Comparison of 5-year progression of retinitis pigmentosa involving the posterior pole among siblings by means of SD-OCT: a retrospective study

The blockchain technology promises to transform finance, money and evengovernments. However, analyses of blockchain applicability and robustness typicallyfocus on isolated systems whose actors contribute mainly by running the consensusalgorithm. Here, we highlight the importance of considering trustless platformswithin the broader ecosystem that includes social and communication networks. Asan example, we analyse the flash-crash observed on 21st June 2017 in the Ethereumplatform and show that a major phenomenon of social coordination led to acatastrophic cascade of events across several interconnected systems. We proposethe concept of “emergent centralisation” to describe situations where a single systembecomes critically important for the functioning of the whole ecosystem, and arguethat such situations are likely to become more and more frequent in interconnectedsocio-technical systems. We anticipate that the systemic approach we propose willhave implications for future assessments of trustless systems and call for the attentionof policy-makers on the fragility of our interconnected and rapidly changing world

Intravitreal anti-VEGF treatment in eyes with combined choroidal neovascularisation and vitreomacular traction syndrome

International audiencePurpose: To report the effect of intravitreal anti VEGF injections (IVI) on visual acuity (VA) in eyes with choroidal neovascularisation (CNVM) and coexistent vitreomacular traction (VMT) or when VMT has developed during the course of treatment. Methods: Retrospective interventional case series of 7 eyes in 7 patients. VMT was monitored with serial optical coherence tomography scans. Results: The aetiology of the CNVM was wet age-related macular degeneration in 5 eyes (72%), angioid streaks in 1 eye (14%) and pathological myopia in 1 eye (14%). Ranibizumab was used in 4 eyes (57%) and bevacizumab in 3 (43%) for the active CNVM component. The mean follow-up was 11 months (range 2-28 months). Visual acuity was stabilized or improved in 5 of the 7 eyes (71%) with IVI. Visual acuity results across the whole group were gain of 3 or more lines of Snellen visual acuity in 2 eyes (28%), gain of up to 3 lines in 3 eyes (42%), no change in visual acuity in 1 eye (14%) and loss of up to 3 lines in 1 eye (14%). In 4 eyes with pre-existing VMT, VA improved in 3 with IVI. In 3 eyes that developed VMT after IVI, VA improved in 2 with IVI. Delay from diagnosis of CNVM to treatment with IVI contributed to a poor response. Conclusions: Most eyes improved VA with IVI for combined CNVM and VMT. Despite the often dramatic features of VMT on optical coherence tomography, treatment of co-existing CNVM should be prompt

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis

Impact of Evidence-Based Practice Education on New Graduate Nurses

A large hospital in the western United States developed a new graduate nurse residency program. As the hospital works to achieve Magnet status, education leaders identified that a specific focus on evidence- based practice (EBP) would assist in meeting program objectives. Methods: An EBP course was developed using current EBP literature. The EBP course was implemented and presented to residency program nurses. These nurses were provided the opportunity to evaluate the course and the instructor as part of a post-implementation survey. Pre- and post-surveys were created and used to assess student knowledge of EBP. Results: The average score was the same for the pre-survey (80%; n=15) and the post-survey (80%: n=14). Student knowledge increased on two questions regarding levels of EBP evidence and bias. Two questions were revised between the pre-and post-survey to address a knowledge gap regarding the role of stakeholders in quality improvement. The course was evaluated using a Likert scale, where 7/10 was the average score. Conclusions: The integration of this course serves as a foundational platform to continue student learning. While initial feedback was positive, the course will need revisions and updates as more current research presents itself and to continue to challenge and develop new graduate nurses. The project identified that students had a basic knowledge of EBP but could benefit from additional education regarding EBP and its application in clinical practice

Impact of Evidence-Based Practice Education on New Graduate Nurses

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Trapped pre-macular bubble of octafluoropropane gas masquerading as retained submacular perfluorocarbon liquid

Introduction: To demonstrate, with the aid of retinal imaging, an abnormal post-operative macular appearance caused by the presence of a "fragmented" pre-retinal bubble of octafluoropropane (C3F8) masquerading as retained subretinal perfluorocarbon liquid (PFCL). Methods: This is an interventional case presentation. Results: Colour fundus photography high-resolution spectral domain-optical coherence tomography (SD-OCT) and clinical progress demonstrate that the abnormal reflex was caused by the presence of a small fragment of C3F8 becoming lodged at the pre-foveal area. Conclusion: Submacular entrapment of various substances used during vitrectomy has been described in a number of case reports and case series. To our knowledge, this is the first described case of a retained fragment of fluorocarbon gas trapped at the macula following successful retinal detachment repair and highlights a previously unreported cause of an abnormal foveal appearance. However, clinical examination together with the use of SD-OCT is helpful in differentiating the appearance from that seen in other retained vitrectomy adjuncts. © 2019 The Author(s). Published by S. Karger AG, Basel