A review of 1000 referrals to Walsall's hospital eye service

BACKGROUND

Referrals to ophthalmology are predominantly made from general practitioners (GPs) and optometrists. These two groups of referrers receive differing types and levels of training and are equipped with different instrumentation. The purpose of this study was to determine whether the quality of referrals to the hospital eye service (HES) differs between GPs and optometrists in Walsall.

METHODS

Referrals into the HES were identified from Q1 2014 retrospectively until 1000 notes had been reached. Each record was scrutinized using a standard template. Data were analysed and summary statistics produced including positive predictive values and interobserver agreement.

RESULTS

We achieved our target of auditing 1000 records. The false-positive rate (patients being discharged from HES with a 'normal vision' diagnosis) was 7.7% of referrals from GPs and 6.2% of referrals from optometrists. Concordance between referred condition and diagnosed condition at HES between optometrists and ophthalmologists was 76.1%, and between GPs and ophthalmologists was 67.2%.

CONCLUSIONS

In view of findings from this study, it is important for commissioners in the new reconfigured National Health Service to ensure that enhanced ophthalmic services are commissioned only on the basis of hard evidence sourced from local data rather than opinion or on data from another geographical area.

Colonization of the Beaver Island Archipelago by deer mice (Peromyscus maniculatus gracilis): mtDNA evidence for multiple origins

The Beaver Island group in Lake Michigan comprises nine islands ranging from 0.3 to 144 km2, lying approximately 30 km west of Michigan’s Lower Peninsula (LP) and 15 km south of the Upper Peninsula (UP). The islands have been isolated from mainland Michigan for most of their postglacial history, but were connected to the mainland LP during the low-water Chippewa stage (ending about 7400 years before present (YBP)). Although plants and animals could have colonized the islands during the Chippewa period, flooding during the subsequent Nipissing high-water stand means that the smaller islands have been colonized more recently. We analyzed 481 bp of mitochondrial D-loop sequences from woodland deer mice (Peromyscus maniculatus (Wagner, 1845)) on six of these islands in northern Lake Michigan to elucidate the mainland origin and minimum number of colonization events for this species. Surprisingly, the distribution of haplotypes on the islands suggests that the populations on most islands likely had separate recent origins on the mainland UP. Approximate Bayesian computation supports a scenario in which individual islands were colonized separately by distinct groups of mice. Together, the data suggest multiple colonization events from the UP, rather than expansion from a bottlenecked population or a single colonization event.

Aligned macroporous monoliths with intrinsic microporosity via a frozen-solvent-templating approach

Aligned macroporous monoliths of an organic cage, a polymer of intrinsic microporosity (PIM-1), and a metal–organic framework (HKUST-1) are prepared by a controlled freezing approach. In addition to macropores, all the monoliths contain the intrinsic micropores.

Synthesis of nanospheres-on-microsphere silica with tunable shell morphology and mesoporosity for improved HPLC

Core-shell particles have a wide range of applications. Most of the core-shell particles are prepared in two or multiple steps. Core-shell silica microspheres, with solid core and porous shell, have been used as novel packing materials in recent years for highly efficient liquid chromatography separation with relatively low back-pressure. These core-shell silica microspheres are usually prepared by the time-consuming layer-by-layer technique. Built on our previous report of one-pot synthesis of core-shell nanospheres-on-microspheres (termed as SOS particles for "spheres-on-spheres"), we describe here a two-stage synthesis for the introduction of shell mesoporosity into SOS particles with tunable shell morphology by co-condensation of tetraethyl orthosilicate (TEOS) with 3-mercaptopropyltrimethoxysilane (MPTMS) in the presence of surfactant in the second stage. With MPTMS as the primary precursor at the first stage, some other silica precursors (apart from TEOS) are also employed at the second stage. Expansion of the surfactant-templated mesopores with swelling agents during the reaction and by hydrothermal postsynthesis treatment is then performed to allow the pore sizes (> 6 nm) suitable for separation of small molecules in liquid chromatography. Compared to the standard SOS silica (both the nanospheres and microspheres contain nearly no mesopores), the introduction of mesoporosity into the nanosphere shell increases the separation efficiency of small molecule mixtures by 4 times as judged by the height equivalent plate number, while the separation of protein mixtures is not negatively affected.

Monodisperse sphere-on-sphere silica particles for fast HPLC separation of peptides and proteins

One-pot synthesis of monodisperse sphere-on-sphere (SOS) silica microspheres is developed for fast separation of peptide and protein mixtures by HPLC.

Hierarchical porous metal–organic framework monoliths

A simple powder-packing synthesis is developed to produce crystalline MOF monoliths containing micropores and highly interconnected macropores. Fast HPLC separation using the monolithic column is demonstrated.

One-pot synthesis of spheres-on-sphere silica particles from a single precursor for fast HPLC with low back pressure

Spheres-on-sphere (SOS) silica particles are prepared in a one-pot scalable synthesis from mercaptopropyltrimethoxysilane with hydrophilic polymer and cationic surfactant under alkaline conditions. The SOS particles exhibit solid-core porous-shell properties. The fast separation of small molecules and proteins with low back pressure are demonstrated by high-performance liquid chromatography (HPLC) for the columns packed with SOS-particles.

SU-E-T-387: Validation of a New System for Patient Specific IMRT QA and Comparison with Other Commerical Systems

PURPOSE

The focus of this project is to compare the Octavius 4D with current commercial available dose validation systems: MatriXX MultiCube and Delta4.

METHODS AND MATERIALS

Many challenges are faced with properly measuring Intensity Modulated Radiotherapy (IMRT). It has become common practice for clinics to use film, arrays, or multiple detectors to validate dose measurements pretreatment for static and dynamic treatments. IMRT QAs for various treatment sites were measured for patients using three different dose validation systems. All measurements were taken on a Varian CLinac 2100 C/D, SN-757, 80 MLC with 6MV. The treatment plans evaluated were Step-N-Shoot. Data analysis was performed using the software provided with each dose validation system. Detailed information was gathered from each system with their perspective advantages. The latest system, Octavius 4D, allows one to calculate the Gamma Index for Coronal, Sagittal, and Transversal views for every slice included in the measurement along with the traditional data analysis provided; histograms, horizontal and vertical profiles, DTA.

RESULTS AND DISCUSSION

The Gamma Index values were observed using the MatriXX Multicube, Delta4, and Octavius 4D. The treatment plan included five fields at various gantry angles. Also the gamma index and profiles were calculated for various treatment sites. Delta 4 and the Octavius 4D appears to be quite comparable. Each device has the ability to allow one to verify segmented and composite fields, measure dose profiles and analysis using the Gamma Method. ConclusionsSimilar IMRT QA measurements will be made for more Step-N-Shoot cases with the addition of SmartArcs. The limitations of each system will be determined for each system using the Gamma Index as a reference while varying the Region of Interest, Threshold, and Gamma Method (local, normalization, and maximum dose), as well as the 2D- profiles for these cases.