric lens surgery. SETTING The Hospital for Sick Children, Toronto, Canada. DESIGN Retrospective consecutive cohort study. METHODS This equivalence study compared 95% CI in the difference between the preoperative and postoperative safety variables of best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density (ECD), corneal edema, and anterior chamber (AC) inflammation in IC-Mox with SC-Abs. The zone of clinical equivalence for BCVA was set at ±0.2 logarithm of the minimum angle of resolution, IOP at ±3 mm Hg, CCT at ±30 μm, and ECD at ±400 cells/mm. RESULTS The charts of 358 patients undergoing lens-related surgeries were reviewed. Of 317 eyes (215 patients) included, 170 eyes received IC-Mox and 147 eyes had SC-Abs. The mean age was 4.9 and 5.1 years with a mean follow-up of 19 and 34.4 months (P < .001) in IC-Mox and SC-Ab groups, respectively. The 95% CIs for the change from preoperative to postoperative safety parameters between IC-Mox and SC-Abs were all in the zones of clinical equivalence (BCVA, P = 0.75; highest IOP in the first 6 weeks postoperatively, P = 0.27; IOP at the last visit, P = 0.74; CCT, P = 0.89; and ECD, P = 0.76). During the first 6 weeks postoperatively, there was no difference in corneal edema (P = .69) and AC flare (P = .4) between IC-Mox and SC-Ab groups, whereas AC cellular activity was significantly higher in the SC-Ab group (P = .028). CONCLUSIONS IC-Mox prophylaxis in pediatric patients showed equivalent postoperative safety outcomes when compared with SC-Abs. The use of IC-Mox (250 μg) for endophthalmitis prophylaxis appears to be safe in the pediatric population.

OBJECTIVE: To evaluate longitudinal endothelial cell characteristics of children with posterior polymorphous corneal dystrophy (PPCD). METHODS: In this prospective case-control study, children with PPCD were followed with slit-lamp photography and non-contact specular microscopy. Patient’s eyes were subdivided according to the clinical subtypes of PPCD (vesicular, band, diffuse, and unaffected) and the number of lesions present on the posterior corneal surface. Findings were then compared with age-matched controls. RESULTS: Thirty eyes of 15 patients with PPCD with a mean age 10.5 ± 3.1 years were analysed. Mean follow-up was 3.0 ± 1.0 years. PPCD morphology was vesicular in 40%, diffuse in 37%, band type in 10% and 13% had no detectable lesions despite contralateral involvement. Fourteen eyes (47%) had ≥5 endothelial lesions. Patients with PPCD had significantly lower endothelial cell densities (ECD) at recruitment (1918.9 ± 666.3 vs. 3340.1 ± 286.5 cells/mm(2), p

Engaging young citizens with drought risk and positive water behaviours is essential in domestic water demand management within the wider climate crisis. This paper evaluates a new research-informed, picture book—‘DRY: The Diary of a Water Superhero’—that explores UK drought. The book’s development was underpinned by research within the Drought Risk and You (DRY) project. The book’s concept and storyline were co-produced by an interdisciplinary team, including a creative practitioner. This focused on key themes: drought definitions and types, drought myths, adaptation and young people’s (YP) agency. Characters and storyline were co-created to promote YP’s autonomy as change agents, and to encourage intergenerational and community learning. This paper evaluates the book from three perspectives: of YP, trainee teachers (TT) and teachers. Emergent themes are triangulated: drought as a sensitive issue, subject knowledge and changes in behaviour, and YP’s misconceptions about drought and place. TT also contemplated their improved subject knowledge and barriers to engaging with positive water behaviours. Teachers reflected on classroom use of the book, prior experiences about teaching drought, curriculum context and st/age of YP engaged. This paper reflects on how these insights feed into school practice and water industry outreach, in developing effective learning resources that promote a valuing of water, behaviour change and wider hydrocitizenship among YP and their communities.

To compare the symptoms and signs of dry eye disease (DED) in children with systemic lupus erythematosus (SLE) with those in healthy children using common diagnostic tools.Prospective, observational, single-center cohort study. Thirty-four subjects with SLE and 15 healthy subjects were recruited from the Hospital for Sick Children in Toronto, Canada. Subjects underwent subjective and objective dry eye assessments using the Canadian Dry Eye Assessment (CDEA) questionnaire, tear film osmolarity, slit lamp examination, tear film break-up time, corneal fluorescein staining, Schirmer test 1, and conjunctival lissamine green staining.No difference in symptoms was found between children with SLE and healthy children (CDEA score 6.4 ± 5.4 vs. 3.8 ± 3.2; P = 0.09). Corneal staining was more prevalent in children with SLE than in healthy children (58.8% vs. 20.0%; P = 0.01), and children with SLE had higher mean corneal fluorescein staining scores (1.7 ± 1.7 vs. 0.2 ± 0.4; P = 0.002). No statistically significant differences in tear osmolarity, inter-eye differences in tear osmolarity, tear film break-up time, Schirmer test 1, or lissamine green staining scores were observed between the 2 groups. In healthy children, CDEA scores weakly correlated with corneal fluorescein staining score (r = 0.53, P = 0.04). In children with SLE, no correlation between CDEA score and any of the diagnostic test outcomes was found.There is discordance between symptoms and signs of DED in children with SLE. Corneal fluorescein staining is essential for the diagnosis of DED in these children.

Purpose To assess the impact of ocular trauma associated with obstetric forceps delivery on the corneal endothelium in children. Methods Five patients who attended the Hospital for Sick Children, Toronto, between 2013 and 2016 with a diagnosis of unilateral obstetrical forceps-related corneal injury were included. Clinical presentation, best-corrected visual acuity, corneal endothelial cell density (ECD, cells/mm), and measures of cellular morphology were obtained. Results The mean follow-up duration was 30 ± 10 months. Mean ECD in the affected eye at initial assessment was significantly lower than that of the fellow eye (2576 ± 733 vs. 3481 ± 288 cells/mm, P = 0.02). At final follow-up, mean ECD was 3293 ± 175 and 1907 ± 524 cells/mm in the normal and affected eyes, respectively (P = 0.004). The mean annual rate of the ECD decrease was higher in the affected eyes than in the normal eyes (9.1% ± 4.2% vs. 2.0% ± 2.5%), although this difference was not statistically significant (P = 0.06). Conclusions In children with forceps-related corneal injury, lower ECD with a higher annual decrease can be assessed with specular microscopy for risk stratification and parental counseling purposes.

Purpose To establish a normative database of endothelial cell density (ECD) using in vivo specular microscopy in children under 5 years old. Design Cross-sectional study. Methods Specular microscopy was performed during a clinic visit in cooperative children in the standard upright position. In uncooperative children, specular microscopy was performed in the lateral decubitus position under general anesthesia, before surgery for other reasons. Corneal diameter (CD) was measured in children undergoing general anesthesia and was stratified according to age. Results One hundred and eighteen eyes of 118 patients were included in the study. The mean patient age was 2.6 ± 1.4 years (range 0.1–5 years) and the mean ECD was 3746 ± 370 cells/mm 2 (range 3145–5013 cells/mm 2 ). The mean CD under 2 years of age was 11.85 ± 0.57 mm (n = 40, range 10.50–12.75 mm). Up to 2 years of age, ECD was more inversely correlated with CD than with age (r = −0.61, P P = .01, respectively). In contrast, after the age of 2 years, the ECD was inversely correlated with age but not with CD (r = −0.27, P = .02; r = −0.24, P = .2). Between the first and second year of life, the rate of ECD decrease was significantly higher than between 2 and 5 years of age (8.2%, 334 cells/mm 2 vs 2.7%, 100 cells/mm 2 a year, respectively). Conclusion In the first 2 years of life there is a rapid decline in ECD, which is likely related to growth in CD and hence surface area. After the cornea reaches adult size, the ECD decreases at a rate similar to that reported in adults.

Stroke is one of the major causes of childhood mortality. Pediatric arterial ischemic stroke (PAIS) has an annual estimated rate as high as 3.3 cases per 100,000 children (with the vertebrobasilar territory involved in up to 36% of cases); however, the incidence of isolated childhood basilar artery occlusion (BAO) and stroke (BAS) is unknown.1 Adult BAO carries up to a 90% mortality rate, while death or severe neurologic deficits may be seen in 50% of children with BAO/BAS.1,2 The following case report describes a 12-year-old boy with BAO leading to BAS. Clinical symptoms, differential diagnoses, associated comorbidities, and current trends in acute treatment of pediatric BAO/BAS are also discussed.

© 2017 Taylor & Francis Group, LLC. It is a concern that children represent an under-researched group in flood education and preparedness because as adults they are more likely to experience flooding as the climate changes, and because it suggests their potential today, as agents of change, is being undervalued. Using action-based, participatory methodology with seven to nine-year-old children, a creative and inclusive flood education resource was developed as a stimulus for learning. Evaluation revealed that young children can learn about flooding and preparedness, and that intergenerational learning from child to parent can also occur, with children transferring the messages learned in school to home. However, thematic analysis suggests key factors such as family relationships (empowerment of children) and the parents’ disconnection and dissociation from risk limit the success of intergenerational learning. The implications of these in relation to flood education, flood preparedness, and household resilience levels are explored.

This article explores resilience in the context of busy healthcare environments, and raises the question as to whether there is another way of looking at it. We know healthcare is under intense pressure to deliver, with less resources which can squeeze staff to feel stretched, and rushing from pillar to post. Resilience has been a way of looking for more steadiness in these environments, and typically engenders notions of protection, toughening up, steeling oneself and developing a thicker skin in the face of some adversity, but is hardiness or mental toughness the way to respond while working in intensely busy working environments, particularly where patient care is involved? What if sensitivity was the order of the day?.

Over the last ten years, local government modernisation and the growth of community safety agendas have called for change in the public sector at a local level. This has been typified by partnership work, improvement and inspection and community governance. The fire and rescue services, despite some initial cultural difficulties, haveworked hard to adapt themselves to modern local government, for example through community fire safety work, which is presented as a case study. However, the culmination of the modernisation project, Comprehensive Area Assessment, does not favour the fire and rescue service, and to an extent excludes them from its formula. In this light, it seems that there is little incentive for the Fire Service to continue its modernising trajectory.

The integral place of information and communications technology (ICT) in UK lifelong education has been established by a series of technology-based initiatives introduced by the New Labour government since 1997. Initiatives such as the University for Industry, learndirect, People's Network and National Grid for Learning are being implemented as part of a coherent lifelong education policy-agenda fundamentally based upon the use of ICT. Yet, beneath the political enthusiasm for technology-based education, the role of ICT in lifelong learning remains largely unexamined and unproblematized, with many policy-makers and educationalists content to view technology as providing a ‘technical fix’ for many of education's problems. From this background, the present paper provides a critical perspective on the technological foundations of the UK government's lifelong education agenda. In particular, it examines the nature and form of the policies that have been introduced and then contrasts them with the rhetorical c...

The current Government has placed lifelong learning high on its agenda, both for reasons of economic benefit and to increase social inclusion. At 'half-term', what are the prospects for a 'pass' in this course? Using data from a new National Institute of Adult Continuing Education survey of adult participation in learning, and early results from participant observation of the setting up of a 'virtual college', as well as published findings from pilot studies for the University for Industry, this article considers the challenges facing the Government in widening participation through the use of digital technology. The 'problem', of widening access to learning opportunities for all, is not a new one, and it is unlikely to be one with a simple technical fix. The conclusion drawn here is that the emerging use of digital technology is likely to replicate existing inequalities in access to learning. Despite the fine efforts of those involved, and some ingenious technical and distributional suggestions, the reco...

This study sought to uncover information regarding prenatal care services as reported by primiparas. Inadequate prenatal care has been linked with the delivery of low birth weight (LBW) infants and infant mortality. This secondary analysis of a larger study (N = 426) examined the need for and availability, accessibility, and use of prenatal care services by primiparas (n = 141). Results indicated that primiparas delivering LBW infants reported less satisfaction with information on birth control and less information on infant feeding. In addition, mothers of LBW infants reported more often than mothers of normal birthweight infants that transportation and finances were barriers to prenatal care. Childbirth preparation class was the only predictor variable for birth weight in this study.

Set against his earlier epic and sprawling examples of cosmic horror, H. P. Lovecraft’s claustrophobic “The Dreams in the Witch-House” (1933)1 has been thought of as unsuccessful, with S. T. Joshi describing the story as “one of his poorest later efforts” (2001 335), and Steven Mariconda condemning it as “Lovecraft’s magnificent failure” (192). It is this comparative claustrophobia that lends the story of how Walter Gilman meets his maker to a Female Gothic reading, as he takes on the role of the hysterical Female Gothic heroine, pursuing his “lost mother,” Keziah Mason, through the uncanny Gothic wombspace to a fatal end. “The Dreams in the Witch-House” is an intriguing example of Lovecraft’s work, relocating his anxieties about the devastating sense of “lostness” created by the “endless time and space” of the universe (Selected Letters, II 357) inside the “crazily-angled”architecture of Gilman’s room in the Witch-House. This leads to the forbidden loft “where Keziah was held to have practised her spells” (320), an interstitial space that consumes him in his pursuit of understanding its geometry, as his “absorption in the irregular wall and ceiling of his room” evokes the Female Gothic archetype of the house as devouring maternal body (328, 320).

Purpose:To investigate the effects of acute exercise on serum hepcidin and iron (sFe) in active women. Changes in interleukin-6 (IL-6), hepcidin, ferritin, and sFe in response to 2 different exercise durations were compared.Methods:Twelve women age 19–32 yr performed 2 treadmill runs (60 and 120 min) at 65% of VO2max. Blood samples were obtained before, immediately after, and 3, 6, 9, and 24 hr after exercise. Two-way repeatedmeasures ANOVA was conducted to examine changes in measured variables. Significance was accepted at p < .05.Results:Significant effects for trial were observed for hepcidin (60 min: 1.15 ± 0.48 nmol/L; 120 min: 2.28 ± 1.44 nmol/L) and for time, with hepcidin significantly increased 3 hr postexercise in both trials (60 min: 3 hr – 1.99 ± 2.00 nmol/L; 120 min: 3 hr – 4.60 ± 4.61 nmol/L). Significant main effects for time occurred for sFe, ferritin, and IL-6. sFe was significantly decreased 9 hr postexercise compared with 3 and 24 hr postexercise. IL-6 was significantly increased immediately postexercise.Conclusions:Both runs resulted in significant increases in hepcidin 3 hr after exercise. Increases in hepcidin were preceded by significant increases in IL-6 immediately postexercise and followed by significant decreases in sFe 9 hr postexercise. It was concluded that endurance exercise increases the production of hepcidin, which affects sFe. The 2-hr exercise bout stimulated greater changes in serum hepcidin than the 1-hr bout.

Background Patients undergoing abdominoplasty often have breast concerns, as well as abdominal concerns, because pregnancy is often the etiologic factor in both. Although concerns about combination procedures have been raised recently, the specific issue of combining abdominoplasty and breast surgery has been scarcely addressed. Objective This study was designed to evaluate the morbidity of abdominoplasty alone versus that associated with abdominoplasty combined with breast surgery. Methods A retrospective review of 92 consecutive cases performed by a single surgeon in an outpatient setting was performed. Two groups of patients were identified, those who had abdominoplasty alone, and those who had abdominoplasty with associated breast surgery. Breast surgery included augmentation, mastopexy, augmentation/mastopexy, implant removal/exchange, and breast reduction. The groups were compared with respect to morbidity rates, and, additionally, operative time, body mass index, volume of liposate removed (all patients underwent some lipoplasty), and age were evaluated as potential contributing factors in morbidity. Results No significant difference in morbidity was seen between patients undergoing abdominoplasty alone and patients undergoing abdominoplasty with combined breast surgery. There were no deaths or hospital admissions with either group of patients. Conclusions This study provides additional evidence that abdominoplasty and breast surgery can be combined safely.

In this report, we present the results of surveys administered to participants and nonparticipants in the Carolina Breast Cancer Study (CBCS). Surveys and structured interviews were administered to determine women's concerns regarding participation in research studies, access to health care, and beliefs regarding causes of breast cancer. Survey results showed the highest concern for the growing number of women diagnosed with breast cancer in North Carolina and potential environmental agents that may cause breast cancer. Negative responses were noted for time constraints related to participation and lack of familiarity with epidemiologic research; another concern noted was the lack of centralized information regarding breast cancer treatment. These issues were addressed by (1) developing a web site that provided background information about the CBCS, summaries of published study results, and information about the etiology of breast cancer; and (2) creating a statewide, comprehensive breast cancer resource directory for women who need information about breast cancer diagnosis, treatment, and support. These two projects were carried out in collaboration with breast cancer advocates, and demonstrate the important role that advocates can play in making epidemiologic research more responsive to the needs of communities.

Single sutural craniosynostosis is a disorder wherein a calvarial suture fuses prematurely, resulting in an abnormally shaped head. Children afflicted are normal neurologically, and the bone bridging the sutures is normal histologically. The mechanism of normal or pathologic sutural fusion is unknown. These facts prompted the authors to reexamine normal sutural anatomy and the concepts of skull growth in an animal model. Histochemical staining to identify osteoblasts and osteoclasts and tetracycline labeling were performed on neonatal rabbit calvarial sutures. Osteoblasts are found on all bony surfaces including the sutural edges, but do not extend across the sutural space. Thus the periosteum per se does not bridge the suture. Osteoclasts are found only in the diploic space. Thus, there is no mechanism to remove bone at/or within the suture. Tetracycline labeling revealed immense bone production at the suture as compared with dural and periosteal surfaces. Microscopic spicules of bone bridging the suture were identified. Based upon the above observations, we propose a new hypothesis for the mechanism of normal and pathologic sutural fusion. Bony microspicules normally and intermittently form and bridge the suture. As there is no mechanism to remove these spicules, we propose that normal mechanical forces cause them to fracture. A spicule that fails to fracture functions as a scaffold, upon which more bone is deposited, resulting in sutural fusion. Single sutural craniosynostosis results when a normal process occurs prematurely.

The use of information technology in education is now a political orthodoxy, seen by many politicians and educators as a ready means of widening participation to those social groups traditionally excluded from learning. However, the role of technology in overcoming social exclusion in education and lifetime learning practices has often failed to be objectively discussed, with a tendency for many educationalists to adopt either overtly optimistic or pessimistic positions. From this background, the present article objectively examines both current patterns of exclusion from education and technology alongside the range of ongoing policies and initiatives established in the United States concerned with technology and education. Moreover, based on a range of North American and European research literature concerned with participation in education, the article then discusses the issues and problems faced by U.S. educationalists and policy makers in proactively using technology as a means of reducing social exclusion in lifelong education. Opportunity for all requires something else today—having access to a computer and knowing how to use it. This means that we must close the digital divide between those who have got the tools and those who do not.