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Did you know that there's a huge shortage of young people attracted to engineering jobs and a lack of diversity in the profession with the workforce being 88% male and 92% white! I remember taking part in a special engineering event many years ago which was trying to encourage more women into the field, so it makes me quite sad that in the last 20 years the situation hasn't changed much.
However, hopefully things are about to improve! A government initiative called the Year of Engineering aims to shake-up people's ideas about engineering, inspiring the next generation of innovators, inventors and problem solvers by showing them what engineers actually do.
The Holiday Makers
The Holiday Makers is a fun series of activities and challenges for parents to do with their children ( aged 7-16 ). I am always looking for ideas to keep my kids busy and active so these are perfect for us. My girls love anything creative and crafty so these inventive challenges will defintiely appeal to their inquisitive nature.
There is a new challenge each week with fantastic prizes up for grabs and exciting events and days out across the UK as well. Enter your postcode on the website to find out what's going on near you.
We love that there's a journal to download to record all your Holiday Makers progress over the summer as well.
Holiday Makers and the Year of Engineering rather like Science Sparks hope to capture the imagination of a generation of children, showing them that science and engineering knowledge and skills open up a world of opportunities. So make some time, pick a challenge and go for it!
Chain Reaction Challenge
Holiday Makers challenged us to make our own chain reaction. Inspired by their guide on the website, this is what we came up with.
What is a chain reaction?
A chain reaction is a sequence of events where one thing triggers another.
This is also an example of a Rube Goldberg machine
What is a Rube Goldberg Machine?
Rube Goldberg machines use the principle of a chain reaction to achieve an end goal. The end goal in the case of our chain reaction is the popping of the balloon. Creating a machine like this is a great way for children to learn about cause and effect, conservation of energy and momentum.
Step 1
The force of air from the fan starts off the chain reaction by knocking over dominoes. The first domino collides with the second knocking that over and so on until the ball is pushed down the ramp.
Step 2
The ball is initially stationary until the force of the last dominoes forces it forwards and down the ramp. The downward slope of the ramp means the ball gains momentum as it travels.
Step 3
The ball pushes a wooden car with a needle attached forward. This is an example of conservation of momentum. Momentum from the ball is transferred to the car, forcing it forwards.
Remember only moving objects have momentum.
Step 4
The needle bursts the balloon.
This part was a little tricky to get working. The first car we tried was too heavy for the ball to push forwards and the second too small.
Experimenting with different objects actually made the process even more fun and the end result very rewarding.
We LOVED creating a chain reaction and can't wait to design and build more.
Are you ready to start inventing?
Post in collaboration with The Holiday Makers


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The Times of Israel cites the Financial Times in an article praising Ilan Goldfajn's performance at the head of the Brazil Central Bank and her success in fighting inflation that has grown threatening since Dilma Rousseff's rule. in less than a year, ahead of the Central Bank, Goldfajn reversed the trend and placed the Brazilian currency at a plateau that was not reached since at 1998.
"Brazil's Central Bank president, an Israeli native, was named central banker of the year by a British magazine". said Times of Israel.
Ilan Goldfajn, who was born in Haifa and raised in Rio de Janeiro, was selected by The Banker magazine due to his successful performance taming Latin America's largest nation's annual inflation. Since Goldfaj was named Governor of the Central Bank of Brazil last may, inflation dipped to 2.95 percent in 2017, the lowest in nearly 20 years, reported O Globo newspaper.
"This is far from an easy accomplishment in a country that has struggled with inflation rising at double digits in the recent past," wrote the magazine, which is part of the Financial Times group.
Goldfajn, 51, an economist, has a career in both the public and private sectors. He served as chief economist at Itau, Brazil's largest private bank, and deputy to the bank governor of Brazil, as well as adviser to the World Bank and the International Monetary Fund.
Fluent in Hebrew, English, Portuguese and Spanish, he is an active member of the Brazilian Jewish community. He was educated in Rio's Liessin Jewish day school. At a meeting held by the Brazil-Israel Chamber of Commerce one month before he took over the Central Bank, Goldfajn said, "Brazil has a lot to learn from Israel."
In 2015, Goldfajn argued during an Israel-Brazil chamber event in Tel Aviv that the deep economic crisis affecting Brazil stems from a lack of fiscal responsibility. In response, he said, Brazil must boost exports and raise taxes, cut government spending and raise the retirement age.


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Earliest `Oyster Bar' Found in Africa / It shows that humans took up coastal life earlier than thought
Scientists have discovered the earliest well-dated example of an oyster bar -- a fossil reef on Africa's Red Sea coast where ancestral humans must have waded out to collect oysters, clams, scallops and crabs some 125,000 years ago.
The discovery shows that early humans had taken up coastal life at least 10,000 years earlier than previously believed, and it suggests that waves of those humans could have migrated out of Africa and into Europe and Asia along the Red Sea coast, in addition to other routes.
An international team of geologists and anthropologists unearthed a trove of stone tools from the fossil reef along the Red Sea coast of Eritrea. The researchers like to call their discovery "the world's first oyster bar."
But they also propose a far more significant meaning to their find: It could help resolve long-standing debates about the origin and evolution of modern humans and their migration routes out of Africa.
A report in the current issue of the journal Nature describes the scientists' discovery of two-sided stone hand axes and flaked obsidian blades in the same fossil reef terrace as the fossil remains of shelled bivalves and crabs.
The site where the stone tools were found is near the Red Sea coastal village of Abdur in Eritrea's Gulf of Zula. In the same area, the team also discovered fossil bones of large land animals, including elephants, antelopes, rhinoceros and hippopotamus.
It appears that the humans who lived at the site may have driven some of those animals toward the sea and killed them there to supplement their seafood diet, the team suggested.
The expedition was led by Robert C. Walter, a geologist with Mexico's Center for Scientific Investigations and Higher Education in Ensenada, Mexico, and included scientists from Mexico, Canada, the United States, the Netherlands, France and Eritrea.
According to Walter, the site offers the oldest evidence of modern humans' adaptation to seashore living -- at least 10,000 years older than similar evidence from recent finds along the shores of South Africa.
It is clear, Walter said, that the people of 125,000 years ago were living during a relatively warm "interglacial" period that succeeded an earlier cold epoch when inland humans might have been driven toward the east African coast as lakes and rivers froze or dried up.
No one doubts that Africa was the original home of humanity. Recent studies of the genes of today's humans strongly imply that modern Homo sapiens arose from more primitive species of Homo between 200,000 and 150,000 years ago. Those studies also suggest that humanity began spreading into Europe, the Near East, and Asia well before 100,000 years ago.
In Europe, those modern humans eventually must have displaced the evolutionary dead-end Neanderthal peoples, while other migration waves eastward reached India about 60,000 years ago and Australia by 40,000 years ago.
Fossil bones of long-ago peoples discovered in Israel and Jordan seem to confirm that pattern of northward and eastward migration, and the discovery by Walter's team provides a significant clue to at least one of the migration routes out of Africa.
"Our discovery opens up a whole new way of looking at early man, his origins and immigration routes all along that coast -- and probably during many more waves of migration," said Richard Buffler, a geologist at the University of Texas at Austin who first explored the site with Walter and his team three years ago.
The bones of the larger animals, Buffler said, were found close to the "oyster bar," and must have offered the early humans who lived there the world's first opportunity for "surf and turf dining."
Members of the expedition hope to return to the site soon to search for other coastal dwelling places by humans. But that hope may prove difficult to realize right now, Buffler said, because of the uncertainties raised by the border war between Eritrea and Ethiopia.


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Trade Mining* will begin during December 2018 under the schedule which will be separately announced by ProBit.
*Under Trade Mining, for qualified transactions at ProBit, PROB worth 80% of the trading fee will be mined and issued to the trader as a reward. Any instance in which the trading fee is paid by PROB will not qualify for Trade Mining, but trading fee discount applies instead. The Trade Mining will continue until all tokens allocated for Trading Mining (i.e. 100,000,000 tokens, 50% of total PROB) have been mined.


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Cloud Infrastructure Security
- Ami West
- 4 years ago
- Views:
1 Cloud Infrastructure Security Dimiter Velev 1 and Plamena Zlateva 2 1 University of National and World Economy, UNSS - Studentski grad, 1700 Sofia, Bulgaria 2 Institute of Control and System Research - Bulgarian Academy of Sciences Acad. G. Bonchev Str., Bl. 2, P.O.Box 79, 1113 Sofia, Bulgaria Abstract. Cloud computing can help companies accomplish more by eliminating the physical bonds between an IT infrastructure and its users. Users can purchase services from a cloud environment that could allow them to save money and focus on their core business. At the same time certain concerns have emerged as potential barriers to rapid adoption of cloud services such as security, privacy and reliability. Usually the information security professionals define the security rules, guidelines and best practices of the IT infrastructure of a given organization at the network, host and application levels. The current paper discusses miscellaneous problems of providing the infrastructure security. The different aspects of data security are given a special attention, especially data and its security. The main components of cloud infrastructure security are defined and the corresponding issues and recommendations are given. Key words: cloud, service, infrastructure, IaaS, security, data. 1 Introduction to Cloud Computing Basics Currently one of the major topics of many information technology discussions is cloud computing and the key point in them is cloud computing security. Usually conversations focus on all standard security advantages, disadvantages and requirements. Nevertheless the fact the most common security measures protect data from loss, unauthorized access, integrity disruption, etc., there are other necessary and important characteristics of any IT infrastructure that must implemented in a much more serious way. One of those structures is the cloud infrastructure. 1.1 Cloud Computing Definition Cloud computing is an on-demand service model for IT provision based on virtualization and distributed computing technologies [1], [9], [10]. Typical cloud computing providers deliver common business applications online as services which are accessed from another web service or software like a web browser,
2 while the software and data are stored on servers. The abstraction of computing, network and storage infrastructure is the foundation of cloud computing. The infrastructure is a service, and its components must be readily accessible and available to the immediate needs of the application stacks it supports. Cloud computing removes the traditional application silos within the data center and introduces a new level of flexibility and scalability to the IT organization. This flexibility helps address challenges facing enterprises and IT service providers that include rapidly changing IT landscapes, cost reduction pressures, and focus on time to market. Cloud users are maybe identified as follows [1]: Individual consumers; Individual businesses; Start-ups; Small and medium-size businesses; Enterprise businesses Cloud computing architectures offer to its users numerous advantages that can be briefly summarized to [2]: reduced cost since services are provided on demand with pay-as-you-use billing system; highly abstracted resources; instant scalability and flexibility; instantaneous provisioning; shared resources, such as hardware, database, etc.; programmatic management through API of Web services; increased mobility - information is accessed from any location. 1.2 Cloud Computing Categories The following cloud computing categories have been identified and defined in the process of cloud development [1], [10]: Infrastructure as Service (IaaS): provides virtual machines and other abstracted hardware and operating systems which may be controlled through a service Application Programming Interface (API). IaaS includes the entire infrastructure resource stack from the facilities to the hardware platforms that reside in them. It incorporates the capability to abstract resources as well as deliver physical and logical connectivity to those resources. IaaS provides a set of APIs which allow management and other forms of interaction with the infrastructure by consumers. Platform as a Service (PaaS): allows customers to develop new applications using APIs, implemented and operated remotely. The platforms offered include development tools, configuration management and deployment platforms. PaaS is positioned over IaaS and adds an additional layer of integration with application development frameworks and functions such as database, messaging, and queuing that allow developers to build applications for the platform with programming languages and tools are supported by the stack.
3 Software as a Service (SaaS): is software offered by a third party provider, available on demand, usually through a Web browser, operating in a remote manner. Examples include online word processing and spreadsheet tools, CRM services and Web content delivery services. SaaS in turn is built upon the underlying IaaS and PaaS stacks and provides a self-contained operating environment used to deliver the entire user experience including the content, its presentation, the applications and management capabilities. Multi-Tenancy: the need for policy-driven enforcement, segmentation, isolation, governance, service levels and billing models for different consumer constituencies. Consumers might utilize a public cloud provider s service offerings or actually be from the same organization, but would still share infrastructure. 1.3 Cloud Deployment Models The cloud services can be implemented in four deployment models [1], [10]: Public Cloud. The cloud infrastructure is made available to the general public or large industry group and is owned by an organization selling cloud services. Private Cloud. The cloud infrastructure is operated entirely for a single organization. It may be managed by the organization or a third party, and may exist on-premises or off-premises. Community Cloud. The cloud infrastructure is shared by several organizations and supports a specific community. It may be managed by the organizations or a third party, and may exist on-premises or off-premises. Hybrid Cloud. The cloud infrastructure is a composition of two or more clouds (private, community or public) that are bound together by standardized or proprietary technology that enables portability of data and application. 2 Risks and Security Concerns With Cloud Computing Many of the cloud computing associated risks are not new and can be found in the computing environments. There are many companies and organizations that outsource significant parts of their business due to the globalization. It means not only using the services and technology of the cloud provider, but many questions dealing with the way the provider runs his security policy. After performing an analysis the top threats to cloud computing can be summarized as follows [3], [7]: Abuse and Unallowed Use of Cloud Computing; Insecure Application Programming Interfaces; Malicious Insiders; Shared Technology Vulnerabilities; Data Loss and Leakage
4 Account, Service and Traffic Hijacking; Unknown Risk Profile. It has been established that the most common topics related with cloud computing risk at present include [6], [11]: The cloud provider takes responsibility for information handling which is a critical part of the business. Failure to perform to agreed service levels can impact not only confidentiality but also availability. The dynamic nature of cloud computing may result in confusion as to where information actually resides. This may create delays when information retrieval is required. Third-party access to sensitive information creates a risk of compromise to confidential information. This can pose a significant threat to ensuring the protection of intellectual property and trade secrets. Public clouds allow high-availability systems to be developed at service levels often impossible to create in private networks. Compliance to regulations and laws in different geographic regions can be a challenge for business. Due to the dynamic nature of the cloud, information may not be located in the event of a disaster immediately. Business continuity and disaster recovery plans must be well documented and tested. Recovery time objectives should be stated in the contract. When faced with the paradigm change and nature of services provided through cloud computing, there are many challenges for cloud providers [6]. Some of the major security issues that will need to be addressed are [4], [5], [12]: Transparency - Service providers must provide for the existence of effective and robust security controls, assuring customers that their information is properly secured against unauthorized access, change and Privacy - With privacy concerns growing across the globe it will be imperative for cloud computing service providers to prove to existing and prospective customers that privacy controls are in place and demonstrate their ability to prevent, detect and react to breaches in a proper manner. Information and reporting communication lines need to be organized and agreed before service provisioning starts. These communication channels should be tested periodically during operations. Compliance - Most organizations must comply with a wide set of laws, regulations and standards. There are concerns with cloud computing that data may not be stored in one place and may not be easily retrievable. Audits completed by legal, standard and regulatory authorities demonstrate that there can be plenty of problems. When using cloud services there is no guarantee that a certain company can get its information when needed, and even some providers are reserving the right to withhold information from authorities. Transborder information flow - When information can be stored anywhere in the cloud, the physical location of the information can become an issue. Physical location rules jurisdiction and legal obligation. Country laws governing personally identifiable information may vary significantly.
5 Certification - Cloud computing service providers will need to provide their customers assurance that they operate surely. Independent assurance from third-party audits and/or service auditor reports should be a vital part of any assurance program. 3 Cloud Security Principles Public cloud computing requires a security model that coordinates scalability and multi-tenancy with the requirement for trust. As enterprises move their computing environments with their identities, information and infrastructure to the cloud, they must be willing to give up some level of control. In order to do so they must be able to trust cloud systems and providers, as well as to verify cloud processes and events. Important building blocks of trust and verification relationships include access control, data security, compliance and event management - all security elements well understood by IT departments today, implemented with existing products and technologies, and extendable into the cloud. The cloud security principles comprise three categories: identity, information and infrastructure. 3.1 Identity security End-to-end identity management, third-party authentication services and identity must become a key element of cloud security. Identity security keeps the integrity and confidentiality of data and applications while making access readily available to appropriate users. Support for these identity management capabilities for both users and infrastructure components will be a major requirement for cloud computing and identity will have to be managed in ways that build trust. It will require: Stronger authentication: Cloud computing must move beyond authentication of username and password, which means adopting methods and technologies that are IT standard IT such as strong authentication, coordination within and between enterprises, and risk-based authentication, measuring behavior history, current context and other factors to assess the risk level of a user request. Stronger authorization: Authorization can be stronger within an enterprise or a private cloud, but in order to handle sensitive data and compliance requirements, public clouds will need stronger authorization capabilities that can be constant throughout the lifecycle of the cloud infrastructure and the data. 3.2 Information security In the traditional data center, controls on physical access, access to hardware and software and identity controls all combine to protect the data. In the cloud, that protective barrier that secures infrastructure is diffused. The data needs its own security and will require [5], [14]:
6 Data isolation: In multi-tenancy environment data must be held securely in order to protect it when multiple customers use shared resources. Virtualization, encryption and access control will be workhorses for enabling varying degrees of separation between corporations, communities of interest and users. Stronger data security: In existing data center environments the role-based access control at the level of user groups is acceptable in most cases since the information remains within the control of the enterprise. However, sensitive data will require security at the file, field or block level to meet the demands of assurance and compliance for information in the cloud. Effective data classification: Enterprises will need to know what type of data is important and where it is located as prerequisites to making performance cost-benefit decisions, as well as ensuring focus on the most critical areas for data loss prevention procedures. Information rights management: it is often treated as a component of identity on which users have access to. The stronger data-centric security requires policies and control mechanisms on the storage and use of information to be associated directly with the information itself. Governance and compliance: A major requirement of corporate information governance and compliance is the creation of management and validation information - monitoring and auditing the security state of the information with logging capabilities. The cloud computing infrastructures must be able to verify that data is being managed per the applicable local and international regulations with appropriate controls, log collection and reporting. 3.3 Security Compromises Between the Three Cloud Deployment Models The following security compromises between the three cloud deployment models have been identified [7], [10]: SaaS provides the most integrated functionality built directly into the offering, with the least consumer extensibility, and a relatively high level of integrated security since at the least the provider bears a responsibility for the security. PaaS is intended to enable developers to build their own applications on top of the platform. As a result it tends to be more extensible than SaaS, at the expense of customer ready features. This tradeoff extends to security features and capabilities, where the built-in capabilities are less complete, but there is more flexibility to layer on additional security. IaaS provides few if any application-like features, but enormous extensibility. This generally means less integrated security capabilities and functionality beyond protecting the infrastructure itself. This model requires that operating systems, applications, and content be managed and secured by the cloud consumer.
7 4 Infrastructure Security IaaS application providers treat the applications within the customer virtual instance as a black box and therefore are completely indifferent to the operations and management of a applications of the customer [13]. The entire pack (customer application and run time application) is run on the customers server on provider infrastructure and is managed by customers themselves. For this reason it is important to note that the customer must take full responsibility for securing their cloud deployed applications [7], [8], [12]. Cloud deployed applications must be designed for the internet threat model. They must be designed with standard security countermeasures to guard against the common web vulnerabilities. Customers are responsible for keeping their applications up to date - and must therefore ensure they have a patch strategy to ensure their applications are screened from malware and hackers scanning for vulnerabilities to gain unauthorized access to their data within the cloud. Customers should not be tempted to use custom implementations of Authentication, Authorization and Accounting as these can become weak if not properly implemented. The foundational infrastructure for a cloud must be inherently secure whether it is a private or public cloud or whether the service is SAAS, PAAS or IAAS. It will require [7], [9]: Inherent component-level security: The cloud needs to be architected to be secure, built with inherently secure components, deployed and provisioned securely with strong interfaces to other components and supported securely, with vulnerability-assessment and change-management processes that produce management information and service-level assurances that build trust. Stronger interface security: The points in the system where interaction takes place (user-to-network, server-to application) require stronger security policies and controls that ensure consistency and accountability. Resource lifecycle management: The economics of cloud computing are based on multi-tenancy and the sharing of resources. As the needs of the customers and requirements will change, a service provider must provision and decommission correspondingly those resources - bandwidth, servers, storage and security. This lifecycle process must be managed in order to build trust. The infrastructure security can be viewed, assessed and implemented according its building levels - the network, host and application levels [7], [11]. 4.1 Infrastructure Security - The Network Level When looking at the network level of infrastructure security, it is important to distinguish between public clouds and private clouds. important to distinguish between public clouds and private clouds. With private clouds, there are no new
8 attacks, vulnerabilities, or changes in risk specific to this topology that information security personnel need to consider. If public cloud services are chosen, changing security requirements will require changes to the network topology and the manner in which the existing network topology interacts with the cloud provider s network topology should be taken into account [7]. There are four significant risk factors in this use case: Ensuring the confidentiality and integrity of organization s data-in-transit to and from a public cloud provider; Ensuring proper access control (authentication, authorization, and auditing) to whatever resources are used at the public cloud provider; Ensuring the availability of the Internet-facing resources in a public cloud that are being used by an organization, or have been assigned to an organization by public cloud providers; Replacing the established model of network zones and tiers with domains. 4.2 Infrastructure Security - The Host Level When reviewing host security and assessing risks, the context of cloud services delivery models (SaaS, PaaS, and IaaS) and deployment models public, private, and hybrid) should be considered [7]. The host security responsibilities in SaaS and PaaS services are transferred to the provider of cloud services. IaaS customers are primarily responsible for securing the hosts provisioned in the cloud (virtualization software security, customer guest OS or virtual server security). 4.3 Infrastructure Security - The Application Level Application or software security should be a critical element of a security program. Most enterprises with information security programs have yet to institute an application security program to address this realm. Designing and implementing applications aims at deployment on a cloud platform will require existing application security programs to reevaluate current practices and standards. The application security spectrum ranges from standalone single-user applications to sophisticated multiuser e-commerce applications used by many users. The level is responsible for managing [7], [9], [10]: Application-level security threats; End user security; SaaS application security; PaaS application security; Customer-deployed application security IaaS application security Public cloud security limitations It can be summarized that the issues of infrastructure security and cloud computing lie in the area of definition and provision of security specified aspects each party delivers.
9 5 Conclusion The cloud is a major challenge in how computing resources will be utilized since aim of the cloud computing is to change the economics of the data center, but before sensitive and regulated data move into the public cloud, issues of security standards and compatibility must be addressed including strong authentication, delegated authorization, key management for encrypted data, data loss protections and regulatory reporting. All are elements of a secure identity, information and infrastructure model and can be applied to private and public clouds as well as to IAAS, PAAS and SAAS services. In the development of public and private clouds the service providers will need to use these guiding principles to adopt and extend security tools and secure products to build and offer end-to-end trustworthy cloud computing and services. References 1. Cloud Computing, computing. 2. Cloud Computing: Business Benefits With Security, Governance and Assurance Perspectives. An ISACA Emerging Technology White Paper, 3. Dhanjani, N., Rios, B., Hardi, B.: acking: The Next Generation. HO Reilly Media, Inc., (2009). 4. ENISA.: Cloud Computing: Information Assurance Framework. ENISA, November ENISA.: Cloud Computing: Benefits, risks and recommendations for information security. ENISA, November Lyong, L.: How to Select a Cloud Computing Infrastructure Provider. Gartner, Inc. Research. ID Number: G Mather, T., Kumaraswamy, S., Latif, S.: Cloud Security and Privacy: An Enterprise Perspective on Risks and Compliance. O Reilly Media, Inc., Owens, K.: Securing Virtual Compute Infrastructure in the Cloud. White Paper: Cloud Computing, 9. Reese, G.: Cloud Application Architectures: Building Applications and Infrastructure in the Cloud. O Reilly Media, Inc., Rittinghouse, J.W., Ransome, J.F.: Cloud Computing: Implementation, Management and Security. CRC Press, Secure Cloud Architecture, NetApp, August 2009, WP Security Guidance for Critical Areas of Focus in Cloud Computing V2.1, Cloud Security Alliance Securing Microsoft s Cloud Infrastructure. A Microsoft White Paper The Role of Security in Trustworthy Cloud Computing. RSA, White paper.
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text:
To Kill a Mockingbird by Harper Lee
Everyone should read this book… as early in life as possible! Young adults can relate to the coming-of-age themes, while parents can look up to Atticus; possibly the best Dad in literature. A novel that's taught me more about right and wrong – and knowing the difference between the two – than any other.
See book on Amazon or The Book Depository


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Lydia Wondimu
Hey, hello, hi. How are you?
My name is Lydia. I'm a sophomore in high school, born in Ethiopia, but raised in none other than the US. I know I'm pretty young, but I hope my story can aspire others to love themselves endlessly. At only a few months old, I was adopted. It honestly was the greatest blessing in my life. But I grew up feeling unwanted; I struggled with self love and acceptance for the longest time. It's hard since I am young, not many people think that we also deal with self acceptance issues as well. And being told that, no matter how much you love your parents, they aren't your bio ones, can be a real bump in the road. But soon I learned that if I can't change the situation, it's best if I change my perspective of the situation. I learned that I am truly blessed with this life, and that I am here for a reason. That you know what, it is pretty cool that I was adopted. Who knows what could have happened if I wasn't. So through my long 15 years of age, I turned to counting my blessings as my fuel to love myself. And I hope I can help other lovely people to love themselves as well 💕 God Bless and I hope my story helped


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Following a blind review of the EOIs by the Foundation's Scientific Review Committee we have now moved on to the next stage in the process. We have contacted all of the EOI Applicants and approximately half of them have been invited to submit full applications by Wednesday, 30 May. We regret that we are unable to provide feedback to unsuccessful EOI Applicants.
Invited Applicants are reminded that Foundation Grant funds cannot be used for general overheads, including the infrastructure levy imposed in some cases by the universities. Applicants are advised to be conscious of this condition of funding when calculating their project budgets.
All invited applications received by the due date and conforming to the Grant Guidelines will then be blind assessed by our impressive team of volunteer reviewers, drawing on an outstanding array of expertise from across Australia and New Zealand. Each application will receive at least two blind assessments before the shortlisted Applications proceed to the Scientific Review Committee in August/September for their detailed deliberations and final funding recommendations to the Foundation Board. The Foundation Grant Awards will be announced at the ANZICS/ACCCN ASM gala dinner in Adelaide on 13 October.


text:
Improving the ocular surface for cataract and refractive surgeons
Challenging dry eye cases
by Ellen Stodola EyeWorld Senior Staff Writer/Digital Editor
An example of graft-versus-host disease. These cases may be challenging to treat, and surgeons may want to avoid using premium lenses in these patients.
Source: Melissa Daluvoy, MD
Experts discuss how to handle a variety of scenarios
Optimizing the ocular surface is an important step for treatment of patients with dry eye. Depending on the patient and co-existing conditions, full optimization may prove particularly challenging for ophthalmologists. Melissa Daluvoy, MD, assistant professor of ophthalmology, Duke University Eye Center, Durham, North Carolina, Deborah Jacobs, MD, associate professor of ophthalmology, Harvard Medical School, Boston, and Bennie Jeng, MD, professor and chair of the Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, weighed in on a variety of scenarios and how they would approach these patients.
Scenario 1:
Progressive keratoconus
The first scenario involves a patient with progressive keratoconus and severe atopic keratoconjunctivitis with diffuse corneal and conjunctival staining and active lid eczema. EyeWorld asked Drs. Daluvoy, Jacobs, and Jeng about their protocol to settle the ocular surface prior to crosslinking in such cases.
Dr. Daluvoy said she would aggressively treat the surface disease. "To start, I would try petroleum jelly or a mild hydrocortisone ointment to the lids and treat the surface with a course of mild topical steroid and preservative-free tears," she said. "I would also reiterate the importance of not rubbing the eyes." Other treatments might include oral doxycycline or prescription-strength dry eye medications.
In terms of residual corneal staining, Dr. Daluvoy said she would tolerate only a mild amount because of concern about poor healing after epithelial debridement.
Dr. Jacobs said she is not currently doing crosslinking. "I think that the goal, as far as the ocular surface [is concerned], is to optimize healing—especially if the procedure is to be epi-off—to reduce the likelihood of persistent epi defect or residual haze. You would want to have the surface at a plateau, and if there is some staining, so be it."
Dr. Jacobs is a "huge fan" of soft steroid ointment (loteprednol or fluorometholone) at bedtime for treatment and suppression of atopic blepharoconjunctivitis. Some patients benefit from tacrolimus ointment as a steroid suppressing strategy, she added. "I would continue this through the post-crosslinking period in addition to protocol topical steroid drops."
Dr. Jeng said that before any ocular surgery or procedure, eyelid disease needs to be addressed. Atopic keratoconjunctivitis is especially difficult for a lot of ophthalmologists, he said. Treating it systemically is the only way to address it, he added.
Dr. Jeng noted that he tries not to use steroids on the eyelid because the eyelid skin is so thin, and it can cause depigmentation. Since this is a systemic disease, Dr. Jeng said it's important to "buddy up with an allergist."
When considering residual corneal staining, Dr. Jeng stressed again that the systemic disease has to be under good control, and you need to make sure the body and eyelids are "as optimized as possible." Invariably, these patients will still get staining, he said.
If a patient has atopic disease and keratoconus and you want to crosslink them, you need to realize they could end up with slow-healing epithelium. For these patients, Dr. Jeng suggested considering an epi-on protocol so you don't destroy the epithelium. Or, if you do epi-off (the current FDA-approved protocol), he said a contact lens or amniotic membrane could help them epithelialize again after.
"In terms of giving them better vision, these patients do well with a scleral lens," Dr. Jeng said. "It not only gives them better vision by giving a new surface to see out of but also keeps them more comfortable."
Scenario 2:
Severe graft-versus-host disease related dry eye
The physicians discussed how they settle the ocular surface prior to cataract surgery and IOL calculations in patients with severe graft-versus-host disease related dry eye with diffuse corneal and conjunctival staining, and oral steroid induced dense posterior capsular opacity.
Dr. Jeng said that this can be an extremely challenging problem for patients. The ocular surface in these patients with bad dry eyes may or may not ever become normal, he said.
Dr. Jeng said that often these patients might do best with a scleral lens. He added that the surgeon may have to do the best he or she can with the Ks and biometry. These patients are generally going to be in a scleral lens, and after surgery they'll be back in the scleral lens. "For that reason, if they're already in a scleral lens to treat the ocular surface, don't put in a toric because I don't think they would get the benefit of it," he said.
These cases are often recalcitrant to common dry eye treatments, Dr. Daluvoy said. They typically are already using preservative-free tears, punctal plugs, cyclosporine, etc., she said. "I am a big proponent of serum tears in these patients," Dr. Daluvoy said. "I also use amniotic membrane graft in the clinic and in some cases recommend scleral lens fitting to let the surface improve."
The goal, Dr. Jacobs said, is plateau. Plugs, lubricant, and low dose soft steroid (ointment form at bedtime) can be helpful, she said. "For these patients, comfort and quality of vision are more important than refractive outcome," she said. "The goal is a well-healed wound and a comfortable eye." If there is doubt about the IOL calculations, Dr. Jacobs said choosing more power in the IOL as a myopic result is always preferable to hyperopic.
Dr. Daluvoy and Dr. Jacobs said they don't generally use postoperative topical NSAIDs in these cases. Dr. Daluvoy noted she would allow it if CME develops, but she watches the surface closely. Meanwhile, Dr. Jacobs recommends avoiding topical NSAIDs, unless there is a specific indication, such as a broken capsule or history of diabetic macula edema or postop CME in the fellow eye.
Dr. Jacobs added that corneal melt is a concern after topical NSAIDs. "These patients can melt quickly and don't report symptoms as their background symptoms obscure the symptoms of the melt," she said.
Surgeons may also want to use caution when choosing premium lenses in these cases. Dr. Daluvoy said she will not use extended depth of focus lenses in patients with graft-versus-host disease with a poor surface, and she noted that she would only choose a toric in a mild case if the measurements were consistent and stable.
Dr. Jacobs thinks that multifocal IOLs are not a good idea, and she would only use a toric IOL if the patient's graft-versus-host disease and ocular surface have been stable for years and there is no likelihood of needing a scleral lens.
She added that she thinks a scleral lens can improve the surface, but "this would be an indefinite intervention and not simply a preop maneuver." Soft lenses have also been shown to improve comfort, vision, and the ocular surface in ocular chronic graft-versus-host disease, Dr. Jacobs said.
She said "a patient who wears a scleral lens for ocular surface disease should not have a toric IOL." There will be need for spectacle correction of astigmatism when a toric IOL is used in combination with a scleral lens, she said. The scleral lens can be refitted to incorporate a toric front surface, but this is tricky for both the patient and contact lens fitter.
Scenario 3:
Moderate to high myope with limbal stem cell deficiency
The third scenario involves a young patient with soft contact lens wear related limbal stem cell deficiency who is a moderate to high myope and wants to get rid of their contact lenses. The physicians were asked what regimen they use to optimize the ocular surface.
Dr. Jacobs said that most limbal stem cell deficiency (LSCD) will improve with low-dose soft steroid, elimination of problematic lens/solutions combos, and time. "Some can return to contact lens wear with altered lens wear and care regimens," she said, adding that punctal occlusion can be helpful.
Dr. Daluvoy said that if the area is affecting the central visual acuity, she debrides and places an amniotic membrane graft. If there are only mild findings, she treats aggressively to start with oral doxycycline, topical steroids, and preservative-free artificial tears. Dr. Daluvoy is also quick to recommend serum tears.
She added that she will wait for the LSCD late staining changes to completely resolve prior to LASIK because she wants the patient to be clear for 1 year prior to refractive surgery. She added that she would tolerate only very mild residual peripheral late staining.
Dr. Jeng stressed that if a patient has stem cell deficiency from contact lens wear, they should be out of their contacts, and he noted that choosing refractive surgery should be a good option. He explained that before doing refractive surgery, you should wait until the patient is stable, though their issues may never resolve. He added that LASIK could be a better option because you don't need to debride the epithelium.
Scenario 4:
Severe dry eye disease
So what do ophthalmologists tell patients with severe dry eye disease who need surgery but risk having a sub-optimal outcome due to their dry eye? EyeWorld asked for any pearls in counseling such patients.
Dr. Jeng said that each scenario depends on how bad a patient's dry eyes are. "If they have dry eyes and decreased vision because of ocular surface changes from it, then they aren't optimized for surgery," he said.
Dr. Jeng added that he would work hard to optimize the patient, and if they're still not optimizable, they would need to go into a scleral lens.
If Dr. Jeng thinks the patient's surface is good enough for surgery without a scleral lens, he tells them their vision might not be quite as good right after surgery, but he stresses that they have to keep up with their treatment regimen.
Dr. Jacobs said she thinks the goal is good healing, with fully correctable vision postop. "The goal of spectacle independence may not be a reasonable expectation for someone with severe ocular surface disease about to undergo cataract surgery," she said. "They may have read about premium IOL options or heard about them from friends or from your staff, but it is best to explain why these cutting-edge optical solutions might not be appropriate or might yield disappointing results."
Dr. Daluvoy added that she explains it to patients like a math equation, stressing that "if we put the wrong numbers in to start, we will get the wrong answer." It can be frustrating for the patient to wait when they think that if you could just take out the cataract or do LASIK, their vision would be fine. "I assure them it is what I would want for me or my family, and if I could fix it quickly with surgery, I certainly would," she said. "Most of these patients are aware they have a surface issue, so they understand. It is much harder when they are comfortable and don't know the contribution of the surface to their poor visual acuity."
Editors' note: Drs. Daluvoy and Jeng have no financial interests related to their comments. Dr. Jacobs was an employee of BostonSight in 2018.
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