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Sample records for acuity emergency calls

  1. Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers.

    Science.gov (United States)

    Scott, Greg; Clawson, Jeff; Fivaz, Mark C; McQueen, Jennie; Gardett, Marie I; Schultz, Bryon; Youngquist, Scott; Olola, Christopher H O

    2016-02-01

    Using the Medical Priority Dispatch System (MPDS) - a systematic 911 triage process - to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews. The primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews' patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN). In this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a "hot" (lights-and-siren) transport. Out of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren. With the exception of the low-acuity, ALPHA

  2. The difficult medical emergency call

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Kjærulff, Thora Majlund; Viereck, Søren

    2017-01-01

    BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories and the ......BACKGROUND: Pre-hospital emergency care requires proper categorization of emergency calls and assessment of emergency priority levels by the medical dispatchers. We investigated predictors for emergency call categorization as "unclear problem" in contrast to "symptom-specific" categories...... and the effect of categorization on mortality. METHODS: Register-based study in a 2-year period based on emergency call data from the emergency medical dispatch center in Copenhagen combined with nationwide register data. Logistic regression analysis (N = 78,040 individuals) was used for identification...

  3. The flex track: flexible partitioning between low- and high-acuity areas of an emergency department.

    Science.gov (United States)

    Laker, Lauren F; Froehle, Craig M; Lindsell, Christopher J; Ward, Michael J

    2014-12-01

    Emergency departments (EDs) with both low- and high-acuity treatment areas often have fixed allocation of resources, regardless of demand. We demonstrate the utility of discrete-event simulation to evaluate flexible partitioning between low- and high-acuity ED areas to identify the best operational strategy for subsequent implementation. A discrete-event simulation was used to model patient flow through a 50-bed, urban, teaching ED that handles 85,000 patient visits annually. The ED has historically allocated 10 beds to a fast track for low-acuity patients. We estimated the effect of a flex track policy, which involved switching up to 5 of these fast track beds to serving both low- and high-acuity patients, on patient waiting times. When the high-acuity beds were not at capacity, low-acuity patients were given priority access to flexible beds. Otherwise, high-acuity patients were given priority access to flexible beds. Wait times were estimated for patients by disposition and Emergency Severity Index score. A flex track policy using 3 flexible beds produced the lowest mean patient waiting time of 30.9 minutes (95% confidence interval [CI] 30.6 to 31.2 minutes). The typical fast track approach of rigidly separating high- and low-acuity beds produced a mean patient wait time of 40.6 minutes (95% CI 40.2 to 50.0 minutes), 31% higher than that of the 3-bed flex track. A completely flexible ED, in which all beds can accommodate any patient, produced mean wait times of 35.1 minutes (95% CI 34.8 to 35.4 minutes). The results from the 3-bed flex track scenario were robust, performing well across a range of scenarios involving higher and lower patient volumes and care durations. Using discrete-event simulation, we have shown that adding some flexibility into bed allocation between low and high acuity can provide substantial reductions in overall patient waiting and a more efficient ED. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc

  4. EMERGENCY CALLS

    CERN Multimedia

    Medical Service

    2001-01-01

    IN URGENT NEED OF A DOCTOR GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors ...

  5. Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre

    DEFF Research Database (Denmark)

    Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte

    2018-01-01

    with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. DISCUSSION: We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered......BACKGROUND: Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. METHODS: We...... records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. RESULTS: Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15...

  6. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls.

    Science.gov (United States)

    Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette; Folke, Fredrik; Lippert, Freddy

    2017-02-01

    This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPR prior ) versus during the emergency call following dispatcher-assisted CPR (CPR during ) - was associated with return of spontaneous circulation (ROSC) and 30-day survival. The secondary aim was to identify predictors of CPR prior . This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPR prior . The study included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPR prior group and 65.1% (n=357) in the CPR during group. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPR prior and CPR during . Predictors positively associated with CPR prior included witnessed OHCA and healthcare professional bystanders. Predictors negatively associated with CPR prior included residential location, solitary bystanders, and bystanders related to the patient. The majority of bystander CPR (65%) was initiated during the emergency call, following dispatcher-assisted CPR instructions. Whether bystander CPR was initiated prior to emergency call versus during the emergency call following dispatcher-assisted CPR was not associated with ROSC or 30-day survival. Dispatcher-assisted CPR was especially beneficial for the initiation of bystander CPR in residential areas. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  7. 47 CFR 25.284 - Emergency Call Center Service.

    Science.gov (United States)

    2010-10-01

    ... mobile satellite service to end-user customers (part 25, subparts A-D) must provide Emergency Call Center... Center personnel must determine the emergency caller's phone number and location and then transfer or otherwise redirect the call to an appropriate public safety answering point. Providers of mobile satellite...

  8. Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

    Science.gov (United States)

    Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

    2018-01-05

    Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

  9. Managing the impact of growing low-acuity demand on ambulance services

    OpenAIRE

    KATHRYN JEAN EASTWOOD

    2018-01-01

    Increasing demand for emergency ambulances places a substantial burden on ambulance services. Many cases are low-acuity, having no urgent clinical need for paramedic treatment. Ambulance Victoria implemented a secondary telephone triage services to divert low-acuity cases away from emergency ambulances to more appropriate care. This research found this ‘Referral Service’ has had a substantial impact upon emergency operations, referring over 70% of the cases it managed away from emergency am...

  10. On-call emergency workload of a general surgical team.

    Science.gov (United States)

    Jawaid, Masood; Raza, Syed Muhammad; Alam, Shams Nadeem; Manzar, S

    2009-01-01

    To examine the on-call emergency workload of a general surgical team at a tertiary care teaching hospital to guide planning and provision of better surgical services. During six months period from August to January 2007; all emergency calls attended by general surgical team of Surgical Unit II in Accident and Emergency department (A and E) and in other units of Civil, Hospital Karachi, Pakistan were prospectively recorded. Data recorded includes timing of call, diagnosis, operation performed and outcome apart from demography. Total 456 patients (326 males and 130 females) were attended by on-call general surgery team during 30 emergency days. Most of the calls, 191 (41.9%) were received from 8 am to 5 pm. 224 (49.1%) calls were of abdominal pain, with acute appendicitis being the most common specific pathology in 41 (9.0%) patients. Total 73 (16.0%) calls were received for trauma. Total 131 (28.7%) patients were admitted in the surgical unit for urgent operation or observation while 212 (46.5%) patients were discharged from A and E. 92 (20.1%) patients were referred to other units with medical referral accounts for 45 (9.8%) patients. Total 104 (22.8%) emergency surgeries were done and the most common procedure performed was appendicectomy in 34 (32.7%) patients. Major workload of on-call surgical emergency team is dealing with the acute conditions of abdomen. However, significant proportion of patients are suffering from other conditions including trauma that require a holistic approach to care and a wide range of skills and experience. These results have important implications in future healthcare planning and for the better training of general surgical residents.

  11. Why and when citizens call for emergency help

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Tolstrup, Janne Schurmann

    2015-01-01

    BACKGROUND: A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels, and temp...

  12. On-call emergency workload of a general surgical team

    Directory of Open Access Journals (Sweden)

    Jawaid Masood

    2009-01-01

    Full Text Available Background: To examine the on-call emergency workload of a general surgical team at a tertiary care teaching hospital to guide planning and provision of better surgical services. Patients and Methods: During six months period from August to January 2007; all emergency calls attended by general surgical team of Surgical Unit II in Accident and Emergency department (A and E and in other units of Civil, Hospital Karachi, Pakistan were prospectively recorded. Data recorded includes timing of call, diagnosis, operation performed and outcome apart from demography. Results: Total 456 patients (326 males and 130 females were attended by on-call general surgery team during 30 emergency days. Most of the calls, 191 (41.9% were received from 8 am to 5 pm. 224 (49.1% calls were of abdominal pain, with acute appendicitis being the most common specific pathology in 41 (9.0% patients. Total 73 (16.0% calls were received for trauma. Total 131 (28.7% patients were admitted in the surgical unit for urgent operation or observation while 212 (46.5% patients were discharged from A and E. 92 (20.1% patients were referred to other units with medical referral accounts for 45 (9.8% patients. Total 104 (22.8% emergency surgeries were done and the most common procedure performed was appendicectomy in 34 (32.7% patients. Conclusion: Major workload of on-call surgical emergency team is dealing with the acute conditions of abdomen. However, significant proportion of patients are suffering from other conditions including trauma that require a holistic approach to care and a wide range of skills and experience. These results have important implications in future healthcare planning and for the better training of general surgical residents.

  13. Tactile acuity charts: a reliable measure of spatial acuity.

    Science.gov (United States)

    Bruns, Patrick; Camargo, Carlos J; Campanella, Humberto; Esteve, Jaume; Dinse, Hubert R; Röder, Brigitte

    2014-01-01

    For assessing tactile spatial resolution it has recently been recommended to use tactile acuity charts which follow the design principles of the Snellen letter charts for visual acuity and involve active touch. However, it is currently unknown whether acuity thresholds obtained with this newly developed psychophysical procedure are in accordance with established measures of tactile acuity that involve passive contact with fixed duration and control of contact force. Here we directly compared tactile acuity thresholds obtained with the acuity charts to traditional two-point and grating orientation thresholds in a group of young healthy adults. For this purpose, two types of charts, using either Braille-like dot patterns or embossed Landolt rings with different orientations, were adapted from previous studies. Measurements with the two types of charts were equivalent, but generally more reliable with the dot pattern chart. A comparison with the two-point and grating orientation task data showed that the test-retest reliability of the acuity chart measurements after one week was superior to that of the passive methods. Individual thresholds obtained with the acuity charts agreed reasonably with the grating orientation threshold, but less so with the two-point threshold that yielded relatively distinct acuity estimates compared to the other methods. This potentially considerable amount of mismatch between different measures of tactile acuity suggests that tactile spatial resolution is a complex entity that should ideally be measured with different methods in parallel. The simple test procedure and high reliability of the acuity charts makes them a promising complement and alternative to the traditional two-point and grating orientation thresholds.

  14. Tactile acuity charts: a reliable measure of spatial acuity.

    Directory of Open Access Journals (Sweden)

    Patrick Bruns

    Full Text Available For assessing tactile spatial resolution it has recently been recommended to use tactile acuity charts which follow the design principles of the Snellen letter charts for visual acuity and involve active touch. However, it is currently unknown whether acuity thresholds obtained with this newly developed psychophysical procedure are in accordance with established measures of tactile acuity that involve passive contact with fixed duration and control of contact force. Here we directly compared tactile acuity thresholds obtained with the acuity charts to traditional two-point and grating orientation thresholds in a group of young healthy adults. For this purpose, two types of charts, using either Braille-like dot patterns or embossed Landolt rings with different orientations, were adapted from previous studies. Measurements with the two types of charts were equivalent, but generally more reliable with the dot pattern chart. A comparison with the two-point and grating orientation task data showed that the test-retest reliability of the acuity chart measurements after one week was superior to that of the passive methods. Individual thresholds obtained with the acuity charts agreed reasonably with the grating orientation threshold, but less so with the two-point threshold that yielded relatively distinct acuity estimates compared to the other methods. This potentially considerable amount of mismatch between different measures of tactile acuity suggests that tactile spatial resolution is a complex entity that should ideally be measured with different methods in parallel. The simple test procedure and high reliability of the acuity charts makes them a promising complement and alternative to the traditional two-point and grating orientation thresholds.

  15. Accuracy of 'My Gut Feeling:' Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department.

    Science.gov (United States)

    Cabrera, Daniel; Thomas, Jonathan F; Wiswell, Jeffrey L; Walston, James M; Anderson, Joel R; Hess, Erik P; Bellolio, M Fernanda

    2015-09-01

    Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis. Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient's chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU), non-ICU bed) and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria. We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%]), specificity 83.3% (95% CI [79.5-86.7%]), positive predictive value 70.3% (95% CI [64.1-75.9%]) and negative predictive value 85.7% (95% CI [82.0-88.9%]). For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%]) of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%]) and a specificity of 96.9% (95% CI [94.0-98.7%]). The correct diagnosis was made 54% of the time with the limited data available. System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.

  16. The Barbados Emergency Ambulance Service: High Frequency of Nontransported Calls

    Directory of Open Access Journals (Sweden)

    Sherwin E. Phillips

    2012-01-01

    Full Text Available Objectives. There are no published studies on the Barbados Emergency Ambulance Service and no assessment of the calls that end in nontransported individuals. We describe reasons for the nontransport of potential clients. Methods. We used the Emergency Medical Dispatch (Medical Priority Dispatch System instrument, augmented with five local call types, to collect information on types of calls. The calls were categorised under 7 headings. Correlations between call types and response time were calculated. Results. Most calls were from the category medical (54%. Nineteen (19% percent of calls were in the non-transported category. Calls from call type Cancelled accounted for most of these and this was related to response time, while Refused service was inversely related (. Conclusions. The Barbados Ambulance Service is mostly used by people with a known illness and for trauma cases. One-fifth of calls fall into a category where the ambulance is not used often due to cancellation which is related to response time. Other factors such as the use of alternative transport are also important. Further study to identify factors that contribute to the non-transported category of calls is necessary if improvements in service quality are to be made.

  17. Hospital emergency on-call coverage: is there a doctor in the house?

    Science.gov (United States)

    O'Malley, Ann S; Draper, Debra A; Felland, Laurie E

    2007-11-01

    The nation's community hospitals face increasing problems obtaining emergency on-call coverage from specialist physicians, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. The diminished willingness of specialist physicians to provide on-call coverage is occurring as hospital emergency departments confront an ever-increasing demand for services. Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to non-hospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns. Hospital strategies to secure on-call coverage include enforcing hospital medical staff bylaws that require physicians to take call, contracting with physicians to provide coverage, paying physicians stipends, and employing physicians. Nonetheless, many hospitals continue to struggle with inadequate on-call coverage, which threatens patients' timely access to high-quality emergency care and may raise health care costs.

  18. Eight Leadership Emergency Codes Worth Calling.

    Science.gov (United States)

    Freed, David H

    Hospitals have a contemporary opportunity to change themselves before attempting to transform the larger US health care system. However, actually implementing change is much more easily described than accomplished in practice. This article calls out 8 dysfunctional behaviors that compromise professional standards at the ground level of the hospital. The construct of calling a code when one witnesses such behaviors is intended to make it safe for leaders to "See something, say something" and confront them in real time. The coordinated continuum of services that health care reform seeks to attain will not emerge until individual hospital organizations prepare themselves to operate better in their own spaces and the ones that immediately surround them.

  19. Repeatability of visual acuity measurement.

    Science.gov (United States)

    Raasch, T W; Bailey, I L; Bullimore, M A

    1998-05-01

    This study investigates features of visual acuity chart design and acuity testing scoring methods which affect the validity and repeatability of visual acuity measurements. Visual acuity was measured using the Sloan and British Standard letter series, and Landolt rings. Identifiability of the different letters as a function of size was estimated, and expressed in the form of frequency-of-seeing curves. These functions were then used to simulate acuity measurements with a variety of chart designs and scoring criteria. Systematic relationships exist between chart design parameters and acuity score, and acuity score repeatability. In particular, an important feature of a chart, that largely determines the repeatability of visual acuity measurement, is the amount of size change attributed to each letter. The methods used to score visual acuity performance also affect repeatability. It is possible to evaluate acuity score validity and repeatability using the statistical principles discussed here.

  20. Accuracy of ‘My Gut Feeling:’ Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Daniel Cabrera

    2015-10-01

    Full Text Available Introduction: Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis. Methods: Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient’s chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU, non-ICU bed and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria. Results: We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%], specificity 83.3% (95% CI [79.5-86.7%], positive predictive value 70.3% (95% CI [64.1-75.9%] and negative predictive value 85.7% (95% CI [82.0-88.9%]. For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%] of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%] and a specificity of 96.9% (95% CI [94.0-98.7%]. The correct diagnosis was made 54% of the time with the limited data available. Conclusion: System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.

  1. Acuity-adaptable nursing care: exploring its place in designing the future patient room.

    Science.gov (United States)

    Kwan, Melissa A

    2011-01-01

    To substantiate the anticipated benefits of the original acuity-adaptable care delivery model as defined by innovator Ann Hendrich. In today's conveyor belt approach to healthcare, upon admission and through discharge, patients are commonly transferred based on changing acuity needs. Wasted time and money and inefficiencies in hospital operations often result-in addition to jeopardizing patient safety. In the last decade, a handful of hospitals pioneered the implementation of the acuity-adaptable care delivery model. Built on the concept of eliminating patient transfers, the projected outcomes of acuity-adaptable units-decreased average lengths of stay, increased patient safety and satisfaction, and increased nurses' satisfaction from reduced walking distances-make a good case for a model patient room. Although some hospitals experienced the projected benefits of the acuity-adaptable care delivery model, sustaining the outcomes proved to be difficult; hence, the original definition of acuity-adaptable units has not fared well. Variations on the original concept demonstrate that eliminating patient transfers has not been completely abandoned in healthcare redesign and construction initiatives. Terms such as flex-up, flex-down, universal room, and single-stay unit have since emerged. These variations convolute the search for empirical evidence to support the anticipated benefits of the original concept. To determine the future of this concept and its variants, a significant amount of outcome data must be generated by piloting the concept in different hospital settings. As further refinements and adjustments to the concept emerge, the acuity-adaptable room may find a place in future hospitals.

  2. Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses.

    Science.gov (United States)

    Chang, Wen; Liu, Hsueh-Erh; Goopy, Suzanne; Chen, Li-Chin; Chen, Hsiao-Jung; Han, Chin-Yen

    2017-10-01

    Triage classifies and prioritizes patients' care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses' decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients' health status, and nurses' experiences. This study suggests ensuring the patient's privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public's understanding of the ED visits. These will make ED triage more efficient.

  3. Visual acuity test

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003396.htm Visual acuity test To use the sharing features on this page, please enable JavaScript. The visual acuity test is used to determine the smallest ...

  4. Barriers to recognition of out-of-hospital cardiac arrest during emergency medical calls

    DEFF Research Database (Denmark)

    Alfsen, David; Møller, Thea Palsgaard; Egerod, Ingrid

    2015-01-01

    the dispatchers' recognition of OHCA, focusing on the communication during the emergency call. The purpose of this study is to identify factors affecting medical dispatchers' recognition of OHCA during emergency calls in a qualitative analysis of calls. METHODS: An investigator triangulated inductive thematic...... to an automated external defibrillator should be initiated. Previous studies have investigated barriers to recognition of OHCA, and found the caller's description of sign of life, the type of caller, caller's emotional state, an inadequate dialogue during the emergency call, and patient's agonal breathing...... as influential factors. Though many of these factors are included in the algorithms used by medical dispatchers, many OHCA still remain not recognised. Qualitative studies investigating the communication between the caller and dispatcher are very scarce. There is a lack of knowledge about what influences...

  5. 38 CFR 4.76 - Visual acuity.

    Science.gov (United States)

    2010-07-01

    ... DISABILITIES Disability Ratings The Organs of Special Sense § 4.76 Visual acuity. (a) Examination of visual acuity. Examination of visual acuity must include the central uncorrected and corrected visual acuity for... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Visual acuity. 4.76...

  6. Non-Communicable Diseases in Emergencies: A Call to Action

    Science.gov (United States)

    Demaio, Alessandro; Jamieson, Jennifer; Horn, Rebecca; de Courten, Maximilian; Tellier, Siri

    2013-01-01

    Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and thereby highlighted the importance of comprehensive and collaborative approaches to humanitarian responses and risk reduction. Simultaneously, noncommunicable diseases are now recognised as a real and growing threat to population health and development; a threat that is magnified by and during emergencies. Noncommunicable diseases, however, continue to receive little attention from humanitarian organisations in the acute phase of disaster and emergency response. This paper calls on all sectors to recognise and address the specific health challenges posed by noncommunicable diseases in emergencies and disaster situations. This publication aims to highlight the need for: • Increased research on morbidity and mortality patterns due to noncommunicable diseases during and following emergencies; • Raised awareness through greater advocacy for the issue and challenges of noncommunicable diseases during and following emergencies; • Incorporation of noncommunicable diseases into existing emergency-related policies, standards, and resources; • Development of technical guidelines on the clinical management of noncommunicable diseases in emergencies; • Greater integration and coordination in health service provision during and following emergencies; • Integrating noncommunicable diseases into practical and academic training of emergency workers and emergency-response coordinators. PMID:24056956

  7. Improved Mental Acuity Forecasting with an Individualized Quantitative Sleep Model

    Directory of Open Access Journals (Sweden)

    Brent D. Winslow

    2017-04-01

    Full Text Available Sleep impairment significantly alters human brain structure and cognitive function, but available evidence suggests that adults in developed nations are sleeping less. A growing body of research has sought to use sleep to forecast cognitive performance by modeling the relationship between the two, but has generally focused on vigilance rather than other cognitive constructs affected by sleep, such as reaction time, executive function, and working memory. Previous modeling efforts have also utilized subjective, self-reported sleep durations and were restricted to laboratory environments. In the current effort, we addressed these limitations by employing wearable systems and mobile applications to gather objective sleep information, assess multi-construct cognitive performance, and model/predict changes to mental acuity. Thirty participants were recruited for participation in the study, which lasted 1 week. Using the Fitbit Charge HR and a mobile version of the automated neuropsychological assessment metric called CogGauge, we gathered a series of features and utilized the unified model of performance to predict mental acuity based on sleep records. Our results suggest that individuals poorly rate their sleep duration, supporting the need for objective sleep metrics to model circadian changes to mental acuity. Participant compliance in using the wearable throughout the week and responding to the CogGauge assessments was 80%. Specific biases were identified in temporal metrics across mobile devices and operating systems and were excluded from the mental acuity metric development. Individualized prediction of mental acuity consistently outperformed group modeling. This effort indicates the feasibility of creating an individualized, mobile assessment and prediction of mental acuity, compatible with the majority of current mobile devices.

  8. Grating-acuity in children. Normal values of visual acuity in children up to 13 years as assessed by the acuity card procedure.

    Science.gov (United States)

    Schenk-Rootlieb, A J; van Nieuwenhuizen, O; van Zoggel, J; van der Graaf, Y; Willemse, J

    1992-09-01

    The acuity card procedure proved to be a useful method for assessing visual acuity in children. Normal values of visual acuity measured by this method had already been assessed in children up to four years. To enable application of the test in older children this study obtained values in a group of 396 normal children, aged three months to 13 years. The mean curve as well as the 10th centile was calculated in different age groups. A considerable variation of acuity values causing a 'dip' in the 10th centile was found in the ages 18 to 24 months. A smaller 'dip' was found in the ages 48 to 52 months. This has to be attributed to behavioural properties connected with age. The results obtained in the group of children under four years of age corresponded fairly well with other studies. In schoolchildren a fair agreement could also be found between the data obtained using the acuity card procedure and the data obtained with the Landolt-C rings. Obtaining normal values for the acuity card procedure in children covering a wide age range facilitates recognition of visual handicap in children who are difficult to assess.

  9. Emergency distress call system for automobiles in Lagos state, Nigeria

    African Journals Online (AJOL)

    Emergency distress call system for automobiles in Lagos state, Nigeria. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... and communications technology capabilities to transportation and the medical care system in order to save lives, ...

  10. Mediating Systems of Care: Emergency Calls to Long-Term Care Facilities at Life's End.

    Science.gov (United States)

    Waldrop, Deborah P; McGinley, Jacqueline M; Clemency, Brian

    2018-04-09

    Nursing home (NH) residents account for over 2.2 million emergency department visits yearly; the majority are cared for and transported by prehospital providers (emergency medical technicians and paramedics). The purpose of this study was to investigate prehospital providers' perceptions of emergency calls at life's end. This article focuses on perceptions of end-of-life calls in long-term care (LTC). This pilot study employed a descriptive cross-sectional design. Concepts from the symbolic interaction theory guided the exploration of perceptions and interpretations of emergency calls in LTC facilities. A purposeful sample of prehospital providers was developed from one agency in a small northeastern U.S. city. Semistructured interviews were conducted with 43 prehospital providers to explore their perceptions of factors that trigger emergency end-of-life calls in LTC facilities. Qualitative data analysis involved iterative coding in an inductive process that included open, systematic, focused, and axial coding. Interview themes illustrated the contributing factors as follows: care crises; dying-related turmoil; staffing ratios; and organizational protocols. Distress was crosscutting and present in all four themes. The findings illuminate how prehospital providers become mediators between NHs and emergency departments by managing tension, conflict, and challenges in patient care between these systems and suggest the importance of further exploration of interactions between LTC staff, prehospital providers, and emergency departments. Enhanced communication between LTC facilities and prehospital providers is important to address potentially inappropriate calls and transport requests and to identify means for collaboration in the care of sick frail residents.

  11. When seconds count: A study of communication variables in the opening segment of emergency calls.

    Science.gov (United States)

    Penn, Claire; Koole, Tom; Nattrass, Rhona

    2017-09-01

    The opening sequence of an emergency call influences the efficiency of the ambulance dispatch time. The greeting sequences in 105 calls to a South African emergency service were analysed. Initial results suggested the advantage of a specific two-part opening sequence. An on-site experiment aimed at improving call efficiency was conducted during one shift (1100 calls). Results indicated reduced conversational repairs and a significant reduction of 4 seconds in mean call length. Implications for systems and training are derived.

  12. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival

    DEFF Research Database (Denmark)

    Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær

    2017-01-01

    BACKGROUND: Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated...... with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. METHODS: We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from...... the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. RESULTS: We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised...

  13. Assessment of Grating Acuity in Infants and Toddlers Using an Electronic Acuity Card: The Dobson Card.

    Science.gov (United States)

    Mohan, Kathleen M; Miller, Joseph M; Harvey, Erin M; Gerhart, Kimberly D; Apple, Howard P; Apple, Deborah; Smith, Jordana M; Davis, Amy L; Leonard-Green, Tina; Campus, Irene; Dennis, Leslie K

    2016-01-01

    To determine if testing binocular visual acuity in infants and toddlers using the Acuity Card Procedure (ACP) with electronic grating stimuli yields clinically useful data. Participants were infants and toddlers ages 5 to 36.7 months referred by pediatricians due to failed automated vision screening. The ACP was used to test binocular grating acuity. Stimuli were presented on the Dobson Card. The Dobson Card consists of a handheld matte-black plexiglass frame with two flush-mounted tablet computers and is similar in size and form to commercially available printed grating acuity testing stimuli (Teller Acuity Cards II [TACII]; Stereo Optical, Inc., Chicago, IL). On each trial, one tablet displayed a square-wave grating and the other displayed a luminance-matched uniform gray patch. Stimuli were roughly equivalent to the stimuli available in the printed TACII stimuli. After acuity testing, each child received a cycloplegic eye examination. Based on cycloplegic retinoscopy, patients were categorized as having high or low refractive error per American Association for Pediatric Ophthalmology and Strabismus vision screening referral criteria. Mean acuities for high and low refractive error groups were compared using analysis of covariance, controlling for age. Mean visual acuity was significantly poorer in children with high refractive error than in those with low refractive error (P = .015). Electronic stimuli presented using the ACP can yield clinically useful measurements of grating acuity in infants and toddlers. Further research is needed to determine the optimal conditions and procedures for obtaining accurate and clinically useful automated measurements of visual acuity in infants and toddlers. Copyright 2016, SLACK Incorporated.

  14. Exploration of Textual Interactions in CALL Learning Communities: Emerging Research and Opportunities

    Science.gov (United States)

    White, Jonathan R.

    2017-01-01

    Computer-assisted language learning (CALL) has greatly enhanced the realm of online social interaction and behavior. In language classrooms, it allows the opportunity for students to enhance their learning experiences. "Exploration of Textual Interactions in CALL Learning Communities: Emerging Research and Opportunities" is an ideal…

  15. The Microcirculation is Preserved in Emergency Department Low‐acuity Sepsis Patients Without Hypotension

    DEFF Research Database (Denmark)

    Skibsted, Simon; Filbin, Michael; Hou, Peter

    2014-01-01

    -acuity sepsis patients. The hypothesis was that patients with sepsis, but without hypotension, will demonstrate signs of flow abnormalities compared to noninfected control patients. Methods This was a prospective, observational study in a convenience sample of patients with sepsis and noninfected controls...

  16. When seconds count : A study of communication variables in the opening segment of emergency calls

    NARCIS (Netherlands)

    Penn, Claire; Koole, Tom; Natrass, Rhona

    2017-01-01

    The opening sequence of an emergency call influences the efficiency of the ambulance dispatch time. The greeting sequences in 105 calls to a South African emergency service were analysed. Initial results suggested the advantage of a specific two-part opening sequence. An on-site experiment aimed at

  17. Acuity and case management: a healthy dose of outcomes, part III.

    Science.gov (United States)

    Huber, Diane L; Craig, Kathy

    2007-01-01

    draft and final tools for evaluator concordance, b testing for content accuracy and appropriateness, and representative sample size testing were done. Expert panel reviews occurred at multiple junctures along the development pathway, including the 5 critical points after initial tool draft and both before and after b-test (n = 5) and pilot-test (n = 28) evaluations. The pilot testing body (n = 33) consisted of a team of case managers (n = 28) along with quality analysts (n = 2), supervisory personnel (n = 2), and the lead product analyst (the developer). Product evaluation included monitoring weekly reports of open cases for the 28 case managers for 3 months (June-August 2000). The Acuity Tools Suite was used to calculate individual case acuity, overall caseload acuity profiles, case length, and acuity differentials. Normal distributions and outliers were analyzed and the results were used for internal quality improvement and outcomes monitoring. To show value, case managers need to access the evidence base for practice, use tools to capture quantities of intervention intensity, and precisely specify the activities that produce better outcomes. Acuity and dosage can help case managers explore and fully describe their own practice in ways that can be measured, and thus provide data and evidence that contributes to the accumulating body of definitive proof regarding the exceptional worth of CM. Proving business and professional worth in CM through EBP is a clarion call that case managers must heed and an innovation that all case managers can practice.

  18. Acuity and case management: a healthy dose of outcomes, part II.

    Science.gov (United States)

    Craig, Kathy; Huber, Diane L

    2007-01-01

    development, interrater reliability testing of draft and final tools for evaluator concordance, beta (beta) testing for content accuracy and appropriateness, and representative sample size testing were done. Expert panel reviews occurred at multiple junctures along the development pathway, including the 5 critical points after initial tool draft and both before and after beta-test (n = 5) and pilot-test (n = 28) evaluations. The pilot testing body (n = 33) consisted of a team of case managers (n = 28) along with quality analysts (n = 2), supervisory personnel (n = 2), and the lead product analyst (the developer). Product evaluation included monitoring weekly reports of open cases for the 28 case managers for 3 months (June-August 2000). The Acuity Tools suite was used to calculate individual case acuity, overall caseload acuity profiles, case length, and acuity differentials. Normal distributions and outliers were analyzed and the results used for internal quality improvement and outcomes monitoring. To show value, case managers need to access the evidence base for practice, use tools to capture quantities of intervention intensity, and specify precisely the activities that produce better outcomes. Acuity and dosage can help case managers explore and fully describe their own practice in ways that can be measured. This data-driven evidence contributes to the accumulating body of definitive proof regarding the exceptional worth of CM. Proving business and professional worth in CM though evidence-based practice is a clarion call that case managers must heed and an innovation that all case managers can practice.

  19. [Personal emergency call system based on human vital and system technical parameters in a Smart Home environment].

    Science.gov (United States)

    Hampicke, M; Schadow, B; Rossdeutscher, W; Fellbaum, K; Boenick, U

    2002-11-01

    Progress in microtechnology and radio transmission technology has enabled the development of highly reliable emergency-call systems. The present article describes systems that have been specially designed to improve the safety and independence of handicapped and elderly persons living at home. For such persons immediate help in an emergency situation is of crucial importance. The technical state of the art of emergency-call systems specially developed for use by the elderly, is briefly discussed, in particular the well-known radio emergency-call button, with the aid of which an alarm can be activated manually. This system, however, does not offer adequate safety in all emergency situations. Alternative or complementary systems designed to automatically trigger an alarm on the basis of the recording and evaluation of so-called vital parameters, are therefore proposed. In addition, in a smart-home environment with networked devices, further parameters--so-called environment parameters can be used. It is found that the identification of an emergency situation becomes more reliable as the number of parameters employed increases.

  20. Barriers and opportunities in assessing calls to emergency medical communication centre--a qualitative study.

    Science.gov (United States)

    Lindström, Veronica; Heikkilä, Kristiina; Bohm, Katarina; Castrèn, Maaret; Falk, Ann-Charlotte

    2014-11-11

    Previous studies have described the difficulties and the complexity of assessing an emergency call, and assessment protocols intended to support the emergency medical dispatcher's (EMD) assessment have been developed and evaluated in recent years. At present, the EMD identifies about 50-70 % of patients suffering from cardiac arrest, acute myocardial infarction or stroke. The previous research has primarily been focused on specific conditions, and it is still unclear whether there are any overall factors that may influence the assessment of the call to the emergency medical communication centre (EMCC). The aim of the study was to identify overall factors influencing the registered nurses' (RNs) assessment of calls to the EMCC. A qualitative study design was used; a purposeful selection of calls to the EMCC was analysed by content analysis. One hundred calls to the EMCC were analysed. Barriers and opportunities related to the RN or the caller were identified as the main factors influencing the RN's assessment of calls to the EMCC. The opportunities appeared in the callers' symptom description and the communication strategies used by the RN. The barriers appeared in callers' descriptions of unclear symptoms, paradoxes and the RN's lack of communication strategies during the call. Barriers in assessing the call to the EMCC were associated with contradictory information, the absence of a primary problem, or the structure of the call. Opportunities were associated with a clear symptom description that was also repeated, and the RN's use of different communication strategies such as closed loop communication.

  1. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival

    DEFF Research Database (Denmark)

    Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette

    2017-01-01

    BACKGROUND: This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPRprior) versus during the emergency call following dispatcher-assisted CPR (CPRduring) - was associated with return of spontaneous circulation (ROSC...... and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPRprior. RESULTS: The study...... included 548 emergency calls for OHCA patients receiving bystander CPR, 34.9% (n=191) in the CPRpriorgroup and 65.1% (n=357) in the CPRduringgroup. Multivariable analyses showed no difference in ROSC (OR=0.88, 95% CI: 0.56-1.38) or 30-day survival (OR=1.14, 95% CI: 0.68-1.92) between CPRpriorand CPRduring...

  2. Predicting visual acuity from detection thresholds.

    Science.gov (United States)

    Newacheck, J S; Haegerstrom-Portnoy, G; Adams, A J

    1990-03-01

    Visual performance based exclusively on high luminance and high contrast letter acuity measures often fails to predict individual performance at low contrast and low luminance. Here we measured visual acuity over a wide range of contrasts and luminances (low mesopic to photopic) for 17 young normal observers. Acuity vs. contrast functions appear to fit a single template which can be displaced laterally along the log contrast axis. The magnitude of this lateral displacement for different luminances was well predicted by the contrast threshold difference for a 4 min arc spot. The acuity vs. contrast template, taken from the mean of all 17 subjects, was used in conjunction with individual spot contrast threshold measures to predict an individual's visual acuity over a wide range of luminance and contrast levels. The accuracy of the visual acuity predictions from this simple procedure closely approximates test-retest accuracy for both positive (projected Landolt rings) and negative contrast (Bailey-Lovie charts).

  3. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival.

    Science.gov (United States)

    Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Bækgaard, Josefine Stokholm; Claesson, Andreas; Hollenberg, Jacob; Folke, Fredrik; Lippert, Freddy K

    2017-06-01

    Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from 01/01/2013-31/12/2013. OHCAs were collected from the Danish Cardiac Arrest Registry and the Mobile Critical Care Unit database. Emergency call recordings were identified and evaluated. Multivariable logistic regression analyses were applied to all OHCAs and witnessed OHCAs only to analyse the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised; OHCA recognition was positively associated with bystander CPR (odds ratio [OR]=7.84, 95% confidence interval [CI]: 5.10-12.05) in all OHCAs; and ROSC (OR=1.86, 95% CI: 1.13-3.06) and 30-day survival (OR=2.80, 95% CI: 1.58-4.96) in witnessed OHCA. Predictors of OHCA recognition were addressing breathing (OR=1.76, 95% CI: 1.17-2.66) and callers located by the patient's side (OR=2.16, 95% CI: 1.46-3.19). Recognition of OHCA during emergency calls was positively associated with the provision of bystander CPR, ROSC, and 30-day survival in witnessed OHCA. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  4. An emergency call system for patients in locked-in state using an SSVEP-based brain switch.

    Science.gov (United States)

    Lim, Jeong-Hwan; Kim, Yong-Wook; Lee, Jun-Hak; An, Kwang-Ok; Hwang, Han-Jeong; Cha, Ho-Seung; Han, Chang-Hee; Im, Chang-Hwan

    2017-11-01

    Patients in a locked-in state (LIS) due to severe neurological disorders such as amyotrophic lateral sclerosis (ALS) require seamless emergency care by their caregivers or guardians. However, it is a difficult job for the guardians to continuously monitor the patients' state, especially when direct communication is not possible. In the present study, we developed an emergency call system for such patients using a steady-state visual evoked potential (SSVEP)-based brain switch. Although there have been previous studies to implement SSVEP-based brain switch system, they have not been applied to patients in LIS, and thus their clinical value has not been validated. In this study, we verified whether the SSVEP-based brain switch system can be practically used as an emergency call system for patients in LIS. The brain switch used for our system adopted a chromatic visual stimulus, which proved to be visually less stimulating than conventional checkerboard-type stimuli but could generate SSVEP responses strong enough to be used for brain-computer interface (BCI) applications. To verify the feasibility of our emergency call system, 14 healthy participants and 3 patients with severe ALS took part in online experiments. All three ALS patients successfully called their guardians to their bedsides in about 6.56 seconds. Furthermore, additional experiments with one of these patients demonstrated that our emergency call system maintains fairly good performance even up to 4 weeks after the first experiment without renewing initial calibration data. Our results suggest that our SSVEP-based emergency call system might be successfully used in practical scenarios. © 2017 Society for Psychophysiological Research.

  5. Medical dispatchers recognise substantial amount of acute stroke during emergency calls

    DEFF Research Database (Denmark)

    Viereck, Søren; Møller, Thea Palsgaard; Iversen, Helle Klingenberg

    2016-01-01

    without an inappropriate amount of false positive cases. CONCLUSIONS: We report an overall high recognition of stroke by medical dispatchers. A final diagnosis of TIA, compared to ICH, was positively associated with recognition of acute stroke. Emergency medical dispatchers serve as the essential first...... stroke are therefore critical in organising emergency stroke care. We aimed to describe the sensitivity and positive predictive value of medical dispatchers' ability to recognise acute stroke during emergency calls, and to identify factors associated with recognition. METHODS: This was an observational...... study of 2653 consecutive unselected patients with a final diagnosis of stroke or transient ischemic attack (TIA). All admitted through the Emergency Medical Services Copenhagen, during a 2-year study period (2012-2014). Final diagnoses were matched with dispatch codes from the Emergency Medical...

  6. Wavefront coherence area for predicting visual acuity of post-PRK and post-PARK refractive surgery patients

    Science.gov (United States)

    Garcia, Daniel D.; van de Pol, Corina; Barsky, Brian A.; Klein, Stanley A.

    1999-06-01

    Many current corneal topography instruments (called videokeratographs) provide an `acuity index' based on corneal smoothness to analyze expected visual acuity. However, post-refractive surgery patients often exhibit better acuity than is predicted by such indices. One reason for this is that visual acuity may not necessarily be determined by overall corneal smoothness but rather by having some part of the cornea able to focus light coherently onto the fovea. We present a new method of representing visual acuity by measuring the wavefront aberration, using principles from both ray and wave optics. For each point P on the cornea, we measure the size of the associated coherence area whose optical path length (OPL), from a reference plane to P's focus, is within a certain tolerance of the OPL for P. We measured the topographies and vision of 62 eyes of patients who had undergone the corneal refractive surgery procedures of photorefractive keratectomy (PRK) and photorefractive astigmatic keratectomy (PARK). In addition to high contrast visual acuity, our vision tests included low contrast and low luminance to test the contribution of the PRK transition zone. We found our metric for visual acuity to be better than all other metrics at predicting the acuity of low contrast and low luminance. However, high contrast visual acuity was poorly predicted by all of the indices we studied, including our own. The indices provided by current videokeratographs sometimes fail for corneas whose shape differs from simple ellipsoidal models. This is the case with post-PRK and post-PARK refractive surgery patients. Our alternative representation that displays the coherence area of the wavefront has considerable advantages, and promises to be a better predictor of low contrast and low luminance visual acuity than current shape measures.

  7. IoTA: IoT Automated SIP-based Emergency Call Triggering System for general eHealth purposes

    OpenAIRE

    Andriopoulou, F; Orphanoudakis, T; Dagiuklas, A

    2017-01-01

    The expansion of Internet of Things (IoT) and the evolution in communication technologies have enabled homes, cars even whole cities to be network connected. However, during an emergency incident, IoT devices have not been used to trigger emergency calls directly to healthcare providers mainly due to their constrained capabilities and lack of support session-oriented communications. Moreover, emergency services are currently offered by public safety stakeholders that do not support call trigg...

  8. Recognition of out-of-hospital cardiac arrest during emergency calls - a systematic review of observational studies

    DEFF Research Database (Denmark)

    Viereck, Søren; Møller, Thea Palsgaard; Rothman, Josephine Philip

    2017-01-01

    BACKGROUND: The medical dispatcher plays an essential role as part of the first link in the Chain of Survival, by recognising the out-of-hospital cardiac arrest (OHCA) during the emergency call, dispatching the appropriate first responder or emergency medical services response, performing...... in compliance with the PRISMA guidelines. We systematically searched MEDLINE, Embase and the Cochrane Library on 4 November 2015. Observational studies, reporting the proportion of clinically confirmed OHCAs that was recognised during the emergency call, were included. Two authors independently screened...

  9. Photometric Compliance of Tablet Screens and Retro-Illuminated Acuity Charts As Visual Acuity Measurement Devices.

    Science.gov (United States)

    Livingstone, I A T; Tarbert, C M; Giardini, M E; Bastawrous, A; Middleton, D; Hamilton, R

    2016-01-01

    Mobile technology is increasingly used to measure visual acuity. Standards for chart-based acuity tests specify photometric requirements for luminance, optotype contrast and luminance uniformity. Manufacturers provide some photometric data but little is known about tablet performance for visual acuity testing. This study photometrically characterised seven tablet computers (iPad, Apple inc.) and three ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity charts with room lights on and off, and compared findings with visual acuity measurement standards. Tablet screen luminance and contrast were measured using nine points across a black and white checkerboard test screen at five arbitrary brightness levels. ETDRS optotypes and adjacent white background luminance and contrast were measured. All seven tablets (room lights off) exceeded the most stringent requirement for mean luminance (≥ 120 cd/m2) providing the nominal brightness setting was above 50%. All exceeded contrast requirement (Weber ≥ 90%) regardless of brightness setting, and five were marginally below the required luminance uniformity threshold (Lmin/Lmax ≥ 80%). Re-assessing three tablets with room lights on made little difference to mean luminance or contrast, and improved luminance uniformity to exceed the threshold. The three EDTRS charts (room lights off) had adequate mean luminance (≥ 120 cd/m2) and Weber contrast (≥ 90%), but all three charts failed to meet the luminance uniformity standard (Lmin/Lmax ≥ 80%). Two charts were operating beyond manufacturer's recommended lamp replacement schedule. With room lights on, chart mean luminance and Weber contrast increased, but two charts still had inadequate luminance uniformity. Tablet computers showed less inter-device variability, higher contrast, and better luminance uniformity than charts in both lights-on and lights-off environments, providing brightness setting was >50%. Overall, iPad tablets matched or marginally out

  10. Photometric Compliance of Tablet Screens and Retro-Illuminated Acuity Charts As Visual Acuity Measurement Devices.

    Directory of Open Access Journals (Sweden)

    I A T Livingstone

    Full Text Available Mobile technology is increasingly used to measure visual acuity. Standards for chart-based acuity tests specify photometric requirements for luminance, optotype contrast and luminance uniformity. Manufacturers provide some photometric data but little is known about tablet performance for visual acuity testing. This study photometrically characterised seven tablet computers (iPad, Apple inc. and three ETDRS (Early Treatment Diabetic Retinopathy Study visual acuity charts with room lights on and off, and compared findings with visual acuity measurement standards. Tablet screen luminance and contrast were measured using nine points across a black and white checkerboard test screen at five arbitrary brightness levels. ETDRS optotypes and adjacent white background luminance and contrast were measured. All seven tablets (room lights off exceeded the most stringent requirement for mean luminance (≥ 120 cd/m2 providing the nominal brightness setting was above 50%. All exceeded contrast requirement (Weber ≥ 90% regardless of brightness setting, and five were marginally below the required luminance uniformity threshold (Lmin/Lmax ≥ 80%. Re-assessing three tablets with room lights on made little difference to mean luminance or contrast, and improved luminance uniformity to exceed the threshold. The three EDTRS charts (room lights off had adequate mean luminance (≥ 120 cd/m2 and Weber contrast (≥ 90%, but all three charts failed to meet the luminance uniformity standard (Lmin/Lmax ≥ 80%. Two charts were operating beyond manufacturer's recommended lamp replacement schedule. With room lights on, chart mean luminance and Weber contrast increased, but two charts still had inadequate luminance uniformity. Tablet computers showed less inter-device variability, higher contrast, and better luminance uniformity than charts in both lights-on and lights-off environments, providing brightness setting was >50%. Overall, iPad tablets matched or marginally out

  11. Emergency team calls for critically ill non-trauma patients in the emergency department

    DEFF Research Database (Denmark)

    Jensen, Søren Marker; Do, Hien Quoc; Rasmussen, Søren W.

    2015-01-01

    BACKGROUND: Handling critically ill patients is a complex task for Emergency Department (ED) personnel. Initial treatment is of major importance and requires adequately experienced ED doctors to initiate and decide for the right medical or surgical treatment. Our aim was, with regard to clinical...... the study period. RESULTS: A total of 109 emergency team calls were triggered (79 orange and 30 red), comprising 66 (60.6 %) men and 43 women, with a median age of 64 years. Patients presented with: 4 Airway, 27 Breathing, 41 Circulation, 31 Disability, 2 Exposure and 4 Other problems. Overall, 58/109 (53.......2 %) patients were admitted to the ICU, while 20/109 (18.3 %) patients were deemed ineligible for ICU admission. 30-day mortality was 34/109 (31.2 %), and circulatory problems were the most frequent cause of death (61.8 %, p = 0.02). Patients who died were significantly older than those who survived (p = 0...

  12. [Schoolchildren's visual acuity in the dynamics of learning].

    Science.gov (United States)

    Bezrukikh, M M; Voinov, V B; Kul'ba, S N; Shurygina, I P

    2014-12-01

    The results of the screening study of the acuity of schoolchildren between 7 and 17 years old living in Rostov Region of the Russian Federation are discussed in the article. The method of computer optometry was used to measure acuity. 93772 pupils, 48621 girls and 45151 boys, from 150 schools participated in this examination. It was found that there is sustained growth of those with low acuity (0,2 and less) among children of both sexes from junior group (7 years) to the senior (17). The signs of the decline in visual acuity among girls (14%) are manifested earlier than in boys (8%). The decline in visual acuity among 7-8-year-old children is about 3%. While comparing children from rural areas with those from big cities a true dependence of the parameter (acuity) on the factors (city and sex) was found.

  13. Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

    Science.gov (United States)

    Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

    2015-08-01

    The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

  14. Evaluation of contrast visual acuity in patients with retinitis pigmentosa

    Science.gov (United States)

    Oomachi, Kazumi; Ogata, Kazuha; Sugawara, Takeshi; Hagiwara, Akira; Hata, Akira; Yamamoto, Shuichi

    2011-01-01

    Background The purpose of this study was to determine visual acuity at different contrast levels under photopic and mesopic conditions in patients with retinitis pigmentosa. Methods Sixty eyes of 31 normal controls, 92 eyes of 52 patients with retinitis pigmentosa without other ocular disorders (RP-1 group), and 20 eyes of 14 patients with retinitis pigmentosa with cataracts and without other ocular disorders (RP-2 group) were studied. Conventional visual acuity was measured using a conventional Landolt ring chart with 100% contrast and luminance of 150 cd/m2. All of the patients with retinitis pigmentosa had a decimal visual acuity better than 1.0. Contrast visual acuity was measured with the same Landolt ring chart with contrasts of 100% and 10% and under photopic (200 cd/m2) and mesopic (10 cd/m2) conditions. Decimal visual acuities were converted to logMAR units for the analyses. Results The 100% contrast visual acuity and the 10% contrast visual acuity determined under both photopic and mesopic conditions were significantly poorer in both the RP-1 and RP-2 groups than in the controls. The differences between the conventional visual acuity and the 100% contrast visual acuity were significantly greater in the RP-1 and RP-2 groups than in the controls under both photopic and mesopic conditions. The differences between the 100% contrast visual acuity and the 10% contrast visual acuity were not significant among the three groups under photopic and mesopic conditions. Conclusion Contrast visual acuities were greatly reduced in patients with retinitis pigmentosa with relatively well preserved conventional visual acuity, and the contrast visual acuity was largely influenced by ambient light levels in patients with retinitis pigmentosa. Although a longitudinal study for confirmation has to be performed, our findings indicate that contrast visual acuity is a better test to follow changes in visual function in patients with retinitis pigmentosa. PMID:22069346

  15. Color improves ‘visual’ acuity via sound

    Directory of Open Access Journals (Sweden)

    Shelly eLevy-Tzedek

    2014-11-01

    Full Text Available Visual-to-auditory sensory substitution devices (SSDs convey visual information via sound, with the primary goal of making visual information accessible to blind and visually impaired individuals. We developed the EyeMusic SSD, which transforms shape, location and color information into musical notes. We tested the 'visual' acuity of 23 individuals (13 blind and 10 blindfolded sighted on the Snellen tumbling-E test, with the EyeMusic. Participants were asked to determine the orientation of the letter ‘E’. The test was repeated twice: in one test, the letter ‘E’ was drawn with a single color (white, and in the other test, with two colors (red and white. In the latter case, the vertical line in the letter, when upright, was drawn in red, with the three horizontal lines drawn in white. We found no significant differences in performance between the blind and the sighted groups. We found a significant effect of the added color on the ‘visual’ acuity. The highest acuity participants reached in the monochromatic test was 20/800, whereas with the added color, acuity doubled to 20/400. We conclude that color improves 'visual' acuity via sound.

  16. Visual acuity and stereoacuity among mentally retarded children.

    Science.gov (United States)

    Letourneau, J E; Beaulne, C; Duplessis, L

    1992-12-01

    To evaluate the reliability and the validity of Landolt Rings and of the Frisby Test as measures of visual acuity and stereoacuity, respectively, the visual acuity of 30 mentally retarded children was measured with Landolt Rings shown as games, the Sjögren Test, the Dot Visual Acuity Test and stereoacuity with the Frisby Test. Subjects were tested 3 times over a period of 3 weeks to measure the reliability of the tests. No significant difference was observed among these tests. The validity of the Landolt Rings was measured by a correlation of .55 for the highest logMAR values of the Sjögren Test with the highest logMAR values of the Landolt Rings. Visual acuity was systematically lower on the Dot Visual Acuity Test. The Frisby Test was not reliable among a group of 16 normal children who improved systematically over 3 weeks.

  17. Salivary alpha amylase in on-call from home fire and emergency service personnel

    Directory of Open Access Journals (Sweden)

    Sarah J Hall

    2017-10-01

    Full Text Available The effect of working on-call from home on the sympatho-adrenal medullary system activity is currently unknown. This study had two aims, Aim 1: examine salivary alpha amylase awakening response (AAR and diurnal salivary alpha amylase (sAA profile in fire and emergency service workers who operate on-call from home following a night on-call with a call (NIGHT-CALL, a night on-call without a call (NO-CALL and an off-call night (OFF-CALL, and Aim 2: explore whether there was an anticipatory effect of working on-call from home (ON compared to when there was an off-call (OFF on the diurnal sAA profile. Participants wore activity monitors, completed sleep and work diaries and collected seven saliva samples a day for one week. AAR area under the curve with respect to ground (AUCG, AAR area under the curve with respect to increase (AUCI, AAR reactivity, diurnal sAA slope, diurnal sAA AUCG and mean 12-h sAA concentrations were calculated. Separate generalised estimating equation models were constructed for each variable of interest for each aim. For Aim 1, there were no differences between NIGHT-CALL or NO-CALL and OFF-CALL for any response variable. For Aim 2, there was no difference between any response variable of interest when ON the following night compared to when OFF the following night (n = 14. These findings suggest that there is no effect of working on-call from home on sAA, but should be interpreted with caution, as overnight data were not collected. Future research, using overnight heart rate monitoring, could help confirm these findings.

  18. Self-Regulatory Processes Mediating between Career Calling and Perceived Employability and Life Satisfaction in Emerging Adults

    Science.gov (United States)

    Praskova, Anna; Creed, Peter A.; Hood, Michelle

    2015-01-01

    We tested a cross-sectional, mediation model of career calling, in which career calling was associated positively with life satisfaction and perceptions of future employability, and these relationships were explained by the self-regulatory mechanisms of work effort, career strategies, and emotional regulation. Using a sample of 664 emerging adults…

  19. 21 CFR 886.1150 - Visual acuity chart.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Visual acuity chart. 886.1150 Section 886.1150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1150 Visual acuity chart. (a) Identification...

  20. Contributing factors to VEP grating acuity deficit and inter-ocular acuity difference in children with cerebral visual impairment.

    Science.gov (United States)

    Cavascan, Nívea Nunes; Salomão, Solange Rios; Sacai, Paula Yuri; Pereira, Josenilson Martins; Rocha, Daniel Martins; Berezovsky, Adriana

    2014-04-01

    To investigate contributing factors to visual evoked potential (VEP) grating acuity deficit (GAD) and inter-ocular acuity difference (IAD) measured by sweep-VEPs in children with cerebral visual impairment (CVI). VEP GAD was calculated for the better acuity eye by subtracting acuity thresholds from mean normal VEP grating acuity according to norms from our own laboratory. Deficits were categorized as mild (0.17 ≤ deficit children (66 males-57 %) with ages ranging from 1.2 to 166.5 months (median = 17.7) was examined. VEP GAD ranged from 0.17 to 1.28 log units (mean = 0.68 ± 0.27; median = 0.71), and it was mild in 23 (20 %) children, moderate in 32 (28 %) and severe in 60 (52 %). Severe deficit was significantly associated with older age and anti-seizure drug therapy. IAD ranged from 0 to 0.49 log units (mean = 0.06 ± 0.08; median = 0.04) and was acceptable in 96 (83 %) children. Children with strabismus and nystagmus had IAD significantly larger compared to children with orthoposition. In a large cohort of children with CVI, variable severity of VEP GAD was found, with more than half of the children with severe deficits. Older children and those under anti-seizure therapy were at higher risk for larger deficits. Strabismus and nystagmus provided larger IADs. These results should be taken into account on the clinical management of children with this leading cause of bilateral visual impairment.

  1. VEP-based acuity assessment in low vision.

    Science.gov (United States)

    Hoffmann, Michael B; Brands, Jan; Behrens-Baumann, Wolfgang; Bach, Michael

    2017-12-01

    Objective assessment of visual acuity (VA) is possible with VEP methodology, but established with sufficient precision only for vision better than about 1.0 logMAR. We here explore whether this can be extended down to 2.0 logMAR, highly desirable for low-vision evaluations. Based on the stepwise sweep algorithm (Bach et al. in Br J Ophthalmol 92:396-403, 2008) VEPs to monocular steady-state brief onset pattern stimulation (7.5-Hz checkerboards, 40% contrast, 40 ms on, 93 ms off) were recorded for eight different check sizes, from 0.5° to 9.0°, for two runs with three occipital electrodes in a Laplace-approximating montage. We examined 22 visually normal participants where acuity was reduced to ≈ 2.0 logMAR with frosted transparencies. With the established heuristic algorithm the "VEP acuity" was extracted and compared to psychophysical VA, both obtained at 57 cm distance. In 20 of the 22 participants with artificially reduced acuity the automatic analysis indicated a valid result (1.80 logMAR on average) in at least one of the two runs. 95% test-retest limits of agreement on average were ± 0.09 logMAR for psychophysical, and ± 0.21 logMAR for VEP-derived acuity. For 15 participants we obtained results in both runs and averaged them. In 12 of these 15 the low-acuity results stayed within the 95% confidence interval (± 0.3 logMAR) as established by Bach et al. (2008). The fully automated analysis yielded good agreement of psychophysical and electrophysiological VAs in 12 of 15 cases (80%) in the low-vision range down to 2.0 logMAR. This encourages us to further pursue this methodology and assess its value in patients.

  2. Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call.

    Science.gov (United States)

    Berdowski, Jocelyn; Beekhuis, Freerk; Zwinderman, Aeilko H; Tijssen, Jan G P; Koster, Rudolph W

    2009-04-21

    The content of emergency calls for suspected cardiac arrest is rarely analyzed. This study investigated the recognition of a cardiac arrest by dispatchers and its influence on survival rates. During 8 months, voice recordings of 14,800 consecutive emergency calls were collected to audit content and cardiac arrest recognition. The presence of cardiac arrest during the call was assessed from the ambulance crew report. Included calls were placed by laypersons on site and did not involve trauma. Prevalence of cardiac arrest was 3.0%. Of the 285 cardiac arrests, 82 (29%) were not recognized during the call, and 64 of 267 suspected calls (24%) were not cardiac arrest. We analyzed a random sample (n=506) of 9230 control calls. Three-month survival was 5% when a cardiac arrest was not recognized versus 14% when it was recognized (P=0.04). If the dispatcher did not recognize the cardiac arrest, the ambulance was dispatched a mean of 0.94 minute later (P<0.001) and arrived 1.40 minutes later on scene (P=0.01) compared with recognized calls. The main reason for not recognizing the cardiac arrest was not asking if the patient was breathing (42 of 82) and not asking to describe the type of breathing (16 of 82). Normal breathing was never mentioned in true cardiac arrest calls. A logistic regression model identified spontaneous trigger words like facial color that could contribute to cardiac arrest recognition (odds ratio, 7.8 to 9.7). Not recognizing a cardiac arrest during emergency calls decreases survival. Spontaneous words that the caller uses to describe the patient may aid in faster and better recognition of a cardiac arrest.

  3. How to call the Fire Brigade

    CERN Multimedia

    2003-01-01

    The telephone numbers for the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from "wired" telephones, however, from mobile phones it leads to non-CERN emergency services.

  4. Effects of lighting and task parameters on visual acuity and performance

    Energy Technology Data Exchange (ETDEWEB)

    Halonen, L.

    1993-12-31

    Lighting and task parameters and their effects on visual acuity and visual performance are dealt with. The parameters studied are target contrast, target size and subject`s age; and also adaptation luminance, luminance ratio between task and its surrounding and temporal change in luminances are studied. Experiments were carried out to examine the effects of luminance and light spectrum on visual acuity. Young normally sighted, older and low vision people participated in the measurements. In the young and older subject groups the visual acuity remained unchanged at contrasts 0.93 and 0.63 at the luminance range of 15-630 cd/m{sub 2}. The results show that at contrasts 0.03-0.93 young and older subjects` visual acuity remained unchanged in the luminance range of 105-630 cd/m{sub 2}. In the low vision group, the changes in luminances between 25-860 cd/m{sub 2} did not have significant effects on visual acuity measured at high contrast 0.93, at low contrast, slight individual changes were found. The colour temperature of the light sources was altered between 2900-9500 K in the experiment. In the groups of the older, young and low vision subjects the light spectrum did not have significant effects on visual acuity, except for two retinitis pigmentosa subjects. On the basis of the visual acuity experiments, a three dimensional visual acuity model (VA-HUT) has been developed. The model predicts visual acuity as a function of luminance, target contrast and observer age. On the basis of visual acuity experiments visual acuity reserve values have been calculated for different text sizes

  5. Perspectives on a 'Sit Less, Move More' Intervention in Australian Emergency Call Centres.

    Science.gov (United States)

    Chau, Josephine Y; Engelen, Lina; Burks-Young, Sarah; Daley, Michelle; Maxwell, Jen-Kui; Milton, Karen; Bauman, Adrian

    2016-01-01

    Prolonged sitting is associated with increased risk of chronic diseases. Workplace programs that aim to reduce sitting time (sit less) and increase physical activity (move more) have targeted desk-based workers in corporate and university settings with promising results. However, little is known about 'move more, sit less' programs for workers in other types of jobs and industries, such as shift workers. This formative research examines the perceptions of a 'sit less, move more' program in an Australian Emergency Call Centre that operates 24 hours per day, 7 days per week. Participants were employees (N = 39, 72% female, 50% aged 36-55 years) recruited from Emergency Services control centres located in New South Wales, Australia. The 'sit less, move more' intervention, consisting of emails, posters and timer lights, was co-designed with the management team and tailored to the control centre environment and work practices, which already included electronic height-adjustable sit-stand workstations for all call centre staff. Participants reported their perceptions and experiences of the intervention in a self-report online questionnaire, and directly to the research team during regular site visits. Questionnaire topics included barriers and facilitators to standing while working, mental wellbeing, effects on work performance, and workplace satisfaction. Field notes and open-ended response data were analysed in an iterative process during and after data collection to identify the main themes. Whilst participants already had sit-stand workstations, use of the desks in the standing position varied and sometimes were contrary to expectations (e.g, less tired standing than sitting; standing when experiencing high call stress). Participants emphasised the "challenging" and "unrelenting" nature of their work. They reported sleep issues ("always tired"), work stress ("non-stop demands"), and feeling mentally and physically drained due to shift work and length of shifts

  6. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    OpenAIRE

    Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-01-01

    Introduction Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. T...

  7. Emergency Severity Index version 4: a valid and reliable tool in pediatric emergency department triage.

    Science.gov (United States)

    Green, Nicole A; Durani, Yamini; Brecher, Deena; DePiero, Andrew; Loiselle, John; Attia, Magdy

    2012-08-01

    The Emergency Severity Index version 4 (ESI v.4) is the most recently implemented 5-level triage system. The validity and reliability of this triage tool in the pediatric population have not been extensively established. The goals of this study were to assess the validity of ESI v.4 in predicting hospital admission, emergency department (ED) length of stay (LOS), and number of resources utilized, as well as its reliability in a prospective cohort of pediatric patients. The first arm of the study was a retrospective chart review of 780 pediatric patients presenting to a pediatric ED to determine the validity of ESI v.4. Abstracted data included acuity level assigned by the triage nurse using ESI v.4 algorithm, disposition (admission vs discharge), LOS, and number of resources utilized in the ED. To analyze the validity of ESI v.4, patients were divided into 2 groups for comparison: higher-acuity patients (ESI levels 1, 2, and 3) and lower-acuity patients (ESI levels 4 and 5). Pearson χ analysis was performed for categorical variables. For continuous variables, we conducted a comparison of means based on parametric distribution of variables. The second arm was a prospective cohort study to determine the interrater reliability of ESI v.4 among and between pediatric triage (PT) nurses and pediatric emergency medicine (PEM) physicians. Three raters (2 PT nurses and 1 PEM physician) independently assigned triage scores to 100 patients; k and interclass correlation coefficient were calculated among PT nurses and between the primary PT nurses and physicians. In the validity arm, the distribution of ESI score levels among the 780 cases are as follows: ESI 1: 2 (0.25%); ESI 2: 73 (9.4%); ESI 3: 289 (37%); ESI 4: 251 (32%); and ESI 5: 165 (21%). Hospital admission rates by ESI level were 1: 100%, 2: 42%, 3: 14.9%, 4: 1.2%, and 5: 0.6%. The admission rate of the higher-acuity group (76/364, 21%) was significantly greater than the lower-acuity group (4/415, 0.96%), P group was

  8. Empiric determination of corrected visual acuity standards for train crews.

    Science.gov (United States)

    Schwartz, Steven H; Swanson, William H

    2005-08-01

    Probably the most common visual standard for employment in the transportation industry is best-corrected, high-contrast visual acuity. Because such standards were often established absent empiric linkage to job performance, it is possible that a job applicant or employee who has visual acuity less than the standard may be able to satisfactorily perform the required job activities. For the transportation system that we examined, the train crew is required to inspect visually the length of the train before and during the time it leaves the station. The purpose of the inspection is to determine if an individual is in a hazardous position with respect to the train. In this article, we determine the extent to which high-contrast visual acuity can predict performance on a simulated task. Performance at discriminating hazardous from safe conditions, as depicted in projected photographic slides, was determined as a function of visual acuity. For different levels of visual acuity, which was varied through the use of optical defocus, a subject was required to label scenes as hazardous or safe. Task performance was highly correlated with visual acuity as measured under conditions normally used for vision screenings (high-illumination and high-contrast): as the acuity decreases, performance at discriminating hazardous from safe scenes worsens. This empirically based methodology can be used to establish a corrected high-contrast visual acuity standard for safety-sensitive work in transportation that is linked to the performance of a job-critical task.

  9. [The relationship between eyeball structure and visual acuity in high myopia].

    Science.gov (United States)

    Liu, Yi-Chang; Xia, Wen-Tao; Zhu, Guang-You; Zhou, Xing-Tao; Fan, Li-Hua; Liu, Rui-Jue; Chen, Jie-Min

    2010-06-01

    To explore the relationship between eyeball structure and visual acuity in high myopia. Totally, 152 people (283 eyeballs) with different levels of myopia were tested for visual acuity, axial length, and fundus. All cases were classified according to diopter, axial length, and fundus. The relationships between diopter, axial length, fundus and visual acuity were studied. The mathematical models were established for visual acuity and eyeball structure markers. The visual acuity showed a moderate correlation with fundus class, comus, axial length and diopter ([r] > 0.4, P eyeball structure markers. The visual acuity should decline with axial length extension, diopter deepening and pathological deterioration of fundus. To detect the structure changes by combining different kinds of objective methods can help to assess and to judge the vision in high myopia.

  10. A case-control study of visual acuity in onychocryptosis.

    LENUS (Irish Health Repository)

    Hogan, Aisling M

    2012-02-01

    BACKGROUND: There are many theories surrounding the etiology of ingrown toenails (IGTN). Few factors have been formally assessed, but it is widely accepted that a poor nail cutting technique has a causative role. AIM: To investigate the hypothesis that decreased visual acuity may lead to inadequate nail cutting and the formation of IGTN. METHODS: A prospective case-control study was performed. Near and distance visual acuity were tested on a population with IGTN (n = 19) and compared with that of an age- and sex-matched control cohort (n = 24) who underwent epidermal cyst excision in the same tertiary referral center. Comparisons of visual acuity were made between groups by Mann-Whitney U-test. Differences were taken to be significant if P < 0.05. Institutional Review Board approval was sought and granted. RESULTS: No significant difference in visual acuity (near or distance) was demonstrated between patients with IGTN and the control group (P = 0.33). CONCLUSION: Visual acuity does not appear to play a significant role in the development of IGTN.

  11. Individual differences in non-verbal number acuity correlate with maths achievement.

    Science.gov (United States)

    Halberda, Justin; Mazzocco, Michèle M M; Feigenson, Lisa

    2008-10-02

    Human mathematical competence emerges from two representational systems. Competence in some domains of mathematics, such as calculus, relies on symbolic representations that are unique to humans who have undergone explicit teaching. More basic numerical intuitions are supported by an evolutionarily ancient approximate number system that is shared by adults, infants and non-human animals-these groups can all represent the approximate number of items in visual or auditory arrays without verbally counting, and use this capacity to guide everyday behaviour such as foraging. Despite the widespread nature of the approximate number system both across species and across development, it is not known whether some individuals have a more precise non-verbal 'number sense' than others. Furthermore, the extent to which this system interfaces with the formal, symbolic maths abilities that humans acquire by explicit instruction remains unknown. Here we show that there are large individual differences in the non-verbal approximation abilities of 14-year-old children, and that these individual differences in the present correlate with children's past scores on standardized maths achievement tests, extending all the way back to kindergarten. Moreover, this correlation remains significant when controlling for individual differences in other cognitive and performance factors. Our results show that individual differences in achievement in school mathematics are related to individual differences in the acuity of an evolutionarily ancient, unlearned approximate number sense. Further research will determine whether early differences in number sense acuity affect later maths learning, whether maths education enhances number sense acuity, and the extent to which tertiary factors can affect both.

  12. The association between higher education and approximate number system acuity.

    Science.gov (United States)

    Lindskog, Marcus; Winman, Anders; Juslin, Peter

    2014-01-01

    Humans are equipped with an approximate number system (ANS) supporting non-symbolic numerosity representation. Studies indicate a relationship between ANS-precision (acuity) and math achievement. Whether the ANS is a prerequisite for learning mathematics or if mathematics education enhances the ANS remains an open question. We investigated the association between higher education and ANS acuity with university students majoring in subjects with varying amounts of mathematics (mathematics, business, and humanities), measured either early (First year) or late (Third year) in their studies. The results suggested a non-significant trend where students taking more mathematics had better ANS acuity and a significant improvement in ANS acuity as a function of study length that was mainly confined to the business students. The results provide partial support for the hypothesis that education in mathematics can enhance the ANS acuity.

  13. The Association Between Higher Education and Approximate Number System Acuity

    Directory of Open Access Journals (Sweden)

    Marcus eLindskog

    2014-05-01

    Full Text Available Humans are equipped with an Approximate Number System (ANS supporting non-symbolic numerosity representation. Studies indicate a relationship between ANS-precision (acuity and math achievement. Whether the ANS is a prerequisite for learning mathematics or if mathematics education enhances the ANS remains an open question. We investigated the association between higher education and ANS acuity with university students majoring in subjects with varying amounts of mathematics (mathematics, business, and humanities, measured either early (1th year or late (3rd year in their studies. The results suggested a non-significant trend where students taking more mathematics had better ANS acuity and a significant improvement in ANS acuity as a function of study length that was mainly confined to the business students. The results provide partial support for the hypothesis that education in mathematics can enhance the ANS acuity.

  14. The association between higher education and approximate number system acuity

    Science.gov (United States)

    Lindskog, Marcus; Winman, Anders; Juslin, Peter

    2014-01-01

    Humans are equipped with an approximate number system (ANS) supporting non-symbolic numerosity representation. Studies indicate a relationship between ANS-precision (acuity) and math achievement. Whether the ANS is a prerequisite for learning mathematics or if mathematics education enhances the ANS remains an open question. We investigated the association between higher education and ANS acuity with university students majoring in subjects with varying amounts of mathematics (mathematics, business, and humanities), measured either early (First year) or late (Third year) in their studies. The results suggested a non-significant trend where students taking more mathematics had better ANS acuity and a significant improvement in ANS acuity as a function of study length that was mainly confined to the business students. The results provide partial support for the hypothesis that education in mathematics can enhance the ANS acuity. PMID:24904478

  15. [Determining visual acuity with LH symbols and Landolt rings].

    Science.gov (United States)

    Gräf, M; Becker, R

    1999-08-01

    Lea (LH) symbols seem to be favourable for visual acuity assessment in childhood. The symbols of the LH test are well standardized and applicable to preschool children. We compared the visual acuity determined by LH single symbols (LH) and the acuity measured with the Landolt-C (LC). 138 cooperative subjects aged 7 to 91 years were examined. Their visual acuity was either normal or reduced due to various etiologies. Their refractive error was corrected. The monocular LH and LC were determined by a 3/4 criterion (study 1). In 19 healthy subjects aged 21 to 58 years, acuity was reduced stepwise by 5 different calibrated occlusives (study 2). A Lighthouse single symbol book (LH symbols) was used at a distance of 3 m. LC was determined at a distance of 5 m. The luminance of the test field was 180-200 cd/m2. The right eye of each patient and the amblyopic eye of the squinting patients was taken for statistical evaluation. The strabismic patients' interocular differences of LC and LH were compared. Within study 1, LC ranged from 0.02 to 2.0 and LH from 0.03 to 2.5. LH overestimated LC by 1.4 lines on an average (t-test p 1 line, 85.7% resp. 90% of the strabismic amblyopic patients with an interocular LC difference > 1 resp > 2 lines were detected. In study 2, LC ranged from 0.1 to 1.6, LH from 0.12 to 2.0. The mean difference LH-LC was 1.3 lines. The regression equation was lgLH = 0.91 lgLC + 0.08 (r = 0.95). LH symbols allow a reliable measurement of recognition acuity. Due to the design of the symbols, they are excellently suitable for application to preschool children. Age related normal values should be established. The systematic difference between the LC acuity and the LH acuity measured with the Lighthouse LH single symbol book by 1.4 lines has to be considered.

  16. Tactile spatial acuity in childhood: effects of age and fingertip size.

    Directory of Open Access Journals (Sweden)

    Ryan M Peters

    Full Text Available Tactile acuity is known to decline with age in adults, possibly as the result of receptor loss, but less is understood about how tactile acuity changes during childhood. Previous research from our laboratory has shown that fingertip size influences tactile spatial acuity in young adults: those with larger fingers tend to have poorer acuity, possibly because mechanoreceptors are more sparsely distributed in larger fingers. We hypothesized that a similar relationship would hold among children. If so, children's tactile spatial acuity might be expected to worsen as their fingertips grow. However, concomitant CNS maturation might result in more efficient perceptual processing, counteracting the effect of fingertip growth on tactile acuity. To investigate, we conducted a cross-sectional study, testing 116 participants ranging in age from 6 to 16 years on a precision-controlled tactile grating orientation task. We measured each participant's grating orientation threshold on the dominant index finger, along with physical properties of the fingertip: surface area, volume, sweat pore spacing, and temperature. We found that, as in adults, children with larger fingertips (at a given age had significantly poorer acuity, yet paradoxically acuity did not worsen significantly with age. We propose that finger growth during development results in a gradual decline in innervation density as receptive fields reposition to cover an expanding skin surface. At the same time, central maturation presumably enhances perceptual processing.

  17. Retention of high tactile acuity throughout the life span in blindness.

    Science.gov (United States)

    Legge, Gordon E; Madison, Cindee; Vaughn, Brenna N; Cheong, Allen M Y; Miller, Joseph C

    2008-11-01

    Previous studies of tactile acuity on the fingertip, using passive touch, have demonstrated an age-related decline in spatial resolution for both sighted and blind subjects. We have reexamined this age dependence with two newly designed tactile-acuity charts that require active exploration of the test symbols. One chart used dot patterns similar to braille, and the other used embossed Landolt rings. Groups of blind braille readers and sighted subjects ranging from 12 to 85 years old were tested in two experiments. We replicated previous findings for sighted subjects by showing an age-related decrease in tactile acuity by nearly 1% per year. Surprisingly, the blind subjects retained high acuity into old age, showing no age-related decline. For the blind subjects, tactile acuity did not correlate with braille reading speed, the amount of daily reading, or the age at which braille was learned. We conclude that when measured with active touch, blind subjects retain high tactile acuity into old age, unlike their aging sighted peers. We propose that blind people's use of active touch in daily activities, not specifically braille reading, results in preservation of tactile acuity across the life span.

  18. IMPORTANT REMINDER - In a Medical Emergency Call 74444

    CERN Multimedia

    2005-01-01

    What happened? A CERN employee, complaining of pains that might indicate a serious heart problem, went to building 57 for medical assistance1). He went to the first floor and found the reception desk temporarily unoccupied. He then went to the CERN Fire Station. The firemen and the CERN medical team took care of him and requested helicopter transport to the Geneva cantonal hospital, where he responded well to medical treatment. What do we learn from this event? Although in this case the patient is doing well, precious time was lost. In the event of serious and acute illness, you must call the CERN internal number 74444 and avoid going in person, even accompanied by someone else. This number is available for all types of emergency. The firemen can provide professional assistance at all times as required: first aid on the spot, ambulance transport and medical assistance as necessary. The CERN Fire Station is located in building 65, on ‘Route Einstein', the first road on your right when you enter CERN Ent...

  19. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2002-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.  

  20. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2002-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.

  1. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2001-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.

  2. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2001-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note: the number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.

  3. Relationships between luminance and visual acuity in the rhesus monkey

    Science.gov (United States)

    Cavonius, C. R.; Robbins, D. O.

    1973-01-01

    1. The ability of rhesus monkeys to detect the gap in Landolt ring test-objects that were presented against background luminances between 5 × 10-5 cd/m2 and 5 × 103 cd/m2 was compared with similar human data. 2. At high luminance-levels the acuity of human observers is slightly better than that of rhesus, but rhesus have better acuity at scotopic luminance-levels. Both species have distinct photopic and scotopic acuity functions that cross at 6 × 10-3 cd/m2. 3. The threshold for light detection is estimated to be the same for both species when specified in quanta incident on the retina. 4. It is concluded that the receptor and neural mechanisms that mediate visual-acuity function similarly in rhesus and man, and that the differences in acuity that were measured in the two species may be attributed to optical rather than to physiological factors. PMID:4199366

  4. Distinct Circuits for Recovery of Eye Dominance and Acuity in Murine Amblyopia.

    Science.gov (United States)

    Stephany, Céleste-Élise; Ma, Xiaokuang; Dorton, Hilary M; Wu, Jie; Solomon, Alexander M; Frantz, Michael G; Qiu, Shenfeng; McGee, Aaron W

    2018-05-24

    Degrading vision by one eye during a developmental critical period yields enduring deficits in both eye dominance and visual acuity. A predominant model is that "reactivating" ocular dominance (OD) plasticity after the critical period is required to improve acuity in amblyopic adults. However, here we demonstrate that plasticity of eye dominance and acuity are independent and restricted by the nogo-66 receptor (ngr1) in distinct neuronal populations. Ngr1 mutant mice display greater excitatory synaptic input onto both inhibitory and excitatory neurons with restoration of normal vision. Deleting ngr1 in excitatory cortical neurons permits recovery of eye dominance but not acuity. Reciprocally, deleting ngr1 in thalamus is insufficient to rectify eye dominance but yields improvement of acuity to normal. Abolishing ngr1 expression in adult mice also promotes recovery of acuity. Together, these findings challenge the notion that mechanisms for OD plasticity contribute to the alterations in circuitry that restore acuity in amblyopia. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. Visual acuity and visual field impairment in Usher syndrome.

    Science.gov (United States)

    Edwards, A; Fishman, G A; Anderson, R J; Grover, S; Derlacki, D J

    1998-02-01

    To determine the extent of visual acuity and visual field impairment in patients with types 1 and 2 Usher syndrome. The records of 53 patients with type 1 and 120 patients with type 2 Usher syndrome were reviewed for visual acuity and visual field area at their most recent visit. Visual field areas were determined by planimetry of the II4e and V4e isopters obtained with a Goldmann perimeter. Both ordinary and logistic regression models were used to evaluate differences in visual acuity and visual field impairment between patients with type 1 and type 2 Usher syndrome. The difference in visual acuity of the better eye between patients with type 1 and type 2 varied by patient age (P=.01, based on a multiple regression model). The maximum difference in visual acuity between the 2 groups occurred during the third and fourth decades of life (with the type 1 patients being more impaired), while more similar acuities were seen in both younger and older patients. Fifty-one percent (n=27) of the type 1 patients had a visual acuity of 20/40 or better in at least 1 eye compared with 72% (n=87) of the type 2 patients (age-adjusted odds ratio, 3.9). Visual field area to both the II4e (P=.001) and V4e (Ptype 1 patients than type 2 patients. A concentric central visual field greater than 20 degrees in at least 1 eye was present in 20 (59%) of the available 34 visual fields of type 1 patients compared with 70 (67%) of the available 104 visual fields of type 2 patients (age-adjusted odds ratio, 2.9) with the V4e target and in 6 (21%) of the available 29 visual fields of type 1 patients compared with 36 (38%) of the available 94 visual fields of type 2 patients (age-adjusted odds ratio, 4.9) with the II4e target. The fraction of patients who had a visual acuity of 20/40 or better and a concentric central visual field greater than 20 degrees to the II4e target in at least 1 eye was 17% (n=5) in the type 1 patients and 35% (n=33) in the type 2 patients (age-adjusted odds ratio, 3

  6. Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure.

    Science.gov (United States)

    Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

    2015-02-27

    We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009-2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10-I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS>600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR=1.12; 95% confidence interval (CI) 1.04-1.21); and WS≥3.5 knots during days of Tweather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions.

  7. An acuity cards cookbook.

    Science.gov (United States)

    Vital-Durand, F

    1996-01-01

    Acuity cards are being more commonly used in clinical and screening practice. The author describes his experience from over 6000 infants tested with the method, using two commercially available sets of cards to provide users with comprehensive guidelines to allow them to get the most out of this useful test.

  8. Development and clinical application of a color pediatric visual acuity chart

    Directory of Open Access Journals (Sweden)

    Shu-Guo Yin

    2014-12-01

    Full Text Available AIM: To introduce a new color pediatric visual acuity chart and its clinical application.METHODS:The color pediatric visual acuity chart was designed based on principle of visual angle. The optotype on the color chart had graphics. The progression rate of optotype size between 2 lines was 10(101/2 and 1.2589. A regular geometric progression of optotype sizes and distribution was employed to arrange 8 lines with 11 optotype on the color chart. The testing distance was 3m. The visual acuity score could be recorded as logarithm of the minimum angle of resolution notation or decimal notation. The reliability of naked distant measurements with this new chart was tested in one eye of 100 children(4 ~6 years oldtaking the Chinese national standard logarithm visual acuity chart standard. RESULTS: The color pediatric visual acuity chart and logarithmic chart controls, visual acuity test results that in the two groups had no significant difference(t=1.2671, P>0.05. Two sets of vision data existed positive correlation(r=0.924, PCONCLUSION:Children are easier to accept used new color pediatric visual acuity chart to inspect vision. New chart is reliability and apply to children's vision screening.

  9. VISUAL ABILITY IN AMBLYOPIC CHILDREN COMPARED TO CHILDREN WITH NORMAL VISUAL ACUITY

    Directory of Open Access Journals (Sweden)

    Zorica Tončić

    2016-03-01

    Full Text Available Vision rehabilitation in adults with low vision, even in children, is achieved with special devices, called low vision aids, LVA. The aim of the study is to determine the degree of visual function in amblyopic children and daily activities that are best related to those of normally sighted peers with normal visual acuity. The subjects were divided into two groups, matched 1:1 by age and gender: the first group consisted of 19 amblyopic children, and the second one consisted of 19 children with normal visual acuity. The questionnaire used to assess visual ability was Cardiff Visual Ability Questionnaire for Children (CVAQC, a reliable instrument for measuring visual ability in children with low vision. The study was conducted in the only rehabilitation center for amblyopic children in this region, so this is also a pioneer study. The overall result of CVAQC in amblyopic children was 1.287 log vs.-2.956, representing statistically significantly poorer visual ability in comparison to peers without vision deficit (p˂0.005. Amblyopic children function best in entertainment activities, especially in listening music (-2.31 log; as for sport, these children report swimming to be their favourite activity (-0.99 log. In the field of education they show best results in language acquisition (-0.79 log and the worst in mathematics (3.13 log. The greatest problem is reading small print texts books (2.61 log. Low vision children have poorer result of visual function in comparison to their peers with normal visual acuity. A precise deficit assessment in the most important spheres of life can be determined by using the questionnaires, so the rehabilitation can be rightly chosen.

  10. Artificial Intelligence Can Predict Daily Trauma Volume and Average Acuity.

    Science.gov (United States)

    Stonko, David P; Dennis, Bradley M; Betzold, Richard D; Peetz, Allan B; Gunter, Oliver L; Guillamondegui, Oscar D

    2018-04-19

    The goal of this study was to integrate temporal and weather data in order to create an artificial neural network (ANN) to predict trauma volume, the number of emergent operative cases, and average daily acuity at a level 1 trauma center. Trauma admission data from TRACS and weather data from the National Oceanic and Atmospheric Administration (NOAA) was collected for all adult trauma patients from July 2013-June 2016. The ANN was constructed using temporal (time, day of week), and weather factors (daily high, active precipitation) to predict four points of daily trauma activity: number of traumas, number of penetrating traumas, average ISS, and number of immediate OR cases per day. We trained a two-layer feed-forward network with 10 sigmoid hidden neurons via the Levenberg-Marquardt backpropagation algorithm, and performed k-fold cross validation and accuracy calculations on 100 randomly generated partitions. 10,612 patients over 1,096 days were identified. The ANN accurately predicted the daily trauma distribution in terms of number of traumas, number of penetrating traumas, number of OR cases, and average daily ISS (combined training correlation coefficient r = 0.9018+/-0.002; validation r = 0.8899+/- 0.005; testing r = 0.8940+/-0.006). We were able to successfully predict trauma and emergent operative volume, and acuity using an ANN by integrating local weather and trauma admission data from a level 1 center. As an example, for June 30, 2016, it predicted 9.93 traumas (actual: 10), and a mean ISS score of 15.99 (actual: 13.12); see figure 3. This may prove useful for predicting trauma needs across the system and hospital administration when allocating limited resources. Level III STUDY TYPE: Prognostic/Epidemiological.

  11. Human locognosic acuity on the arm varies with explicit and implicit manipulations of attention: implications for interpreting elevated tactile acuity on an amputation stump.

    Science.gov (United States)

    O'Boyle, D J; Moore, C E; Poliakoff, E; Butterworth, R; Sutton, A; Cody, F W

    2001-06-01

    In Experiment 1, normal subjects' ability to localize tactile stimuli (locognosia) delivered to the upper arm was significantly higher when they were instructed explicitly to direct their attention selectively to that segment than when they were instructed explicitly to distribute their attention across the whole arm. This elevation of acuity was eliminated when subjects' attentional resources were divided by superimposition of an effortful, secondary task during stimulation. In Experiment 2, in the absence of explicit attentional instruction, subjects' locognosic acuity on one of three arm segments was significantly higher when stimulation of that segment was 2.5 times more probable than that of stimulation of the other two segments. We surmise that the attentional mechanisms responsible for such modulations of locognosic acuity in normal subjects may contribute to the elevated sensory acuity observed on the stumps of amputees.

  12. Gender and environmental influences on visual acuity in Owerri ...

    African Journals Online (AJOL)

    This study assessed the gender and environmental influences on visual function among adults in Owerri, Nigeria. Visual acuity (V.A.) is a measure of visual function in health and disease. Visual disability together with other disabling conditions is a barrier to development, yet there is little known about the visual acuity and ...

  13. The high cost of low-acuity ICU outliers.

    Science.gov (United States)

    Dahl, Deborah; Wojtal, Greg G; Breslow, Michael J; Holl, Randy; Huguez, Debra; Stone, David; Korpi, Gloria

    2012-01-01

    Direct variable costs were determined on each hospital day for all patients with an intensive care unit (ICU) stay in four Phoenix-area hospital ICUs. Average daily direct variable cost in the four ICUs ranged from $1,436 to $1,759 and represented 69.4 percent and 45.7 percent of total hospital stay cost for medical and surgical patients, respectively. Daily ICU cost and length of stay (LOS) were higher in patients with higher ICU admission acuity of illness as measured by the APACHE risk prediction methodology; 16.2 percent of patients had an ICU stay in excess of six days, and these LOS outliers accounted for 56.7 percent of total ICU cost. While higher-acuity patients were more likely to be ICU LOS outliers, 11.1 percent of low-risk patients were outliers. The low-risk group included 69.4 percent of the ICU population and accounted for 47 percent of all LOS outliers. Low-risk LOS outliers accounted for 25.3 percent of ICU cost and incurred fivefold higher hospital stay costs and mortality rates. These data suggest that severity of illness is an important determinant of daily resource consumption and LOS, regardless of whether the patient arrives in the ICU with high acuity or develops complications that increase acuity. The finding that a substantial number of long-stay patients come into the ICU with low acuity and deteriorate after ICU admission is not widely recognized and represents an important opportunity to improve patient outcomes and lower costs. ICUs should consider adding low-risk LOS data to their quality and financial performance reports.

  14. Emergency electroencephalogram: Usefulness in the diagnosis of nonconvulsive status epilepticus by the on-call neurologist.

    Science.gov (United States)

    Máñez Miró, J U; Díaz de Terán, F J; Alonso Singer, P; Aguilar-Amat Prior, M J

    2018-03-01

    We aim to describe the use of emergency electroencephalogram (EmEEG) by the on-call neurologist when nonconvulsive status epilepticus (NCSE) is suspected, and in other indications, in a tertiary hospital. Observational retrospective cohort study of emergency EEG (EmEEG) recordings with 8-channel systems performed and analysed by the on-call neurologist in the emergency department and in-hospital wards between July 2013 and May 2015. Variables recorded were sex, age, symptoms, first diagnosis, previous seizure and cause, previous stroke, cancer, brain computed tomography, diagnosis after EEG, treatment, patient progress, routine control EEG (rEEG), and final diagnosis. We analysed frequency data, sensitivity, and specificity in the diagnosis of NCSE. The study included 135 EEG recordings performed in 129 patients; 51.4% were men and their median age was 69 years. In 112 cases (83%), doctors ruled out suspected NCSE because of altered level of consciousness in 42 (37.5%), behavioural abnormalities in 38 (33.9%), and aphasia in 32 (28.5%). The EmEEG diagnosis was NCSE in 37 patients (33%), and this was confirmed in 35 (94.6%) as the final diagnosis. In 3 other cases, NCSE was the diagnosis on discharge as confirmed by rEEG although the EmEEG missed this condition at first. EmEEG performed to rule out NCSE showed 92.1% sensitivity, 97.2% specificity, a positive predictive value of 94.6%, and a negative predictive value of 96%. Our experience finds that, in an appropriate clinical context, EmEEG performed by the on-call neurologist is a sensitive and specific tool for diagnosing NCSE. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Perspectives on a ‘Sit Less, Move More’ Intervention in Australian Emergency Call Centres

    Directory of Open Access Journals (Sweden)

    Michelle Daley

    2016-05-01

    Full Text Available Background: Prolonged sitting is associated with increased risk of chronic diseases. Workplace programs that aim to reduce sitting time (sit less and increase physical activity (move more have targeted desk-based workers in corporate and university settings with promising results. However, little is known about ‘move more, sit less’ programs for workers in other types of jobs and industries, such as shift workers. This formative research examines the perceptions of a ‘sit less, move more’ program in an Australian Emergency Call Centre that operates 24 hours per day, 7 days per week. Methods: Participants were employees (N = 39, 72% female, 50% aged 36–55 years recruited from Emergency Services control centres located in New South Wales, Australia. The ‘sit less, move more’ intervention, consisting of emails, posters and timer lights, was co-designed with the management team and tailored to the control centre environment and work practices, which already included electronic height-adjustable sit-stand workstations for all call centre staff. Participants reported their perceptions and experiences of the intervention in a self-report online questionnaire, and directly to the research team during regular site visits. Questionnaire topics included barriers and facilitators to standing while working, mental wellbeing, effects on work performance, and workplace satisfaction. Field notes and open-ended response data were analysed in an iterative process during and after data collection to identify the main themes. Results: Whilst participants already had sit-stand workstations, use of the desks in the standing position varied and sometimes were contrary to expectations (e.g, less tired standing than sitting; standing when experiencing high call stress. Participants emphasised the “challenging” and “unrelenting” nature of their work. They reported sleep issues (“always tired”, work stress (“non-stop demands”, and feeling

  16. FreeCall, a system for emergency-call-handling support

    NARCIS (Netherlands)

    Post, W.M.; Koster, W.; Šrámek, M.; Schreiber, G.; Zocca, V.; Vries, B. de

    1996-01-01

    This article describes a system for the optimization of the prehospital assessment of emergency, in cases involving thoraco-abdominal complaints and consciousness problems. This assessment is performed by nurses on the basis of a telephone interview at ambulance dispatch centers. The system has a

  17. Arithmetic Training Does Not Improve Approximate Number System Acuity

    Directory of Open Access Journals (Sweden)

    Marcus Lindskog

    2016-10-01

    Full Text Available The Approximate Number System (ANS is thought to support non-symbolic representations of numerical magnitudes in humans. Recently much debate has focused on the causal direction for an observed relation between ANS acuity and arithmetic fluency. Here we investigate if arithmetic training can improve ANS acuity. We show with an experimental training study consisting of six 45-minute training sessions that although feedback during arithmetic training improves arithmetic performance substantially, it does not influence ANS acuity. Hence, we find no support for a causal link where symbolic arithmetic training influences the ANS acuity. Further, although short-term number memory is likely involved in arithmetic tasks we did not find that short-term memory capacity for numbers, measured by a digit-span test, was effected by arithmetic training. This suggests that the improvement in arithmetic fluency may have occurred independent of short-term memory efficiency, but rather due to long-term memory processes and/or mental calculation strategy development. The theoretical implications of these findings are discussed.

  18. Improvement of visual acuity by refraction in a low-vision population.

    Science.gov (United States)

    Sunness, Janet S; El Annan, Jaafar

    2010-07-01

    Refraction often may be overlooked in low-vision patients, because the main cause of vision decrease is not refractive, but rather is the result of underlying ocular disease. This retrospective study was carried out to determine how frequently and to what extent visual acuity is improved by refraction in a low-vision population. Cross-sectional study. Seven hundred thirty-nine low-vision patients seen for the first time. A database with all new low-vision patients seen from November 2005 through June 2008 recorded presenting visual acuity using an Early Treatment Diabetic Retinopathy Study chart; it also recorded the best-corrected visual acuity (BCVA) if it was 2 lines or more better than the presenting visual acuity. Retinoscopy was carried out on all patients, followed by manifest refraction. Improvement in visual acuity. Median presenting acuity was 20/80(-2) (interquartile range, 20/50-20/200). There was an improvement of 2 lines or more of visual acuity in 81 patients (11% of all patients), with 22 patients (3% of all patients) improving by 4 lines or more. There was no significant difference in age or in presenting visual acuity between the group that did not improve by refraction and the group that did improve. When stratified by diagnosis, the only 2 diagnoses with a significantly higher rate of improvement than the age-related macular degeneration group were myopic degeneration and progressive myopia (odds ratio, 4.8; 95% confidence interval [CI], 3.0-6.7) and status post-retinal detachment (odds ratio, 7.1; 95% CI, 5.2-9.0). For 5 patients (6% of those with improvement), the eye that was 1 line or more worse than the fellow eye at presentation became the eye that was 1 line or more better than the fellow eye after refraction. A significant improvement in visual acuity was attained by refraction in 11% of the new low-vision patients. Improvement was seen across diagnoses and the range of presenting visual acuity. The worse-seeing eye at presentation may

  19. Assessing physician leadership styles: application of the situational leadership model to transitions in patient acuity.

    Science.gov (United States)

    Skog, Alexander; Peyre, Sarah E; Pozner, Charles N; Thorndike, Mary; Hicks, Gloria; Dellaripa, Paul F

    2012-01-01

    The situational leadership model suggests that an effective leader adapts leadership style depending on the followers' level of competency. We assessed the applicability and reliability of the situational leadership model when observing residents in simulated hospital floor-based scenarios. Resident teams engaged in clinical simulated scenarios. Video recordings were divided into clips based on Emergency Severity Index v4 acuity scores. Situational leadership styles were identified in clips by two physicians. Interrater reliability was determined through descriptive statistical data analysis. There were 114 participants recorded in 20 sessions, and 109 clips were reviewed and scored. There was a high level of interrater reliability (weighted kappa r = .81) supporting situational leadership model's applicability to medical teams. A suggestive correlation was found between frequency of changes in leadership style and the ability to effectively lead a medical team. The situational leadership model represents a unique tool to assess medical leadership performance in the context of acuity changes.

  20. Visual Acuity in Primary School Pupils in Lagos, Nigeria | Okoro ...

    African Journals Online (AJOL)

    ... in visual acuity. Conclusion: Eye defects occur among school children with potential negative effects. Pre-school entry eye examinations and regular screening is advocated and glasses should be made available for children with refractive error. Keywords: Visual Acuity, Screening, School Children, School Health ...

  1. Modelling the training effects of kinaesthetic acuity measurement in children.

    Science.gov (United States)

    Sims, K; Morton, J

    1998-07-01

    In previous papers (Sims, Henderson, Hulme, & Morton, 1996a; Sims, Henderson, Morton, & Hulme, 1996b) we have found that the motor skills of clumsy children are capable of significant improvement following relatively brief interventions. Most remarkably, this included a 10-minute intervention while testing the kinaesthetic acuity of the children using a staircase method (Pest). In this paper, we show that Pest testing improves the kinaesthetic acuity of normal children as well. We analyse the available data on the development and improvement of motor skills and kinaesthetic acuity and derive a causal model for the underlying skills. We show that at least three independent cognitive/biological components are required to account for the data. These three components are affected differently by the various interventions that have been tried. We deduce that improvement on a general test of motor impairment can be found as a result of training in kinaesthetic acuity or through other, independent factors.

  2. BUSINESS MODELS FOR EXTENDING OF 112 EMERGENCY CALL CENTER CAPABILITIES WITH E-CALL FUNCTION INSERTION

    Directory of Open Access Journals (Sweden)

    Pop Dragos Paul

    2010-12-01

    Full Text Available The present article concerns present status of implementation in Romania and Europe of eCall service and the proposed business models regarding eCall function implementation in Romania. eCall system is used for reliable transmission in case of crush between In Vehicle System and Public Service Answering Point, via the voice channel of cellular and Public Switched Telephone Network (PSTN. eCall service could be initiated automatically or manual the driver. All data presented in this article are part of researches made by authors in the Sectorial Contract Implementation study regarding eCall system, having as partners ITS Romania and Electronic Solution, with the Romanian Ministry of Communication and Information Technology as beneficiary.

  3. When approximate number acuity predicts math performance: The moderating role of math anxiety

    Science.gov (United States)

    Libertus, Melissa E.

    2018-01-01

    Separate lines of research suggest that people who are better at estimating numerical quantities using the approximate number system (ANS) have better math performance, and that people with high levels of math anxiety have worse math performance. Only a handful of studies have examined both ANS acuity and math anxiety in the same participants and those studies report contradictory results. To address these inconsistencies, in the current study 87 undergraduate students completed assessments of ANS acuity, math anxiety, and three different measures of math. We considered moderation models to examine the interplay of ANS acuity and math anxiety on different aspects of math performance. Math anxiety and ANS acuity were both unique significant predictors of the ability to automatically recall basic number facts. ANS acuity was also a unique significant predictor of the ability to solve applied math problems, and this relation was further qualified by a significant interaction with math anxiety: the positive association between ANS acuity and applied problem solving was only present in students with high math anxiety. Our findings suggest that ANS acuity and math anxiety are differentially related to various aspects of math and should be considered together when examining their respective influences on math ability. Our findings also raise the possibility that good ANS acuity serves as a protective factor for highly math-anxious students on certain types of math assessments. PMID:29718939

  4. When approximate number acuity predicts math performance: The moderating role of math anxiety.

    Science.gov (United States)

    Braham, Emily J; Libertus, Melissa E

    2018-01-01

    Separate lines of research suggest that people who are better at estimating numerical quantities using the approximate number system (ANS) have better math performance, and that people with high levels of math anxiety have worse math performance. Only a handful of studies have examined both ANS acuity and math anxiety in the same participants and those studies report contradictory results. To address these inconsistencies, in the current study 87 undergraduate students completed assessments of ANS acuity, math anxiety, and three different measures of math. We considered moderation models to examine the interplay of ANS acuity and math anxiety on different aspects of math performance. Math anxiety and ANS acuity were both unique significant predictors of the ability to automatically recall basic number facts. ANS acuity was also a unique significant predictor of the ability to solve applied math problems, and this relation was further qualified by a significant interaction with math anxiety: the positive association between ANS acuity and applied problem solving was only present in students with high math anxiety. Our findings suggest that ANS acuity and math anxiety are differentially related to various aspects of math and should be considered together when examining their respective influences on math ability. Our findings also raise the possibility that good ANS acuity serves as a protective factor for highly math-anxious students on certain types of math assessments.

  5. When approximate number acuity predicts math performance: The moderating role of math anxiety.

    Directory of Open Access Journals (Sweden)

    Emily J Braham

    Full Text Available Separate lines of research suggest that people who are better at estimating numerical quantities using the approximate number system (ANS have better math performance, and that people with high levels of math anxiety have worse math performance. Only a handful of studies have examined both ANS acuity and math anxiety in the same participants and those studies report contradictory results. To address these inconsistencies, in the current study 87 undergraduate students completed assessments of ANS acuity, math anxiety, and three different measures of math. We considered moderation models to examine the interplay of ANS acuity and math anxiety on different aspects of math performance. Math anxiety and ANS acuity were both unique significant predictors of the ability to automatically recall basic number facts. ANS acuity was also a unique significant predictor of the ability to solve applied math problems, and this relation was further qualified by a significant interaction with math anxiety: the positive association between ANS acuity and applied problem solving was only present in students with high math anxiety. Our findings suggest that ANS acuity and math anxiety are differentially related to various aspects of math and should be considered together when examining their respective influences on math ability. Our findings also raise the possibility that good ANS acuity serves as a protective factor for highly math-anxious students on certain types of math assessments.

  6. Patient outcome of emergency laparotomy improved with increasing "number of surgeons on-call" in a university hospital: Audit loop.

    Science.gov (United States)

    Hussain, Anwar; Mahmood, Fahad; Teng, Chui; Jafferbhoy, Sadaf; Luke, David; Tsiamis, Achilleas

    2017-11-01

    Emergency laparotomy is a commonly performed high-mortality surgical procedure. The National Emergency Laparotomy Network (NELA) published an average mortality rate of 11.1% and a median length of stay equivalent to 16.3 days in patients undergoing emergency laparotomy. This study presents a completed audit loop after implementing the change of increasing the number of on-call surgeons in the general surgery rota of a university hospital. The aim of this study was to evaluate the outcomes of emergency laparotomy in a single UK tertiary centre after addition of one more consultant in the daily on-call rota. This is a retrospective study involving patients who underwent emergency laparotomy between March to May 2013 (first audit) and June to August 2015 (second audit). The study parameters stayed the same. The adult patients undergoing emergency laparotomy under the general surgical take were included. Appendicectomy, cholecystectomy and simple inguinal hernia repair patients were excluded. Data was collected on patient demographics, ASA, morbidity, 30-day mortality and length of hospital stay. Statistical analysis including logistic regression was performed using SPSS. During the second 3-month period, 123 patients underwent laparotomy compared to 84 in the first audit. Median age was 65(23-93) years. 56.01% cases were ASA III or above in the re-audit compared to 41.9% in the initial audit. 38% patients had bowel anastomosis compared to 35.7% in the re-audit with 4.2% leak rate in the re-audit compared to 16.6% in the first audit. 30-day mortality was 10.50% in the re-audit compared to 21% and median length of hospital stay 11 days in the re-audit compared to 16 days. The lower ASA grade was significantly associated with increased likelihood of being alive, as was being female, younger age and not requiring ITU admission post-operatively. However, having a second on-call consultant was 2.231 times more likely to increase the chances of patients not dying (p = 0

  7. Local and non-local deficits in amblyopia: acuity and spatial interactions.

    Science.gov (United States)

    Bonneh, Yoram S; Sagi, Dov; Polat, Uri

    2004-12-01

    Amblyopic vision is thought to be limited by abnormal long-range spatial interactions, but their exact mode of action and relationship to the main amblyopic deficit in visual acuity is largely unknown. We studied this relationship in a group (N=59) of anisometropic (N=21) and strabismic (or combined, N=38) subjects, using (1) a single and multi-pattern (crowded) computerized static Tumbling-E test with scaled spacing of two pattern widths (TeVA), in addition to an optotype (ETDRS chart) acuity test (VA) and (2) contrast detection of Gabor patches with lateral flankers (lateral masking) along the horizontal and vertical axes as well as in collinear and parallel configurations. By correlating the different measures of visual acuity and contrast suppression, we found that (1) the VA of the strabismic subjects could be decomposed into two uncorrelated components measured in TeVA: acuity for isolated patterns and acuity reduction due to flanking patterns. The latter comprised over 60% of the VA magnitude, on the average and accounted for over 50% of its variance. In contrast, a slight reduction in acuity was found in the anisometropic subjects, and the acuity for a single pattern could account for 70% of the VA variance. (2) The lateral suppression (contrast threshold elevation) in a parallel configuration along the horizontal axis was correlated with the VA (R2=0.7), as well as with the crowding effect (TeVA elevation, R2=0.5) for the strabismic group. Some correlation with the VA was also found for the collinear configuration in the anisometropic group, but less suppression and no correlation were found for all the vertical configurations in all the groups. The results indicate the existence of a specific non-local component of the strabismic deficit, in addition to the local acuity deficit in all amblyopia types. This deficit might reflect long-range lateral inhibition, or alternatively, an inaccurate and scattered top-down attentional selection mechanism.

  8. Impact of new technologies on stress, attrition and well-being in emergency call centers: the NextGeneration 9-1-1 study protocol.

    Science.gov (United States)

    Baseman, Janet; Revere, Debra; Painter, Ian; Stangenes, Scott; Lilly, Michelle; Beaton, Randal; Calhoun, Rebecca; Meischke, Hendrika

    2018-05-04

    Our public health emergency response system relies on the "first of the first responders"-the emergency call center workforce that handles the emergency needs of a public in distress. Call centers across the United States have been preparing for the "Next Generation 9-1-1" initiative, which will allow citizens to place 9-1-1 calls using a variety of digital technologies. The impacts of this initiative on a workforce that is already highly stressed is unknown. There is concern that these technology changes will increase stress, reduce job performance, contribute to maladaptive coping strategies, lower employee retention, or change morale in the workplace. Understanding these impacts to inform approaches for mitigating the health and performance risks associated with new technologies is crucial for ensuring the 911 system fulfills its mission of providing optimal emergency response to the public. Our project is an observational, prospective cohort study framed by the first new technology that will be implemented: text-to-911 calling. Emergency center call takers will be recruited nationwide. Data will be collected by online surveys distributed at each center before text-to-911 implementation; within the first month of implementation; and 6 months after implementation. Primary outcome measures are stress as measured by the Calgary Symptoms of Stress Index, use of sick leave, job performance, and job satisfaction. Primary analyses will use mixed effects regression models and mixed effects logistic regression models to estimate the change in outcome variables associated with text-to-911 implementation. Multiple secondary analyses will examine effects of stress on absenteeism; associations between technology attitudes and stress; effects of implementation on attitudes towards technology; and mitigating effects of job demands, job satisfaction, attitudes towards workplace technology and workplace support on change in stress. Our public health dependence on this workforce

  9. P3-4: Binocular Visual Acuity in Exotropia

    Directory of Open Access Journals (Sweden)

    Heekyung Yang

    2012-10-01

    Full Text Available Purpose: To investigate binocular interaction of visual acuity in patients with intermittent exotropia and its relationship with accommodative responses during binocular vision. Methods: Sixty-seven patients with intermittent exotropia of 8 years or older were included. Binocular visual acuity (BVA and monocular visual acuity (MVA were measured in sequence. Accommodative responses of both eyes were measured using the WAM-5500 autorefractor/keratometer (GrandSeiko, Fukuyama, Japan during binocular and monocular viewing conditions at 6 m. Accommodative responses during binocular vision were calculated using the difference between the refractive errors of binocular and monocular vision. Main outcome measures: Binocular interactions of visual acuity were categorized as binocular summation, equivalency, or inhibition. The prevalence of the 3 patterns of binocular interaction was investigated. Accommodative responses were correlated with differences between BVA and better MVA. Results: Most patients (41 patients, 61.2% showed binocular equivalency. Binocular inhibition and summation were noted in 6 (9.0% and 20 (29.9% patients, respectively. Linear regression analysis revealed a significant correlation between binocular interaction and accommodative responses during binocular vision (p < .001. Accommodative responses significantly correlated with the angle of exodeviation at distance (p = .002. Conclusions: In patients with intermittent exotropia, binocular inhibition is associated with increased accommodation and a larger angle of exodeviation, suggesting that accommodative convergence is a mechanism that maintains ocular alignment. Thus, BVA inhibition may be attributed to diminishing fusional control in patients with intermittent exotropia.

  10. The effect of state medicaid case-mix payment on nursing home resident acuity.

    Science.gov (United States)

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

    2006-08-01

    To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents.

  11. Perceptual learning improves contrast sensitivity, visual acuity, and foveal crowding in amblyopia.

    Science.gov (United States)

    Barollo, Michele; Contemori, Giulio; Battaglini, Luca; Pavan, Andrea; Casco, Clara

    2017-01-01

    Amblyopic observers present abnormal spatial interactions between a low-contrast sinusoidal target and high-contrast collinear flankers. It has been demonstrated that perceptual learning (PL) can modulate these low-level lateral interactions, resulting in improved visual acuity and contrast sensitivity. We measured the extent and duration of generalization effects to various spatial tasks (i.e., visual acuity, Vernier acuity, and foveal crowding) through PL on the target's contrast detection. Amblyopic observers were trained on a contrast-detection task for a central target (i.e., a Gabor patch) flanked above and below by two high-contrast Gabor patches. The pre- and post-learning tasks included lateral interactions at different target-to-flankers separations (i.e., 2, 3, 4, 8λ) and included a range of spatial frequencies and stimulus durations as well as visual acuity, Vernier acuity, contrast-sensitivity function, and foveal crowding. The results showed that perceptual training reduced the target's contrast-detection thresholds more for the longest target-to-flanker separation (i.e., 8λ). We also found generalization of PL to different stimuli and tasks: contrast sensitivity for both trained and untrained spatial frequencies, visual acuity for Sloan letters, and foveal crowding, and partially for Vernier acuity. Follow-ups after 5-7 months showed not only complete maintenance of PL effects on visual acuity and contrast sensitivity function but also further improvement in these tasks. These results suggest that PL improves facilitatory lateral interactions in amblyopic observers, which usually extend over larger separations than in typical foveal vision. The improvement in these basic visual spatial operations leads to a more efficient capability of performing spatial tasks involving high levels of visual processing, possibly due to the refinement of bottom-up and top-down networks of visual areas.

  12. Effects of Weather and Heliophysical Conditions on Emergency Ambulance Calls for Elevated Arterial Blood Pressure

    Directory of Open Access Journals (Sweden)

    Jone Vencloviene

    2015-02-01

    Full Text Available We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs, in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T, wind speed (WS, relative humidity, and barometric pressure (BP. We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s increased the daily number of elevated arterial blood pressure (EABP by 12% (RR = 1.12; 95% confidence interval (CI 1.04–1.21; and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12. An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditions.

  13. Perception of Komfo Anokye Teaching Hospital Emergency Centre staff on acuity of patients” presentation and appropriateness of attendance

    Directory of Open Access Journals (Sweden)

    P.K. Forson

    2013-06-01

    Discussion: Staff in this study were not unanimous on the acuity of presentation of walk-in patients and referred patients. Walk-in patients were more likely turned away from the EC. Though perception of staff may hold inherent weakness of objectiveness, this may inform staff attitudes to care for walk-in patients. Negative perceptions of staff on overcrowding in EC could be addressed through staff training and policy directed at reducing EC overcrowding.

  14. Visual Acuity does not Moderate Effect Sizes of Higher-Level Cognitive Tasks

    Science.gov (United States)

    Houston, James R.; Bennett, Ilana J.; Allen, Philip A.; Madden, David J.

    2016-01-01

    Background Declining visual capacities in older adults have been posited as a driving force behind adult age differences in higher-order cognitive functions (e.g., the “common cause” hypothesis of Lindenberger & Baltes, 1994). McGowan, Patterson and Jordan (2013) also found that a surprisingly large number of published cognitive aging studies failed to include adequate measures of visual acuity. However, a recent meta-analysis of three studies (LaFleur & Salthouse, 2014) failed to find evidence that visual acuity moderated or mediated age differences in higher-level cognitive processes. In order to provide a more extensive test of whether visual acuity moderates age differences in higher-level cognitive processes, we conducted a more extensive meta-analysis of topic. Methods Using results from 456 studies, we calculated effect sizes for the main effect of age across four cognitive domains (attention, executive function, memory, and perception/language) separately for five levels of visual acuity criteria (no criteria, undisclosed criteria, self-reported acuity, 20/80-20/31, and 20/30 or better). Results As expected, age had a significant effect on each cognitive domain. However, these age effects did not further differ as a function of visual acuity criteria. Conclusion The current meta-analytic, cross-sectional results suggest that visual acuity is not significantly related to age group differences in higher-level cognitive performance—thereby replicating LaFleur and Salthouse (2014). Further efforts are needed to determine whether other measures of visual functioning (e.g. contrast sensitivity, luminance) affect age differences in cognitive functioning. PMID:27070044

  15. Female carpet weavers' visual acuity and effective factors: Fordu rural area of Qom

    Directory of Open Access Journals (Sweden)

    Khajenasiri F.

    2007-11-01

    Full Text Available Background: Healthy vision of workers is one of the important elements in carpet weaving industry which has essential role in improving of the job quality and efficiency. Visual acuity is the primary outcome measure in most studies involving eye diseases. Ihe aim of this study was determination of visual acuity and its effective factors in women carpet weaver in fordu rural area of Qom has been investigated.  Methods: In a cross-sectional (descriptive-analytical study visual acuity of 177 women carpet weaver has been determined. Job hours per day, job history, age, literacy, trauma history, diabetes history, family history of eye diseases, eye diseases history and family size  of subjects were determined .Results: The results of study indicated that the right eyes visual acuity of 72.4 % of women were desirable (0 - 0.8 and 27.6 % were undesirable (0.9-1.2. These results for the left eyes were 69.5 % and 30.5 % respectively. In addition, the result showed that with increasing the job hours and history and age, percent of women with undesirable both eyes visual acuity were increased. With higher literacy levels, percent of women with undesirable both eyes visual acuity decreased. In subjects with truma history, the undesirable visual acuity was higher. In this study the relation between visual acuity and job history, age, literacy, truma history and eye diseases history were statistically significant (in all cases P<0.05.Conclusions: High percentage of women carpet weaver were in undesirable  visual acuity and in this study the relation between visual acuity and job history, age, literacy, trauma history and eye diseases history were statistically significant (in all cases P<0.05.

  16. MEDICAL SERVICE - URGENT CALLS

    CERN Multimedia

    Service Médical

    2000-01-01

    IN URGENT NEED OF A DOCTOR GENEVA: EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME: Open 24h/24h 748-49-50 AMG- Association Of Geneva Doctors: Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin 719-61-11 EMERGENCIES 719-61-11 CHILDREN'S EMERGENCIES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112   FRANCE: EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ...

  17. Variable acuity remote viewing system flight demonstration

    Science.gov (United States)

    Fisher, R. W.

    1983-01-01

    The Variable Acuity Remote Viewing System (VARVS), originally developed under contract to the Navy (ONR) as a laboratory brassboard, was modified for flight demonstration. The VARVS system was originally conceived as a technique which could circumvent the acuity/field of view/bandwidth tradeoffs that exists in remote viewing to provide a nearly eye limited display in both field of view (160 deg) and resolution (2 min arc) while utilizing conventional TV sensing, transmission, and display equipment. The modifications for flight demonstration consisted of modifying the sensor so it could be installed and flow in a Piper PA20 aircraft, equipped for remote control and modifying the display equipment so it could be integrated with the NASA Research RPB (RPRV) remote control cockpit.

  18. Visual acuity outcomes in eyes with flat corneas after PRK.

    Science.gov (United States)

    Varssano, David; Waisbourd, Michael; Minkev, Liza; Sela, Tzahi; Neudorfer, Meira; Binder, Perry S

    2013-06-01

    To evaluate the impact of corneal curvatures less than 35 diopters (D) after photorefractive keratectomy (PRK) on visual acuity outcomes. Visual acuity outcomes of 5,410 eyes that underwent PRK from January 2006 to November 2010 were retrospectively analyzed for the impact of postoperative corneal curvatures on visual outcomes. All procedures were performed on a single platform (Allegretto 200Hz excimer laser; Alcon Laboratories, Inc., Irvine, CA). Main outcome measures were postoperative corrected distance visual acuity (CDVA) and loss of CDVA. Corneas with a measured or a calculated postoperative flat meridian less than 35 D and those with a measured postoperative steep meridian less than 35 D had worse postoperative CDVA than corneas with meridians of either 35 D or more (P ≤ .021). However, the preoperative CDVA was worse in the flatter curvatures in all comparisons performed (P ≤ .024). Consequently, the measured or calculated meridian curvature had no effect on CDVA loss (P ≥ .074). Postoperative corneal keratometry values (flat and steep meridians) less than 35 D did not have a predictive effect on the risk of losing visual acuity following myopic PRK performed on the Allegretto 200Hz excimer laser. Copyright 2013, SLACK Incorporated.

  19. Evaluating the effect of emergency residency training on productivity in the emergency department.

    Science.gov (United States)

    Henning, Daniel J; McGillicuddy, Daniel C; Sanchez, Leon D

    2013-09-01

    Resident productivity, defined as patients seen per unit time, is one measure that is used to assess the performance and educational progress of residents in the emergency department (ED). One published study suggested that emergency residency training (EM) does not improve productivity compared with that in other specialties, including internal medicine (IM). This study assesses how EM and IM trainees perform in the ED and illustrates how resident productivity changes through the academic year. A retrospective review of attending physicians and residents working 8-h shifts in the higher acuity zone of a large-volume, tertiary, academic health care center was performed for July 2009, October 2009, January 2010, and April 2010. The total number of patients seen primarily and admitted during each shift was recorded. ED volume was approximated by the number of patients seen by the attending physician, and acuity was approximated by admission rate. A mixed model regression assessed the impact of year and type of residency training (e.g., EM1, EM2, IM1, and IM2), ED volume, and acuity on resident productivity (number of patients per shift). The study was granted waiver of informed consent by our institutional review board. We reviewed 936 shifts. After adjusting for acuity and ED volume, the EM1 group had a significant increase in patients per shift over the year, from 6.11 in July to 10.3 in April (p increased productivity significantly. The first EM training year leads to a significant change in productivity that separates EM from IM residents. This contradicts the previous assertion that non-EM residents have the same productivity as EM residents in the ED. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Should we add visual acuity ratios to referral criteria for potential cerebral visual impairment?

    Science.gov (United States)

    van der Zee, Ymie J; Stiers, Peter; Evenhuis, Heleen M

    To determine whether the assessment of visual acuity ratios might improve the referral of children with (sub)normal visual acuity but at risk of cerebral visual impairment. In an exploratory study, we assessed visual acuity, crowding ratio and the ratios between grating acuity (Teller Acuity Cards-II) and optotype acuity (Cambridge Crowding Cards) in 60 typically developing school children (mean age 5y8m±1y1m), 21 children with ocular abnormalities only (5y7m±1y9m) and 26 children with (suspected) brain damage (5y7m±1y11m). Sensitivities and specificities were calculated for targets and controls from the perspective of different groups of diagnosticians: youth health care professionals (target: children with any visual abnormalities), ophthalmologists and low vision experts (target: children at risk of cerebral visual impairment). For youth health care professionals subnormal visual acuity had the best sensitivity (76%) and specificity (70%). For ophthalmologists and low vision experts the crowding ratio had the best sensitivity (67%) and specificity (79 and 86%). Youth health care professionals best continue applying subnormal visual acuity for screening, whereas ophthalmologists and low vision experts best add the crowding ratio to their routine diagnostics, to distinguish children at risk of visual impairment in the context of brain damage from children with ocular pathology only. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  1. Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

    Science.gov (United States)

    Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

    2014-06-01

    This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

  2. A study on the impact of prioritising emergency department arrivals on the patient waiting time.

    Science.gov (United States)

    Van Bockstal, Ellen; Maenhout, Broos

    2018-05-03

    In the past decade, the crowding of the emergency department has gained considerable attention of researchers as the number of medical service providers is typically insufficient to fulfil the demand for emergency care. In this paper, we solve the stochastic emergency department workforce planning problem and consider the planning of nurses and physicians simultaneously for a real-life case study in Belgium. We study the patient arrival pattern of the emergency department in depth and consider different patient acuity classes by disaggregating the arrival pattern. We determine the personnel staffing requirements and the design of the shifts based on the patient arrival rates per acuity class such that the resource staffing cost and the weighted patient waiting time are minimised. In order to solve this multi-objective optimisation problem, we construct a Pareto set of optimal solutions via the -constraints method. For a particular staffing composition, the proposed model minimises the patient waiting time subject to upper bounds on the staffing size using the Sample Average Approximation Method. In our computational experiments, we discern the impact of prioritising the emergency department arrivals. Triaging results in lower patient waiting times for higher priority acuity classes and to a higher waiting time for the lowest priority class, which does not require immediate care. Moreover, we perform a sensitivity analysis to verify the impact of the arrival and service pattern characteristics, the prioritisation weights between different acuity classes and the incorporated shift flexibility in the model.

  3. Out of sight, out of mind? Relations between visual acuity and cognition.

    Science.gov (United States)

    La Fleur, Claire G; Salthouse, Timothy A

    2014-10-01

    Prior research has established significant relations between measures of sensory ability and cognitive function in adults of different ages, and several explanations for this relation have been proposed. One explanation is that sensory abilities restrict cognitive processing, a second is that cognitive abilities influence assessments of sensory ability, and a third is that both sensory function and cognition are affected by a common, potentially age-based, third factor. These explanations were investigated using mediation and moderation analyses, with near visual acuity as the sensory measure and scores on visual speed tests and auditory memory tests as the cognitive measures. Measures of visual acuity, speed, and memory were obtained from three moderately large samples, two cross-sectional (N = 380, N = 4,779) and one longitudinal (N = 2,258), with participants ranging from 18 to 90 years of age. The visual acuity and cognitive measures had different age trajectories, and the visual acuity-cognition relations were similar in each 5-year age band. The results suggest that the age-related differences and changes in near visual acuity are unlikely to contribute to the age-related differences and changes in speed and memory measures.

  4. Visual Acuity Testing: Feedback Affects Neither Outcome nor Reproducibility, but Leaves Participants Happier.

    Science.gov (United States)

    Bach, Michael; Schäfer, Kerstin

    2016-01-01

    Assessment of visual acuity is a well standardized procedure at least for expert opinions and clinical trials. It is often recommended not giving patients feedback on the correctness of their responses. As this viewpoint has not been quantitatively examined so far, we quantitatively assessed possible effects of feedback on visual acuity testing. In 40 normal participants we presented Landolt Cs in 8 orientations using the automated Freiburg Acuity Test (FrACT, feedback was provided in 2 x 4 conditions: (A) no feedback, (B) acoustic signals indicating correctness, (C)visual indication of correct orientation, and (D) a combination of (B) and (C). After each run the participants judged comfort. Main outcome measures were absolute visual acuity (logMAR), its test-retest agreement (limits of agreement) and participants' comfort estimates on a 5-step symmetric Likert scale. Feedback influenced acuity outcome significantly (p = 0.02), but with a tiny effect size: 0.02 logMAR poorer acuity for (D) compared to (A), even weaker effects for (B) and (C). Test-retest agreement was high (limits of agreement: ± 1.0 lines) and did not depend on feedback (p>0.5). The comfort ranking clearly differed, by 2 steps on the Likert scale: the condition (A)-no feedback-was on average "slightly uncomfortable", the other three conditions were "slightly comfortable" (pFeedback affected neither reproducibility nor the acuity outcome to any relevant extent. The participants, however, reported markedly greater comfort with any kind of feedback. We conclude that systematic feedback (as implemented in FrACT) offers nothing but advantages for routine use.

  5. Visual Acuity Improvement in Continuous vs Divided Occlusion in Anisometropic Amblyopia.

    Science.gov (United States)

    Irfani, Irawati; Feriyanto, Feri; Oktarima, Primawita; Kartasasmita, Arief

    2018-01-01

    To compare visual acuity improvement between continuous and split part-time occlusion for the treatment of moderate and severe anisometropic amblyopia. Randomised clinical trials in 6 - 13 y.o children with moderate and severe anisometropic amblyopia. Each patient was consecutively selected with continuous or split part-time occlusion. Best corrected visual acuity's improvement was followed up to six weeks and statistical data were analyzed using chi square and unpaired t-test. Best corrected visual acuity's improvement was comparable between continuous and split part-time occlusion (0.20±0.27 vs 0.21±0.25; p = 0.79). Split part-time occlusion may be considered as an alternative treatment for moderate and severe anisometropic amblyopia treatment.

  6. Measuring the Influence of Galilean Loupe System on Near Visual Acuity of Dentists under Simulated Clinical Conditions

    Directory of Open Access Journals (Sweden)

    Iris Urlić

    2016-01-01

    Full Text Available Aim: The purpose of this study was to compare near visual acuity of dentists without optical aids (VSC with near visual acuity of those using the Galilean telescope system (VGA2 with magnification of x 2.5, and the distance of 350 mm in simulated clinical conditions. Methods: The study included 46 dentists (visual acuity 1.0 without correction. A visual acuity testing was carried out using a miniaturized Snellen visual acuity chart which was placed in the cavity of molar teeth mounted in a phantom head in simulated clinical conditions. Near visual acuity for the vicinity was examined: 1 without correction at a distance of 300-400 mm (VSC; 2 with Galilean loupes with magnification of x2.5, focal length of 350mm. Results: The distributions of near visual acuity recorded using VSC and VGA2, 5 systems were compared by the Wilcoxon Signed Rank test. The results obtained by Wilcoxon Signed Rank test pointed to a statistically significant difference in the distribution of recorded visual acuity between the VSC and VGA2 optical systems (W = - 403.5; p <0.001. Conclusion: If using the VGA2, 5 systems, higher values of the near visual acuity were recorded and subsequently compared to near visual acuity without magnifying aids (VSC.

  7. [Congenital lens subluxation: visual acuity outcomes and intraocular lens postoperative position].

    Science.gov (United States)

    Arraes, Caroline; Endriss, Daniela; Lobato, Francisco; Arraes, João; Ventura, Marcelo

    2010-01-01

    To evaluate the visual acuity outcomes and to investigate the intraocular lens (IOL) and endocapsular ring positions with ultrasound biomicroscopy in 17 eyes of 10 patients with congenital lens subluxation who underwent the same surgical technique, by the same surgeon. The study was performed in the ''Hospital de Olhos de Pernambuco'' and ''Fundação Altino Ventura''. The surgical technique consisted of phacoaspiration with implant of endocapsular ring and intraocular lens with one loop haptic amputated. The age varied from 7 to 22 years. Data on visual acuity (VA) before and after surgery, surgery follow-up period, and complications were analyzed. All patients underwent ultrasound biomicroscopy. The mean follow-up period was 2.8 years. There was a VA improvement in 17 (100%) eyes: in 12 eyes (70.6%) the visual acuity was better than 20/40; 4 (23.5%) ranged from 20/40 to 20/100, and 1 (5.9%) had visual acuity worse than 20/100, however better than the preoperative visual acuity. The posterior capsular opacification occurred in 10 eyes (58.9%). Ultrasound biomicroscopy showed that all IOL were partially decentralized, however without surpassing the pupil border limit. Endocapsular ring position was correct and there was a good capsular support in all cases. The evaluated surgical treatment provided good intraocular lens and endocapsular ring position, with VA improvement Thus, this technique is a viable, effective and safe option for the visual rehabilitation of patients with congenital lens subluxation.

  8. ANS acuity and mathematics ability in preschoolers from low-income homes: contributions of inhibitory control.

    Science.gov (United States)

    Fuhs, Mary Wagner; McNeil, Nicole M

    2013-01-01

    Recent findings by Libertus, Feigenson, and Halberda (2011) suggest that there is an association between the acuity of young children's approximate number system (ANS) and their mathematics ability before exposure to instruction in formal schooling. The present study examined the generalizability and validity of these findings in a sample of preschoolers from low-income homes. Children attending Head Start (N = 103) completed measures to assess ANS acuity, mathematics ability, receptive vocabulary, and inhibitory control. Results showed only a weak association between ANS acuity and mathematics ability that was reduced to non-significance when controlling for a direct measure of receptive vocabulary. Results also revealed that inhibitory control plays an important role in the relation between ANS acuity and mathematics ability. Specifically, ANS acuity accounted for significant variance in mathematics ability over and above receptive vocabulary, but only for ANS acuity trials in which surface area conflicted with numerosity. Moreover, this association became non-significant when controlling for inhibitory control. These results suggest that early mathematical experiences prior to formal schooling may influence the strength of the association between ANS acuity and mathematics ability and that inhibitory control may drive that association in young children. © 2012 Blackwell Publishing Ltd.

  9. Visual acuity in adults with Asperger's syndrome: no evidence for "eagle-eyed" vision.

    Science.gov (United States)

    Falkmer, Marita; Stuart, Geoffrey W; Danielsson, Henrik; Bram, Staffan; Lönebrink, Mikael; Falkmer, Torbjörn

    2011-11-01

    Autism spectrum conditions (ASC) are defined by criteria comprising impairments in social interaction and communication. Altered visual perception is one possible and often discussed cause of difficulties in social interaction and social communication. Recently, Ashwin et al. suggested that enhanced ability in local visual processing in ASC was due to superior visual acuity, but that study has been the subject of methodological criticism, placing the findings in doubt. The present study investigated visual acuity thresholds in 24 adults with Asperger's syndrome and compared their results with 25 control subjects with the 2 Meter 2000 Series Revised ETDRS Chart. The distribution of visual acuities within the two groups was highly similar, and none of the participants had superior visual acuity. Superior visual acuity in individuals with Asperger's syndrome could not be established, suggesting that differences in visual perception in ASC are not explained by this factor. A continued search for explanations of superior ability in local visual processing in persons with ASC is therefore warranted. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  10. How to measure distance visual acuity

    Directory of Open Access Journals (Sweden)

    Janet Marsden

    2014-04-01

    Full Text Available Visual acuity (VA is a measure of the ability of the eye to distinguish shapes and the details of objects at a given distance. It is important to assess VA in a consistent way in order to detect any changes in vision. One eye is tested at a time.

  11. [Dice test--a simple method for assessment of visual acuity in infants with visual deficits].

    Science.gov (United States)

    Rohrschneider, K; Brill, B; Bayer, Y; Ahrens, P

    2010-07-01

    Determination of visual acuity in low vision infants or patients with additional cerebral retardation is difficult. In our low vision department we used dice of different sizes and colors as well as other defined objects to determine visual acuity (VA). In this study we compared the results of the dice test with conventional tests for measurement of visual acuity. A total of 88 children with different causes of visual impairment e.g. albinism, retinal scars, retinopathy of prematurity (ROP), achromatopsia and optic atrophy etc., were included in this longitudinal study. Median follow-up time was 8.7 years (range 2.9-18.9 years). The first reliable examination was performed between the ages of 4 and 24 months (median 11 months). We estimated VA depending on the edge length of the dice, which were recognized at a distance of 30 cm, while 4 mm complied with VA 20/200. Best corrected binocular visual acuity was compared between the dice test, measurement with the Lea symbols and with numbers or Landolt rings. Estimation of visual acuity using the dice test was possible at the end of the first year of life (median 11 months, range 4-27 months). Although observation is limited to visual acuity results in the low vision range between light reaction and 20/120 there was nearly complete agreement between all three VA measurements. Visual acuity ranged from light perception to 20/20 with a median of 20/100. In 39 patients visual acuity was 20/200 or less at the end of the observation period. Visual acuity estimation overestimated visual acuity only in 5 out of the 88 patients, while in all of the patients with later acuity measurements better than 20/200, our best value of 20/200 was achieved. Using simple visual objects, such as dice with different colors and size down to an edge length of 4 mm, it is possible to estimate visual acuity in low vision infants within the first year of life. This option is also very helpful in patients who are not able to perform other visual

  12. Desktop publishing and validation of custom near visual acuity charts.

    Science.gov (United States)

    Marran, Lynn; Liu, Lei; Lau, George

    2008-11-01

    Customized visual acuity (VA) assessment is an important part of basic and clinical vision research. Desktop computer based distance VA measurements have been utilized, and shown to be accurate and reliable, but computer based near VA measurements have not been attempted, mainly due to the limited spatial resolution of computer monitors. In this paper, we demonstrate how to use desktop publishing to create printed custom near VA charts. We created a set of six near VA charts in a logarithmic progression, 20/20 through 20/63, with multiple lines of the same acuity level, different letter arrangements in each line and a random noise background. This design allowed repeated measures of subjective accommodative amplitude without the potential artifact of familiarity of the optotypes. The background maintained a constant and spatial frequency rich peripheral stimulus for accommodation across the six different acuity levels. The paper describes in detail how pixel-wise accurate black and white bitmaps of Sloan optotypes were used to create the printed custom VA charts. At all acuity levels, the physical sizes of the printed custom optotypes deviated no more than 0.034 log units from that of the standard, satisfying the 0.05 log unit ISO criterion we used to demonstrate physical equivalence. Also, at all acuity levels, log unit differences in the mean target distance for which reliable recognition of letters first occurred for the printed custom optotypes compared to the standard were found to be below 0.05, satisfying the 0.05 log unit ISO criterion we used to demonstrate functional equivalence. It is possible to use desktop publishing to create custom near VA charts that are physically and functionally equivalent to standard VA charts produced by a commercial printing process.

  13. Effect of Target Location on Dynamic Visual Acuity During Passive Horizontal Rotation

    Science.gov (United States)

    Appelbaum, Meghan; DeDios, Yiri; Kulecz, Walter; Peters, Brian; Wood, Scott

    2010-01-01

    The vestibulo-ocular reflex (VOR) generates eye rotation to compensate for potential retinal slip in the specific plane of head movement. Dynamic visual acuity (DVA) has been utilized as a functional measure of the VOR. The purpose of this study was to examine changes in accuracy and reaction time when performing a DVA task with targets offset from the plane of rotation, e.g. offset vertically during horizontal rotation. Visual acuity was measured in 12 healthy subjects as they moved a hand-held joystick to indicate the orientation of a computer-generated Landolt C "as quickly and accurately as possible." Acuity thresholds were established with optotypes presented centrally on a wall-mounted LCD screen at 1.3 m distance, first without motion (static condition) and then while oscillating at 0.8 Hz (DVA, peak velocity 60 deg/s). The effect of target location was then measured during horizontal rotation with the optotypes randomly presented in one of nine different locations on the screen (offset up to 10 deg). The optotype size (logMar 0, 0.2 or 0.4, corresponding to Snellen range 20/20 to 20/50) and presentation duration (150, 300 and 450 ms) were counter-balanced across five trials, each utilizing horizontal rotation at 0.8 Hz. Dynamic acuity was reduced relative to static acuity in 7 of 12 subjects by one step size. During the random target trials, both accuracy and reaction time improved proportional to optotype size. Accuracy and reaction time also improved between 150 ms and 300 ms presentation durations. The main finding was that both accuracy and reaction time varied as a function of target location, with greater performance decrements when acquiring vertical targets. We conclude that dynamic visual acuity varies with target location, with acuity optimized for targets in the plane of motion. Both reaction time and accuracy are functionally relevant DVA parameters of VOR function.

  14. Recognition versus Resolution: a Comparison of Visual Acuity Results Using Two Alternative Test Chart Optotype

    Science.gov (United States)

    Pointer, Jonathan S.

    2010-01-01

    Purpose To quantify the difference between recognition (letter) and resolution (Landolt) visual acuity (VA) in a group of normally sighted subjects. Is it reasonable to assume that the two acuity measures are clinically equivalent? Methods A pair of 6 m acuity test charts was produced: one comprised letters and the other Landolt broken rings. Construction of both charts conformed to the logMAR design format. Monocular VA was determined for the dominant eye of 300 screened and normally sighted optometric patients aged 16 to 40, each wearing an optical refractive (spectacle) correction. Results Letter acuity was superior to Landolt acuity (P≤0.0001). The mean paired acuity difference was -0.041 logMAR (standard deviation 0.034): the 95% limits of agreement were ±0.067 logMAR units or ±3.3 chart optotype. Repeatability was high and similar for each chart type (±2.1 and ±2.4 optotype for letter and Landolt, respectively). Gender, test sequence, and laterality of the dominant eye (left or right) were each non-statistically significant variables. Conclusions For normally sighted subjects wearing an optimal refractive correction, a bias was recorded in favour of recognition over resolution acuity: the clinical difference amounted to approximately 40% of one logMAR chart line, with similar high repeatability for either chart optotype. We conclude that the assumption of clinical equivalence between letter and Landolt acuity is reasonable under optimum test conditions.

  15. [Football, television and emergency services].

    Science.gov (United States)

    Miró, O; Sánchez, M; Borrás, A; Millá, J

    2000-04-15

    To know the influence of televised football on the use of emergency department (ED). We assessed the number, demographic characteristics and acuity of patients attended during the broadcast of football matches played by FC Barcelona during Champions' League (n = 12), and they were compared with days without televised football (n = 12). Televised football was associated with a decrease in visits to ED (-18%; p = 0.002). Such a decrease was observed for all ED units, but only for traumatology unit reached statistical significance (-28%; p = 0.006). Decay of ED visits were mainly due to a decrease of low-acuity consults (-30%; p = 0.04). There is a significant decrease on ED use associated with televised football.

  16. The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity.

    Science.gov (United States)

    Hamm, Lisa M; Yeoman, Janice P; Anstice, Nicola; Dakin, Steven C

    2018-03-01

    When measuring recognition acuity in a research setting, the most widely used symbols are the Early Treatment of Diabetic Retinopathy Study (ETDRS) set of 10 Sloan letters. However, the symbols are not appropriate for patients unfamiliar with letters, and acuity for individual letters is variable. Alternative pictogram sets are available, but are generally comprised of fewer items. We set out to develop an open-access set of 10 pictograms that would elicit more consistent estimates of acuity across items than the ETDRS letters from visually normal adults. We measured monocular acuity for individual uncrowded optotypes within a newly designed set (The Auckland Optotype [TAO]), the ETDRS set, and Landolt Cs. Eleven visually normal adults were assessed on regular and vanishing formats of each set. Inter-optotype reliability and ability to detect subtle differences between participants were assessed using intraclass correlations (ICC) and fractional rank precision (FRP). The TAO vanishing set showed the strongest performance (ICC = 0.97, FRP = 0.90), followed by the other vanishing sets (Sloan ICC = 0.88, FRP = 0.74; Landolt ICC = 0.86, FRP = 0.80). Within the regular format, TAO again outperformed the existing sets (TAO ICC = 0.77, FRP = 0.75; Sloan ICC = 0.65, FRP = 0.64; Landolt ICC = 0.48, FRP = 0.63). For adults with normal visual acuity, the new optotypes (in both regular and vanishing formats) are more equally legible and sensitive to subtle individual differences than their Sloan counterparts. As this set does not require observers to be able to name Roman letters, and is freely available to use and modify, it may have wide application for measurement of acuity.

  17. Video conferencing versus telephone calls for team work across hospitals: a qualitative study on simulated emergencies

    Directory of Open Access Journals (Sweden)

    Hagen Oddvar

    2009-11-01

    Full Text Available Abstract Background Teamwork is important for patient care and outcome in emergencies. In rural areas, efficient communication between rural hospitals and regional trauma centers optimise decisions and treatment of trauma patients. Little is known on potentials and effects of virtual team to team cooperation between rural and regional trauma teams. Methods We adapted a video conferencing (VC system to the work process between multidisciplinary teams responsible for trauma as well as medical emergencies between one rural and one regional (university hospital. We studied how the teams cooperated during simulated critical scenarios, and compared VC with standard telephone communication. We used qualitative observations and interviews to evaluate results. Results The team members found VC to be a useful tool during emergencies and for building "virtual emergency teams" across distant hospitals. Visual communication combined with visual patient information is superior to information gained during ordinary telephone calls, but VC may also cause interruptions in the local teamwork. Conclusion VC can improve clinical cooperation and decision processes in virtual teams during critical patient care. Such team interaction requires thoughtful organisation, training, and new rules for communication.

  18. RETENTION OF HIGH TACTILE ACUITY THROUGHOUT THE LIFESPAN IN BLINDNESS

    OpenAIRE

    Legge, Gordon E.; Madison, Cindee; Vaughn, Brenna N.; Cheong, Allen M.Y.; Miller, Joseph C.

    2008-01-01

    Previous studies of tactile acuity on the fingertip using passive touch have demonstrated an age-related decline in spatial resolution for both sighted and blind subjects. We have re-examined this age dependence with two newly designed tactile-acuity charts requiring active exploration of the test symbols. One chart used dot patterns similar to Braille and the other used embossed Landolt rings. Groups of blind Braille readers and sighted subjects, ranging in age from 12 to 85 years, were test...

  19. The impact of post-discharge patient call back on patient satisfaction in two academic emergency departments.

    Science.gov (United States)

    Guss, David A; Leland, Hyuma; Castillo, Edward M

    2013-01-01

    Patients' satisfaction is a common parameter tracked by health care systems and Emergency Departments (EDs). To determine whether telephone calls by health care providers to patients after discharge from the ED was associated with improved patient satisfaction. Retrospective analysis of Press Ganey (PG; Press Ganey Associates, South Bend, IN) surveys from two EDs operated by the University of California San Diego Health System. Responses to the YES/NO question, "After discharge, did you receive a phone call from an ED staff member?" was compared to the responses to the question "likelihood of recommending this ED to others" (LR). This variable could be ranked with a score of 1 (very poor) to 5 (very good). Responses were dichotomized into two groups, 1-4 and 5. Chi-squared was performed to assess LR between those answering YES vs. NO to the call back question. Differences in proportion, 95% confidence interval (CI), and p-value are reported. Rankings for percentage of 5s across all EDs in the PG database were compared based upon YES/NO responses. In the 12-month study period, about 30,000 surveys were mailed and 2250 (7.5%) were returned. Three hundred forty-seven (15.4%) checked off YES for the call back question. Percentage of 5s for LR for NO call back was 51.1% and for YES call back was 70.6% (difference = 19.5; 95% CI 14.0-24.6; p < 0.001).These values correlated with an ED ranking of 14(th) and 85(th) percentile, respectively. This retrospective study demonstrated a strong association between post-visit patient call back and LR. Further prospective study with control for co-variables is warranted. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Buccal mucosal cancer patient who failed to recover taste acuity after partial oral cavity irradiation

    International Nuclear Information System (INIS)

    Saito, Tsutomu; Fukushima, Shoko; Furuhashi, Satoru; Yoshinobu, Takashi; Takahashi, Motoichiro; Miyake, Masahiko; Kawamori, Jiro; Tanaka, Yoshiaki

    2002-01-01

    We report a patient who suffered from prolonged loss of taste acuity after partial oral cavity irradiation. The electric taste threshold (ETT) of each point in the oral cavity was measured with an electric gustometer to evaluate quantitative local taste acuity. A subjective total taste acuity (STTA) scale was used to evaluate subjective total taste acuity. A 61-year-old male patient with right buccal mucosal cancer underwent radiation therapy more than 11 years ago, and has suffered from loss of taste acuity since then. He received electron beam irradiation to part of the oral cavity and right upper neck, mainly the right buccal mucosa near the retromolar trigone and a metastatic right submandibular node. He did not receive irradiation to the anterior portion of the tongue or left side of the posterior portion of the tongue. His ETT scores for each point were equal to or greater than 26, and his STTA score was grade 3. The present case implies that radiation damage to part of the oral cavity can cause the loss of subjective total taste acuity. (author)

  1. Buccal mucosal cancer patient who failed to recover taste acuity after partial oral cavity irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Tsutomu; Fukushima, Shoko; Furuhashi, Satoru; Yoshinobu, Takashi; Takahashi, Motoichiro [Nihon Univ., Tokyo (Japan). Surugadai Hospital; Miyake, Masahiko [Nihon Univ., Tokyo (Japan). School of Dentistry; Kawamori, Jiro; Tanaka, Yoshiaki [Nihon Univ., Tokyo (Japan). School of Medicine

    2002-10-01

    We report a patient who suffered from prolonged loss of taste acuity after partial oral cavity irradiation. The electric taste threshold (ETT) of each point in the oral cavity was measured with an electric gustometer to evaluate quantitative local taste acuity. A subjective total taste acuity (STTA) scale was used to evaluate subjective total taste acuity. A 61-year-old male patient with right buccal mucosal cancer underwent radiation therapy more than 11 years ago, and has suffered from loss of taste acuity since then. He received electron beam irradiation to part of the oral cavity and right upper neck, mainly the right buccal mucosa near the retromolar trigone and a metastatic right submandibular node. He did not receive irradiation to the anterior portion of the tongue or left side of the posterior portion of the tongue. His ETT scores for each point were equal to or greater than 26, and his STTA score was grade 3. The present case implies that radiation damage to part of the oral cavity can cause the loss of subjective total taste acuity. (author)

  2. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls.

    Science.gov (United States)

    Luomajoki, H; Moseley, G L

    2011-04-01

    Voluntary lumbopelvic control is compromised in patients with back pain. Loss of proprioceptive acuity is one contributor to decreased control. Several reasons for decreased proprioceptive acuity have been proposed, but the integrity of cortical body maps has been overlooked. We investigated whether tactile acuity, a clear clinical signature of primary sensory cortex organisation, relates to lumbopelvic control in people with back pain. Forty-five patients with back pain and 45 age- and sex-matched healthy controls participated in this cross-sectional study. Tactile acuity at the back was assessed using two-point discrimination (TPD) threshold in vertical and horizontal directions. Voluntary motor control was assessed using an established battery of clinical tests. Patients performed worse on the voluntary lumbopelvic tasks than healthy controls did (p<0.001). TPD threshold was larger in patients (mean (SD)=61 (13) mm) than in healthy controls (44 (10) mm). Moreover, larger TPD threshold was positively related to worse performance on the voluntary lumbopelvic tasks (Pearson's r=0.49; p<0.001). Tactile acuity, a clear clinical signature of primary sensory cortex organisation, relates to voluntary lumbopelvic control. This relationship raises the possibility that the former contributes to the latter, in which case training tactile acuity may aid recovery and assist in achieving normal motor performance after back injury.

  3. Advertising Emergency Department Wait Times

    OpenAIRE

    Weiner, Scott G

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED se...

  4. Radiation-induced changes in taste acuity in cancer patients

    International Nuclear Information System (INIS)

    Mossman, K.L.; Henkin, R.I.

    1978-01-01

    Changes in taste acuity were measured in 27 patients with various forms of cancer who received radiation to the head and neck region. In 9 of these patients (group I), measurements of taste acuity were made more than 1 year after completion of radiation therapy. In the other 18 patients (group II), taste measurements were made before, during, and approximately 1 month after radiation therapy. Taste acuity was measured for four taste qualities (salt, sweet, sour, and bitter) by a forced choice-three stimulus drop technique which measured detection and recognition thresholds and by a forced scaling technique which measured taste intensity responsiveness. In group II patients, impaired acuity, as indicated by elevated detection and recognition thresholds, was observed approximately 3 weeks after initiation of radiotherapy. The bitter and salt qualities showed the earliest and greatest impairment and the sweet quality the least. Taste intensity responsiveness also was impaired in group II patients. As for thresholds, scaling impairment was most severe for bitter and salt taste qualities. Scaling impairment occurred before changes in either detection or recognition thresholds. Detection and recognition thresholds determined in group I patients also showed salt and bitter qualities were affected more severely than either sweet or sour qualities. Zinc administration to group I patients in an uncontrolled study suggested that zinc therapy may be useful in ameliorating taste impairment in some patients. These results suggest that taste loss may be a factor in the anorexia and weight loss that is observed commonly in patients who have undergone radiation treatment. Correction of this abnormality may be useful in aiding the nutritional status of these patients

  5. Analysis of relationship among visual evoked potential, oscillatory potential and visual acuity under stimulated weightlessness

    Directory of Open Access Journals (Sweden)

    Jun Zhao

    2013-05-01

    Full Text Available AIM: To observe the influence of head-down tilt simulated weightlessness on visual evoked potential(VEP, oscillatory potentials(OPsand visual acuity, and analyse the relationship among them. METHODS: Head-down tilt for -6° was adopted in 14 healthy volunteers. Distant visual acuity, near visual acuity, VEP and OPs were recorded before, two days and five days after trial. The record procedure of OPs followed the ISCEV standard for full-field clinical electroretinography(2008 update. RESULTS: Significant differences were detected in the amplitude of P100 waves and ∑OPs among various time points(P<0.05. But no relationship was observed among VEP, OPs and visual acuity. CONCLUSION: Head-down tilt simulated weightlessness induce the rearrange of blood of the whole body including eyes, which can make the change of visual electrophysiology but not visual acuity.

  6. Visual acuity and associated factors. The Central India Eye and Medical Study.

    Directory of Open Access Journals (Sweden)

    Vinay Nangia

    Full Text Available Visual acuity is a major parameter for quality of vision and quality of life. Information on visual acuity and its associated factors in rural societies almost untouched by any industrialization is mostly non-available. It was, therefore, the purpose of our study to determine the distribution of visual acuity and its associated factors in a rural population not marked influenced by modern lifestyle. The population-based Central India Eye and Medical Study included 4711 subjects (aged 30+ years, who underwent a detailed ophthalmologic examination including visual acuity measurement. Visual acuity measurements were available for 4706 subjects with a mean age of 49.5±13.4 years (range: 30-100 years. BCVA decreased significantly (P<0.001 from the moderately hyperopic group (0.08±0.15 logMAR to the emmetropic group (0.16±0.52 logMAR, the moderately myopic group (0.28±0.33 logMAR, the highly hyperopic group (0.66±0.62 logMAR and finally the highly myopic group (1.32±0.92 logMAR. In multivariate analysis, BCVA was significantly associated with the systemic parameters of lower age (P<0.001, higher level of education (P<0.001, higher body stature (P<0.001 and higher body mass index (P<0.001, and with the ophthalmic parameters of more hyperopic refractive error (spherical equivalent (P<0.001, shorter axial length (P<0.001, lower degree of nuclear cataract (P<0.001, and lower intraocular pressure (P = 0.006. The results suggest that in the rural population of Central India, major determinants of visual acuity were socioeconomic background, body stature and body mass index, age, refractive error, cataract and intraocular pressure.

  7. VISUAL ACUITY AND CLINICAL REFRACTION FOLLOWING IMPLANTATION OF VARIOUS MULTIFOCAL INTRAOCULAR LENSES

    Directory of Open Access Journals (Sweden)

    N. N. Temirov

    2015-01-01

    Full Text Available Aim. To analyze visual acuity, clinical refraction, and defocusing tolerance after the implantation of monofocal IOL with rotational asymmetric optic (Lentis Mplus 313 MF compared with Acrysof ReSTOR SN6AD1.Materials and methods. Phacoemulsification was performed in a total of 194 patients (288 eyes, i.e., 144 patients (188 eyes with cataract and 50 patients (100 eyes with presbyopia and high ametropia. The patients were divided into two groups. Study group included 132 patients (194 eyes implanted with Lentis Mplus while control group included 62 patients (94 eyes implanted with Acrysof ReSTOR. Uncorrected distance (5 m, intermediate (50‑70 cm, and near (20‑40 cm visual acuity under photopic (85 cd/m2 and mesopic (8 cd/m2 conditions were measured, objective and subjective refractometry were performed, and defocusing tolerance was evaluated.Results. Postoperatively, uncorrected distance and near visual acuity was high while intermediate visual acuity was moderately low. Lentis Mplus patients had better near and intermediate visual acuity under mesopic conditions as compared with Acrysof ReSTOR patients. Emmetropia (target refraction was achieved in 90.2% of study group patients and in 87.2% of control group patients. In patients implanted with Lentis Mplus, refraction was measured by subjective method. Optimal A-constant for Lentis Mplus and Acrysof ReSTOR was 118.0 and 118.6, respectively. Under defocusing, Lentis Mplus patients had better visual acuity than Acrysof ReSTOR patients. This indirectly confirms better intermediate vision.Conclusions. Lentis Mplus provides better vision at various distances that does not almost depend on light levels and induces minimal dysphotopsia. 

  8. Relationship between photoreceptor outer segment length and visual acuity in diabetic macular edema.

    Science.gov (United States)

    Forooghian, Farzin; Stetson, Paul F; Meyer, Scott A; Chew, Emily Y; Wong, Wai T; Cukras, Catherine; Meyerle, Catherine B; Ferris, Frederick L

    2010-01-01

    The purpose of this study was to quantify photoreceptor outer segment (PROS) length in 27 consecutive patients (30 eyes) with diabetic macular edema using spectral domain optical coherence tomography and to describe the correlation between PROS length and visual acuity. Three spectral domain-optical coherence tomography scans were performed on all eyes during each session using Cirrus HD-OCT. A prototype algorithm was developed for quantitative assessment of PROS length. Retinal thicknesses and PROS lengths were calculated for 3 parameters: macular grid (6 x 6 mm), central subfield (1 mm), and center foveal point (0.33 mm). Intrasession repeatability was assessed using coefficient of variation and intraclass correlation coefficient. The association between retinal thickness and PROS length with visual acuity was assessed using linear regression and Pearson correlation analyses. The main outcome measures include intrasession repeatability of macular parameters and correlation of these parameters with visual acuity. Mean retinal thickness and PROS length were 298 mum to 381 microm and 30 microm to 32 mum, respectively, for macular parameters assessed in this study. Coefficient of variation values were 0.75% to 4.13% for retinal thickness and 1.97% to 14.01% for PROS length. Intraclass correlation coefficient values were 0.96 to 0.99 and 0.73 to 0.98 for retinal thickness and PROS length, respectively. Slopes from linear regression analyses assessing the association of retinal thickness and visual acuity were not significantly different from 0 (P > 0.20), whereas the slopes of PROS length and visual acuity were significantly different from 0 (P < 0.0005). Correlation coefficients for macular thickness and visual acuity ranged from 0.13 to 0.22, whereas coefficients for PROS length and visual acuity ranged from -0.61 to -0.81. Photoreceptor outer segment length can be quantitatively assessed using Cirrus HD-OCT. Although the intrasession repeatability of PROS

  9. Presenting visual acuities in a new eye centre in Port Harcourt: initial ...

    African Journals Online (AJOL)

    Background: Visual acuity is a fundamental of an eye examination. It establishes in a quantitative way how well an eye can see. Apart from being a starting point in dealing with an eye, it is also a prognostic reference point and a medico-legal tool. Very few studies directly related to visual acuities are available as many ...

  10. Impact of Near Work Activity on Visual Acuity among Junior High School Students

    Directory of Open Access Journals (Sweden)

    Raisha Pratiwi Indrawati

    2016-03-01

    Full Text Available Background: Uncorrected refractive error is experienced by at least 45 million productive-aged adults (aged 16–45 years old and 13 million children (aged 5–15 years old, and being the main cause of visual impairment in children worldwide and third cause of blindness in any age in Indonesia. Near work activity is estimated as one of environmental risk factor causing this refractive error, leading into decreased visual acuity. This study was conducted to analyse the impact of near work activity on visual acuity among junior high school students in Jatinangor Methods: This study was conducted in junior high school in Jatinangor, using cross sectional method. Total of 147 subjects were screened for visual impairment using Rapid Assessment of Avoidable Blindness (RAAB tumbling E chart and assesed for near work activity using questionnaire-guided interview method after informed consent had been obtained. Data were analysed using unpaired-T test and Mann-Whitney test. Results: Total diopter hours of near work activity among the group with visual acuity ≥6/18 and group with visual acuity <6/18 showed no significant difference (p=0.329, with latter group had less time-spent in near work activity. Similarly, each activity such as reading, watching TV, and using computer also showed no significant difference , except for playing games where the group with better visual acuity had shown significantly longer time spent than another group (p=0.018. Conclusions: Near work activity does not have impact on visual acuity among junior high school students, except for playing games

  11. Vernier But Not Grating Acuity Contributes to an Early Stage of Visual Word Processing.

    Science.gov (United States)

    Tan, Yufei; Tong, Xiuhong; Chen, Wei; Weng, Xuchu; He, Sheng; Zhao, Jing

    2018-03-28

    The process of reading words depends heavily on efficient visual skills, including analyzing and decomposing basic visual features. Surprisingly, previous reading-related studies have almost exclusively focused on gross aspects of visual skills, while only very few have investigated the role of finer skills. The present study filled this gap and examined the relations of two finer visual skills measured by grating acuity (the ability to resolve periodic luminance variations across space) and Vernier acuity (the ability to detect/discriminate relative locations of features) to Chinese character-processing as measured by character form-matching and lexical decision tasks in skilled adult readers. The results showed that Vernier acuity was significantly correlated with performance in character form-matching but not visual symbol form-matching, while no correlation was found between grating acuity and character processing. Interestingly, we found no correlation of the two visual skills with lexical decision performance. These findings provide for the first time empirical evidence that the finer visual skills, particularly as reflected in Vernier acuity, may directly contribute to an early stage of hierarchical word processing.

  12. An assessment of the iPad as a testing platform for distance visual acuity in adults

    Science.gov (United States)

    Black, J M; Jacobs, R J; Phillips, G; Chen, L; Tan, E; Tran, A; Thompson, B

    2013-01-01

    Objectives Visual acuity is a common measurement in general practice, and the advent of new technology such as tablet computers offers a change in the way in which these tests are delivered. The aim of this study was to assess whether measurements of distance visual acuity using LogMAR letter charts displayed on an iPad tablet computer were in agreement with standard clinical tests of visual acuity in adults with normal vision. Design Blinded, diagnostic test study. Setting Single centre (University) in Auckland, New Zealand. Participants University staff and students (n=85). Participants were required to have visual acuity better than 6/60 and wear habitual refractive correction during testing. Participants were excluded if there was any history of ocular pathology. Primary and secondary outcome measures Visual acuity measured under a number of conditions. Results The iPad tablet with its glossy screen was highly susceptible to glare resulting in acuity measurements that were significantly poorer (approximately 2 LogMAR lines) than those made using an ETDRS chart and a standard computerised testing system (n=56). However, fitting the iPad with an antiglare screen and positioning the device away from sources creating reflected (veiling) glare resulted in acuity measurements that were equivalent those made using gold standard charts (n=29). Conclusions Tablet computers are an attractive option for visual acuity measurement due to portability, the ability to randomise letters, automated scoring of acuity and the ability to select from a range of charts. However, these devices are only suitable for use in situations where sources of glare can be eliminated. PMID:23794568

  13. Fluctuation in visual acuity during soft toric contact lens wear.

    Science.gov (United States)

    Chamberlain, Paul; Morgan, Philip B; Moody, Kurt J; Maldonado-Codina, Carole

    2011-04-01

    To quantify changes in visual acuity (VA) with soft toric contact lenses as a result of lens movement and/or rotational instability caused by versional eye movements. A novel chart for vision assessment at near (40 cm) for soft toric contact lenses (VANT chart),consisting of a central, color-coded logMAR panel and eight peripheral letter targets set on a white background measuring 60 × 40 cm was constructed. In the developmental phase of the work, 10 subjects (20 eyes) wore 2 toric lenses in random order, and the impact of rapid and delayed eye versions in 8 directions of gaze on VANT acuity was investigated. In phase 2, 35 subjects (68 eyes) wore 4 toric lenses in random order, and a streamlined clinical protocol using the VANT chart was implemented. Standard assessments of toric lens fit and distance VA were also performed. Testing in the first phase showed no difference for change in VA for rapid vs. delayed version movements, (p = 0.17) but acuity reduction was greater for diagonal compared with horizontal/vertical versions (p = 0.06). As such, testing in phase 2 proceeded using rapid, diagonal versions only. In this second phase, there were differences for low-contrast distance VA measures between lens types (p = 0.02) and for both VANT baseline acuity (p = 0.03) and postversion acuity (p = 0.04), but no differences were found between lenses for magnitude of vision loss (p = 0.91), which was about one line. No relationship was established between the magnitude of vision loss and measured rotational stability (p = 0.75). This work has demonstrated that conventional approaches to measuring VA do not fully replicate the "real world" experience of soft toric lens wearers. The VANT chart has shown that VA is reduced immediately after versional eye movements and suggests that more dynamic methods of assessing visual performance should be considered for soft toric contact lens wearers, especially given the apparent inability of lens stability measurements to predict

  14. [Measuring contrast sensitivity using visual acuity tests in retinal and optic nerve diseases].

    Science.gov (United States)

    Sommer, E; Marré, E; Mierdel, P

    1990-01-01

    The luminance contrast needed to discern various test types was measured with monochromatic and achromatic light to detect discrete functional deficiencies of the retina and optic nerve in cases of normal visual acuity. Landolt rings corresponding to visual acuity levels from 0.04 to 1.0 were used as test types. A significant increase in the necessary minimum contrast was detectable with blue test light on large Landolt rings in patients with diabetic retinopathy, ocular hypertension and glaucoma and with green or yellow test light on medium-sized and small Landolt rings in patients with central serous chorioidopathy and optic atrophy. The additional contrast needed to reach the maximum visual acuity amounts to 14-100% compared with normal visual acuity, depending on the color of the test light and the diagnosis. The amount of contrast needed is greatest in retinal diseases, and it is therefore possible to a certain extent to distinguish these from diseases of the optic nerve.

  15. Impact of Target Distance, Target Size, and Visual Acuity on the Video Head Impulse Test.

    Science.gov (United States)

    Judge, Paul D; Rodriguez, Amanda I; Barin, Kamran; Janky, Kristen L

    2018-05-01

    The video head impulse test (vHIT) assesses the vestibulo-ocular reflex. Few have evaluated whether environmental factors or visual acuity influence the vHIT. The purpose of this study was to evaluate the influence of target distance, target size, and visual acuity on vHIT outcomes. Thirty-eight normal controls and 8 subjects with vestibular loss (VL) participated. vHIT was completed at 3 distances and with 3 target sizes. Normal controls were subdivided on the basis of visual acuity. Corrective saccade frequency, corrective saccade amplitude, and gain were tabulated. In the normal control group, there were no significant effects of target size or visual acuity for any vHIT outcome parameters; however, gain increased as target distance decreased. The VL group demonstrated higher corrective saccade frequency and amplitude and lower gain as compared with controls. In conclusion, decreasing target distance increases gain for normal controls but not subjects with VL. Preliminarily, visual acuity does not affect vHIT outcomes.

  16. Crowded letter and crowded picture logMAR acuity in children with amblyopia: a quantitative comparison.

    Science.gov (United States)

    O'Boyle, Cathy; Chen, Sean I; Little, Julie-Anne

    2017-04-01

    Clinically, picture acuity tests are thought to overestimate visual acuity (VA) compared with letter tests, but this has not been systematically investigated in children with amblyopia. This study compared VA measurements with the LogMAR Crowded Kay Picture test to the LogMAR Crowded Keeler Letter acuity test in a group of young children with amblyopia. 58 children (34 male) with amblyopia (22 anisometropic, 18 strabismic and 18 with both strabismic/anisometropic amblyopia) aged 4-6 years (mean=68.7, range=48-83 months) underwent VA measurements. VA chart testing order was randomised, but the amblyopic eye was tested before the fellow eye. All participants wore up-to-date refractive correction. The Kay Picture test significantly overestimated VA by 0.098 logMAR (95% limits of agreement (LOA), 0.13) in the amblyopic eye and 0.088 logMAR (95% LOA, 0.13) in the fellow eye, respectively (pocclusion therapy, refractive correction or type of amblyopia on VA results (p>0.23). For both the amblyopic and fellow eyes, Bland-Altman plots demonstrated a systematic and predictable difference between Kay Picture and Keeler Letter charts across the range of acuities tested (Keeler acuity: amblyopic eye 0.75 to -0.05 logMAR; fellow eye 0.45 to -0.15 logMAR). Linear regression analysis (pamblyopia. Due to the predictable difference found between both crowded logMAR acuity tests, it is reasonable to adjust Kay Picture acuity thresholds by +0.10 logMAR to compute expected Keeler Letter acuity scores. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Factors accounting for the 4-year change in acuity in patients between 50 and 80 years.

    Science.gov (United States)

    Koenig, Darren E; Nguyen, Lan Chi; Parker, Katrina E; Applegate, Raymond A

    2013-07-01

    It is well known that acuity slowly decreases in the later decades of life. We wish to determine the extent by which 4-year longitudinal acuity changes can be accounted for by changes in optical quality, or combination of optical quality metrics and of age between 50 and 80 years. High-contrast logMAR acuity, 35 image quality metrics, 4 intraocular scatter metrics, and 4 Lens Opacification Classification System III metrics and entry age were measured on one eye of each of the 148 subjects. Acuity change between baseline and the last visit was regressed against change in each metric for all eyes and a faster changing subset of 50 eyes with a gain or loss of four or more letters. Average change across 148 subjects was a 1.6 ± 4 letter loss (t148 = 4.31, p model for faster changing eyes included change in point spread function entropy, posterior subcapsular cataract, and trefoil and baseline age (sequential r adjusted values of 0.19, 0.27, 0.32, and 0.34, respectively; p = 1.48 × 10 for the full four-factor model). The same variables entered the multiple-regression model for the full 148 data set where most of the acuity measurements were within test-retest error and accounted for less of the variance (r adjusted = 0.15, p = 2.37 × 10). Despite being near noise levels for the measurement of acuity, change in optical quality metrics was the most important factor in eyes that lost or gained four or more letters of acuity. These findings should be generalizable given that our 4-year acuity change is essentially identical to other studies and indicate that these optical quality markers can be used to help identify those on a faster track to an acuity change.

  18. Simulating Visibility Under Reduced Acuity and Contrast Sensitivity

    Science.gov (United States)

    Thompson, William B.; Legge, Gordon E.; Kersten, Daniel J.; Shakespeare, Robert A.; Lei, Quan

    2017-01-01

    Architects and lighting designers have difficulty designing spaces that are accessible to those with low vision, since the complex nature of most architectural spaces requires a site-specific analysis of the visibility of mobility hazards and key landmarks needed for navigation. We describe a method that can be utilized in the architectural design process for simulating the effects of reduced acuity and contrast on visibility. The key contribution is the development of a way to parameterize the simulation using standard clinical measures of acuity and contrast sensitivity. While these measures are known to be imperfect predictors of visual function, they provide a way of characterizing general levels of visual performance that is familiar to both those working in low vision and our target end-users in the architectural and lighting design communities. We validate the simulation using a letter recognition task. PMID:28375328

  19. The validity of visual acuity assessment using mobile technology devices in the primary care setting.

    Science.gov (United States)

    O'Neill, Samuel; McAndrew, Darryl J

    2016-04-01

    The assessment of visual acuity is indicated in a number of clinical circumstances. It is commonly conducted through the use of a Snellen wall chart. Mobile technology developments and adoption rates by clinicians may potentially provide more convenient methods of assessing visual acuity. Limited data exist on the validity of these devices and applications. The objective of this study was to evaluate the assessment of distance visual acuity using mobile technology devices against the commonly used 3-metre Snellen chart in a primary care setting. A prospective quantitative comparative study was conducted at a regional medical practice. The visual acuity of 60 participants was assessed on a Snellen wall chart and two mobile technology devices (iPhone, iPad). Visual acuity intervals were converted to logarithm of minimum angle of resolution (logMAR) scores and subjected to intraclass correlation coefficient (ICC) assessment. The results show a high level of general agreement between testing modality (ICC 0.917 with a 95% confidence interval of 0.887-0.940). The high level of agreement of visual acuity results between the Snellen wall chart and both mobile technology devices suggests that clinicians can use this technology with confidence in the primary care setting.

  20. Telephone calls by individuals with cancer.

    Science.gov (United States)

    Flannery, Marie; McAndrews, Leanne; Stein, Karen F

    2013-09-01

    To describe symptom type and reporting patterns found in spontaneously initiated telephone calls placed to an ambulatory cancer center practice. Retrospective, descriptive. Adult hematology oncology cancer center. 563 individuals with a wide range of oncology diagnoses who initiated 1,229 telephone calls to report symptoms. Raw data were extracted from telephone forms using a data collection sheet with 23 variables obtained for each phone call, using pre-established coding criteria. A literature-based, investigator-developed instrument was used for the coding criteria and selection of which variables to extract. Symptom reporting, telephone calls, pain, and symptoms. A total of 2,378 symptoms were reported by telephone during the four months. At least 10% of the sample reported pain (38%), fatigue (16%), nausea (16%), swelling (12%), diarrhea (12%), dyspnea (10%), and anorexia (10%). The modal response was to call only one time and to report only one symptom (55%). Pain emerged as the symptom that most often prompted an individual to pick up the telephone and call. Although variation was seen in symptom reporting, an interesting pattern emerged with an individual reporting on a solitary symptom in a single telephone call. The emergence of pain as the primary symptom reported by telephone prompted educational efforts for both in-person clinic visit management of pain and prioritizing nursing education and protocol management of pain reported by telephone. Report of symptoms by telephone can provide nurses unique insight into patient-centered needs. Although pain has been an important focus of education and research for decades, it remains a priority for individuals with cancer. A wide range in symptom reporting by telephone was evident.

  1. A new era of emergency care: planning and design consideration.

    Science.gov (United States)

    Zilm, Frank

    2007-01-01

    Emergency care is one of the most complex, rapidly growing areas of ambulatory care. Providers need to consider new issues related to management of low-acuity patients, capacity for surge events, and the need to integrate patient focused care into the emergency department environment. This article explores these issues and discusses basic organizational topologies for facilities.

  2. Relationship between socioeconomic deprivation 
or urban/rural residence and visual acuity before cataract surgery in Northern Scotland.

    Science.gov (United States)

    Chua, Paul Y; Mustafa, Mohammed S; Scott, Neil W; Kumarasamy, Manjula; Azuara-Blanco, Augusto

    2013-01-01

    To evaluate the influence of socioeconomic factors on visual acuity before cataract surgery. 
 The medical case notes of 240 consecutive patients listed for cataract surgery from January 1, 2010, at Grampian University Hospital, Aberdeen, were reviewed retrospectively. Patients with ocular comorbidity were excluded. Demographics, postal codes, and visual acuity were recorded. Scottish Index of Multiple Deprivation was used to determine the deprivation rank. Home location was classified as urban or rural. The effect of these parameters on preoperative visual acuity was investigated using chi-square tests or Fisher exact test as appropriate. 
 A total of 184 patients (mean 75 years) were included. A total of 127 (69%) patients had visual acuity of 6/12 or better. An association was found between affluence and preoperative visual acuity of 6/12 or better (χ2trend = 4.97, p = 0.03), with a significant rising trend across quintile of deprivation. There was no evidence to suggest association between geographical region and preoperative visual acuity (p = 0.63). 
 Affluence was associated with good visual acuity (6/12 or better) before cataract surgery. There was no difference in preoperative visual acuity between rural and urban populations.

  3. Visual acuity and quality of life in dry eye disease: Proceedings of the OCEAN group meeting.

    Science.gov (United States)

    Benítez-Del-Castillo, José; Labetoulle, Marc; Baudouin, Christophe; Rolando, Maurizio; Akova, Yonca A; Aragona, Pasquale; Geerling, Gerd; Merayo-Lloves, Jesús; Messmer, Elisabeth M; Boboridis, Kostas

    2017-04-01

    Dry eye disease (DED) results in tear film instability and hyperosmolarity, inflammation of the ocular surface and, ultimately, visual disturbance that can significantly impact a patient's quality of life. The effects on visual acuity result in difficulties with driving, reading and computer use and negatively impact psychological health. These effects also extend to the workplace, with a loss of productivity and quality of work causing substantial economic losses. The effects of DED and the impact on vision experienced by patients may not be given sufficient importance by ophthalmologists. Functional visual acuity (FVA) is a measure of visual acuity after sustained eye opening without blinking for at least 10 s and mimics the sustained visual acuity of daily life. Measuring dynamic FVA allows the detection of impaired visual function in patients with DED who may display normal conventional visual acuity. There are currently several tests and methods that can be used to measure dynamic visual function: the SSC-350 FVA measurement system, assessment of best-corrected visual acuity decay using the interblink visual acuity decay test, serial measurements of ocular and corneal higher order aberrations, and measurement of dynamic vision quality using the Optical Quality Analysis System. Although the equipment for these methods may be too large or unaffordable for use in clinical practice, FVA testing is an important assessment for DED. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. The use of acuity and frailty measures for district nursing workforce plans.

    Science.gov (United States)

    David, Ami; Saunders, Mary

    2018-02-02

    This article discusses the use of Quest acuity and frailty measures for community nursing interventions to quantify and qualify the contributions of district nursing teams. It describes the use of a suite of acuity and frailty tools tested in 8 UK community service trusts over the past 5years. In addition, a competency assessment tool was used to gauge both capacity and capability of individual nurses. The consistency of the results obtained from the Quest audits offer significant evidence and potential for realigning community nursing services to offer improvements in efficiency and cost-effectiveness. The National Quality Board (NQB) improvement resource for the district nursing services ( NQB, 2017 ) recommends a robust method for classifying patient acuity/frailty/dependency. It is contended the Quest tools and their usage articulated here offer a suitable methodology.

  5. High visual acuity revealed in dogs.

    Science.gov (United States)

    Lind, Olle; Milton, Ida; Andersson, Elin; Jensen, Per; Roth, Lina S V

    2017-01-01

    Humans have selectively bred and used dogs over a period of thousands of years, and more recently the dog has become an important model animal for studies in ethology, cognition and genetics. These broad interests warrant careful descriptions of the senses of dogs. Still there is little known about dog vision, especially what dogs can discriminate in different light conditions. We trained and tested whippets, pugs, and a Shetland sheepdog in a two-choice discrimination set-up and show that dogs can discriminate patterns with spatial frequencies between 5.5 and 19.5 cycle per degree (cpd) in the bright light condition (43 cd m-2). This is a higher spatial resolution than has been previously reported although the individual variation in our tests was large. Humans tested in the same set-up reached acuities corresponding to earlier studies, ranging between 32.1 and 44.2 cpd. In the dim light condition (0.0087 cd m-2) the acuity of dogs ranged between 1.8 and 3.5 cpd while in humans, between 5.9 and 9.9 cpd. Thus, humans make visual discrimination of objects from roughly a threefold distance compared to dogs in both bright and dim light.

  6. High visual acuity revealed in dogs.

    Directory of Open Access Journals (Sweden)

    Olle Lind

    Full Text Available Humans have selectively bred and used dogs over a period of thousands of years, and more recently the dog has become an important model animal for studies in ethology, cognition and genetics. These broad interests warrant careful descriptions of the senses of dogs. Still there is little known about dog vision, especially what dogs can discriminate in different light conditions. We trained and tested whippets, pugs, and a Shetland sheepdog in a two-choice discrimination set-up and show that dogs can discriminate patterns with spatial frequencies between 5.5 and 19.5 cycle per degree (cpd in the bright light condition (43 cd m-2. This is a higher spatial resolution than has been previously reported although the individual variation in our tests was large. Humans tested in the same set-up reached acuities corresponding to earlier studies, ranging between 32.1 and 44.2 cpd. In the dim light condition (0.0087 cd m-2 the acuity of dogs ranged between 1.8 and 3.5 cpd while in humans, between 5.9 and 9.9 cpd. Thus, humans make visual discrimination of objects from roughly a threefold distance compared to dogs in both bright and dim light.

  7. Relationship between Outer Retinal Layers Thickness and Visual Acuity in Diabetic Macular Edema

    Directory of Open Access Journals (Sweden)

    Raymond L. M. Wong

    2015-01-01

    Full Text Available Purpose. To investigate the correlation of outer retinal layers (ORL thickness and visual acuity (VA in patients with diabetic macular edema (DME. Methods. Consecutive DME patients seen at the Retina Clinic of The University of Hong Kong were recruited for OCT assessment. The ORL thickness was defined as the distance between external limiting membrane (ELM and retinal pigment epithelium (RPE at the foveal center. The correlation between total retinal thickness, ORL thickness, and vision was calculated. Results. 78 patients with DME were recruited. The mean age was 58.1 years (±11.5 years and their mean visual acuity measured with Snellen chart was 0.51 (±0.18. The correlation coefficient between total retinal thickness and visual acuity was 0.34 (P < 0.001 whereas the correlation coefficient was 0.65 between ORL thickness and visual acuity (P < 0.001. Conclusion. ORL thickness correlates better with vision than the total retinal thickness. It is a novel OCT parameter in the assessment of DME. Moreover, it could be a potential long term visual prognostic factor for patients with DME.

  8. Proprioceptive acuity into knee hypermobile range in children with Joint Hypermobility Syndrome

    OpenAIRE

    Pacey, Verity; Adams, Roger D; Tofts, Louise; Munns, Craig F; Nicholson, Leslie L

    2014-01-01

    Background Children with Joint Hypermobility Syndrome (JHS) have reduced knee joint proprioceptive acuity compared to peers. Altered proprioception at end of range in individuals with JHS is hypothesised to contribute to recurrent joint injuries and instability. This study aims to provide the first objective comparison of functional knee joint proprioceptive acuity in hyperextension range compared to early flexion range in children with JHS. Methods Active, weight-bearing knee joint proprioce...

  9. Bevacizumab Injection in Patients with Age-Related Macular Degeneration Associated with Poor Initial Visual Acuity

    Directory of Open Access Journals (Sweden)

    Leila El Matri

    2012-01-01

    Full Text Available Purpose. To evaluate functional and anatomic effects of intravitreal bevacizumab in patients with neovascular AMD and initial low visual acuity. Methods. Retrospective case series of 38 eyes with neovascular AMD and initial visual acuity of 20/200 or less, treated with intravitreal bevacizumab injection. Results. Mean followup was 14.1 months ±7.1 (range: 5 to 24 months. Mean logMAR vision at baseline was 1.38 logMAR ±0.33, at 6 months was 1.14 logMAR ±0.37 (=0.001 and at 12 months was 1.22 logMar ±0.33 (=0.004. Mean baseline central retinal thickness was 431 μm ±159.7 at 6 months was 293.43 μm  ±122.79 (=10−4 and at 12 months was 293.1 μm  ±130 (=0.004. Visual acuity improved in both patients with or without prior PDT treatment. Conclusions. Intravitreal bevacizumab injection may increase the chance of visual acuity gain in neovascular AMD even in cases with initial low visual acuity.

  10. Eye size and visual acuity influence vestibular anatomy in mammals.

    Science.gov (United States)

    Kemp, Addison D; Christopher Kirk, E

    2014-04-01

    The semicircular canals of the inner ear detect head rotations and trigger compensatory movements that stabilize gaze and help maintain visual fixation. Mammals with large eyes and high visual acuity require precise gaze stabilization mechanisms because they experience diminished visual functionality at low thresholds of uncompensated motion. Because semicircular canal radius of curvature is a primary determinant of canal sensitivity, species with large canal radii are expected to be capable of more precise gaze stabilization than species with small canal radii. Here, we examine the relationship between mean semicircular canal radius of curvature, eye size, and visual acuity in a large sample of mammals. Our results demonstrate that eye size and visual acuity both explain a significant proportion of the variance in mean canal radius of curvature after statistically controlling for the effects of body mass and phylogeny. These findings suggest that variation in mean semicircular canal radius of curvature among mammals is partly the result of selection for improved gaze stabilization in species with large eyes and acute vision. Our results also provide a possible functional explanation for the small semicircular canal radii of fossorial mammals and plesiadapiforms. Copyright © 2014 Wiley Periodicals, Inc.

  11. Preventable deaths following emergency medical dispatch - an audit study

    DEFF Research Database (Denmark)

    Andersen, Mikkel S; Johnsen, Søren; Hansen, Andreas

    2014-01-01

    an ambulance with lights and sirens by the Emergency Medical Communication Centre (EMCC).MethodsAn audit was performed by an external panel of experienced prehospital consultant anaesthesiologists. The panel focused exclusively on the role of the EMCC, assessing whether same-day deaths among 112 callers could...... have been prevented if the EMCC had assessed the situations as highly urgent. The panels¿ assessments were based on review of patient charts and voice-log recordings of 112 calls. All patient related material was reviewed by the audit panel and all cases where then scored as preventable, potentially......¿100 years) and 45.4% were female. The audit panel found no definitively preventable deaths; however, 18 (11.8%) of the analysed same-day deaths (0.02% of all non-high-acuity callers) were found to be potentially preventable. In 13 of these 18 cases, the dispatch protocol was either not used or not used...

  12. Recognition versus Resolution: a Comparison of Visual Acuity Results Using Two Alternative Test Chart Optotype

    OpenAIRE

    Jonathan S. Pointer

    2008-01-01

    Purpose: To quantify the difference between recognition (letter) and resolution (Landolt) visual acuity (VA) in a group of normally sighted subjects. Is it reasonable to assume that the two acuity measures are clinically equivalent? Methods: A pair of 6 m acuity test charts was produced: one comprised letters and the other Landolt broken rings. Construction of both charts conformed to the logMAR design format. Monocular VA was determined for the dominant eye of 300 screened and normally si...

  13. A call for a community of practice to assess the impact of emerging technologies on undergraduate biology education.

    Science.gov (United States)

    Jensen, Jamie L; Dario-Becker, Juville; Hughes, Lee E; Amburn, D Sue Katz; Shaw, Joyce A

    2012-01-01

    Recent recommendations for educational research encourage empirically tested, theory-based, completely transparent, and broadly applicable studies. In light of these recommendations, we call for a research standard and community of practice in the evaluation of technology use in the undergraduate life science classroom. We outline appropriate research methodology, review and critique the past research on technology usage and, lastly, suggest a new and improved focus for research on emerging technologies.

  14. Visual Temporal Acuity Is Related to Auditory Speech Perception Abilities in Cochlear Implant Users.

    Science.gov (United States)

    Jahn, Kelly N; Stevenson, Ryan A; Wallace, Mark T

    Despite significant improvements in speech perception abilities following cochlear implantation, many prelingually deafened cochlear implant (CI) recipients continue to rely heavily on visual information to develop speech and language. Increased reliance on visual cues for understanding spoken language could lead to the development of unique audiovisual integration and visual-only processing abilities in these individuals. Brain imaging studies have demonstrated that good CI performers, as indexed by auditory-only speech perception abilities, have different patterns of visual cortex activation in response to visual and auditory stimuli as compared with poor CI performers. However, no studies have examined whether speech perception performance is related to any type of visual processing abilities following cochlear implantation. The purpose of the present study was to provide a preliminary examination of the relationship between clinical, auditory-only speech perception tests, and visual temporal acuity in prelingually deafened adult CI users. It was hypothesized that prelingually deafened CI users, who exhibit better (i.e., more acute) visual temporal processing abilities would demonstrate better auditory-only speech perception performance than those with poorer visual temporal acuity. Ten prelingually deafened adult CI users were recruited for this study. Participants completed a visual temporal order judgment task to quantify visual temporal acuity. To assess auditory-only speech perception abilities, participants completed the consonant-nucleus-consonant word recognition test and the AzBio sentence recognition test. Results were analyzed using two-tailed partial Pearson correlations, Spearman's rho correlations, and independent samples t tests. Visual temporal acuity was significantly correlated with auditory-only word and sentence recognition abilities. In addition, proficient CI users, as assessed via auditory-only speech perception performance, demonstrated

  15. Creation of an Accurate Algorithm to Detect Snellen Best Documented Visual Acuity from Ophthalmology Electronic Health Record Notes.

    Science.gov (United States)

    Mbagwu, Michael; French, Dustin D; Gill, Manjot; Mitchell, Christopher; Jackson, Kathryn; Kho, Abel; Bryar, Paul J

    2016-05-04

    Visual acuity is the primary measure used in ophthalmology to determine how well a patient can see. Visual acuity for a single eye may be recorded in multiple ways for a single patient visit (eg, Snellen vs. Jäger units vs. font print size), and be recorded for either distance or near vision. Capturing the best documented visual acuity (BDVA) of each eye in an individual patient visit is an important step for making electronic ophthalmology clinical notes useful in research. Currently, there is limited methodology for capturing BDVA in an efficient and accurate manner from electronic health record (EHR) notes. We developed an algorithm to detect BDVA for right and left eyes from defined fields within electronic ophthalmology clinical notes. We designed an algorithm to detect the BDVA from defined fields within 295,218 ophthalmology clinical notes with visual acuity data present. About 5668 unique responses were identified and an algorithm was developed to map all of the unique responses to a structured list of Snellen visual acuities. Visual acuity was captured from a total of 295,218 ophthalmology clinical notes during the study dates. The algorithm identified all visual acuities in the defined visual acuity section for each eye and returned a single BDVA for each eye. A clinician chart review of 100 random patient notes showed a 99% accuracy detecting BDVA from these records and 1% observed error. Our algorithm successfully captures best documented Snellen distance visual acuity from ophthalmology clinical notes and transforms a variety of inputs into a structured Snellen equivalent list. Our work, to the best of our knowledge, represents the first attempt at capturing visual acuity accurately from large numbers of electronic ophthalmology notes. Use of this algorithm can benefit research groups interested in assessing visual acuity for patient centered outcome. All codes used for this study are currently available, and will be made available online at https://phekb.org.

  16. Stimulus-dependent effects on tactile spatial acuity

    Directory of Open Access Journals (Sweden)

    Tommerdahl M

    2005-10-01

    Full Text Available Abstract Background Previous studies have shown that spatio-tactile acuity is influenced by the clarity of the cortical response in primary somatosensory cortex (SI. Stimulus characteristics such as frequency, amplitude, and location of tactile stimuli presented to the skin have been shown to have a significant effect on the response in SI. The present study observes the effect of changing stimulus parameters of 25 Hz sinusoidal vertical skin displacement stimulation ("flutter" on a human subject's ability to discriminate between two adjacent or near-adjacent skin sites. Based on results obtained from recent neurophysiological studies of the SI response to different conditions of vibrotactile stimulation, we predicted that the addition of 200 Hz vibration to the same site that a two-point flutter stimulus was delivered on the skin would improve a subject's spatio-tactile acuity over that measured with flutter alone. Additionally, similar neurophysiological studies predict that the presence of either a 25 Hz flutter or 200 Hz vibration stimulus on the unattended hand (on the opposite side of the body from the site of two-point limen testing – the condition of bilateral stimulation – which has been shown to evoke less SI cortical activity than the contralateral-only stimulus condition would decrease a subject's ability to discriminate between two points on the skin. Results A Bekesy tracking method was employed to track a subject's ability to discriminate between two-point stimuli delivered to the skin. The distance between the two points of stimulation was varied on a trial-by-trial basis, and several different stimulus conditions were examined: (1 The "control" condition, in which 25 Hz flutter stimuli were delivered simultaneously to the two points on the skin of the attended hand, (2 the "complex" condition, in which a combination of 25 Hz flutter and 200 Hz vibration stimuli were delivered to the two points on the attended hand, and (3 a

  17. A Call for a Community of Practice to Assess the Impact of Emerging Technologies on Undergraduate Biology Education

    Directory of Open Access Journals (Sweden)

    Jamie L. Jensen

    2012-02-01

    Full Text Available Recent recommendations for educational research encourage empirically tested, theory-based, completely transparent, and broadly applicable studies. In light of these recommendations, we call for a research standard and community of practice in the evaluation of technology use in the undergraduate life science classroom. We outline appropriate research methodology, review and critique the past research on technology usage and, lastly, suggest a new and improved focus for research on emerging technologies.

  18. Lawn mower injuries as a cause of serious visual acuity impairment - Case reports.

    Science.gov (United States)

    Jasielska, Monika; Winiarczyk, Mateusz; Bieliński, Paweł; Mackiewicz, Jerzy

    2017-05-11

    [b]Abstract Objective.[/b] The aim of the study is to present four cases of lawn mowers injuries as a cause of serious visual acuity impairment. [b]Materials and Method[/b]. A retrospective study of four patients admitted in 2013-2015 to the Department of Vitreoretinal Surgery in Lublin with severe open or closed globe injury, one with an intraocular foreign body (IOFB). The presence of eye protective equipment was assessed, as well as visual acuity, eye tissue condition before and after treatment, and applied therapy. In all cases an improvement was achieved in local conditions. The intraocular foreign body was removed, wounds sutured and damaged tissues placed in position. All eyeballs were saved. In three cases, visual acuity was improved to a usable level. Three patients underwent pars plana vitrectomy, one with IOFB removal from the vitreous cavity. [b]Conclusions[/b]. Lawn mower induced eye injuries are a significant cause of serious visual acuity impairment or blindness. The presented study shows that lawn mower eye injuries are still a therapeutic, social and economic problem, yet are very preventable with proper eye protection and patients' education. Current prevention strategies are inadequate, and therefore should be updated.

  19. Contrast visual acuity after multifocal intraocular lens implantation:aspheric versus spherical design

    Directory of Open Access Journals (Sweden)

    Jun-Hua Li

    2014-02-01

    Full Text Available AIM: To evaluate contrast visual acuity (CVA after implantation of an aspheric apodized diffractive intraocular lens (IOL or a spherical apodized diffractive IOL in cataract surgery.METHOD: This prospective randomized controlled study with a 12-month follow-up compared the results of cataract surgery with implantation of an aspheric AcrySof ReSTOR SN6AD3 IOL (30 eyes and a spherical AcrySof ReSTOR SN60D3 IOL (30 eyes. CVA with best distance correction was measured at 4 contrast levels (100%, 25%, 10% and 5% under 3 levels of chart luminance [250, 85 and 25 candelas per square meter (cd/m2] using a multi-functional visual acuity tester (MFVA-100.RESULTS:At 12 months after surgery, there were no statistically significant differences in 100% CVA and 25% CVA under 250cd/m2 (P100%=0.875 and P25%=0.057 and 85cd/m2 (P100%=0.198 and P25%=0.193 between the aspheric group and the spherical group. However, the 10% CVA and 5% CVA were significant better in aspheric group than spherical group under 250cd/m2 (P10%=0.042 and P5%=0.007 and 85cd/m2 (P10%=0.002 and P5%=0.039. Under the luminance level of 25cd/m2, no significant differences was found in the 100% CVA between the 2 group (P100%=0.245, while aspheric group had better visual acuity in the remaining 3 contracts (P25%=0.023, P10%=0.026 and P5%=0.002, respectively.CONCULSION:The aspheric AcrySof ReSTOR SN6AD3 IOL provided patients with better low-contrast visual acuity than the spherical AcrySof ReSTOR SN60D3 IOL.Keyword:cataract surgery; intraocular lens; contrast sensitivity; visual acuity

  20. Gender and environmental influences on visual acuity in Owerri ...

    African Journals Online (AJOL)

    olayemitoyin

    1Optometry Unit, Eye Clinic, Federal Medical Centre, Owerri, Imo State, 2Department of Physiology, College ... Visual acuity (V.A.) is a measure of visual function in health and disease. ..... environment especially during harmattan and dry.

  1. [Evaluation of visual acuity in a historical cohort of 137 patients treated for amblyopia by occlusion 30-35 years ago].

    Science.gov (United States)

    Simonsz-Tóth, B; Loudon, S E; van Kempen-du Saar, H; van de Graaf, E S; Groenewoud, J H; Simonsz, H J

    2007-01-01

    Opinions differ on the course of the visual acuity in the amblyopic eye after cessation of occlusion therapy. This study evaluated visual acuity in a historical cohort treated for amblyopia with occlusion therapy 30-35 years ago. Between 1968 and 1975, 1250 patients had been treated by the orthoptist in the Waterland Hospital in Purmerend, The Netherlands. Of these, 471 received occlusion treatment for amblyopia (prevalence 5.0%, after comparison with the local birth rate). We were able to contact 203 of these patients, 137 were orthoptically re-examined in 2003. We correlated the current visual acuity with the cause of amblyopia, the age at start and end of treatment, the visual acuity at start and end of treatment, fixation, binocular vision and refractive errors. Mean age at the start of treatment was 5.4 +/- 1.9 years, 7.4 +/- 1.7 years at the end and 37 +/- 2.7 years at follow-up. Current visual acuity in the amblyopic eye was correlated with a low visual acuity at the start (p occlusion therapy, an eccentric fixation (p amblyopia (p = 0.005). At the end of the treatment, patients with a strabismic amblyopia (n = 98) had a visual acuity in the amblyopic eye of 0.29 logMAR +/- 0.3, and in 2003 0.27 +/- 0.3 logMAR. In patients with an anisometropic amblyopia (> 1 D, n = 16) visual acuity had decreased from 0.17 +/- 0.23 logMAR to 0.21 logMAR +/- 0.23. In patients with both strabismic and anisometropic amblyopia (n = 23), visual acuity had decreased from 0.52 logMAR +/- 0.54 to 0.65 logMAR +/- 0.54. Overall, acuity had decreased in 54 patients (39%) after cessation of treatment. Of these, 18 patients had an acuity decrease to less than 50% of their acuity at the end of treatment. In 15 of these 18 patients anisohypermetropia had increased. A decrease in visual acuity after cessation of occlusion therapy occurred in patients with a combined cause of amblyopia or with an increase in anisohypermetropia.

  2. Linking Calling Orientations to Organizational Attachment via Organizational Instrumentality

    Science.gov (United States)

    Cardador, M. Teresa; Dane, Erik; Pratt, Michael G.

    2011-01-01

    Despite an emerging interest in callings, researchers know little about whether calling orientations matter in the workplace. We explore the under-examined relationship between a calling orientation and employees' attachment to their organizations. Although some theory suggests that callings may be negatively related to organizational attachment,…

  3. Visual acuity loss associated with excessive “dry macula” in exudative age-related macular degeneration

    Directory of Open Access Journals (Sweden)

    Takahashi H

    2018-02-01

    Full Text Available Hidenori Takahashi,1–3 Yuji Inoue,1,2 Xue Tan,2,3 Satoru Inoda,1 Shinichi Sakamoto,1 Yusuke Arai,1 Yasuo Yanagi,4–6 Yujiro Fujino,2,3 Hidetoshi Kawashima1 1Department of Ophthalmology, Jichi Medical University, Shimotsuke, 2Department of Ophthalmology, The University of Tokyo, Bunkyo, 3Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Shinjuku, Japan; 4Medical Retina, Singapore National Eye Centre, 5Medical Retina, Singapore Eye Research Institute, 6Eye-ACP, Duke NUS Medical School, National University of Singapore, Singapore Purpose: To investigate the correlation between visual acuity and central macular thickness (CMT and choroidal thickness (CCT in patients with wet age-related macular degeneration (AMD. Methods: In this retrospective analysis, 14 eyes that received >10 ranibizumab injections (based on pro re nata [PRN] regimen and maintained initial visual acuity gain were analyzed. The following 5 parameters were measured at the foveal center: CMT (distance from the inner limiting membrane [ILM] to Bruch’s membrane; central retinal thickness (CRT; distance from the ILM to the inner limit of the retinal pigment epithelium or subretinal fluid [SRF]; SRF thickness (SRFT; pigment epithelium detachment thickness (PEDT; and CCT. The correlation between the logarithm of the minimum angle of resolution (logMAR best-corrected visual acuity (BCVA and the 5 parameters was examined with generalized estimating equations. Results: CMT, CRT, and CCT were negatively correlated with logMAR BCVA (P=0.031, 0.023, and 0.036, respectively when only CMT values less than the thickness that maximized visual acuity for each eye were used for the analysis. Each 100-µm reduction in CMT, CRT, or CCT improved logMAR BCVA by -0.1, -0.08, or -0.07, respectively. SRFT and PEDT were not correlated with BCVA. The median CMT that maximized the visual acuity was 230 µm. Conclusion: Dry macula with CMT <230 µm was

  4. Tactile acuity is disrupted in osteoarthritis but is unrelated to disruptions in motor imagery performance.

    NARCIS (Netherlands)

    Stanton, T.R.; Lin, C.W.; Bray, H.; Smeets, R.J.P.; Taylor, D.; Law, R.Y.; Moseley, G.L.

    2013-01-01

    OBJECTIVE: To determine whether tactile acuity is disrupted in people with knee OA and to determine whether tactile acuity, a clinical signature of primary sensory cortex representation, is related to motor imagery performance (MIP; evaluates working body schema) and pain. METHODS: Experiment 1:

  5. A comparison of static near stereo acuity in youth baseball/softball players and non-ball players.

    Science.gov (United States)

    Boden, Lauren M; Rosengren, Kenneth J; Martin, Daniel F; Boden, Scott D

    2009-03-01

    Although many aspects of vision have been investigated in professional baseball players, few studies have been performed in developing athletes. The issue of whether youth baseball players have superior stereopsis to nonplayers has not been addressed specifically. The purpose of this study was to determine if youth baseball/softball players have better stereo acuity than non-ball players. Informed consent was obtained from 51 baseball/softball players and 52 non-ball players (ages 10 to 18 years). Subjects completed a questionnaire, and their static near stereo acuity was measured using the Randot Stereotest (Stereo Optical Company, Chicago, Illinois). Stereo acuity was measured as the seconds of arc between the last pair of images correctly distinguished by the subject. The mean stereo acuity score was 25.5 +/- 1.7 seconds of arc in the baseball/softball players and 56.2 +/- 8.4 seconds of arc in the non-ball players. This difference was statistically significant (P softball players had significantly better static stereo acuity than non-ball players, comparable to professional ball players.

  6. Developing an Emergency Physician Productivity Index Using Descriptive Health Analytics.

    Science.gov (United States)

    Khalifa, Mohamed

    2015-01-01

    Emergency department (ED) crowding became a major barrier to receiving timely emergency care. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, we identified variables and factors affecting crowding and performance to develop indicators to help evaluation and improvement. Measuring efficiency of work and activity of throughput processes; it was important to develop an ED physician productivity index. Data on all ED patients' encounters over the last six months of 2014 were retrieved and descriptive health analytics methods were used. Three variables were identified for their influence on productivity and performance; Number of Treated Patients per Physician, Patient Acuity Level and Treatment Time. The study suggested a formula to calculate the productivity index of each physician through dividing the Number of Treated Patients by Patient Acuity Level squared and Treatment Time to identify physicians with low productivity index and investigate causes and factors.

  7. Prevalence of high astigmatism, eyeglass wear, and poor visual acuity among Native American grade school children.

    Science.gov (United States)

    Harvey, Erin M; Dobson, Velma; Miller, Joseph M

    2006-04-01

    The purpose of this study was to examine the prevalence of astigmatism and poor visual acuity and rate of eyeglass wear in grade school children who are members of a Native American tribe reported to have a high prevalence of large amounts of astigmatism. Vision screening was conducted on 1,327 first through eighth grade children attending school on the Tohono O'odham Reservation. Noncycloplegic autorefraction was conducted on the right and left eye of each child using the Nikon Retinomax K+ autorefractor, and monocular recognition acuity was tested using ETDRS logarithm of the minimum angle of resolution (logMAR) letter charts. Tohono O'odham children had a high prevalence of high astigmatism (42% had > or = 1.00 D in the right or left eye) and the axis of astigmatism was uniformly with-the-rule. However, only a small percentage of children arrived at the vision screening wearing glasses, and the prevalence of poor visual acuity (20/40 or worse in either eye) was high (35%). There was a significant relation between amount of astigmatism and uncorrected visual acuity with each additional diopter of astigmatism resulting in an additional 1 logMAR line reduction in visual acuity. Uncorrected astigmatism and poor visual acuity are prevalent among Tohono O'odham children. The results highlight the importance of improving glasses-wearing compliance, determining barriers to receiving eye care, and initiating public education programs regarding the importance of early identification and correction of astigmatism in Tohono O'odham children.

  8. Correlation Between Near-Vision Acuity and the Incidence of Peritoneal Dialysis-Related Infections.

    Science.gov (United States)

    Kojima, Shigeki; Sakurada, Tsutomu; Koitabashi, Kenichiro; Kojima, Kaori; Watanabe, Shiika; Uchida, Daisuke; Kaneshiro, Nagayuki; Konno, Yusuke; Shibagaki, Yugo

    Peritoneal dialysis (PD)-related infections (PDIs) such as peritonitis, exit-site infection, and tunnel infection are serious complications affecting patients on PD. Because patients with diabetes (DM) and of older age have increased in number in Japan, the number of patients with visual impairment is estimated also to have increased. Near vision is necessary for performing proper PD daily care. However, no studies have reported whether visual impairment is likely to increase the risk of PDIs.Our study included 31 PD patients (16 men, 15 women; mean age: 61.5 ± 11.8 years; mean PD duration: 27.3 ± 20.3 months; 38.7% with DM; 54.8% wearing glasses) who performed their own PD care. At our facility and related facilities, we used a standard near-vision test chart, which classifies vision into 12 grades, from 0.1 (poor) to 1.5 (clear), to assess near-vision binocular visual acuity in those patients between March 2015 and September 2015. In addition, we retrospectively examined the medical records of the patients to determine their history of PDIs. We then evaluated the correlation between near-vision acuity and the incidence of PDIs.Mean measured near-vision acuity was 0.61 ± 0.29, and we observed no significant difference in the visual acuity of patients with and without DM (0.55 ± 0.31 vs. 0.63 ± 0.26 respectively, p = 0.477). In addition, we observed no significant difference in the incidence of PDIs between patients with and without DM (1.298 ± 1.609 per year vs. 1.164 ± 0.908 per year respectively, p = 0.804). We did not find a correlation between near-vision acuity and the incidence of PDIs (r = -0.071, p = 0.795).

  9. A new specialized visual acuity chart for amblyopic children aged 3-5 years old:development and its clinical applications

    Directory of Open Access Journals (Sweden)

    Yang-Qing Huang

    2013-12-01

    Full Text Available AIM: To introduce a new specialized visual acuity chart for amblyopic children aged 3-5 years old and its clinical applications.METHODS:The new visual acuity chart and notations were designed based on Weber-Fechner law. The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle, square, triangle,and cross. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 14 lines. The progression rate of the optotype size between two lines was 1.2589 and the testing distance was 3m. Visual acuity score could be recorded as logMAR notation or decimal notation. Age-stratified diagnostic criteria for amblyopia established by consensus statement on diagnosis of amblyopia (2011 among members of the Strabismus and Pediatric Ophthalmology Group, Ophthalmology Society, Chinese Medical Association (SPOGOSCMA were illustrated in the new visual acuity chart.RESULTS: When assessing visual acuity in children aged 3-5 years old, this new visual acuity chart that consists of four symmetrical shapes (triangle, square, cross, and circle overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling ‘E’ or Landolt ‘C’, which the subjects were prone to lose interest in. The visual acuity score may be recorded in different notations:decimal acuity and logMAR. These two notations can be easily converted each other in the new eye chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the international standard logarithmic visual acuity chart (r=0.932, P<0.01, but also indicated a high test-retest reliability (89% of retest scores were within 0.1logMAR units of the initial test score.CONCLUSION: The results of this study support the validity and reliability of distance visual acuity measurements using the new eye chart in

  10. An Acuity Tool for Heart Failure Case Management: Quantifying Workload, Service Utilization, and Disease Severity.

    Science.gov (United States)

    Kilgore, Matthew D

    The cardiology service line director at a health maintenance organization (HMO) in Washington State required a valid, reliable, and practical means for measuring workloads and other productivity factors for six heart failure (HF) registered nurse case managers located across three geographical regions. The Kilgore Heart Failure Case Management (KHFCM) Acuity Tool was systematically designed, developed, and validated to measure workload as a dependent function of the number of heart failure case management (HFCM) services rendered and the duration of times spent on various care duties. Research and development occurred at various HMO-affiliated internal medicine and cardiology offices throughout Western Washington. The concepts, methods, and principles used to develop the KHFCM Acuity Tool are applicable for any type of health care professional aiming to quantify workload using a high-quality objective tool. The content matter, scaling, and language on the KHFCM Acuity Tool are specific to HFCM settings. The content matter and numeric scales for the KHFCM Acuity Tool were developed and validated using a mixed-method participant action research method applied to a group of six outpatient HF case managers and their respective caseloads. The participant action research method was selected, because the application of this method requires research participants to become directly involved in the diagnosis of research problems, the planning and execution of actions taken to address those problems, and the implementation of progressive strategies throughout the course of the study, as necessary, to produce the most credible and practical practice improvements (; ; ; ). Heart failure case managers served clients with New York Heart Association Functional Class III-IV HF (), and encounters were conducted primarily by telephone or in-office consultation. A mix of qualitative and quantitative results demonstrated a variety of quality improvement outcomes achieved by the design

  11. Patient satisfaction with wait times at an emergency ophthalmology on-call service.

    Science.gov (United States)

    Chan, Brian J; Barbosa, Joshua; Moinul, Prima; Sivachandran, Nirojini; Donaldson, Laura; Zhao, Lily; Mullen, Sarah J; McLaughlin, Christopher R; Chaudhary, Varun

    2018-04-01

    To assess patient satisfaction with emergency ophthalmology care and determine the effect provision of anticipated appointment wait time has on scores. Single-centre, randomized control trial. Fifty patients triaged at the Hamilton Regional Eye Institute (HREI) from November 2015 to July 2016. Fifty patients triaged for next-day appointments at the HREI were randomly assigned to receive standard-of-care preappointment information or standard-of-care information in addition to an estimated appointment wait time. Patient satisfaction with care was assessed postvisit using the modified Judgements of Hospital Quality Questionnaire (JHQQ). In determining how informing patients of typical wait times influenced satisfaction, the Mann-Whitney U test was performed. As secondary study outcomes, we sought to determine patient satisfaction with the intervention material using the Fisher exact test and the effect that wait time, age, sex, education, mobility, and number of health care providers seen had on satisfaction scores using logistic regression analysis. The median JHQQ response was "very good" (4/5) and between "very good" and "excellent" (4.5/5) in the intervention and control arms, respectively. There was no difference in patient satisfaction between the cohorts (Mann-Whitney U = 297.00, p = 0.964). Logistic regression analysis demonstrated that wait times influenced patient satisfaction (OR = 0.919, 95% CI 0.864-0.978, p = 0.008). Of the intervention arm patients, 92.0% (N = 23) found the preappointment information useful, whereas only 12.5% (N = 3) of the control cohort patients noted the same (p < 0.001). Provision of anticipated wait time information to patients in an emergency on-call ophthalmology clinic did not influence satisfaction with care as captured by the JHQQ. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  12. Influence of Passive Joint Stiffness on Proprioceptive Acuity in Individuals With Functional Instability of the Ankle.

    Science.gov (United States)

    Marinho, Hellen Veloso Rocha; Amaral, Giovanna Mendes; de Souza Moreira, Bruno; Araújo, Vanessa Lara; Souza, Thales Rezende; Ocarino, Juliana Melo; da Fonseca, Sérgio Teixeira

    2017-12-01

    Study Design Controlled laboratory study, cross-sectional. Background Deficits in ankle proprioceptive acuity have been reported in persons with functional instability of the ankle. Passive stiffness has been proposed as a possible mechanism underlying proprioceptive acuity. Objective To compare proprioceptive acuity and passive ankle stiffness in persons with and without functional ankle instability, and to assess the influence of passive joint stiffness on proprioceptive acuity in persons with functional ankle instability. Methods A sample of 18 subjects with and 18 without complaints of functional ankle instability following lateral ankle sprain participated. An isokinetic dynamometer was used to compare motion perception threshold, passive position sense, and passive ankle stiffness between groups. To evaluate the influence of passive stiffness on proprioceptive acuity, individuals in the lateral functional ankle instability group were divided into 2 subgroups: "high" and "low" passive ankle stiffness. Results The functional ankle instability group exhibited increased motion perception threshold when compared with the corresponding limb of the control group. Between-group differences were not found for passive position sense and passive ankle stiffness. Those in the functional ankle instability group with higher passive ankle stiffness had smaller motion perception thresholds than those with lower passive ankle stiffness. Conclusion Unlike motion perception threshold, passive position sense is not affected by the presence of functional ankle instability. Passive ankle stiffness appears to influence proprioceptive acuity in persons with functional ankle instability. J Orthop Sports Phys Ther 2017;47(12):899-905. Epub 7 Oct 2017. doi:10.2519/jospt.2017.7030.

  13. PATTERN ELECTRORETINOGRAPHY IN RELATION TO KINETIC AND STATIC PERIMETRY AND VISUAL ACUITY IN RETINITIS PIGMENTOSA

    Directory of Open Access Journals (Sweden)

    Petra Popović

    2002-12-01

    Full Text Available Background. This study was conducted to assess whether pattern ERG is a sensitive test in evaluating the retinal function in patients with retinitis pigmentosa. We wanted to determine how pattern ERG, reflecting the activity of inner retinal layers, is related to other psychophysical tests such as perimetry and visual acuity.Methods. An analysis was performed on 50 eyes of 25 patients with typical rod-cone retinitis pigmentosa. The standard Snellen visual acuity was tested. Visual field sensitivity was measured with automated static perimetry (Octopus G2 program where mean defect was taken as an index of visual field loss. In kinetic perimetry (Goldmann the average radius of the visual field measured with target II/4 and V/4 was calculated. Transient pattern ERG and all five flash ERG responses were also measured according to ISCEV standards. Amplitudes of pattern ERG P50 and N95 waves were compared to results of visual acuity and visual field testing.Results. In our group of 25 RP patients with visual acuity ranging from 0.16 to 1.0, PERG responses were preserved much better than full field ERGs. 72% of them had still recordable PERG responses, while 48% had cone and only 32% maximal responses. Scotopic rod responses were extinguished in all eyes. The normalized amplitudes of the PERG responses were also much higher (43.5% than cone (22.5% or maximal responses (4.5%. A strong correlation of both P50 and N95 amplitudes with Octopus mean defect index was found. In kinetic perimetry the correlation with PERG amplitudes was also high, but it was better with II/4 than with V/4 target. Patients with high preserved ERG responses had good visual acuity. In all patients with visual acuity less than 0.4 both flash and pattern ERG responses were already absent.Conclusions. This study shows that pattern ERG is an objective and sensitive test in evaluating the functional visual loss in retinitis pigmentosa. Amplitudes of P50 and N95 responses are linearly

  14. Color improves “visual” acuity via sound

    OpenAIRE

    Levy-Tzedek, Shelly; Riemer, Dar; Amedi, Amir

    2014-01-01

    Visual-to-auditory sensory substitution devices (SSDs) convey visual information via sound, with the primary goal of making visual information accessible to blind and visually impaired individuals. We developed the EyeMusic SSD, which transforms shape, location, and color information into musical notes. We tested the “visual” acuity of 23 individuals (13 blind and 10 blindfolded sighted) on the Snellen tumbling-E test, with the EyeMusic. Participants were asked to determine the orientation of...

  15. Visual acuity after trans-scleral sutured posterior chamber intraocular lens

    International Nuclear Information System (INIS)

    Mahmood, S.A.; Zafar, S.

    2014-01-01

    To determine the changes in visual acuity in patients undergoing Trans-Scleral Sutured Posterior Chamber Intra-Ocular Lens (TSSPCIOL) implantation at a tertiary care hospital in Karachi, Pakistan. Study Design: Case series. Place and Duration of Study: LRBT Tertiary Eye Hospital, Karachi, from January 2006 to December 2010. Methodology: Records of all patients undergoing implantation of TSSPCIOL were reviewed. Patients with diagnosed glaucoma, diabetic retinopathy, macular degeneration, history of recurrent uveitis, corneal haze or central corneal scars were excluded. For the final analysis, 70 eyes out of a total of 75 were selected. Main outcomes of interest were pre and postoperative visual acuities and surgical complications. SPSS 21 was used for data analysis. Results: Pre-operatively, the average Best Spectacle-Corrected Visual Acuity (BSCVA) was 6/36 on the Snellen chart. This improved to 6/12 postoperatively. The mean improvement seen was 2.4 lines on the Snellen chart (p < 0.05). Complications include transient intraocular pressure elevation in 25 eyes (36%), IOL tilt in 4 eyes (7.1%), Cystoid Macular Edema (CME) in 4 eyes (5.7%), vitreous haemorrhage in 2 eyes (2.9%), hyphema in 2 eyes (2.9%), uveitis in 1 eye (1.4%), and retinal detachment 1 eye (1.4%). No IOL subluxation, suture erosion, iris capture, choroidal effusion or endophthalmitis was encountered and no re-operations were needed. Conclusion: TSSPCIOLs are a good management option for patients with aphakia in whom PC IOLs cannot be placed. (author)

  16. Help Options in CALL: A Systematic Review

    Science.gov (United States)

    Cardenas-Claros, Monica S.; Gruba, Paul A.

    2009-01-01

    This paper is a systematic review of research investigating help options in the different language skills in computer-assisted language learning (CALL). In this review, emerging themes along with is-sues affecting help option research are identified and discussed. We argue that help options in CALL are application resources that do not only seem…

  17. Is theta burst stimulation applied to visual cortex able to modulate peripheral visual acuity?

    Directory of Open Access Journals (Sweden)

    Sabrina Brückner

    Full Text Available Repetitive transcranial magnetic stimulation is usually applied to visual cortex to explore the effects on cortical excitability. Most researchers therefore concentrate on changes of phosphene threshold, rarely on consequences for visual performance. Thus, we investigated peripheral visual acuity in the four quadrants of the visual field using Landolt C optotypes before and after repetitive stimulation of the visual cortex. We applied continuous and intermittend theta burst stimulation with various stimulation intensities (60%, 80%, 100%, 120% of individual phosphene threshold as well as monophasic and biphasic 1 Hz stimulation, respectively. As an important result, no serious adverse effects were observed. In particular, no seizure was induced, even with theta burst stimulation applied with 120% of individual phosphene threshold. In only one case stimulation was ceased because the subject reported intolerable pain. Baseline visual acuity decreased over sessions, indicating a continuous training effect. Unexpectedly, none of the applied transcranial magnetic stimulation protocols had an effect on performance: no change in visual acuity was found in any of the four quadrants of the visual field. Binocular viewing as well as the use of peripheral instead of foveal presentation of the stimuli might have contributed to this result. Furthermore, intraindividual variability could have masked the TMS- induced effects on visual acuity.

  18. Distinct eye movement patterns enhance dynamic visual acuity

    Science.gov (United States)

    Palidis, Dimitrios J.; Wyder-Hodge, Pearson A.; Fooken, Jolande; Spering, Miriam

    2017-01-01

    Dynamic visual acuity (DVA) is the ability to resolve fine spatial detail in dynamic objects during head fixation, or in static objects during head or body rotation. This ability is important for many activities such as ball sports, and a close relation has been shown between DVA and sports expertise. DVA tasks involve eye movements, yet, it is unclear which aspects of eye movements contribute to successful performance. Here we examined the relation between DVA and the kinematics of smooth pursuit and saccadic eye movements in a cohort of 23 varsity baseball players. In a computerized dynamic-object DVA test, observers reported the location of the gap in a small Landolt-C ring moving at various speeds while eye movements were recorded. Smooth pursuit kinematics—eye latency, acceleration, velocity gain, position error—and the direction and amplitude of saccadic eye movements were linked to perceptual performance. Results reveal that distinct eye movement patterns—minimizing eye position error, tracking smoothly, and inhibiting reverse saccades—were related to dynamic visual acuity. The close link between eye movement quality and DVA performance has important implications for the development of perceptual training programs to improve DVA. PMID:28187157

  19. Distinct eye movement patterns enhance dynamic visual acuity.

    Science.gov (United States)

    Palidis, Dimitrios J; Wyder-Hodge, Pearson A; Fooken, Jolande; Spering, Miriam

    2017-01-01

    Dynamic visual acuity (DVA) is the ability to resolve fine spatial detail in dynamic objects during head fixation, or in static objects during head or body rotation. This ability is important for many activities such as ball sports, and a close relation has been shown between DVA and sports expertise. DVA tasks involve eye movements, yet, it is unclear which aspects of eye movements contribute to successful performance. Here we examined the relation between DVA and the kinematics of smooth pursuit and saccadic eye movements in a cohort of 23 varsity baseball players. In a computerized dynamic-object DVA test, observers reported the location of the gap in a small Landolt-C ring moving at various speeds while eye movements were recorded. Smooth pursuit kinematics-eye latency, acceleration, velocity gain, position error-and the direction and amplitude of saccadic eye movements were linked to perceptual performance. Results reveal that distinct eye movement patterns-minimizing eye position error, tracking smoothly, and inhibiting reverse saccades-were related to dynamic visual acuity. The close link between eye movement quality and DVA performance has important implications for the development of perceptual training programs to improve DVA.

  20. Video calls from lay bystanders to dispatch centers - risk assessment of information security.

    Science.gov (United States)

    Bolle, Stein R; Hasvold, Per; Henriksen, Eva

    2011-09-30

    Video calls from mobile phones can improve communication during medical emergencies. Lay bystanders can be instructed and supervised by health professionals at Emergency Medical Communication Centers. Before implementation of video mobile calls in emergencies, issues of information security should be addressed. Information security was assessed for risk, based on the information security standard ISO/IEC 27005:2008. A multi-professional team used structured brainstorming to find threats to the information security aspects confidentiality, quality, integrity, and availability. Twenty security threats of different risk levels were identified and analyzed. Solutions were proposed to reduce the risk level. Given proper implementation, we found no risks to information security that would advocate against the use of video calls between lay bystanders and Emergency Medical Communication Centers. The identified threats should be used as input to formal requirements when planning and implementing video calls from mobile phones for these call centers.

  1. Evaluating the construct of triage acuity against a set of reference vignettes developed via modified Delphi method.

    Science.gov (United States)

    Twomey, Michèle; Wallis, Lee A; Myers, Jonathan E

    2014-07-01

    To evaluate the construct of triage acuity as measured by the South African Triage Scale (SATS) against a set of reference vignettes. A modified Delphi method was used to develop a set of reference vignettes. Delphi participants completed a 2-round consensus-building process, and independently assigned triage acuity ratings to 100 written vignettes unaware of the ratings given by others. Triage acuity ratings were summarised for all vignettes, and only those that reached 80% consensus during round 2 were included in the reference set. Triage ratings for the reference vignettes given by two independent experts using the SATS were compared with the ratings given by the international Delphi panel. Measures of sensitivity, specificity, associated percentages for over-triage/under-triage were used to evaluate the construct of triage acuity (as measured by the SATS) by examining the association between the ratings by the two experts and the international panel. On completion of the Delphi process, 42 of the 100 vignettes reached 80% consensus on their acuity rating and made up the reference set. On average, over all acuity levels, sensitivity was 74% (CI 64% to 82%), specificity 92% (CI 87% to 94%), under-triage occurred 14% (CI 8% to 23%) and over-triage 12% (CI 8% to 23%) of the time. The results of this study provide an alternative to evaluating triage scales against the construct of acuity as measured with the SATS. This method of using 80% consensus vignettes may, however, systematically bias the validity estimate towards better performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. A comparison of Lea Symbol vs ETDRS letter distance visual acuity in a population of young children with a high prevalence of astigmatism.

    Science.gov (United States)

    Dobson, Velma; Clifford-Donaldson, Candice E; Miller, Joseph M; Garvey, Katherine A; Harvey, Erin M

    2009-06-01

    To compare visual acuity results obtained by use of the Lea Symbols chart with results obtained with Early Treatment Diabetic Retinopathy Study (ETDRS) charts in young children who are members of a population with a high prevalence of astigmatism. Subjects were 438 children ages 5 through 7 years who were enrolled in kindergarten or first grade on the Tohono O'odham Reservation: 241 (55%) had astigmatism >or=1.00 D in one or both eyes (range, 0.00-6.75 D). While wearing best correction, each child had right eye visual acuity tested with the 62 cm by 65 cm Lea Symbols chart at 3 m and with the 62 cm by 65 cm ETDRS chart at 4 m. Visual acuity was scored as the smallest optotype size at which the child correctly identified 3 of a maximum of 5 optotypes. ETDRS visual acuity also was scored based on the total number of letters that the child correctly identified. Correlation between Lea Symbols visual acuity and ETDRS visual acuity was 0.78 (p < 0.001). Mean Lea Symbols visual acuity was one-half line (0.04-0.06 logMAR) better than mean ETDRS visual acuity (p < 0.001). The difference between Lea Symbols and ETDRS visual acuity was not correlated with the mean of the Lea Symbols and ETDRS visual acuity scores, which ranged from -0.3 logMAR (20/10) to 0.74 logMAR (20/110). In this population of young children, in whom the primary source of reduced visual acuity is astigmatism-related amblyopia, the Lea Symbols chart produced visual acuity scores that were about 0.5 line better than visual acuity scores obtained with ETDRS charts.

  3. [Amblyopia: reading speed in comparison with visual acuity for gratings, single Landolt Cs and series Landolt Cs].

    Science.gov (United States)

    Bach, M; Strahl, P; Waltenspiel, S; Kommerell, G

    1990-01-01

    In the treatment of amblyopia in preschool children, a means of predicting later reading ability would be helpful. This prediction might be possible using a test for visual acuity where the results correlate with reading ability in adult patients with amblyopia. We measured the following four parameters in 18 experienced readers with strabismic amblyopia: (1) time spent reading ten lines of a standard text in one of three magnifications, (2) visual acuity for gratings, (3) visual acuity for single Landolt Cs, and (4) visual acuity for crowded Landolt Cs (one Landolt C flanked by two full rings on each side each at a distance of 2.6 min of arc). The reading text was presented on paper at a distance of 40 cm; the subject had a choice of three magnifications. The acuity tests were generated by a computer on a VDU at 4.6 m. The relative impairment of the amblyopic eye was defined as the quotient between the performance of the amblyopic and the good eye. In addition, the difference between the times spent reading the ten lines with the amblyopic and with the good eye was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Recognition versus Resolution: a Comparison of Visual Acuity Results Using Two Alternative Test Chart Optotype

    Directory of Open Access Journals (Sweden)

    Jonathan S. Pointer

    2008-01-01

    Conclusions: For normally sighted subjects wearing an optimal refractive correction, a bias was recorded in favour of recognition over resolution acuity: the clinical difference amounted to approximately 40% of one logMAR chart line, with similar high repeatability for either chart optotype. We conclude that the assumption of clinical equivalence between letter and Landolt acuity is reasonable under optimum test conditions.

  5. Evaluation of a Public Child Eye Health Tertiary Facility for Pediatric Cataract in Southern Nigeria I: Visual Acuity Outcome

    Science.gov (United States)

    Duke, Roseline E.; Adio, Adedayo; Oparah, Sidney K.; Odey, Friday; Eyo, Okon A.

    2016-01-01

    Purpose: A retrospective study of the outcome of congenital and developmental cataract surgery was conducted in a public child eye health tertiary facility in children <16 years of age in Southern Nigeria, as part of an evaluation. Materials and Method: Manual Small Incision Cataract Surgery with or without anterior vitrectomy was performed. The outcome measures were visual acuity (VA) and change (gain) in visual acuity. The age of the child at onset, duration of delay in presentation, ocular co-morbidity, non ocular co-morbidity, gender, and pre operative visual acuity were matched with postoperative visual acuity. A total of 66 children were studied for a period of six weeks following surgery. Results: Forty eight (72.7%) children had bilateral congenital cataracts and 18 (27.3%) children had bilateral developmental cataracts. There were 38(57.6%) males and 28 (42.4%) females in the study. Thirty Five (53%) children had good visual outcome (normal vision range 6/6/ -6/18) post-operatively. The number of children with blindness (vision <3/60) decreased from 61 (92.4%) pre-operatively to 4 (6.1%) post-operatively. Post operative complication occurred in 6.8% of cases six week after surgery. Delayed presentation had an inverse relationship with change (gain) in visual acuity (r = - 0.342; p-value = 0.005). Pre-operative visual acuity had a positive relationship with post operative change (gain) in visual acuity (r = 0.618; p-value = 0.000). Conclusion: Predictors of change in visual acuity in our study were; delayed presentation and pre-operative VA. Cataract surgery in children showed clinical benefit. PMID:27347247

  6. LASER PHOTOCOAGULATION IN DIABETIC MACULAR EDEMA: EFFECTS ON VISUAL ACUITY AND MACULAR EDEMA

    Directory of Open Access Journals (Sweden)

    M.H. Dehghan

    1999-06-01

    Full Text Available Due to the importance of clinically significant macular edema in diabetic patients, this study is aimed to determine if laser photocoagulation is effective in the treatment of clinically significant diabetic macular edema. In addition, the effects of risk factors arc surveyed* This is an existing data study considering patients with clinically significant diabetic macular edema, treated with argon-green laser photocoagulation in Labbafinejad hospital, department of lasertherapy, from 1995 to 1997. in 60 (42.6% eyes the treatment method was focal, in 22 (15.6% eyes grid, and in 59 (41.84 modified grid laser photocoagulation was performed. The results are based upon deterioration of visual acuity, occurance of moderate visual loss and improvement or persistence of CSME. We studied 114 eyes from 87 patients. Two years after initial treatment, visual acuity improved in 19.1% of eyes, unchanged in 9.5% and worsened in 71.4% of eyes. After this period the rate of moderate visual loss was 28.6% and CSME was improved in 23.8% of eyes. According to our study, baseline visual acuity and retinopathy severity were two important intervening factors in response to lasertherapy. Comparing our results with natural course of diabetic macular edema, indicates that in assessing visual outcome laser photocoagulation is an effective modality in treatment of CSME, but it is not effective in maintaining or improving visual acuity, which is due to patients delay in visiting ophthalmologists and paying not enough attention to follow-up visits.

  7. Visual acuity testing of radiographic inspectors in nondestructive inspection. Final report

    International Nuclear Information System (INIS)

    Yonemura, G.T.

    1981-06-01

    Visual acuity tests for radiographic inspectors should be correlated with the type of tasks encountered in real world radiography. The testing procedures should be capable of assessing differences in day to day performance of a given inspector as well as the performance of one inspector relative to other inspectors. Single line targets with specific parametric values for contrast, width, and blur are recommended to provide a means for testing a radiographic inspector for visual acuity. These targets may be used for periodic tests by the employing organization or for more frequent self testing by the inspector. Statistics from the National Health Survey, procedures recommended by the NAS-NRC Committee on Vision and real world radiographs have been utilized in arriving at recommended test configurations

  8. Visual Acuity is Related to Parafoveal Retinal Thickness in Patients with Retinitis Pigmentosa and Macular Cysts

    Science.gov (United States)

    Brockhurst, Robert J.; Gaudio, Alexander R.; Berson, Eliot L.

    2008-01-01

    Purpose To quantify the prevalence and effect on visual acuity of macular cysts in a large cohort of patients with retinitis pigmentosa. Methods In 316 patients with typical forms of retinitis pigmentosa, we measured visual acuities with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, detected macular cysts with optical coherence tomography (OCT), and quantified retinal thicknesses by OCT. We used the FREQ, LOGISTIC, and GENMOD procedures of SAS to evaluate possible risk factors for cyst prevalence and the MIXED procedure to quantify the relationships of visual acuity to retinal thickness measured at different locations within the macula. Results We found macular cysts in 28% of the patients, 40% of whom had cysts in only one eye. Macular cysts were seen most often in patients with dominant disease and not at all in patients with X-linked disease (p = 0.006). In eyes with macular cysts, multiple regression analysis revealed that visual acuity was inversely and independently related to retinal thickness at the foveal center (p = 0.038) and within a ring spanning an eccentricity of 5° to 10° from the foveal center (p = 0.004). Conclusions Macular cysts are a common occurrence in retinitis pigmentosa, especially among patients with dominantly-inherited disease. Visual acuity is influenced by edema in the parafovea, as well as in the fovea. PMID:18552390

  9. Advertising Emergency Department Wait Times

    Directory of Open Access Journals (Sweden)

    Scott G. Weiner

    2013-03-01

    Full Text Available Advertising emergency department (ED wait times has become a common practice in the UnitedStates. Proponents of this practice state that it is a powerful marketing strategy that can help steerpatients to the ED. Opponents worry about the risk to the public health that arises from a patient withan emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standarddefinition of the reported time, and directing lower acuity patients to the higher cost ED setting insteadto primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times arediscussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects tothe public health, caution about its use is advised

  10. Association between individual differences in non-symbolic number acuity and math performance: a meta-analysis.

    Science.gov (United States)

    Chen, Qixuan; Li, Jingguang

    2014-05-01

    Many recent studies have examined the association between number acuity, which is the ability to rapidly and non-symbolically estimate the quantity of items appearing in a scene, and symbolic math performance. However, various contradictory results have been reported. To comprehensively evaluate the association between number acuity and symbolic math performance, we conduct a meta-analysis to synthesize the results observed in previous studies. First, a meta-analysis of cross-sectional studies (36 samples, N = 4705) revealed a significant positive correlation between these skills (r = 0.20, 95% CI = [0.14, 0.26]); the association remained after considering other potential moderators (e.g., whether general cognitive abilities were controlled). Moreover, a meta-analysis of longitudinal studies revealed 1) that number acuity may prospectively predict later math performance (r = 0.24, 95% CI = [0.11, 0.37]; 6 samples) and 2) that number acuity is retrospectively correlated to early math performance as well (r = 0.17, 95% CI = [0.07, 0.26]; 5 samples). In summary, these pieces of evidence demonstrate a moderate but statistically significant association between number acuity and math performance. Based on the estimated effect sizes, power analyses were conducted, which suggested that many previous studies were underpowered due to small sample sizes. This may account for the disparity between findings in the literature, at least in part. Finally, the theoretical and practical implications of our meta-analytic findings are presented, and future research questions are discussed. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Socio-Demographic Factors Associated With Loss Of Visual Acuity ...

    African Journals Online (AJOL)

    The study was designed to identify the sociodemographic factors, which significantly affect the visual acuity of glaucoma patients at presentation. It is a prospective study of 154 new patients with a diagnosis of primary open angle glaucoma seen over 1 year and 8 months at the eye clinic of the University of Benin Teaching ...

  12. A new dynamic visual acuity test to assess peripheral vestibular function.

    Science.gov (United States)

    Vital, Domenic; Hegemann, Stefan C A; Straumann, Dominik; Bergamin, Oliver; Bockisch, Christopher J; Angehrn, Dominik; Schmitt, Kai-Uwe; Probst, Rudolf

    2010-07-01

    To evaluate a novel test for dynamic visual acuity (DVA) that uses an adaptive algorithm for changing the size of Landolt rings presented during active or passive head impulses, and to compare the results with search-coil head impulse testing. Prospective study in healthy individuals and patients with peripheral vestibular deficits. Tertiary academic center. One hundred neuro-otologically healthy individuals (age range, 19-80 years) and 15 patients with bilateral (n = 5) or unilateral (n = 10) peripheral vestibular loss (age range, 27-72 years). Testing of static visual acuity (SVA), DVA during active and passive horizontal head rotations (optotype presentation at head velocities >100 degrees/s and >150 degrees/s), and quantitative horizontal head impulse testing with scleral search coils. Difference between SVA and DVA, that is, visual acuity loss (VA loss), gain of the high-acceleration vestibulo-ocular reflex. Passive head impulses and higher velocities were more effective than active impulses and lower velocities. Using passive head impulses and velocities higher than 150 degrees/s, the DVA test discriminated significantly (P test sensitivity was 100%, specificity was 94%, and accuracy was 95%, with search-coil head impulse testing used as a reference. In healthy individuals, VA loss increased significantly with age (P testing with Landolt rings that are adaptively changed in size enables detection of peripheral vestibular dysfunction in a fast and simple way.

  13. The influence of tongue strength on oral viscosity discrimination acuity.

    Science.gov (United States)

    Steele, Catriona M

    2018-06-01

    The ability to generate tongue pressures is widely considered to be critical for liquid bolus propulsion in swallowing. It has been proposed that the application of tongue pressure may also serve the function of collecting sensory information regarding bolus viscosity (resistance to flow). In this study, we explored the impact of age-related reductions in tongue strength on oral viscosity discrimination acuity. The experiment employed a triangle test discrimination protocol with an array of xanthan-gum thickened liquids in the mildly to moderately thick consistency range. A sample of 346 healthy volunteers was recruited, with age ranging from 12 to 86 (164 men, 182 women). On average, participants were able to detect a 0.29-fold increase in xanthan-gum concentration, corresponding to a 0.5-fold increase in viscosity at 50/s. Despite having significantly reduced tongue strength on maximum isometric tongue-palate pressure tasks, and regardless of sex, older participants in this study showed no reductions in viscosity discrimination acuity. In this article, the relationship between tongue strength and the ability to discriminate small differences in liquid viscosity during oral processing is explored. Given that tongue strength declines with age in healthy adults and is also reduced in individuals with dysphagia, it is interesting to determine whether reduced tongue strength might contribute to difficulties in evaluating liquid viscosity during the oral stage of swallowing. Using an array of mildly to moderately thick xanthan-gum thickened liquids, this experiment failed to find any evidence that reductions in tongue strength influence oral viscosity discrimination acuity. © 2017 Wiley Periodicals, Inc.

  14. Diagnosing cerebral visual impairment in children with good visual acuity.

    Science.gov (United States)

    van Genderen, Maria; Dekker, Marjoke; Pilon, Florine; Bals, Irmgard

    2012-06-01

    To identify elements that could facilitate the diagnosis of cerebral visual impairment (CVI) in children with good visual acuity in the general ophthalmic clinic. We retrospectively investigated the clinical characteristics of 30 children with good visual acuity and CVI and compared them with those of 23 children who were referred with a suspicion of CVI, but proved to have a different diagnosis. Clinical characteristics included medical history, MRI findings, visual acuity, crowding ratio (CR), visual field assessment, and the results of ophthalmologic and orthoptic examination. We also evaluated the additional value of a short CVI questionnaire. Eighty-three percent of the children with an abnormal medical history (mainly prematurity and perinatal hypoxia) had CVI, in contrast with none of the children with a normal medical history. Cerebral palsy, visual field defects, and partial optic atrophy only occurred in the CVI group. 41% of the children with CVI had a CR ≥2.0, which may be related to dorsal stream dysfunction. All children with CVI, but also 91% of the children without CVI gave ≥3 affirmative answers on the CVI questionnaire. An abnormal pre- or perinatal medical history is the most important risk factor for CVI in children, and therefore in deciding which children should be referred for further multidisciplinary assessment. Additional symptoms of cerebral damage, i.e., cerebral palsy, visual field defects, partial optic atrophy, and a CR ≥2 may support the diagnosis. CVI questionnaires should not be used for screening purposes as they yield too many false positives.

  15. A comparison of behavioural (Landolt C) and anatomical estimates of visual acuity in archerfish (Toxotes chatareus).

    Science.gov (United States)

    Temple, S E; Manietta, D; Collin, S P

    2013-05-03

    Archerfish forage by shooting jets of water at insects above the water's surface. The challenge of detecting small prey items against a complex background suggests that they have good visual acuity, but to date this has never been tested, despite archerfish becoming an increasingly important model species for vertebrate vision. We used a modified Landolt C test to measure visual acuity behaviourally, and compared the results to their predicted minimum separable angle based on both photoreceptor and ganglion cell spacing in the retina. Both measures yielded similar estimates of visual acuity; between 3.23 and 3.57 cycles per degree (0.155-0.140° of visual arc). Such a close match between behavioural and anatomical estimates of visual acuity in fishes is unusual and may be due to our use of an ecologically relevant task that measured the resolving power of the part of the retina that has the highest photoreceptor density and that is used in aligning their spitting angle with potential targets. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Visual acuity and visual skills in Malaysian children with learning disabilities

    Directory of Open Access Journals (Sweden)

    Muzaliha MN

    2012-09-01

    Full Text Available Mohd-Nor Muzaliha,1 Buang Nurhamiza,1 Adil Hussein,1 Abdul-Rani Norabibas,1 Jaafar Mohd-Hisham-Basrun,1 Abdullah Sarimah,2 Seo-Wei Leo,3 Ismail Shatriah11Department of Ophthalmology, 2Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia; 3Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Tan Tock Seng Hospital, SingaporeBackground: There is limited data in the literature concerning the visual status and skills in children with learning disabilities, particularly within the Asian population. This study is aimed to determine visual acuity and visual skills in children with learning disabilities in primary schools within the suburban Kota Bharu district in Malaysia.Methods: We examined 1010 children with learning disabilities aged between 8–12 years from 40 primary schools in the Kota Bharu district, Malaysia from January 2009 to March 2010. These children were identified based on their performance in a screening test known as the Early Intervention Class for Reading and Writing Screening Test conducted by the Ministry of Education, Malaysia. Complete ocular examinations and visual skills assessment included near point of convergence, amplitude of accommodation, accommodative facility, convergence break and recovery, divergence break and recovery, and developmental eye movement tests for all subjects.Results: A total of 4.8% of students had visual acuity worse than 6/12 (20/40, 14.0% had convergence insufficiency, 28.3% displayed poor accommodative amplitude, and 26.0% showed signs of accommodative infacility. A total of 12.1% of the students had poor convergence break, 45.7% displayed poor convergence recovery, 37.4% showed poor divergence break, and 66.3% were noted to have poor divergence recovery. The mean horizontal developmental eye movement was significantly prolonged.Conclusion: Although their visual acuity was satisfactory, nearly 30% of the

  17. Comparing performance on the MNREAD iPad application with the MNREAD acuity chart.

    Science.gov (United States)

    Calabrèse, Aurélie; To, Long; He, Yingchen; Berkholtz, Elizabeth; Rafian, Paymon; Legge, Gordon E

    2018-01-01

    Our purpose was to compare reading performance measured with the MNREAD Acuity Chart and an iPad application (app) version of the same test for both normally sighted and low-vision participants. Our methods included 165 participants with normal vision and 43 participants with low vision tested on the standard printed MNREAD and on the iPad app version of the test. Maximum Reading Speed, Critical Print Size, Reading Acuity, and Reading Accessibility Index were compared using linear mixed-effects models to identify any potential differences in test performance between the printed chart and the iPad app. Our results showed the following: For normal vision, chart and iPad yield similar estimates of Critical Print Size and Reading Acuity. The iPad provides significantly slower estimates of Maximum Reading Speed than the chart, with a greater difference for faster readers. The difference was on average 3% at 100 words per minute (wpm), 6% at 150 wpm, 9% at 200 wpm, and 12% at 250 wpm. For low vision, Maximum Reading Speed, Reading Accessibility Index, and Critical Print Size are equivalent on the iPad and chart. Only the Reading Acuity is significantly smaller (I. E., better) when measured on the digital version of the test, but by only 0.03 logMAR (p = 0.013). Our conclusions were that, overall, MNREAD parameters measured with the printed chart and the iPad app are very similar. The difference found in Maximum Reading Speed for the normally sighted participants can be explained by differences in the method for timing the reading trials.

  18. The correlation between variation of visual acuity and the anterior chamber depth in the early period after phacoemulsification

    Directory of Open Access Journals (Sweden)

    Kai-jian CHEN

    2011-04-01

    Full Text Available Objective To investigate the correlation between the visual acuity variation and the anterior chamber depth in the early period after phacoemulsification.Methods Thirty-six eyes of 32 patients with age-related cataract underwent 3.2mm clear corneal incision phacoemulsification and intraocular lens(IOL implantation.The visual acuity was examined and horizontal curvature(K1,vertical curvature(K2,corneal astigmatism,and anterior chamber depth were measured with IOL-master preoperatively and also on 1,3,7 and 15 postoperative days.The changes in parameters were compared,and the correlations among visual acuity,corneal astigmatism and anterior chamber depth were analyzed.Results Before operation and 1d,3d,7d and 15d after operation,the corneal astigmatism was-0.87±0.40D,-1.92±1.38D,-1.69±1.13D,-1.45±0.79D and-1.36±0.74D;the anterior chamber depth was 3.08±0.35mm,4.04±0.38mm,4.28±0.29mm,4.22±0.17mm and 4.22±0.16mm;the visual acuity was 0.18±0.10,0.44±0.14,0.59±0.12,0.61±0.11 and 0.62±0.14.Significant difference was found between pre-operative and postoperative visual acuity,corneal astigmatism and anterior chamber depth,and it was also found in corneal astigmatism between 1d and 15d post operation(P < 0.05,as well as in anterior chamber depth and visual acuity between 1d and 3d post operation(P < 0.05.A positive correlation was found between visual acuity and corneal astigmatism on 1d(r=0.42,P < 0.05,3d(r=0.35,P < 0.05 and 7d(r=0.35,P < 0.05 post operation;and a negative correlation was found between visual acuity and anterior chamber depth on 3d(r=-0.29,P < 0.05,7d(r=-0.43,P < 0.01 and 15d(r=-0.37,P < 0.05 post operation.Conclusion Both the corneal astigmatism and the anterior chamber depth are correlated with the visual acuity variation in the early period after phacoemulsification.

  19. Effect of pupil size on visual acuity in a laboratory model of pseudophakic monovision.

    Science.gov (United States)

    Kawamorita, Takushi; Uozato, Hiroshi; Handa, Tomoya; Ito, Misae; Shimizu, Kimiya

    2010-05-01

    To investigate the effect of pupil size on visual acuity in pseudophakic monovision. For the simulation, a modified Liou-Brennan model eye was used. The model eye was designed to include a centered optical system, corneal asphericity, an iris pupil, a Stiles-Crawford effect, an intraocular lens, and chromatic aberration. Calculation of the modulation transfer function (MTF) was performed with ZEMAX software. Visual acuity was estimated from the MTF and the retinal threshold curve. The sizes of the entrance pupil were 2.0, 2.5, 3.0, and 4.0 mm. Decreasing pupil diameter and increasing myopia progressively improved near visual acuity. For an entrance pupil size of 2.5 mm and a refractive error of -1.50 diopters, the logMAR value (Snellen; metric) in the non-dominant eye at 40 cm was 0.06 (20/23; 6/6.9). Knowledge of the patient's pupil diameter at near fixation can assist surgeons in determining the optimum degree of myopia for successful monovision.

  20. Calling 911! What role does the pediatrician play?

    Science.gov (United States)

    Grossman, Devin; Kunkov, Sergey; Kaplan, Carl; Crain, Ellen F

    2013-06-01

    The objective of this study was to compare admission rates and medical interventions among children whose caregivers called their child's primary care provider (PCP) before taking an ambulance to the pediatric emergency department (PED) versus those who did not. This was a prospective cohort study of patients brought to an urban, public hospital PED via emergency medical system (EMS). Children were included if the caregiver called 911 to have them transported via EMS and was present in the PED. The main variable was whether the child's PCP was called before EMS utilization. Study outcomes were medical interventions, such as intravenous line insertion or laboratory tests, and hospital admission. χ Test and logistic regression were used to evaluate the relationship of the main variable to the study outcomes. Six hundred fourteen patients met inclusion criteria and were enrolled. Five hundred eighty-five patients (95.3%) were reported to have a PCP. Seventy-four caregivers (12.1%) called their child's PCP before calling EMS. Two hundred seventy-seven patients (45.1%) had medical interventions performed; of these, 42 (15.2%) called their PCP (P = 0.03). Forty-two patients (6.8%) were admitted; among these, 14 (33.3%) called their PCP (P < 0.01). Adjusting for triage level, patients whose caregiver called the PCP before calling EMS were 3.2 times (95% confidence interval, 1.9-5.2 times) more likely to be admitted and 1.7 times (95% confidence interval, 1.1-2.9 times) more likely to have a medical intervention compared with patients whose caregivers did not call their child's PCP. Children were more likely to be admitted or require a medical intervention if their caregiver called their PCP before calling EMS. The availability of a PCP for telephone triage may help to optimize EMS utilization.

  1. Posterior staphyloma in oculocutaneous albinism: another possible cause of reduced visual acuity.

    Science.gov (United States)

    Lee, Susan; Schimmenti, Lisa A; King, Richard A; Brilliant, Murray; Anderson, Jennifer L; Schoonveld, Cheri; Summers, C Gail

    2015-12-01

    Posterior staphyloma is typically associated with myopic degeneration and has not been recognized as a cause of reduced visual acuity in albinism. We report 3 cases of posterior staphyloma, each with oculocutaneous albinism (OCA) defined by phenotype and genotype. Two cases are biological sisters with OCA type 2; one was myopic and the other was hyperopic. The third case involves a man with OCA associated with Hermansky-Pudlak syndrome (HPS-5). Staphyloma may be another cause of reduced visual acuity in albinism, particularly with increasing age. It may occur in association with myopia or hyperopia. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  2. Dynamic Visual Acuity and Landing Sickness in Crewmembers Returning from Long-Duration Spaceflight

    Science.gov (United States)

    Rosenberg, M.J.F; Peters, B.T.; Reschke, M. F.

    2016-01-01

    Long-term exposure to microgravity causes sensorimotor adaptations that result in functional deficits upon returning to a gravitational environment. At landing the vestibular system and the central nervous system, responsible for coordinating head and eye movements, are adapted to microgravity and must re-adapt to the gravitational environment. This re-adaptation causes decrements in gaze control and dynamic visual acuity, with astronauts reporting oscillopsia and blurred vision. Dynamic visual acuity (DVA) is assessed using an oscillating chair developed in the Neuroscience Laboratory at JSC. This chair is lightweight and easily portable for quick deployment in the field. The base of the chair is spring-loaded and allows for manual oscillation of the subject. Using a metronome, the chair is vertically oscillated plus or minus 2 cm at 2 Hz by an operator, to simulate walking. While the subject is being oscillated, they are asked to discern the direction of Landolt-C optotypes of varying sizes and record their direction using a gamepad. The visual acuity thresholds are determined using an algorithm that alters the size of the optotype based on the previous response of the subject using a forced-choice best parameter estimation that is able to rapidly converge on the threshold value. Visual acuity thresholds were determined both for static (seated) and dynamic (oscillating) conditions. Dynamic visual acuity is defined as the difference between the dynamic and static conditions. Dynamic visual acuity measures will be taken prior to flight (typically L-180, L-90, and L-60) and up to eight times after landing, including up to 3 times on R plus 0. Follow up measurements will be taken at R plus 1 (approximately 36 hours after landing). Long-duration International Space Station crewmembers will be tested once at the refueling stop in Europe and once again upon return to Johnson Space Center. In addition to DVA, subjective ratings of motion sickness will be recorded

  3. Impact of colour in the assessment of potential visual acuity in patients with age-related macular degeneration.

    Science.gov (United States)

    Dorrepaal, Stephen J; Markowitz, Samuel N

    2013-06-01

    To compare chromatic and achromatic potential visual acuity (PVA) in patients with bilateral low vision caused by age-related macular degeneration (AMD). Prospective, nonrandomized, observational case series. Fifty-five patients, representing a consecutive series of patients all presenting with bilateral AMD. Best-corrected visual acuity of each eye was measured using an Early Treatment in Diabetic Retinopathy Study (ETDRS) chart with appropriate near correction. Included were cases with visual acuity of 0.4 logMAR (20/50) or worse in both eyes. Achromatic and chromatic PVA were measured in each eye using white on black and red on yellow flooding E charts at 50 cm in controlled lighting conditions. One hundred and seven eyes from 55 patients were included in the analysis. Mean achromatic and chromatic PVA were 0.69 ± 0.26 and 0.65 ± 0.22 logMAR, respectively. Overall, patients had a significantly higher chromatic than achromatic PVA, with a median difference of 0.1 logMAR (p<0.05). Patients with ETDRS visual acuity worse than 0.9 logMAR also had a significantly higher chromatic than achromatic PVA, with a median difference of 0.1 logMAR (p<0.05). Patients with ETDRS visual acuity between 0.4 and 0.9 logMAR had a trend toward a higher chromatic than achromatic visual acuity that was not significant, with a median difference of 0.1 logMAR (p = 0.8539). Patients with low vision caused by AMD can discern smaller targets when a red on yellow colour scheme is used than when using achromatic white on black charts. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  4. A Demonstration Project on Driving with Reduced Visual Acuity and a Bioptic Telescope System in the Netherlands

    NARCIS (Netherlands)

    Melis-Dankers, Bart J.M.; Kooijman, Aart C.; Brouwer, Wiebo H.; Busscher, Rens B.; Bredewoud, Ruud A.; Derksen, Peter H.; Amersfoort, Anoeska; IJsseldijk, Martin A.M.; Delden, Geert W. van; Grotenhuis, Thea H.P.A.; Witvliet, M.D.

    2008-01-01

    Background: In Europe, driving a passenger car is prohibited if binocular best corrected visual acuity (BCVA) is below 0.5 (20/40). Some US states allow people with reduced visual acuity to use a bioptic telescope system when driving. The aim of our study is to introduce a bioptic telescope system

  5. Correlation between contrast sensitivity and visual acuity in retinitis pigmentosa patients.

    Science.gov (United States)

    Akeo, Kiyoshi; Hiida, Yoshiki; Saga, Masamichi; Inoue, Rikako; Oguchi, Yoshihisa

    2002-01-01

    High-contrast figures such as Landolt rings are insufficient to evaluate the function of the foveal cones of retinitis pigmentosa (RP) patients. We investigated the correlation between visual function as determined with Landolt rings and with the Vistech Contrast Sensitivity Function Test (VCTS) at various spatial frequencies, in addition to the Cambridge Low Contrast Grating (CLCG). The study included 30 retinitis pigmentosa patients (53 eyes). All patients were assessed with Landolt rings, the Vistech method, and the CLCG. We estimated the relative contribution of contrast sensitivity to visual acuity by VCTS at each spatial frequency and by CLCG by simple linear regression analysis. The results of the regression analysis of VCTS at 1.5, 3.0, and 6.0 cycles/degree showed a significant correlation between Landolt rings and VCTS and between CLCG and VCTS that was strongest at 6.0 cycles/degree. There was no significant correlation between Landolt rings and VCTS or between CLCG and VCTS at 12.0 and 18.0 cycles/degree. Patients with a visual acuity of 20/25 and CLCG greater than 100 were divided into two groups according to their contrast sensitivity at 18.0 cycles/degree on VCTS. The VCTS at the highest frequency was useful for evaluating the foveal visual function in RP patients having good visual acuity with the Landolt rings. Thus, contrast sensitivity should be useful in detecting minute impairment or improvement of visual function in RP. Copyright 2002 S. Karger AG, Basel

  6. Perceptual learning in children with visual impairment improves near visual acuity.

    Science.gov (United States)

    Huurneman, Bianca; Boonstra, F Nienke; Cox, Ralf F A; van Rens, Ger; Cillessen, Antonius H N

    2013-09-17

    This study investigated whether visual perceptual learning can improve near visual acuity and reduce foveal crowding effects in four- to nine-year-old children with visual impairment. Participants were 45 children with visual impairment and 29 children with normal vision. Children with visual impairment were divided into three groups: a magnifier group (n = 12), a crowded perceptual learning group (n = 18), and an uncrowded perceptual learning group (n = 15). Children with normal vision also were divided in three groups, but were measured only at baseline. Dependent variables were single near visual acuity (NVA), crowded NVA, LH line 50% crowding NVA, number of trials, accuracy, performance time, amount of small errors, and amount of large errors. Children with visual impairment trained during six weeks, two times per week, for 30 minutes (12 training sessions). After training, children showed significant improvement of NVA in addition to specific improvements on the training task. The crowded perceptual learning group showed the largest acuity improvements (1.7 logMAR lines on the crowded chart, P children in the crowded perceptual learning group showed improvements on all NVA charts. Children with visual impairment benefit from perceptual training. While task-specific improvements were observed in all training groups, transfer to crowded NVA was largest in the crowded perceptual learning group. To our knowledge, this is the first study to provide evidence for the improvement of NVA by perceptual learning in children with visual impairment. (http://www.trialregister.nl number, NTR2537.).

  7. Advertising emergency department wait times.

    Science.gov (United States)

    Weiner, Scott G

    2013-03-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised.

  8. Advertising Emergency Department Wait Times

    Science.gov (United States)

    Weiner, Scott G.

    2013-01-01

    Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care. Three sample cases demonstrating the pitfalls of advertising ED wait times are discussed. Given the lack of rigorous evidence supporting the practice and potential adverse effects to the public health, caution about its use is advised. PMID:23599836

  9. Vision-guided ocular growth in a mutant chicken model with diminished visual acuity.

    Science.gov (United States)

    Ritchey, Eric R; Zelinka, Christopher; Tang, Junhua; Liu, Jun; Code, Kimberly A; Petersen-Jones, Simon; Fischer, Andy J

    2012-09-01

    Visual experience is known to guide ocular growth. We tested the hypothesis that vision-guided ocular growth is disrupted in a model system with diminished visual acuity. We examine whether ocular elongation is influenced by form-deprivation (FD) and lens-imposed defocus in the Retinopathy, Globe Enlarged (RGE) chicken. Young RGE chicks have poor visual acuity, without significant retinal pathology, resulting from a mutation in guanine nucleotide-binding protein β3 (GNB3), also known as transducin β3 or Gβ3. The mutation in GNB3 destabilizes the protein and causes a loss of Gβ3 from photoreceptors and ON-bipolar cells (Ritchey et al., 2010). FD increased ocular elongation in RGE eyes in a manner similar to that seen in wild-type (WT) eyes. By comparison, the excessive ocular elongation that results from hyperopic defocus was increased, whereas myopic defocus failed to significantly decrease ocular elongation in RGE eyes. Brief daily periods of unrestricted vision interrupting FD prevented ocular elongation in RGE chicks in a manner similar to that seen in WT chicks. Glucagonergic amacrine cells differentially expressed the immediate early gene Egr1 in response to growth-guiding stimuli in RGE retinas, but the defocus-dependent up-regulation of Egr1 was lesser in RGE retinas compared to that of WT retinas. We conclude that high visual acuity, and the retinal signaling mediated by Gβ3, is not required for emmetropization and the excessive ocular elongation caused by FD and hyperopic defocus. However, the loss of acuity and Gβ3 from RGE retinas causes enhanced responses to hyperopic defocus and diminished responses to myopic defocus. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Visual acuity measures do not reliably detect childhood refractive error--an epidemiological study.

    Directory of Open Access Journals (Sweden)

    Lisa O'Donoghue

    Full Text Available PURPOSE: To investigate the utility of uncorrected visual acuity measures in screening for refractive error in white school children aged 6-7-years and 12-13-years. METHODS: The Northern Ireland Childhood Errors of Refraction (NICER study used a stratified random cluster design to recruit children from schools in Northern Ireland. Detailed eye examinations included assessment of logMAR visual acuity and cycloplegic autorefraction. Spherical equivalent refractive data from the right eye were used to classify significant refractive error as myopia of at least 1DS, hyperopia as greater than +3.50DS and astigmatism as greater than 1.50DC, whether it occurred in isolation or in association with myopia or hyperopia. RESULTS: Results are presented from 661 white 12-13-year-old and 392 white 6-7-year-old school-children. Using a cut-off of uncorrected visual acuity poorer than 0.20 logMAR to detect significant refractive error gave a sensitivity of 50% and specificity of 92% in 6-7-year-olds and 73% and 93% respectively in 12-13-year-olds. In 12-13-year-old children a cut-off of poorer than 0.20 logMAR had a sensitivity of 92% and a specificity of 91% in detecting myopia and a sensitivity of 41% and a specificity of 84% in detecting hyperopia. CONCLUSIONS: Vision screening using logMAR acuity can reliably detect myopia, but not hyperopia or astigmatism in school-age children. Providers of vision screening programs should be cognisant that where detection of uncorrected hyperopic and/or astigmatic refractive error is an aspiration, current UK protocols will not effectively deliver.

  11. Microactuator production via high aspect ratio, high edge acuity metal fabrication technology

    Science.gov (United States)

    Guckel, H.; Christenson, T. R.

    1993-01-01

    LIGA is a procession sequence which uses x-ray lithography on photoresist layers of several hundred micrometers to produce very high edge acuity photopolymer molds. These plastic molds can be converted to metal molds via electroplating of many different metals and alloys. The end results are high edge acuity metal parts with large structural heights. The LIGA process as originally described by W. Ehrfeld can be extended by adding a surface micromachining phase to produce precision metal parts which can be assembled to form three-dimensional micromechanisms. This process, SLIGA, has been used to fabricate a dynamometer on a chip. The instrument has been fully implemented and will be applied to tribology issues, speed-torque characterization of planar magnetic micromotors and a new family of sensors.

  12. Progressive improvement of impaired visual acuity during the first year after transsphenoidal surgery for non-functioning pituitary macroadenoma

    NARCIS (Netherlands)

    Dekkers, O. M.; de Keizer, R. J. W.; Roelfsema, F.; Vd Klaauw, A. A.; Honkoop, P. J.; van Dulken, H.; Smit, J. W. A.; Romijn, J. A.; Pereira, A. M.

    2007-01-01

    Improvement of visual field defects continues even years after the initial surgical treatment. Because this process of continuing improvement has not been documented for visual acuity, we audited our data to explore the pattern of recovery of visual acuity until 1 year after transsphenoidal surgery

  13. Normative monocular visual acuity for early treatment diabetic retinopathy study charts in emmetropic children 5 to 12 years of age.

    Science.gov (United States)

    Dobson, Velma; Clifford-Donaldson, Candice E; Green, Tina K; Miller, Joseph M; Harvey, Erin M

    2009-07-01

    To provide normative data for children tested with Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Cross-sectional study. A total of 252 Native American (Tohono O'odham) children aged 5 to 12 years. On the basis of cycloplegic refraction conducted on the day of testing, all were emmetropic (myopia < or =0.25 diopter [D] spherical equivalent, hyperopia < or =1.00 D spherical equivalent, and astigmatism < or =0.50 D in both eyes). Monocular visual acuity was tested at 4 m, using 1 ETDRS chart for the right eye (RE) and another for the left eye (LE). Visual acuity was scored as the total number of letters correctly identified, by naming or matching to letters on a lap card, and as the smallest letter size for which the child identified 3 of 5 letters correctly. Visual acuity results did not differ for the RE versus the LE, so data are reported for the RE only. Mean visual acuity for 5-year-olds (0.16 logarithm of the minimum angle of resolution [logMAR] [20/29]) was significantly worse than for 8-, 9-, 10-, 11-, and 12-year-olds (0.05 logMAR [20/22] or better at each age). The lower 95% prediction limit for determining whether a child has visual acuity within the normal range was 0.38 (20/48) for 5-year-olds and 0.30 (20/40) for 6- to 12-year-olds, which was reduced to 0.32 (20/42) for 5-year-olds and 0.21 (20/32) for 6- to 12-year-olds when recalculated with outlying data points removed. Mean interocular acuity difference did not vary by age, averaging less than 1 logMAR line at each age, with a lower 95% prediction limit of 0.17 log unit (1.7 logMAR lines) across all ages. For monocular visual acuity based on ETDRS charts to be in the normal range, it must be better than 20/50 for 5-year-olds and better than 20/40 for 6- to 12-year-olds. Normal interocular acuity difference includes values of less than 2 logMAR lines. Normative ETDRS visual acuity values are not as good as norms reported for adults, suggesting that a child's visual acuity results should

  14. Preschool acuity of the approximate number system correlates with school math ability.

    Science.gov (United States)

    Libertus, Melissa E; Feigenson, Lisa; Halberda, Justin

    2011-11-01

    Previous research shows a correlation between individual differences in people's school math abilities and the accuracy with which they rapidly and nonverbally approximate how many items are in a scene. This finding is surprising because the Approximate Number System (ANS) underlying numerical estimation is shared with infants and with non-human animals who never acquire formal mathematics. However, it remains unclear whether the link between individual differences in math ability and the ANS depends on formal mathematics instruction. Earlier studies demonstrating this link tested participants only after they had received many years of mathematics education, or assessed participants' ANS acuity using tasks that required additional symbolic or arithmetic processing similar to that required in standardized math tests. To ask whether the ANS and math ability are linked early in life, we measured the ANS acuity of 200 3- to 5-year-old children using a task that did not also require symbol use or arithmetic calculation. We also measured children's math ability and vocabulary size prior to the onset of formal math instruction. We found that children's ANS acuity correlated with their math ability, even when age and verbal skills were controlled for. These findings provide evidence for a relationship between the primitive sense of number and math ability starting early in life. 2011 Blackwell Publishing Ltd.

  15. Perceptual Learning in Children With Visual Impairment Improves Near Visual Acuity

    NARCIS (Netherlands)

    Huurneman, Bianca; Boonstra, F. Nienke; Cox, Ralf F. A.; van Rens, Ger; Cillessen, Antonius H. N.

    PURPOSE. This study investigated whether visual perceptual learning can improve near visual acuity and reduce foveal crowding effects in four-to nine-year-old children with visual impairment. METHODS. Participants were 45 children with visual impairment and 29 children with normal vision. Children

  16. Perceptual Learning in Children With Visual Impairment Improves Near Visual Acuity

    NARCIS (Netherlands)

    Huurneman, B.; Boonstra, F.N.; Cox, R.F.A.; van Rens, G.H.M.B.; Cillessen, A.H.N.

    2013-01-01

    Purpose. This study investigated whether visual perceptual learning can improve near visual acuity and reduce foveal crowding effects in four- to nine-year-old children with visual impairment. Methods. Participants were 45 children with visual impairment and 29 children with normal vision. Children

  17. Perceptual learning in children with visual impairment improves near visual acuity

    NARCIS (Netherlands)

    Huurneman, B.; Boonstra, F.N.; Cox, R.F.; Rens, G. van; Cillessen, A.H.

    2013-01-01

    PURPOSE: This study investigated whether visual perceptual learning can improve near visual acuity and reduce foveal crowding effects in four- to nine-year-old children with visual impairment. METHODS: Participants were 45 children with visual impairment and 29 children with normal vision. Children

  18. Perceptual Learning in Children With Visual Impairment Improves Near Visual Acuity

    NARCIS (Netherlands)

    Huurneman, B.; Boonstra, F.N.; Cox, R.F.A.; Rens, G.H.M.B. van; Cillessen, A.H.N.

    2013-01-01

    PURPOSE. This study investigated whether visual perceptual learning can improve near visual acuity and reduce foveal crowding effects in four-to nine-year-old children with visual impairment. METHODS. Participants were 45 children with visual impairment and 29 children with normal vision. Children

  19. EXAMINATION OF THE VISUAL ACUITY ON THE LCD OPTOTYPE WITH WHOLE-LINE AND INTERPOLATION METHOD

    OpenAIRE

    Zajíček Tomáš; Veselý Petr; Veselý Petr; Synek Svatopluk; Synek Svatopluk

    2012-01-01

    The goal of this work is to show the possibility of us using the LCD optotype in common optometrist practice. Furthermore two commonly used methods for measuring visual acuity will be compared. 69 respondents were used for the measurements. The respondents were divided into two groups according to the measured LCD optotype. The visual acuity was measured using the whole-line method on modified Snellen charts as well as the interpolation method on ETDRS charts. Measurements were taken on the S...

  20. The effect of medical trainees on pediatric emergency department flow: a discrete event simulation modeling study.

    Science.gov (United States)

    Genuis, Emerson D; Doan, Quynh

    2013-11-01

    Providing patient care and medical education are both important missions of teaching hospital emergency departments (EDs). With medical school enrollment rising, and ED crowding becoming an increasing prevalent issue, it is important for both pediatric EDs (PEDs) and general EDs to find a balance between these two potentially competing goals. The objective was to determine how the number of trainees in a PED affects patient wait time, total ED length of stay (LOS), and rates of patients leaving without being seen (LWBS) for PED patients overall and stratified by acuity level as defined by the Pediatric Canadian Triage and Acuity Scale (CTAS) using discrete event simulation (DES) modeling. A DES model of an urban tertiary care PED, which receives approximately 40,000 visits annually, was created and validated. Thirteen different trainee schedules, which ranged from averaging zero to six trainees per shift, were input into the DES model and the outcome measures were determined using the combined output of five model iterations. An increase in LOS of approximately 7 minutes was noted to be associated with each additional trainee per attending emergency physician working in the PED. The relationship between the number of trainees and wait time varied with patients' level of acuity and with the degree of PED utilization. Patient wait time decreased as the number of trainees increased for low-acuity visits and when the PED was not operating at full capacity. With rising numbers of trainees, the PED LWBS rate decreased in the whole department and in the CTAS 4 and 5 patient groups, but it rose in patients triaged CTAS 3 or higher. A rising numbers of trainees was not associated with any change to flow outcomes for CTAS 1 patients. The results of this study demonstrate that trainees in PEDs have an impact mainly on patient LOS and that the effect on wait time differs between patients presenting with varying degrees of acuity. These findings will assist PEDs in finding a

  1. RISK FOR LOW VISUAL ACUITY AFTER 1 AND 2 YEARS OF TREATMENT WITH RANIBIZUMAB OR BEVACIZUMAB FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

    Science.gov (United States)

    Westborg, Inger; Albrecht, Susanne; Rosso, Aldana

    2017-11-01

    To investigate how patients with neovascular age-related macular degeneration treated with ranibizumab or bevacizumab respond to treatment in daily clinical practice. Data from the Swedish Macula Register on the treatment received by 3,912 patients during 2011 to 2014 is reported. Patients' characteristics at the first visit, visual acuity, number of injections, and reason for terminating the treatment if applicable are discussed. Furthermore, the risk of having poor vision (visual acuity under 60 Early Treatment Diabetes Retinopathy Study letters or approximately 20/60 Snellen) is calculated for the treated eye after 1 year and 2 years. The treatment outcome depends on the visual acuity at the first visit. For patients with visual acuity more than 60 letters, the risk of having a visual acuity lower than 60 letters after 1 year or 2 years of treatment is approximately 20%. However, for patients with low visual acuity at diagnosis (fewer than 60 letters), the risk is approximately 60%. The risk of having a visual acuity lower than 60 letters does not depend on the choice of treatment drug. Treatment with anti-vascular endothelial growth factor intravitreal injections mainly maintains the visual acuity level, and only approximately 20% and 40% of the patients required vision rehabilitation after 1 year and 2 years, respectively.

  2. Effects of international football matches on ambulance call profiles and volumes during the 2006 World Cup.

    Science.gov (United States)

    Deakin, Charles D; Thompson, Fizz; Gibson, Caroline; Green, Mark

    2007-06-01

    Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. All emergency calls to the Hampshire Ambulance Service NHS Trust (currently the Hampshire Division of South Central Ambulance Service, Winchester, UK) during the first weekend of the 2006 World Cup football matches were analysed by call volume and classification of call (call type). On the day of the first football match, call volume was over 50% higher than that on a typical Saturday, with distinct peaks before and after the inaugural match. Call profile analysis showed increases in alcohol-related emergencies, including collapse, unconsciousness, assault and road traffic accidents. The increase in assaults was particularly marked at the end of each match and increased again into the late evening. A detailed mapping of call volumes and profiles during the World Cup football shows a significant increase in overall emergency calls, mostly alcohol related. Mapping of limited resources to these patterns will allow improved responses to emergency calls.

  3. A randomised comparison between an inexpensive, general-purpose headlight and a purpose-built surgical headlight on users' visual acuity and colour vision.

    Science.gov (United States)

    Street, I; Sayles, M; Nistor, M; McRae, A R

    2014-02-01

    To determine if there are any differences in near visual acuity and colour vision between an inexpensive general-purpose light emitting diode (LED) headlight and a purpose-built surgical LED headlight. A prospective study was conducted sequentially comparing near visual acuity and colour vision, the headlights being tested in random order, in a testing room with a constant minimal amount of background light. The participants were NHS employee volunteers, with self-declared normal (or corrected) vision, working in occupations requiring full literacy. For visual acuity, outcome was measured by recording the smallest font legible when using each headlight when the subject read a near visual acuity test card. For colour vision, the outcome was passing or failing the Ishihara test. There was no statistically significant difference between the general-purpose and the purpose-built headlights in users' near visual acuity or colour vision.

  4. Temporal acuity and speech recognition score in noise in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Mehri Maleki

    2014-04-01

    Full Text Available Background and Aim: Multiple sclerosis (MS is one of the central nervous system diseases can be associated with a variety of symptoms such as hearing disorders. The main consequence of hearing loss is poor speech perception, and temporal acuity has important role in speech perception. We evaluated the speech perception in silent and in the presence of noise and temporal acuity in patients with multiple sclerosis.Methods: Eighteen adults with multiple sclerosis with the mean age of 37.28 years and 18 age- and sex- matched controls with the mean age of 38.00 years participated in this study. Temporal acuity and speech perception were evaluated by random gap detection test (GDT and word recognition score (WRS in three different signal to noise ratios.Results: Statistical analysis of test results revealed significant differences between the two groups (p<0.05. Analysis of gap detection test (in 4 sensation levels and word recognition score in both groups showed significant differences (p<0.001.Conclusion: According to this survey, the ability of patients with multiple sclerosis to process temporal features of stimulus was impaired. It seems that, this impairment is important factor to decrease word recognition score and speech perception.

  5. Electoronic Performance Monitoring in Call Centers: An Ethical Decision Model

    OpenAIRE

    Perkins, David

    2013-01-01

    Ever since it emerged on a widespread basis in the 1990s, electronic performance monitoring of employees has received significant scrutiny in the literature. Call centers have been the focus of many of these studies. This particular study addresses the issue of electronic performance monitoring in call centers from an ethical perspective. The following ethical dilemma is offered: "Is it ethical for a call center manager to evaluate the performance of a call center employee using electronic pe...

  6. Advanced nursing interventions and length of stay in the emergency department.

    Science.gov (United States)

    Stauber, Mary A

    2013-05-01

    Over the past 15 years, emergency departments have become overcrowded, with prolonged wait times and an extended length of stay (LOS). These factors cause delay in treatment, which reduces quality of care and increases the potential for adverse events. One suggestion to decrease LOS in the emergency department is to implement advanced nursing interventions (ANIs) at triage. The study purpose was to determine whether there was a difference in ED LOS between patients presenting with a chief complaint of abdominal pain who received ANIs at triage and patients who did not receive ANIs at triage. A retrospective chart review was performed to determine the ED LOS (mean time in department and mean time in room [TIR]). The convenience sample included ED patients who presented to a large Midwestern academic medical center's emergency department with a chief complaint of abdominal pain and Emergency Severity Index level 3. Independent-samples t tests were used to determine whether there was any statistical difference in LOS between the two groups. Cohen's d statistic was used to determine effect size. Implementation of ANIs at triage for patients with low-acuity abdominal pain resulted in an increased time in department and a decreased TIR with a medium effect size. A reduction in TIR optimizes bed availability in the emergency department. Low-acuity patients spend less time occupying an ED bed, which preserves limited bed space for the sickest patients. Results of diagnostic tests are often available by the time the patient is placed in a room, facilitating early medical decision making and decreasing treatment time. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  7. The evolutionary emergence of what we call "emotions".

    Science.gov (United States)

    Frijda, Nico H

    2016-01-01

    The term "emotion" is not precise. It refers to an assemblage of processes that contribute to how we relate to the social and physical world. We need to understand the functional bases of such processes, and one such basis is action readiness. Action readiness is the preparation for movement or action. Preparation for movement occurs in all animals. In more recently evolved species, such as birds and mammals, preparation for directed action is found as well. Action readiness is the basis for the states we now call emotions, but its importance goes far beyond emotions: action readiness is an elementary aspect of the way autonomous living beings regulate their interactions with the world.

  8. REMINDER: In a medical emergency call 74444

    CERN Multimedia

    2005-01-01

    What happened? A CERN colleague, complaining of pains that might indicate serious heart problem, went to the ?infirmary' on the Prévessin site for medical aid. He was unaware that the ?infirmary' was in fact no such thing, but the office of the French contractors' medical practitioner, and, on top of that, it was closed. He therefore took his own car and went to the CERN Fire Station on the Meyrin Site (Building 65). The firemen and the CERN medical team took care of him and requested helicopter transport to the Geneva cantonal hospital, where he responded well to medical treatment. What do we learn from this event? You must call the CERN internal number 74444 in the event of serious and acute illness, and do not have to present yourself in person or get somebody to go with you. This number is not reserved exclusively for accident, pollution, fire etc. The Firemen can prodice professional assistance at all times as required: first aid on the spot, amulance transport and medical assistance as necessary. ...

  9. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments.

    Science.gov (United States)

    Langabeer, James R; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

    2016-11-01

    Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire emergency care system's capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN) program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  10. A new Snellen's visual acuity chart with 'Indian' numerals.

    OpenAIRE

    Al-Salem, M

    1987-01-01

    'Indian' numerals, which are popular among the Arab population, were used to devise a new Snellen's visual acuity chart. The new chart has the advantages of a reading chart. It keeps the patient's interest, does not miss alexic patients, and is quicker to perform. It is also devoid of the many disadvantages of a kinetic response chart (the capital E letter or Landolt's broken rings), especially that of the limited option of test objects.

  11. Changes in smell acuity induced by radiation exposure of the olfactory mucosa

    International Nuclear Information System (INIS)

    Ophir, D.; Guterman, A.; Gross-Isseroff, R.

    1988-01-01

    The effects of ionizing radiation on smell acuity were assessed in 12 patients in whom the olfactory mucosa was exposed to radiation in the course of treatment for nasopharyngeal carcinoma or pituitary adenoma. Olfactory detection thresholds for two odorants (amyl acetate and eugenol) were determined before the start of radiation therapy, within a week of termination of therapy, and 1, 3, and 6 months later. The results show clearly that smell acuity is profoundly affected by therapeutic irradiation. Thresholds had increased in all 12 patients by the end of treatment and were still high one month later. Varying degrees of recovery were noted in most patients three to six months after cessation of treatment. The fate of the sense of smell deserves more attention when considering the disability caused by irradiation to certain head and neck tumors

  12. Efficacy of perceptual vision therapy in enhancing visual acuity and contrast sensitivity function in adult hypermetropic anisometropic amblyopia

    Directory of Open Access Journals (Sweden)

    Yalcin E

    2013-12-01

    Full Text Available Elvan Yalcin, Ozlem BalciWorld Eye Hospital, Department of Pediatric Ophthalmology, Istanbul, TurkeyBackground: The purpose of this study was to evaluate the efficacy of neural vision therapy, also termed perceptual vision therapy, in enhancing best corrected visual acuity (BCVA and contrast sensitivity function in amblyopic patients.Methods: This prospective study enrolled 99 subjects previously diagnosed with unilateral hypermetropic amblyopia aged 9–50 years. The subjects were divided into two groups, with 53 subjects (53 eyes in the perceptual vision therapy group and 46 subjects (46 eyes in the control group. Because the nature of the treatment demands hard work and strict compliance, we enrolled the minimal number of subjects required to achieve statistically significant results. Informed consent was obtained from all subjects. Study phases included a baseline screening, a series of 45 training sessions with perceptual vision therapy, and an end-of-treatment examination. BCVA and contrast sensitivity function at 1.5, 3, 6, 12, and 18 cycles per degree spatial frequencies were obtained for statistical analysis in both groups. All subjects had follow-up examinations within 4–8 months. With the exception of one subject from the study group and two subjects from the control group, all subjects had occlusion during childhood. The study was not masked.Results: The results for the study group demonstrated a mean improvement of 2.6 logarithm of the minimum angle of resolution (logMAR lines in visual acuity (from 0.42 to 0.16 logMAR. Contrast sensitivity function improved at 1.5, 3, 6, 12, and 18 cycles per degree spatial frequencies. The control group did not show any significant change in visual acuity or contrast sensitivity function. None of the treated eyes showed a drop in visual acuity. Manifest refractions remained unchanged during the study.Conclusion: The results of our study demonstrate the efficacy of perceptual vision therapy in

  13. Astronauts Cooper and Conrad prepare cameras during visual acuity tests

    Science.gov (United States)

    1965-01-01

    Astronauts L. Gordon Cooper Jr. (left), command pilot, and Charles Conrad Jr., pilot, the prime crew of the Gemini 5 space flight, prepare their cameras while aboard a C-130 aircraft flying near Laredo. The two astronauts are taking part in a series of visual acuity experiments to aid them in learning to identify known terrestrial features under controlled conditions.

  14. How well do you see what you hear? The acuity of visual-to-auditory sensory substitution

    Directory of Open Access Journals (Sweden)

    Alastair eHaigh

    2013-06-01

    Full Text Available Sensory substitution devices (SSDs aim to compensate for the loss of a sensory modality, typically vision, by converting information from the lost modality into stimuli in a remaining modality. The vOICe is a visual-to-auditory SSD which encodes images taken by a camera worn by the user into soundscapes such that an experienced user can extract information about their surroundings. Here we investigated how much detail was resolvable during the early induction stages by testing the acuity of blindfolded sighted, naïve vOICe users. Initial performance was well above chance. Participants who took the test twice as a form of minimal training showed a marked improvement on the second test. Acuity was slightly but not significantly impaired when participants wore a camera and judged letter orientations live. A positive correlation was found between participants’ musical training and their acuity. The relationship between auditory expertise via musical training and the lack of a relationship with visual imagery, suggests that early use of a sensory substitution device draws primarily on the mechanisms of the sensory modality being used rather than the one being substituted. If vision is lost, audition represents the sensory channel of highest bandwidth of those remaining. The level of acuity found here, and the fact it was achieved with very little experience in sensory substitution by naïve users is promising.

  15. Job satisfaction among emergency department staff.

    Science.gov (United States)

    Suárez, M; Asenjo, M; Sánchez, M

    2017-02-01

    To compare job satisfaction among nurses, physicians and administrative staff in an emergency department (ED). To analyse the relationship of job satisfaction with demographic and professional characteristics of these personnel. We performed a descriptive, cross-sectional study in an ED in Barcelona (Spain). Job satisfaction was evaluated by means of the Font-Roja questionnaire. Multivariate analysis determined relationship between the overall job satisfaction and the variables collected. Fifty-two nurses, 22 physicians and 30 administrative staff were included. Administrative staff were significantly more satisfied than physicians and nurses: 3.42±0.32 vs. 2.87±0.42 and 3.06±0.36, respectively. Multivariate analysis showed the following variables to be associated with job satisfaction: rotation among the different ED acuity levels (OR: 2.34; 95%CI: 0.93-5.89) and being an administrative staff (OR: 0.27; 95%CI: 0.09-0.80). Nurses and physicians reported greater stress and work pressure than administrative staff and described a worse physical working environment. Interpersonal relationships obtained the highest score among the three groups of professionals. Job satisfaction of nurses and physicians in an ED is lower than that of administrative staff with the former perceiving greater stress and work pressure. Conversely, interpersonal relationships are identified as strength. Being nurse or physician and not rotating among the different ED acuity levels increase dissatisfaction. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  16. Consensus methodology to determine minor ailments appropriate to be directed for management within community pharmacy.

    Science.gov (United States)

    Nazar, Hamde; Nazar, Zachariah; Yeung, Andre; Maguire, Mike; Connelly, Alex; Slight, Sarah P

    2018-01-04

    National Health Service (NHS) 111, a medical helpline for urgent care used within the England and Scotland, receives significant numbers of patient calls yearly for a range of clinical conditions. Some are considered high acuity and mainly directed to urgent and emergency care. Low acuity conditions are also directed to these costly, overburdened services. Community pharmacy is a recognised setting for effective low acuity condition management and could offer an alternative. To design and evaluate a new NHS111 pathway re-directing patients with low acuity conditions to community pharmacy. Two consensus development stakeholder workshops were undertaken. A "low acuity" condition was defined as one that can be clinically assessed by a community pharmacist and requires a treatment and/or advice available within a community pharmacy. Retrospective NHS111 patient data (February-August 2016) from the North East of England and access to the NHS Pathways clinical decision support software were available to stakeholders. The NHS111 data demonstrated the volume of patient calls for these conditions that could have been redirected to community pharmacy. Stakeholders reached consensus that 64 low acuity conditions could be safely redirected to community pharmacy via NHS111. This represented approximately 35,000 patients (11.5% of total) being shifted away from the higher cost settings in the North East region alone during February-August 2016. The stakeholder group discussions provided rationale behind their classifications of conditions to ensure patient safety, the care experience and added value. The resulting definitive list of low acuity conditions that could be directed to community pharmacy via NHS111 could result in a shift of workload from urgent and emergency care settings. Future work needs to evaluate the cost, clinical outcomes, patient satisfaction of a community pharmacy referral service that has the potential to improve integration of community pharmacy in the

  17. Improvement of emergency department patient flow using lean thinking.

    Science.gov (United States)

    Sánchez, Miquel; Suárez, Montse; Asenjo, María; Bragulat, Ernest

    2018-05-01

    To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. A prospective interventional study. An ED of a tertiary care hospital. Triage acuity level-3 patients. To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Despite an increment in the daily number of visits (+8.3%, P lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.

  18. The Collaborative Production of Responses and Dispatching on the Radio: Video Analysis in a Medical Emergency Call Center

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    Giolo Fele

    2008-10-01

    Full Text Available What happens when someone rings an emergency hotline for help? How is the emergency handled? How does the emergency service swing into action? Prompt and competent intervention and assessment of the gravity of the situation in a few crucial seconds: these are the quality standards that regulate the organization of emergency operations centers. For a number of years various groups of social science researchers have carried forward a program for the systematic study of work using ethnographic and naturalistic methods of analysis. An interest in work is certainly nothing new in the social sciences, and in sociology in particular. What is new, though, is the particular analytical viewpoint from which such research is now conducted. This program has dispensed with large-scale theorization and has concentrated on the empirical study of activities and practices, achieving an unprecedented level of detail and analytical fineness. Indeed, only by proceeding at this fine level of detail—made possible by the use of videorecordings—has it been possible to document the extraordinary and subtle collaborative production of work, and to do so at a level which extends well beyond the conscious awareness of people in their everyday routine. This aspect concerns in particular the capacity of the latest generation of studies of work to document the tacit procedures and forms of common-sense reasoning involved in the performance of tasks in concrete work settings. This paper focuses on the ways in which the dispatch is done in a medical emergency operation center. Although we know a great deal about the interaction between caller and call-taker from previous research, we know much less about the social organization that makes the dispatch possible. The data analyzed in this paper derive from a research project in which I have been engaged for a number of years on operation centers for the 118 emergency telephone number in Italy. Contrasting the data obtained

  19. Visual acuity at 10 years in Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) study eyes: effect of retinal residua of retinopathy of prematurity.

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    Dobson, Velma; Quinn, Graham E; Summers, C Gail; Hardy, Robert J; Tung, Betty

    2006-02-01

    To describe recognition (letter) acuity at age 10 years in eyes with and without retinal residua of retinopathy of prematurity (ROP). Presence and severity of ROP residua were documented by a study ophthalmologist. Masked testers measured monocular recognition visual acuity (Early Treatment of Diabetic Retinopathy Study) when the children were 10 years old. Two hundred forty-seven of 255 surviving Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) randomized trial patients participated. A reference group of 102 of 104 Philadelphia-based CRYO-ROP study participants who did not develop ROP was also tested. More severe retinal residua were associated with worse visual acuity, regardless of whether retinal ablation was performed to treat the severe acute-phase ROP. However, within each ROP residua category, there was a wide range of visual acuity results. This is the first report of the relation between visual acuity (Early Treatment of Diabetic Retinopathy Study charts) and structural abnormalities related to ROP in a large group of eyes that developed threshold ROP in the perinatal period. Visual deficits are greater in eyes with more severe retinal residua than in eyes with mild or no residua. However, severity of ROP residua does not predict the visual acuity of an individual eye because within a single residua category, acuity may range from near normal to blind.

  20. Sensorimotor posture control in the blind: superior ankle proprioceptive acuity does not compensate for vision loss.

    Science.gov (United States)

    Ozdemir, Recep A; Pourmoghaddam, Amir; Paloski, William H

    2013-09-01

    To better understand sensorimotor posture control differences between blind and sighted individuals, we examined the role of ankle joint proprioception and ankle muscle strength on postural control in healthy blind (n=13, 25-58 years) and age- and sex-matched sighted (n=15, 20-65 years) volunteers. We measured ankle joint proprioceptive acuity and isokinetic muscle strength in plantarflexion and dorsiflexion using an isokinetic dynamometer. We also assessed postural control performance during quiet bipedal stance with and without sudden postural perturbations, and during quiet unipedal stance. We found that while our blind subjects exhibited significantly better proprioceptive acuity than our sighted subjects their postural control performance was significantly poorer than that of the sighted group with eyes open, and no different from that of the sighted group with eyes closed suggesting that their superior proprioceptive acuity does not translate to improved balance control. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. Influences of multiple memory systems on auditory mental image acuity.

    Science.gov (United States)

    Navarro Cebrian, Ana; Janata, Petr

    2010-05-01

    The influence of different memory systems and associated attentional processes on the acuity of auditory images, formed for the purpose of making intonation judgments, was examined across three experiments using three different task types (cued-attention, imagery, and two-tone discrimination). In experiment 1 the influence of implicit long-term memory for musical scale structure was manipulated by varying the scale degree (leading tone versus tonic) of the probe note about which a judgment had to be made. In experiments 2 and 3 the ability of short-term absolute pitch knowledge to develop was manipulated by presenting blocks of trials in the same key or in seven different keys. The acuity of auditory images depended on all of these manipulations. Within individual listeners, thresholds in the two-tone discrimination and cued-attention conditions were closely related. In many listeners, cued-attention thresholds were similar to thresholds in the imagery condition, and depended on the amount of training individual listeners had in playing a musical instrument. The results indicate that mental images formed at a sensory/cognitive interface for the purpose of making perceptual decisions are highly malleable.

  2. Managing pediatric dental trauma in a hospital emergency department.

    Science.gov (United States)

    Mitchell, Jonathan; Sheller, Barbara; Velan, Elizabeth; Caglar, Derya; Scott, Joanna

    2014-01-01

    The purpose of this study was to: (1) examine types of dental trauma presenting to a hospital emergency department (ED); (2) describe the medical services provided to these patients; and (3) quantify time spent during ED encounters for dental trauma emergencies. Records of 265 patients who presented to the ED with dental trauma over a three-year period were reviewed. Demographics, injury types, triage acuity, pain scores, and dental/medical treatment and times were analyzed. Patient demographics and injury types were similar to previous studies. Eighty-two percent of patients received mid-level triage scores; 41 percent of patients had moderate to severe pain. The most frequently provided medical services were administration of analgesics and/or prescriptions (78 percent). The mean times were: 51 minutes waiting for a physician; 55 minutes with dentists; and 176 minutes total time. Higher triage acuity and pain levels resulted in significantly longer wait times for physician assessment. Dental evaluation, including treatment, averaged 32 percent of time spent at the hospital. A dental clinic is the most efficient venue for treating routine dental trauma. Patients in this study spent the majority of time waiting for physicians and receiving nondental services. Most patients required no medical intervention beyond prescriptions commonly used in dental practice.

  3. Gains following perceptual learning are closely linked to the initial visual acuity.

    Science.gov (United States)

    Yehezkel, Oren; Sterkin, Anna; Lev, Maria; Levi, Dennis M; Polat, Uri

    2016-04-28

    The goal of the present study was to evaluate the dependence of perceptual learning gains on initial visual acuity (VA), in a large sample of subjects with a wide range of VAs. A large sample of normally sighted and presbyopic subjects (N = 119; aged 40 to 63) with a wide range of uncorrected near visual acuities (VA, -0.12 to 0.8 LogMAR), underwent perceptual learning. Training consisted of detecting briefly presented Gabor stimuli under spatial and temporal masking conditions. Consistent with previous findings, perceptual learning induced a significant improvement in near VA and reading speed under conditions of limited exposure duration. Our results show that the improvements in VA and reading speed observed following perceptual learning are closely linked to the initial VA, with only a minor fraction of the observed improvement that may be attributed to the additional sessions performed by those with the worse VA.

  4. Influence of head posture on the visual acuity of children with nystagmus

    Directory of Open Access Journals (Sweden)

    Ana Carla Ramos Vieira da Costa

    2014-01-01

    Full Text Available Purpose: Evaluate the relationship between the postural alignment of the head and possible interference in the view of children. Methods: We evaluated 11 children between 2 and 7 years of age of both sexes, with the visually impaired, who had nystagmus and head lock position. The test Lea Grating Acuity Test® was used to collect measurements of visual acuity. This applied on two occasions: with and without postural alignment of the head. For reliability of the postural alignment of the head, the slopes were measured by Fisiologic® software. Results: The children had a poorer performance after physiological postural alignment. This poor performance is possible due to loss of position lock nystagmus to gain postural alignment, said to be ideal. Postural compensations were observed, and sharply increased eyestrain. Conclusion: The pursuit of traditional postural alignment affect the visual response of children with visual impairments.

  5. Outcome of visual acuity after surgical removal of pituitary adenomas

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    Grković Desanka

    2013-01-01

    Full Text Available Introduction. Pituitary adenomas with suprasellar extension may produce anterior visual pathway compression, resulting in characteristic visual deficit. Surgical decompression of these structures prevents further visual deterioration and its postop­ erative recovery. Objective. The aim of this study was to investigate pre­ and postoperative visual acuity (VA in patients with pituitary ad­ enomas, and to detect the influence of prognostic factors, such as symptoms duration, degree of visual acuity reduction and tumor size in the assessment of the prognosis of postoperative visual function. Methods. We analyzed 40 consecutive patients who fulfilled three criteria: evidence of preoperative visual dysfunction, transsphenoidal or transfrontal tumor resection and hystologically verified pituitary adenoma. A visual examination was performed under standard conditions, pre and postoperatively (10 days, one month and six months after surgery. A paired t­test was used to assess the differences of pre­ and postoperative characteristics values, and the Chisquare test of independence in the assessment of the influence of prognostic factors. Results. Postoperative improvement of VA was seen in 84.61% patients (68% eyes. Eyes with preoperative mild and moderate degree of VA reduction showed improvement in 89.65% eyes in contrast to 22.60% eyes with preoperative severe reduction of VA, which was all statistically significant. Eyes in patients with tumor smaller than 20 mm had improvement of VA in 91.66% eyes, while eyes with tumor larger than 40 mm had improvement of VA in 61.11% eyes, which was statistically significant. When symptoms duration was below two years the improvement of VA was detected in 65.38% eyes as related to 50% eyes with symptoms duration exceeding two years, which was not statistically significant. Conclusion. Pituitary adenomas commonly cause visual impairment. Postoperatively the majority of patients show a distinct improvement of

  6. Short-term visual deprivation does not enhance passive tactile spatial acuity.

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    Michael Wong

    Full Text Available An important unresolved question in sensory neuroscience is whether, and if so with what time course, tactile perception is enhanced by visual deprivation. In three experiments involving 158 normally sighted human participants, we assessed whether tactile spatial acuity improves with short-term visual deprivation over periods ranging from under 10 to over 110 minutes. We used an automated, precisely controlled two-interval forced-choice grating orientation task to assess each participant's ability to discern the orientation of square-wave gratings pressed against the stationary index finger pad of the dominant hand. A two-down one-up staircase (Experiment 1 or a Bayesian adaptive procedure (Experiments 2 and 3 was used to determine the groove width of the grating whose orientation each participant could reliably discriminate. The experiments consistently showed that tactile grating orientation discrimination does not improve with short-term visual deprivation. In fact, we found that tactile performance degraded slightly but significantly upon a brief period of visual deprivation (Experiment 1 and did not improve over periods of up to 110 minutes of deprivation (Experiments 2 and 3. The results additionally showed that grating orientation discrimination tends to improve upon repeated testing, and confirmed that women significantly outperform men on the grating orientation task. We conclude that, contrary to two recent reports but consistent with an earlier literature, passive tactile spatial acuity is not enhanced by short-term visual deprivation. Our findings have important theoretical and practical implications. On the theoretical side, the findings set limits on the time course over which neural mechanisms such as crossmodal plasticity may operate to drive sensory changes; on the practical side, the findings suggest that researchers who compare tactile acuity of blind and sighted participants should not blindfold the sighted participants.

  7. Emergency Department Visits by Older Adults for Motor Vehicle Collisions

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    Vogel, Jody A.

    2013-11-01

    Full Text Available Introduction: To describe the epidemiology and characteristics of emergency department (ED visits by older adults for motor vehicle collisions (MVC in the United States (U.S..Methods: We analyzed ED visits for MVCs using data from the 2003–2007 National Hospital Ambulatory Medical Care Survey (NHAMCS. Using U.S. Census data, we calculated annual incidence rates of driver or passenger MVC-related ED visits and examined visit characteristics, including triage acuity, tests performed and hospital admission or discharge. We compared older (65+ years and younger (18-64 years MVC patients and calculated odds ratios (OR and 95% confidence intervals (CIs to measure the strength of associations between age group and various visit characteristics. Multivariable logistic regression was used to identify independent predictors of admissions for MVC-related injuries among older adults.Results: From 2003–2007, there were an average of 237,000 annual ED visits by older adults for MVCs. The annual ED visit rate for MVCs was 6.4 (95% CI 4.6-8.3 visits per 1,000 for older adults and 16.4 (95% CI 14.0-18.8 visits per 1,000 for younger adults. Compared to younger MVC patients, after adjustment for gender, race and ethnicity, older MVC patients were more likely to have at least one imaging study performed (OR 3.69, 95% CI 1.46-9.36. Older MVC patients were not significantly more likely to arrive by ambulance (OR 1.47; 95% CI 0.76–2.86, have a high triage acuity (OR 1.56; 95% CI 0.77-3.14, or to have a diagnosis of a head, spinal cord or torso injury (OR 0.97; 95% CI 0.42-2.23 as compared to younger MVC patients after adjustment for gender, race and ethnicity. Overall, 14.5% (95% CI 9.8-19.2 of older MVC patients and 6.1% (95% CI 4.8-7.5 of younger MVC patients were admitted to the hospital. There was also a non-statistically significant trend toward hospital admission for older versus younger MVC patients (OR 1.78; 95% CI 0.71-4.43, and admission to the ICU if

  8. Demand for Emergency Services Trends in New South Wales Years 2010-2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments.

    Science.gov (United States)

    Dinh, Michael M; Muecke, Sandy; Berendsen Russell, Saartje; Chalkley, Dane; Bein, Kendall J; Muscatello, David; Nagaraj, Guruprasad; Paoloni, Richard; Ivers, Rebecca

    2016-01-01

    The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.

  9. Effect of occlusion amblyopia after prescribed full-time occlusion on long-term visual acuity outcomes.

    Science.gov (United States)

    Longmuir, Susannah; Pfeifer, Wanda; Scott, William; Olson, Richard

    2013-01-01

    To investigate the incidence and characteristics of occlusion amblyopia with prescribed full-time patching and determine its effect on long-term visual acuity outcomes. The records of patients younger than 10 years diagnosed as having amblyopia between 1970 and 2000 were retrospectively reviewed. Patients were prescribed full-time occlusion and observed until completion of therapy. Of 597 patients treated for amblyopia by full-time patching, 115 were diagnosed as having occlusion amblyopia (19.3%). Seventy-five percent (86 of 115) developed occlusion amblyopia during the first episode of full-time patching. Occlusion amblyopia occurred more frequently in children prescribed full-time patching at an earlier age (P = .0002), with an odds ratio of 8.56 (95% confidence interval: 2.73, 26.84) in children younger than 36 months and 2.66 (95% confidence interval: 0.96, 7.37) in children between 36 and 59 months old. Seven of the patients with occlusion amblyopia did not reverse fixation and continued to fixate with the initially amblyopic eye after treatment. Final visual acuity in these eyes with occlusion amblyopia was 20/30 or better. After cessation of treatment, the final interocular difference in visual acuity was less in patients with a history of occlusion amblyopia (P = .003). Occlusion amblyopia occurred at all ages, but the incidence decreased with increasing age. Patients who developed occlusion amblyopia with prescribed full-time occlusion had less interocular visual acuity difference than patients who did not, suggesting that development of occlusion amblyopia can indicate the potential for the development of better vision in the originally amblyopic eye. Copyright 2013, SLACK Incorporated.

  10. Visual Acuity Improvement of Amblyopia in an Adult With Levodopa/Carbidopa Treatment.

    Science.gov (United States)

    Orge, Faruk H; Dar, Suhail A

    2015-09-09

    Amblyopia is the leading cause of visual loss in children, affecting 2% to 3% of the population. Occlusion of the dominant eye is the primary and best treatment, although efficacy decreases after 6 years of age. As a result, levodopa/carbidopa has been explored as an adjunct to conventional therapy and has been shown to have an immediate impact on visual acuity. Several studies to date have shown mixed results on the benefit of supplementing occlusion therapy with levodopa/carbidopa, although they have primarily studied children. The authors describe the oldest patient (46 years old) documented in the literature to have shown improvement in visual acuity using levodopa/carbidopa. He was given a 16-week course at a dose in line with previous studies while being effectively occluded full time due to a glaucomatous right eye with no light perception. On 3-month follow-up, his left eye improved two lines and stabilized at 6 months. Copyright 2015, SLACK Incorporated.

  11. Near-field visual acuity of pigeons: effects of head location and stimulus luminance.

    Science.gov (United States)

    Hodos, W; Leibowitz, R W; Bonbright, J C

    1976-03-01

    Two pigeons were trained to discriminate a grating stimulus from a blank stimulus of equivalent luminance in a three-key chamber. The stimuli and blanks were presented behind a transparent center key. The procedure was a conditional discrimination in which pecks on the left key were reinforced if the blank had been present behind the center key and pecks on the right key were reinforced if the grating had been present behind the center key. The spatial frequency of the stimuli was varied in each session from four to 29.5 lines per millimeter in accordance with a variation of the method of constant stimuli. The number of lines per millimeter that the subjects could discriminate at threshold was determined from psychometric functions. Data were collected at five values of stimulus luminance ranging from--0.07 to 3.29 log cd/m2. The distance from the stimulus to the anterior nodal point of the eye, which was determined from measurements taken from high-speed motion-picture photographs of three additional pigeons and published intraocular measurements, was 62.0 mm. This distance and the grating detection thresholds were used to calculate the visual acuity of the birds at each level of luminance. Acuity improved with increasing luminance to a peak value of 0.52, which corresponds to a visual angle of 1.92 min, at a luminance of 2.33 log cd/m2. Further increase in luminance produced a small decline in acuity.

  12. Evaluation of a visual acuity test using closed Landolt-Cs to determine malingering.

    Science.gov (United States)

    Kröger, Nils; Jürgens, Clemens; Kohlmann, Thomas; Tost, Frank

    2017-12-01

    To evaluate a visual acuity test (VAT) with unexpected optotypes to detect malingering. We tested two groups. Group 1 consisted of 20 individuals with normal best corrected visual acuity (BCVA). Group 2 included participants with ocular diseases and reduced BCVA. All subjects underwent a VAT proposed by Gräf and Roesen to assess suspected malingering. This test used 36 charts with one Landolt-C per page. The first 20 optotypes were Landolt-Cs, while at positions 21, 26, 30, and 34 closed rings were presented. The testing distance was adapted to 50% of the test person's visual acuity. The test person was requested to name the gap direction of the Landolt-C within 3 s. The complete testing conversation was recorded digitally to determine response latency for each optotype from the audio tracks. The average response time was 0.46 s in group 1 and 0.45 s in group 2 for the first 20 Landolt-Cs. In both groups the response time was significantly extended (p ring compared to the mean of the first 20 Landolt-Cs, (group 1: 2.9 s; group 2: 2.3 s). The following three closed rings had also longer response times. However, these differences were not significant. Our results suggest that the proposed test may be helpful to evaluate ocular malingering. The testing procedure appeared to be feasible and showed good repeatability. The fast training effect may be a limitation for malingering detection.

  13. MANAGING THE INTERACTION OF RESOURCE DISTRIBUTION IN PROJECT MANAGEMENT OF IMPLEMENTATION AND FUNCTIONING OF EMERGENCY CALL SYSTEMS

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    Дмитро Сергійович КОБИЛКІН

    2016-02-01

    Full Text Available There have been proposed to use a mobile module "Resources manager" and its component model – scheme for managing the distribution of resources during the project management of implementation and functioning of System 112 in Ukraine. Are described the formalized tasks of performance the processes of managing the model – scheme at all stages of the projects life cycle. Also is developed the model – scheme interaction the blocks of the mobile module of resource management at the System 112 project. It describes the step by step interaction of blocks project management with the project data for successful project implementation and obtaining a product of the project, pointing out the environmental impact of the project on each of the project blocks. The conclusions about the expediency and efficiency of implementation of model – scheme in conditions of managing the emergency call systems at a single number were made.

  14. Impacts of extreme heat on emergency medical service calls in King County, Washington, 2007-2012: relative risk and time series analyses of basic and advanced life support.

    Science.gov (United States)

    Calkins, Miriam M; Isaksen, Tania Busch; Stubbs, Benjamin A; Yost, Michael G; Fenske, Richard A

    2016-01-28

    Exposure to excessive heat kills more people than any other weather-related phenomenon, aggravates chronic diseases, and causes direct heat illness. Strong associations between extreme heat and health have been identified through increased mortality and hospitalizations and there is growing evidence demonstrating increased emergency department visits and demand for emergency medical services (EMS). The purpose of this study is to build on an existing regional assessment of mortality and hospitalizations by analyzing EMS demand associated with extreme heat, using calls as a health metric, in King County, Washington (WA), for a 6-year period. Relative-risk and time series analyses were used to characterize the association between heat and EMS calls for May 1 through September 30 of each year for 2007-2012. Two EMS categories, basic life support (BLS) and advanced life support (ALS), were analyzed for the effects of heat on health outcomes and transportation volume, stratified by age. Extreme heat was model-derived as the 95th (29.7 °C) and 99th (36.7 °C) percentile of average county-wide maximum daily humidex for BLS and ALS calls respectively. Relative-risk analyses revealed an 8 % (95 % CI: 6-9 %) increase in BLS calls, and a 14 % (95 % CI: 9-20 %) increase in ALS calls, on a heat day (29.7 and 36.7 °C humidex, respectively) versus a non-heat day for all ages, all causes. Time series analyses found a 6.6 % increase in BLS calls, and a 3.8 % increase in ALS calls, per unit-humidex increase above the optimum threshold, 40.7 and 39.7 °C humidex respectively. Increases in "no" and "any" transportation were found in both relative risk and time series analyses. Analysis by age category identified significant results for all age groups, with the 15-44 and 45-64 year old age groups showing some of the highest and most frequent increases across health conditions. Multiple specific health conditions were associated with increased risk of an EMS call including abdominal

  15. Changes in brain morphology in albinism reflect reduced visual acuity.

    Science.gov (United States)

    Bridge, Holly; von dem Hagen, Elisabeth A H; Davies, George; Chambers, Claire; Gouws, Andre; Hoffmann, Michael; Morland, Antony B

    2014-07-01

    Albinism, in humans and many animal species, has a major impact on the visual system, leading to reduced acuity, lack of binocular function and nystagmus. In addition to the lack of a foveal pit, there is a disruption to the routing of the nerve fibers crossing at the optic chiasm, resulting in excessive crossing of fibers to the contralateral hemisphere. However, very little is known about the effect of this misrouting on the structure of the post-chiasmatic visual pathway, and the occipital lobes in particular. Whole-brain analyses of cortical thickness in a large cohort of subjects with albinism showed an increase in cortical thickness, relative to control subjects, particularly in posterior V1, corresponding to the foveal representation. Furthermore, mean cortical thickness across entire V1 was significantly greater in these subjects compared to controls and negatively correlated with visual acuity in albinism. Additionally, the group with albinism showed decreased gyrification in the left ventral occipital lobe. While the increase in cortical thickness in V1, also found in congenitally blind subjects, has been interpreted to reflect a lack of pruning, the decreased gyrification in the ventral extrastriate cortex may reflect the reduced input to the foveal regions of the ventral visual stream. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Macular Structures, Optical Components, and Visual Acuity in Preschool Children after Intravitreal Bevacizumab or Laser Treatment.

    Science.gov (United States)

    Lee, Yung-Sung; See, Lai-Chu; Chang, Shu-Hao; Wang, Nan-Kai; Hwang, Yih-Shiou; Lai, Chi-Chun; Chen, Kuan-Jen; Wu, Wei-Chi

    2018-05-10

    To investigate the macular structures, optical components, and visual acuity in preschool-aged children with a history of type I retinopathy of prematurity who underwent either intravitreal bevacizumab (IVB), laser, or a combination of treatments. Comparative interventional case series. A referred medical center in Taiwan. 80 eyes from 42 patients (33 IVB-treated eyes from 17 children, 24 laser-treated eyes from 13 children, and 23 laser + IVB-treated eyes from 12 children). Spectral-domain optical coherence tomography. The retinal thickness in the foveal area and the associated morphologic changes in foveal depression. Compared with the laser-treated and laser + IVB-treated eyes, the IVB-treated eyes had less myopia and deeper anterior chamber depths but presented similar axial lengths and corneal curvatures (P = .001, .002, .95 and .16, respectively). The IVB-treated eyes had significantly thinner foveal, parafoveal, and perifoveal retinal thicknesses (P < .01 for all) and a higher incidence of foveal depression than the laser- or laser + IVB-treated eyes. The macular and subfoveal choroidal thicknesses did not differ among the groups (P = .21 and .63, respectively). Moreover, compared with the eyes treated with laser or laser + IVB, the IVB-treated eyes had better uncorrected visual acuity, although a significant difference was not observed in best-corrected visual acuity (P = .008 and .29, respectively). Compared with laser therapy, IVB-treated eyes were associated with deeper anterior chamber depths and thinner foveal, parafoveal and perifoveal thicknesses. Moreover, these IVB-treated eyes had less refractive errors and better uncorrected visual acuity. Copyright © 2018. Published by Elsevier Inc.

  17. Call Forecasting for Inbound Call Center

    Directory of Open Access Journals (Sweden)

    Peter Vinje

    2009-01-01

    Full Text Available In a scenario of inbound call center customer service, the ability to forecast calls is a key element and advantage. By forecasting the correct number of calls a company can predict staffing needs, meet service level requirements, improve customer satisfaction, and benefit from many other optimizations. This project will show how elementary statistics can be used to predict calls for a specific company, forecast the rate at which calls are increasing/decreasing, and determine if the calls may stop at some point.

  18. Low-level laser therapy improves visual acuity in adolescent and adult patients with amblyopia.

    Science.gov (United States)

    Ivandic, Boris T; Ivandic, Tomislav

    2012-03-01

    The purpose of this study was to examine the effects of low-level laser therapy (LLLT) on visual acuity in adolescent and adult patients with amblyopia. Currently, amblyopia can be treated successfully only in children. In this single-blinded, placebo-controlled study, 178 patients (mean age 46.8 years) with amblyopia caused by ametropia (110 eyes) or strabismus (121 eyes) were included. For LLLT, the area of the macula was irradiated through the conjunctiva from 1 cm distance for 30 sec with laser light (780 nm, 292 Hz, 1:1 duty cycle; average power 7.5 mW; spot area 3 mm(2)). The treatment was repeated on average 3.5 times, resulting in a mean total dose of 0.77 J/cm(2). No occlusion was applied, and no additional medication was administered. Best corrected distant visual acuity was determined using Snellen projection optotypes. In 12 patients (12 eyes), the multifocal visual evoked potential (M-VEP) was recorded. A control group of 20 patients (20 eyes) received mock treatment. Visual acuity improved in ∼90% of the eyes treated with LLLT (pamblyopia caused by ametropia and strabismus, respectively. The treatment effect was maintained for at least 6 months. The mean M-VEP amplitude increased by 1207 nV (pamblyopia caused by ametropia or strabismus.

  19. Effect of neodymium:YAG laser capsulotomy on visual function in patients with posterior capsule opacification and good visual acuity.

    Science.gov (United States)

    Yotsukura, Erisa; Torii, Hidemasa; Saiki, Megumi; Negishi, Kazuno; Tsubota, Kazuo

    2016-03-01

    To evaluate the effect of neodymium:YAG (Nd:YAG) laser capsulotomy on the visual function in patients with posterior capsule opacification (PCO) and good visual acuity. Keio University Hospital, Tokyo, Japan. Observational case series. Eyes were evaluated that had previous cataract surgery with a clinical diagnosis of PCO requiring Nd:YAG laser capsulotomy regardless of a good corrected distance visual acuity (CDVA) (at least 20/20). The CDVA, 10% low contrast visual acuity (LCVA), wavefront aberrations from the 3rd to 6th order, and retinal straylight were measured before and after Nd:YAG laser capsulotomy. The study included 16 eyes of 16 patients (10 men, 6 women; mean age 69.5 years ± 9.3 [SD]). The mean CDVA, LCVA, and straylight after Nd:YAG laser capsulotomy improved significantly (P The root mean square (RMS) of the 3rd Zernike coefficients (S3) and the RMS of the total higher-order aberrations (HOAs) from the 3rd to 6th order decreased significantly after capsulotomy (P The straylight correlated significantly with the total HOAs (r = 0.727, P = .002) and S3 (r = 0.748, P = .001) before capsulotomy. Subjective symptoms resolved after capsulotomy in all cases. Neodymium:YAG laser capsulotomy enabled a significant improvement in visual function even in patients with PCO with good visual acuity. Straylight measurements might be useful to determine the indications for Nd:YAG laser capsulotomy when patients report visual disturbances without decreased visual acuity. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  20. EMS call center models with and without function differentiation: a comparison

    NARCIS (Netherlands)

    van Buuren, M.; Kommer, G.J.; van der Mei, R.D.; Bhulai, Sandjai

    2017-01-01

    In pre-hospital health care the call center plays an important role in the coordination of emergency medical services (EMS). An EMS call center handles inbound requests for EMS and dispatches an ambulance if necessary. The time needed for triage and dispatch is part of the total response time to the

  1. Método computadorizado para medida da acuidade visual A computerized method for visual acuity assessment

    Directory of Open Access Journals (Sweden)

    Patrícia Katayama Kjaer Arippol

    2006-12-01

    Full Text Available OBJETIVO: Elaborar e validar teste computadorizado para medida da acuidade visual de escolares. MÉTODOS: Foi elaborado teste computadorizado para determinação da acuidade visual utilizando os padrões das tabelas logarítmicas impressas adotadas na clínica oftalmológica. Foram avaliados 90 alunos da primeira série do ensino básico, oito estudantes do curso de Tecnologia Oftálmica da UNIFESP-EPM e 10 pacientes do ambulatório de Estrabismo do Departamento de Oftalmologia da UNIFESP-EPM. Todos os sujeitos foram avaliados pelo mesmo examinador e submetidos ao exame de acuidade visual monocular, pela tabela logarítmica de optotipos E impressa e do novo teste computadorizado no mesmo momento. Os participantes forneceram os seus consentimentos após esclarecimento. RESULTADOS: As análises estatísticas revelaram correlação excelente (r>0,75 entre os dois métodos, apesar da leve tendência apresentada pelo teste computadorizado em superestimar a acuidade visual quando comparado com o padrão-ouro. O teste computadorizado apresentou sensibilidade de 100% e especificidade de 94%. CONCLUSÕES: Os resultados obtidos nos permitem dizer que o teste computadorizado pode ser utilizado como novo recurso para triagem da qualidade visual dos escolares, por ser método rápido, de fácil aplicação, barato, automático e atrativo para as crianças. A automatização desvincula o aplicador da interpretação das respostas dadas pelo aluno testado, garante padronização do procedimento, que favorece as análises de acompanhamento e pode ser realizado por diferentes examinadores. Para melhor compreensão da efetividade do teste como instrumento de triagem visual, seria interessante instituí-lo nas escolas do curso básico, após treinamento dos professores para sua aplicação.PURPOSE: To elaborate and to validate a computerized test for visual acuity screening of school-age children. METHODS: We have created a computerized test for visual acuity

  2. Switching from pro re nata to treat-and-extend regimen improves visual acuity in patients with neovascular age-related macular degeneration.

    Science.gov (United States)

    Kvannli, Line; Krohn, Jørgen

    2017-11-01

    To evaluate the visual outcome after transitioning from a pro re nata (PRN) intravitreal injection regimen to a treat-and-extend (TAE) regimen for patients with neovascular age-related macular degeneration (AMD). A retrospective review of patients who were switched from a PRN regimen with intravitreal injections of bevacizumab, ranibizumab or aflibercept to a TAE regimen. The best corrected visual acuity (BCVA), central retinal thickness (CRT) and type of medication used at baseline, at the time of changing treatment regimen and at the end of the study were analysed. Twenty-one eyes of 21 patients met the inclusion criteria. Prior to the switch, the patients received a mean of 13.8 injections (median, 10; range, 3-39 injections) with the PRN regimen for 44 months (range, 3-100 months), which improved the visual acuity in five patients (24%). After a mean of 6.1 injections (median, 5; range, 3-14 injections) with the TAE regimen over 8 months (range, 2-16 months), the visual acuity improved in 12 patients (57%). The improvement in visual acuity during treatment with the TAE regimen was statistically significant (p = 0.005). The proportion of patients with a visual acuity of 0.2 or better was significantly higher after treatment with the TAE regimen than after treatment with the PRN regimen (p = 0.048). No significant differences in CRT were found between the two treatment regimens. Even after prolonged treatment and a high number of intravitreal injections, switching AMD patients from a PRN regimen to a strict TAE regimen significantly improves visual acuity. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  3. Infants in Drug Withdrawal: A National Description of Nurse Workload, Infant Acuity, and Parental Needs.

    Science.gov (United States)

    Smith, Jessica G; Rogowski, Jeannette A; Schoenauer, Kathryn M; Lake, Eileen T

    Infants in drug withdrawal have complex physiological and behavioral states, requiring intensive nursing care. The study objectives were to describe acuity, parental needs, and nurse workload of infants in drug withdrawal compared with other infants. The design was cross-sectional and involved secondary nurse survey data from 6045 staff nurses from a national sample of 104 neonatal intensive care units. Nurses reported the care of 15 233 infants, 361 (2.4%) of whom were in drug withdrawal. Three-fourths of hospitals had at least 1 infant in drug withdrawal. In these hospitals, the mean number of infants in drug withdrawal was 4.7. Infant acuity was significantly higher among infants in drug withdrawal. Parents of infants in drug withdrawal required significantly more care to address complex social situations (51% vs 12%). The number of infants assigned to nurses with at least 1 infant in withdrawal (mean = 2.69) was significantly higher than typical (mean = 2.51). Given infant acuity and parental needs, policies legislating patient-to-nurse ratios should permit professional discretion on the number of patients to assign nurses caring for infants in drug withdrawal. Managers and charge nurses should consider the demands of caring for infants in drug withdrawal in assignment decisions and provide support and education.

  4. Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration

    Directory of Open Access Journals (Sweden)

    Xinyuan Zhang

    2018-01-01

    Full Text Available Age-related macular degeneration (AMD is one of the leading causes of severe vision loss in people over 60 years. Wet AMD (wAMD causes more severe visual acuity (VA loss compared with the dry form due to formation of choroidal neovascularization (CNV. Antivascular endothelial growth factor (anti-VEGF agents such as ranibizumab and aflibercept are now the standard of care treatment for wAMD. Unfortunately, up to a quarter of anti-VEGF-treated wAMD patients might not fully benefit from intravitreal injections and CNV activity may not respond to the treatment and these patients are called anti-VEGF nonresponders. This article aims to discuss the baseline factors associated with VA outcome such as age, initial VA, lesion types, disease duration, optical coherence tomography (OCT features, fundus autofluorescence findings, and the presence of particular genotype risk alleles in patients with wAMD. Recommendations are provided regarding when to consider discontinuation of therapy because of either success or futility. Understanding the predictive factors associated with VA outcome and treatment frequency response to anti-VEGF therapy may help retina specialists to manage patients’ expectations and guide treatment decisions from the beginning of treatment on the basis of “personalized medicine.”

  5. Self reported involvement in emergency medicine among GPs in Norway.

    Science.gov (United States)

    Hjortdahl, Magnus; Zakariassen, Erik; Halvorsen, Peder A

    2018-04-10

    To examine general practitioners' (GPs') perception of their role in emergency medicine and participation in emergency services including ambulance call outs, and the characteristics of the GPs and casualty clinics associated with the GPs' involvement in emergency medicine. Cross-sectional online survey. General practice. General practitioners in Norway (n = 1002). Proportion of GPs perceiving that they have a large role in emergency medicine, regularly being on call, and the proportion of ambulance callouts with GP participation. Forty six percent of the GPs indicated that they play a large role in emergency medicine, 63 percent of the GPs were regularly on call, and 28 percent responded that they usually took part in ambulance call outs. Multivariable logistic regression analyses indicated that these outcomes were strongly associated with participation in multidisciplinary training. Furthermore, the main outcomes were associated with traits commonly seen at smaller casualty clinics such as those with an absence of nursing personnel and extra physicians, and based on the distance to the hospital. Our findings suggest that GPs play an important role in emergency medicine. Multidisciplinary team training may be important for their continued involvement in prehospital emergencies. Key Points   Health authorities and other stakeholders have raised concerns about general practitioner's (GPs) participation in emergency medicine, but few have studied opinions and perceptions among the GPs themselves.   • Norwegian GPs report playing a large role in emergency medicine, regularly being on call, and taking part in selected ambulance call outs.   • A higher proportion of GPs who took part in team training perceived themselves as playing a large role in emergency medicine, regularly being on call, and taking part in ambulance call outs.   • These outcomes were also associated with attributes commonly seen at smaller casualty clinics.

  6. Base Station Ordering for Emergency Call Localization in Ultra-dense Cellular Networks

    KAUST Repository

    Elsawy, Hesham

    2017-10-04

    This paper proposes the base station ordering localization technique (BoLT) for emergency call localization in cellular networks. Exploiting the foreseen ultra-densification of the next-generation (5G and beyond) cellular networks, we utilize higher-order Voronoi tessellations to provide ubiquitous localization services that are in compliance to the public safety standards in cellular networks. The proposed localization algorithm runs at the base stations (BSs) and requires minimal operation from agents (i.e., mobile users). Particularly, BoLT requires each agent to feedback a neighbor cell list (NCL) that contains the order of neighboring BSs based on the received signal power in the pilots sent from these BSs. Moreover, this paper utilizes stochastic geometry to develop a tractable mathematical model to assess the performance of BoLT in a general network setting. The goal of this paper is to answer the following two fundamental questions: i) how many BSs should be ordered and reported by the agent to achieve a desirable localization accuracy? and ii) what is the localization error probability given that the pilot signals are subject to shadowing? Assuming that the BSs are deployed according to a Poisson point process (PPP), we answer these two questions via characterizing the tradeoff between the area of location region (ALR) and the localization error probability in terms of the number of BSs ordered by the agent. The results show that reporting the order of six neighboring BSs is sufficient to localize the agent within 10% of the cell area. Increasing the number of reported BSs to ten confines the location region to 1% of the cell area. This would translate to the range of a few meters to decimeters in the foreseen ultra-dense 5G networks.

  7. Base Station Ordering for Emergency Call Localization in Ultra-dense Cellular Networks

    KAUST Repository

    Elsawy, Hesham; Dai, Wenhan; Alouini, Mohamed-Slim; Win, Moe Z.

    2017-01-01

    This paper proposes the base station ordering localization technique (BoLT) for emergency call localization in cellular networks. Exploiting the foreseen ultra-densification of the next-generation (5G and beyond) cellular networks, we utilize higher-order Voronoi tessellations to provide ubiquitous localization services that are in compliance to the public safety standards in cellular networks. The proposed localization algorithm runs at the base stations (BSs) and requires minimal operation from agents (i.e., mobile users). Particularly, BoLT requires each agent to feedback a neighbor cell list (NCL) that contains the order of neighboring BSs based on the received signal power in the pilots sent from these BSs. Moreover, this paper utilizes stochastic geometry to develop a tractable mathematical model to assess the performance of BoLT in a general network setting. The goal of this paper is to answer the following two fundamental questions: i) how many BSs should be ordered and reported by the agent to achieve a desirable localization accuracy? and ii) what is the localization error probability given that the pilot signals are subject to shadowing? Assuming that the BSs are deployed according to a Poisson point process (PPP), we answer these two questions via characterizing the tradeoff between the area of location region (ALR) and the localization error probability in terms of the number of BSs ordered by the agent. The results show that reporting the order of six neighboring BSs is sufficient to localize the agent within 10% of the cell area. Increasing the number of reported BSs to ten confines the location region to 1% of the cell area. This would translate to the range of a few meters to decimeters in the foreseen ultra-dense 5G networks.

  8. Why are some people who have received overdose education and naloxone reticent to call Emergency Medical Services in the event of overdose?

    Science.gov (United States)

    Koester, Stephen; Mueller, Shane R; Raville, Lisa; Langegger, Sig; Binswanger, Ingrid A

    2017-10-01

    Overdose Education and Naloxone Distribution (OEND) training for persons who inject drugs (PWID) underlines the importance of summoning emergency medical services (EMS). To encourage PWID to do so, Colorado enacted a Good Samaritan law providing limited immunity from prosecution for possession of a controlled substance and/or drug paraphernalia to the overdose victim and the witnesses who in good faith provide emergency assistance. This paper examines the law's influence by describing OEND trained PWIDs' experience reversing overdoses and their decision about calling for EMS support. Findings from two complementary studies, a qualitative study based on semi-structured interviews with OEND trained PWID who had reversed one or more overdoses, and an on-going fieldwork-based project examining PWIDs' self-identified health concerns were triangulated to describe and explain participants' decision to call for EMS. In most overdose reversals described, no EMS call was made. Participants reported several reasons for not doing so. Most frequent was the fear that despite the Good Samaritan law, a police response would result in arrest of the victim and/or witness for outstanding warrants, or sentence violations. Fears were based on individual and collective experience, and reinforced by the city of Denver's aggressive approach to managing homelessness through increased enforcement of misdemeanors and the imposition of more recent ordinances, including a camping ban, to control space. The city's homeless crisis was reflected as well in the concern expressed by housed PWID that an EMS intervention would jeopardize their public housing. Results suggest that the immunity provided by the Good Samaritan law does not address PWIDs' fear that their current legal status as well as the victim's will result in arrest and incarceration. As currently conceived, the Good Samaritan law does not provide immunity for PWIDs' already enmeshed in the criminal justice system, or PWID fearful of

  9. Incidence of emergency contacts (red responses to Norwegian emergency primary healthcare services in 2007 – a prospective observational study

    Directory of Open Access Journals (Sweden)

    Hansen Elisabeth

    2009-07-01

    Full Text Available Abstract Background The municipalities are responsible for the emergency primary health care services in Norway. These services include casualty clinics, primary doctors on-call and local emergency medical communication centres (LEMC. The National centre for emergency primary health care has initiated an enterprise called "The Watchtowers", comprising emergency primary health care districts, to provide routine information (patients' way of contact, level of urgency and first action taken by the out-of-hours services over several years based on a minimal dataset. This will enable monitoring, evaluation and comparison of the respective activities in the emergency primary health care services. The aim of this study was to assess incidence of emergency contacts (potential life-threatening situations, red responses to the emergency primary health care service. Methods A representative sample of Norwegian emergency primary health care districts, "The Watchtowers" recorded all contacts and first action taken during the year of 2007. All the variables were continuously registered in a data program by the attending nurses and sent by email to the National Centre for Emergency Primary Health Care at a monthly basis. Results During 2007 the Watchtowers registered 85 288 contacts, of which 1 946 (2.3% were defined as emergency contacts (red responses, corresponding to a rate of 9 per 1 000 inhabitants per year. 65% of the instances were initiated by patient, next of kin or health personnel by calling local emergency medical communication centres or meeting directly at the casualty clinics. In 48% of the red responses, the first action taken was a call-out of doctor and ambulance. On a national basis we can estimate approximately 42 500 red responses per year in the EPH in Norway. Conclusion The emergency primary health care services constitute an important part of the emergency system in Norway. Patients call the LEMC or meet directly at casualty clinics

  10. Does Knee Osteoarthritis Differentially Modulate Proprioceptive Acuity in the Frontal and Sagittal Planes of the Knee?

    Science.gov (United States)

    Cammarata, Martha L; Schnitzer, Thomas J; Dhaher, Yasin Y

    2012-01-01

    Objective Impaired proprioception may alter joint loading and contribute to the progression of knee osteoarthritis (OA). Though frontal plane loading at the knee contributes to OA, proprioception and its modulation with OA in this direction have not been examined. The aim of this study was to assess knee proprioceptive acuity in the frontal and sagittal planes in knee OA and healthy participants. We hypothesized that proprioceptive acuity will be decreased in the OA population in both planes of movement. Methods Thirteen persons with knee OA and fourteen healthy age-matched subjects participated. Proprioceptive acuity was assessed in varus, valgus, flexion, and extension using the threshold to detection of passive movement (TDPM). Repeated measures analysis of variance was used to assess differences in TDPM between subject groups and across movement directions. Linear regression analyses were performed to assess the correlation of TDPM between and within planes of movement. Results TDPM was found to be significantly higher (Pplanes of movement were only weakly correlated, especially in the OA group. Conclusions Consistent differences in TDPM between the OA and control groups across all movement directions suggest a global, not direction-specific, reduction in sensation in knee OA patients. PMID:21547895

  11. Effect of ocular transverse chromatic aberration on detection acuity for peripheral vision.

    Science.gov (United States)

    Cheney, Frank; Thibos, Larry; Bradley, Arthur

    2015-01-01

    We examined the effect of transverse chromatic aberration (TCA) on detection acuity for white-light interference fringes seen in Maxwellian view at various orientations and locations in the visual field. A circular patch (3.5° diameter, 3.2 log Trolands) of nominally high-contrast fringes was produced on the retina by a commercial instrument (the Lotmar Visometer, Haag Streit) mounted on a gimbal for controlled positioning of the stimulus in the visual field from 0° to 35° eccentricity. Detection acuity for white light fringes for all meridians and eccentricities ≥15° was maximum when fringes were oriented parallel to the visual meridian line. This meridional effect disappeared when a narrow-band filter was used to eliminate TCA. The meridional effect also disappeared when the interferometric stimulator was displaced laterally to align the instrument with the eye's local achromatic axis. Modelling confirmed that TCA is the major factor responsible for white-light meridional bias, with minor contribution arising from higher-order monochromatic aberrations and neural factors. © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.

  12. Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe.

    Science.gov (United States)

    Twomey, Michèle; Šijački, Ana; Krummrey, Gert; Welzel, Tyson; Exadaktylos, Aristomenis K; Ercegovac, Marko

    2018-03-12

    Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM) introduced a standardized triage process at the Clinical Centre of Serbia (CCS). This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

  13. Strengthening Emergency Care Systems to Mitigate Public Health Challenges Arising from Influxes of Individuals with Different Socio-Cultural Backgrounds to a Level One Emergency Center in South East Europe

    Directory of Open Access Journals (Sweden)

    Michèle Twomey

    2018-03-01

    Full Text Available Emergency center visits are mostly unscheduled, undifferentiated, and unpredictable. A standardized triage process is an opportunity to obtain real-time data that paints a picture of the variation in acuity found in emergency centers. This is particularly pertinent as the influx of people seeking asylum or in transit mostly present with emergency care needs or first seek help at an emergency center. Triage not only reduces the risk of missing or losing a patient that may be deteriorating in the waiting room but also enables a time-critical response in the emergency care service provision. As part of a joint emergency care system strengthening and patient safety initiative, the Serbian Ministry of Health in collaboration with the Centre of Excellence in Emergency Medicine (CEEM introduced a standardized triage process at the Clinical Centre of Serbia (CCS. This paper describes four crucial stages that were considered for the integration of a standardized triage process into acute care pathways.

  14. Comparison on testability of visual acuity, stereo acuity and colour vision tests between children with learning disabilities and children without learning disabilities in government primary schools.

    Science.gov (United States)

    Abu Bakar, Nurul Farhana; Chen, Ai-Hong

    2014-02-01

    Children with learning disabilities might have difficulties to communicate effectively and give reliable responses as required in various visual function testing procedures. The purpose of this study was to compare the testability of visual acuity using the modified Early Treatment Diabetic Retinopathy Study (ETDRS) and Cambridge Crowding Cards, stereo acuity using Lang Stereo test II and Butterfly stereo tests and colour perception using Colour Vision Test Made Easy (CVTME) and Ishihara's Test for Colour Deficiency (Ishihara Test) between children in mainstream classes and children with learning disabilities in special education classes in government primary schools. A total of 100 primary school children (50 children from mainstream classes and 50 children from special education classes) matched in age were recruited in this cross-sectional comparative study. The testability was determined by the percentage of children who were able to give reliable respond as required by the respective tests. 'Unable to test' was defined as inappropriate response or uncooperative despite best efforts of the screener. The testability of the modified ETDRS, Butterfly stereo test and Ishihara test for respective visual function tests were found lower among children in special education classes ( P learning disabilities. Modifications of vision testing procedures are essential for children with learning disabilities.

  15. Analysis of laser photocoagulation with cataract surgery for improvement of visual acuity and macular edema in patients with cataract and diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Chao-Yu Wang

    2016-02-01

    Full Text Available AIM:To explore laser photocoagulation with cataract surgery for improvement of visual acuity and macular edema in patients with cataract and diabetic macular edema.METHODS:A total of 60 patients(72 eyesfrom January 2014 to July 2015 in our hospital were selected, which all were diagnosed as cataract with diabetic macular edema. According to a random number table method, the patients were divided into observation group and control group, 30 cases(36 eyesin each group. The observation group was treated with combination therapy of laser photocoagulation before cataract surgeries, while the control group with the combination therapy of laser photocoagulation after cataract surgeries. At 2mo after surgeries, some routine examination, such as visual acuity, fundus examination after mydriasis, slit lamp examination, optical coherence tomography(OCTexamination, fluorescence angiography examination(FFAfor retinal blood vessels were applied in all the patients. RESULTS:The visual acuity of the observation group and the control group before treatments was not significantly different(P>0.05. At 2mo after treatments, the visual inspection showed that compared with the visual acuity before treatment, the visual acuity of the two groups were both significantly improved(PPP>0.05. At 2mo after treatments, compared with those before treatments, the macular thickness of two groups were both significantly improved(PPCONCLUSION:The laser photocoagulation before cataract surgery for patients with cataract and diabetic macular edema can significantly improve their visual acuity and macular thickness.

  16. Applying cognitive acuity theory to the development and scoring of situational judgment tests.

    Science.gov (United States)

    Leeds, J Peter

    2017-11-09

    The theory of cognitive acuity (TCA) treats the response options within items as signals to be detected and uses psychophysical methods to estimate the respondents' sensitivity to these signals. Such a framework offers new methods to construct and score situational judgment tests (SJT). Leeds (2012) defined cognitive acuity as the capacity to discern correctness and distinguish between correctness differences among simultaneously presented situation-specific response options. In this study, SJT response options were paired in order to offer the respondent a two-option choice. The contrast in correctness valence between the two options determined the magnitude of signal emission, with larger signals portending a higher probability of detection. A logarithmic relation was found between correctness valence contrast (signal stimulus) and its detectability (sensation response). Respondent sensitivity to such signals was measured and found to be related to the criterion variables. The linkage between psychophysics and elemental psychometrics may offer new directions for measurement theory.

  17. Possible role for fundus autofluorescence as a predictive factor for visual acuity recovery after epiretinal membrane surgery.

    Science.gov (United States)

    Brito, Pedro N; Gomes, Nuno L; Vieira, Marco P; Faria, Pedro A; Fernandes, Augusto V; Rocha-Sousa, Amândio; Falcão-Reis, Fernando

    2014-02-01

    To study the potential association between fundus autofluorescence, spectral-domain optical coherence tomography, and visual acuity in patients undergoing surgery because of epiretinal membranes. Prospective, interventional case series including 26 patients submitted to vitrectomy because of symptomatic epiretinal membranes. Preoperative evaluation consisted of a complete ophthalmologic examination, autofluorescence, and spectral-domain optical coherence tomography. Studied variables included foveal autofluorescence (fov.AF), photoreceptor inner segment/outer segment (IS/OS) junction line integrity, external limiting membrane integrity, central foveal thickness, and foveal morphology. All examinations were repeated at the first, third, and sixth postoperative months. The main outcome measures were logarithm of minimal angle resolution visual acuity, fov.AF integrity, and IS/OS integrity. All cases showing a continuous IS/OS line had an intact fov.AF, whereas patients with IS/OS disruption could have either an increased area of foveal hypoautofluorescence or an intact fov.AF, with the latter being associated with IS/OS integrity recovery in follow-up spectral-domain optical coherence tomography imaging. The only preoperative variables presenting a significant correlation with final visual acuity were baseline visual acuity (P = 0.047) and fov.AF grade (P = 0.023). Recovery of IS/OS line integrity after surgery, in patients with preoperative IS/OS disruption and normal fov.AF, can be explained by the presence of a functional retinal pigment epithelium-photoreceptor complex, supporting normal photoreceptor activity. Autofluorescence imaging provides a functional component to the study of epiretinal membranes, complementing the structural information obtained with optical coherence tomography.

  18. Emergency motorcycle: has it a place in a medical emergency system?

    Science.gov (United States)

    Soares-Oliveira, Miguel; Egipto, Paula; Costa, Isabel; Cunha-Ribeiro, Luis Manuel

    2007-07-01

    In an emergency medical service system, response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas, mainly during rush hour. Because prehospital emergency care is required to be efficient and swift, alternative measures to achieve this goal should be addressed. We report our experience with a medical emergency motorcycle (MEM) and propose major criteria for dispatching it. This work presents a prospective analysis of the data relating to MEM calls from July 2004 to December 2005. The analyzed parameters were age, sex, reason for call, action, and need for subsequent transport. A comparison was made of the need to activate more means and, if so, whether the MEM was the first to arrive. There were 1972 calls. The average time of arrival at destination was 4.4 +/- 2.5 minutes. The main action consisted of administration of oxygen (n = 626), immobilization (n = 118), and control of hemorrhage (n = 101). In 63% of cases, MEM arrived before other emergency vehicles. In 355 cases (18%), there was no need for transport. The MEM can intervene in a wide variety of clinical situations and a quick response is guaranteed. Moreover, in specific situations, MEM safely and efficiently permits better management of emergency vehicles. We propose that it should be dispatched mainly in the following situations: true life-threatening cases and uncertain need for an ambulance.

  19. Emergencies and emergency planning in France

    International Nuclear Information System (INIS)

    Jammet, H.

    1986-01-01

    The organization for dealing with radiation emergencies in France is complex and centralized. It consists of the Radiation Security Council with participants from the Premier Ministre and the Ministers of Interior, Industry, Health, and Defense. A permanent general secretary for radiation security coordinates the work of the various departments. Planning for nuclear power emergencies is divided between on-site, in which organization and intervention are the responsibilities of the manager of the plant, and off-site, in which organization and intervention are the responsibility of the regional governor. Both on-site and off-site planning have models integrated into a special code of practice called the radiation emergency organization

  20. Visual stimulus parameters seriously compromise the measurement of approximate number system acuity and comparative effects between adults and children

    Directory of Open Access Journals (Sweden)

    Denes eSzucs

    2013-07-01

    Full Text Available It has been suggested that a simple non-symbolic magnitude comparison task is sufficient to measure the acuity of a putative Approximate Number System (ANS. A proposed measure of the ANS, the so-called 'internal Weber fraction' (w, would provide a clear measure of ANS acuity. However, ANS studies have never presented adequate evidence that the visual stimulus parameters did not compromise measurements of w to such extent that w is actually driven by visual instead of numerical processes. We therefore investigated this question by testing non-symbolic magnitude discrimination in seven-year-old children and adults. We controlled for visual parameters in a more stringent manner than usual. As a consequence of these controls, in some trials numerical cues correlated positively with number while in others they correlated negatively with number. This congruency effect strongly correlated with w, which means that congruency effects were probably driving effects in w. Consequently, in both adults and children congruency had a major impact on the fit of the model underlying the computation of w. Furthermore, children showed larger congruency effects than adults. This suggests that ANS tasks are seriously compromised by the visual stimulus parameters, which cannot be controlled. Hence, they are not pure measures of the ANS and some putative w or ratio effect differences between children and adults in previous ANS studies may be due to the differential influence of the visual stimulus parameters in children and adults. In addition, because the resolution of congruency effects relies on inhibitory (interference suppression function, some previous ANS findings were probably influenced by the developmental state of inhibitory processes especially when comparing children with developmental dyscalculia and typically developing children.

  1. Visual acuity in pelagic fishes and mollusks.

    Science.gov (United States)

    Gagnon, Yakir L; Sutton, Tracey T; Johnsen, Sönke

    2013-11-01

    In the sea, visual scenes change dramatically with depth. At shallow and moderate depths (cephalopods, and a gastropod using a custom-built apparatus. The hatchetfishes (Argyropelecus aculeatus and Sternoptyx diaphana) and the barrel-eye (Opisthoproctus soleatus) were found to have the best lenses, which may allow them to break the counterillumination camouflage of their prey. The heteropod lens had unidirectional aberrations that matched its ribbon-shaped retina. We also found that lens angular resolution increased with depth. Due to a similar trend in the angular separation between adjacent ganglion cells in the retinas of fishes, the perceived visual contrast at the retinal cutoff frequency was constant with depth. The increase in acuity with depth allows the predators to focus all the available light bioluminescent prey animals emit and detect their next meal. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Emergency Nurses' Perspectives: Factors Affecting Caring.

    Science.gov (United States)

    Enns, Carol L; Sawatzky, Jo-Ann V

    2016-05-01

    Caring is a universal phenomenon. However, as a result of higher patient acuity and staff shortages within the chaotic ED environment, caring behaviors may be in peril. The purpose of this study was to gain insight into the meaning of caring from the perspective of emergency nurses. Exploring nurses' perspectives of caring is central to improving staffing and retention issues in this unique work environment. As part of a larger study, a subsample of emergency nurses who work in public hospitals in Manitoba, Canada (n = 17) were interviewed. A qualitative descriptive design was used to gain insight into the caring perspectives of nurses by asking them, "What does caring meaning to you?" and "What affects caring in your practice in the emergency department?" Emerging themes were extracted through analysis of audio tapes and transcripts. Advocacy and holistic care emerged as major themes in the meaning of caring for emergency nurses. Caring was affected by a number of factors, including workload, lack of time, staffing issues, shift work, and lack of self-care. However, lack of management support was the most consistent hindrance to caring identified by study participants. Caring continues to be a unifying concept in nursing; however, influencing factors continue to undermine caring for emergency nurses. Caring is not subsidiary to nursing; it is the central core of nursing. Therefore, fostering a caring working environment is essential for nurses to practice holistic nursing care. It is also imperative to job satisfaction and the retention of emergency nurses. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  3. High-Acuity Information Is Retained through the Cortical Visual Hierarchy of Primates.

    Science.gov (United States)

    Chelazzi, Leonardo; Santandrea, Elisa

    2018-04-18

    Vision requires perception of both coarse layout and fine details of objects. In this issue of Neuron, Lu et al. (2018) describe a possible basis for the latter: neuronal clusters in area V4 coding high-acuity information, despite the tendency along the visual hierarchy to generate global representations of objects. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. The AGIS Investigators.

    Science.gov (United States)

    2000-12-01

    To investigate the effect of cataract on visual function and the role of cataract in explaining a race-treatment interaction in outcomes of glaucoma surgery. The Advanced Glaucoma Intervention Study (AGIS) enrolled 332 black patients (451 eyes) and 249 white patients (325 eyes) with advanced glaucoma. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy sequence or a trabeculectomy-ALT-trabeculectomy sequence. From the AGIS experience with cataract surgery during follow-up, we estimated the expected change in visual function scores from before cataract surgery to after cataract surgery. Then, for eyes with cataract not removed, we used these estimates of expected change to adjust visual function scores for the presumed effects of cataract. In turn, we used the adjusted scores to obtain cataract-adjusted main outcome measures. Average percent of eyes with decrease of visual field (APDVF) and average percent of eyes with decrease of visual acuity (APDVA). Within the 2 months before cataract surgery, visual acuity was better in eyes of white patients than of black patients by an average of approximately 2 lines on the visual acuity test chart. Cataract surgery improved visual acuity and visual field defect scores, with the amounts of improvement greater when preoperative visual acuity was lower. Adjustments for cataract brought about the following relative reductions: for APDVF, a relative reduction of 5% to 11% in black patients and 9% to 11% in white patients; for APDVA, a relative reduction of 45% to 49% in black patients and 31% to 38% in white patients; and for the APDVF and APDVA race-treatment interactions, relative reductions of 25% and 45%, respectively. On average, visual function scores improved after cataract surgery. The findings of reduced race-treatment interactions after adjustment for cataract do not alter our earlier conclusion that the AGIS 7-year results support use of the ALT

  5. Night-shift work and risk of compromised visual acuity among the workers in an electronics manufacturing company.

    Science.gov (United States)

    Lin, Yu-Cheng; Ho, Kuo-Jung

    2018-01-01

    To evaluate the association between night-shift work exposure and visual health, this cross-sectional study utilized visual acuity, a surrogate measure for visual function, as a parameter, and performed an analysis comparing visual acuity between daytime and nighttime employees in an electronics manufacturing company. Data of personal histories, occupational records, physical examinations and blood tests was obtained from the electronic health records of workers. The total of 8280 workers including 3098 women and 5182 men, wearing their own daily used eyeglasses, were included in the final analysis. The mean age of the sample population was 34.7 years old (standard deviation = 5.4 years). All workers were divided into 3 work categories - consistent daytime worker (CDW), day-shift worker (DSW) and night-shift worker (NSW). The check-up results of glasses-corrected visual acuity (c-VA) were utilized to classify individuals as good (≥ 1.2, both eyes) and inadequate (electronics manufacturing company. Int J Occup Med Environ Health 2018;31(1):71-79. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  6. “Sickle Cell Disease in the Emergency Department: Atypical Complications and Management”

    OpenAIRE

    Brandow, Amanda M.; Liem, Robert

    2011-01-01

    Sickle cell disease is the most common inherited blood disorder in the United States. This disorder of hemoglobin structure leads to a chronic hemolytic anemia and complex chronic disease manifested by sudden, severe, and life-threatening complications. These acute complications can occur in any organ system beginning in early childhood and lasting throughout life. The intermittent nature and acuity of these complications lend the emergency department to be an important site of care. The hall...

  7. The Prevalence of Visual Acuity Impairment among School Children at Arada Subcity Primary Schools in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Darge, Haile Fentahun; Shibru, Getahun; Mulugeta, Abiy; Dagnachew, Yinebeb Mezgebu

    2017-01-01

    Visual impairment and blindness are major public health problems in developing countries where there is no enough health-care service. To determine the prevalence of visual impairment among school children. A school-based cross-sectional study was conducted between 15 June 2015 and 30 November 2015 at Arada subcity primary schools, Addis Ababa, Ethiopia. Two schools were selected randomly, and 378 students were screened from grades 1 to 8 using systematic random sampling method. Snellen chart was used for visual acuity test. Students who had visual acuity of ≤6/12 were further examined by an ophthalmologist to diagnose the reason for low vision. Data was analyzed using SPSS version 20. A total of 378 students were screened, and 192 (50.8%) were females and the remaining 186 (49.2%) were males. The prevalence of visual impairment (VA) of ≤6/12 on either eye was 5.8%, VA visual acuity impairment. The prevalence of visual impairment among school children in the study area was 5.8% and school screening is recommended.

  8. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    Directory of Open Access Journals (Sweden)

    James Robert Langabeer

    2016-11-01

    Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  9. Refraction and visual acuity in a national Danish cohort of 4-year-old children of extremely preterm delivery

    DEFF Research Database (Denmark)

    Fledelius, Hans C; Bangsgaard, Regitze; Slidsborg, Carina

    2015-01-01

    PURPOSE: A recent threefold increase in laser treatment for advanced retinopathy of prematurity (ROP) triggered a nationwide preschool ophthalmic and developmental status among extremely preterm survivors. Here, we discuss refraction and visual acuity. METHODS: Survivors (n = 178) from a national...... was 0.1 in FT and 0.2 in PT, in Snellen equivalents 0.8 and 0.63. Snellen acuity ≤0.5 occurred across the ROP subgroups, but mainly in those with at least ROP stage 3. Two children had low vision. CONCLUSIONS: The overall fair outcome for refraction and function is in accordance with other recent...

  10. Taste acuity, plasma zinc levels, and weight loss during radiotherapy: a study of relationships

    International Nuclear Information System (INIS)

    Bolze, M.S.; Fosmire, G.J.; Stryker, J.A.; Chung, C.K.; Flipse, B.G.

    1982-01-01

    Thirty-five patients who were to undergo radiotherapy and 13 normal subjects were evaluated with taste questionnaires, taste acuity tests, and plasma zinc analyses. The studies were repeated on the patients in the fifth week of radiotherapy. The mean taste thresholds for NaCl (salt), sucrose (sweet), HCl (sour), and urea (bitter) were elevated and the plasma zinc levels were lower (77.2 +/- 11.8 vs. 94.6 +/- 30.1 g/100 ml, p . 0.055) for the patients than for the controls. However, there was not a significant correlation between the taste thresholds and plasma zinc levels at any time. The mean weight loss experienced by the 14 patients who reported subjective taste alteration in the fifth week was 3.1 kg versus 0.1 kg (p . 0.005) for those who did not report taste alteration. The data suggest that alterations in taste acuity, but not plasma zinc levels, are associated with weight loss during radiotherapy

  11. Taste acuity, plasma zinc levels, and weight loss during radiotherapy: a study of relationships

    International Nuclear Information System (INIS)

    Bolze, M.S.; Fosmire, G.J.; Stryker, J.A.; Chung, C.K.; Flipse, B.G.

    1982-01-01

    Thirty-five patients who were to undergo radiotherapy and 13 normal subjects were evaluated with taste questionnaires, taste acuity tests, and plasma zinc analyses. The studies were repeated on the patients in the fifth week of radiotherapy. The mean taste thresholds for NaCl (salt), sucrose (sweet), HCl (sour), and urea (bitter) were elevated and the plasma zinc levels were lower (77.2 +/- 11.8 vs. 94.6 +/- 30.1 g/100 ml, p = 0.055) for the patients than for the controls. However, there was not a significant correlation between the taste thresholds and plasma zinc levels at any time. The mean weight loss experienced by the 14 patients who reported subjective taste alteration in the fifth week was 3.1 kg versus 0.1 kg (p = 0.005) for those who did not report taste alteration. The data suggest that alterations in taste acuity, but not plasma zinc levels, are associated with weight loss during radiotherapy

  12. PROSPECTIVE EVALUATION OF VISUAL ACUITY AGREEMENT BETWEEN STANDARD EARLY TREATMENT DIABETIC RETINOPATHY STUDY CHART AND A HANDHELD EQUIVALENT IN EYES WITH RETINAL PATHOLOGY.

    Science.gov (United States)

    Rahimy, Ehsan; Reddy, Sahitya; DeCroos, Francis Char; Khan, M Ali; Boyer, David S; Gupta, Omesh P; Regillo, Carl D; Haller, Julia A

    2015-08-01

    To evaluate the visual acuity agreement between a standard back-illuminated Early Treatment Diabetic Retinopathy Study (ETDRS) chart and a handheld internally illuminated ETDRS chart. Two-center prospective study. Seventy patients (134 eyes) with retinal pathology were enrolled between October 2012 and August 2013. Visual acuity was measured using both the ETDRS chart and the handheld device by masked independent examiners after best protocol refraction. Examination was performed in the same room under identical illumination and testing conditions. The mean number of letters seen was 63.0 (standard deviation: 19.8 letters) and 61.2 letters (standard deviation: 19.1 letters) for the ETDRS chart and handheld device, respectively. Mean difference per eye between the ETDRS and handheld device was 1.8 letters. A correlation coefficient (r) of 0.95 demonstrated a positive linear correlation between ETDRS chart and handheld device measured acuities. Intraclass correlation coefficient was performed to assess the reproducibility of the measurements made by different observers measuring the same quantity and was calculated to be 0.95 (95% confidence interval: 0.93-0.96). Agreement was independent of retinal disease. The strong correlation between measured visual acuity using the ETDRS and handheld equivalent suggests that they may be used interchangeably, with accurate measurements. Potential benefits of this device include convenience and portability, as well as the ability to assess ETDRS visual acuity without a dedicated testing lane.

  13. Photovoltaic restoration of sight with high visual acuity

    Science.gov (United States)

    Lorach, Henri; Goetz, Georges; Smith, Richard; Lei, Xin; Mandel, Yossi; Kamins, Theodore; Mathieson, Keith; Huie, Philip; Harris, James; Sher, Alexander; Palanker, Daniel

    2015-01-01

    Patients with retinal degeneration lose sight due to gradual demise of photoreceptors. Electrical stimulation of the surviving retinal neurons provides an alternative route for delivery of visual information. We demonstrate that subretinal arrays with 70 μm photovoltaic pixels provide highly localized stimulation, with electrical and visual receptive fields of comparable sizes in rat retinal ganglion cells. Similarly to normal vision, retinal response to prosthetic stimulation exhibits flicker fusion at high frequencies, adaptation to static images and non-linear spatial summation. In rats with retinal degeneration, these photovoltaic arrays provide spatial resolution of 64 ± 11 μm, corresponding to half of the normal visual acuity in pigmented rats. Ease of implantation of these wireless and modular arrays, combined with their high resolution opens the door to functional restoration of sight. PMID:25915832

  14. Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India.

    Science.gov (United States)

    Singh, Samiksha; Doyle, Pat; Campbell, Oona Mr; Oakley, Laura; Rao, Gv Ramana; Murthy, Gvs

    2017-06-09

    To estimate the proportion of interfacility transfers (IFTs) transported by '108' ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of '108' services for pregnant women in India. A cross-sectional analysis of '108' ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called '108'. Proportion of all pregnancies and institutional deliveries in the population who were transported by '108', both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT. The '108' ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that '108' transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by '108' for IFTs-lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all '108' IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states. Only 6% institutional deliveries made use of the '108' ambulance for IFTs in India. The vast majority did not have any complication or emergency. The '108' service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

  15. Macular edema in Asian Indian premature infants with retinopathy of prematurity: Impact on visual acuity and refractive status after 1-year

    Directory of Open Access Journals (Sweden)

    Anand Vinekar

    2015-01-01

    Full Text Available Purpose: To report the impact of transient, self-resolving, untreated "macular edema" detected on spectral domain optical coherence tomography in Asian Indian premature infants with retinopathy of prematurity (ROP on visual acuity (VA and refraction at 1-year of corrected age. Materials and Methods: Visual acuity and refraction of 11 infants with bilateral macular edema (Group A was compared with gestational age-matched 16 infants with ROP without edema (Group B and 17 preterms infants without ROP and without edema (Group C at 3, 6, 9 and 12 months of corrected age using Teller Acuity Cards and cycloplegic retinoscopy. Sub-group analysis of the previously described pattern A and B macular edema was performed. Results: Visual acuity was lower in infants with macular edema compared with the other two control groups throughout the study period, but statistically significant only at 3 months. Visual improvement in these infants was highest between the 3 rd and 6 th month and plateaued by the end of the 1 st year with acuity comparable to the other two groups. The edema cohort was more hyperopic compared to the other two groups between 3 and 12 months of age. Pattern A edema had worse VA compared to pattern B, although not statistically significant. Conclusion: Macular edema, although transient, caused reduced VA as early as 3 months of corrected age in Asian Indian premature infants weighing <2000 g at birth. The higher hyperopia in these infants is possibly due to visual disturbances caused at a critical time of fovealization. We hypothesize a recovery and feedback mechanism based on the principles of active emmetropization to explain our findings.

  16. Examination of factors affecting gait properties in healthy older adults: focusing on knee extension strength, visual acuity, and knee joint pain.

    Science.gov (United States)

    Demura, Tomohiro; Demura, Shin-ichi; Uchiyama, Masanobu; Sugiura, Hiroki

    2014-01-01

    Gait properties change with age because of a decrease in lower limb strength and visual acuity or knee joint disorders. Gait changes commonly result from these combined factors. This study aimed to examine the effects of knee extension strength, visual acuity, and knee joint pain on gait properties of for 181 healthy female older adults (age: 76.1 (5.7) years). Walking speed, cadence, stance time, swing time, double support time, step length, step width, walking angle, and toe angle were selected as gait parameters. Knee extension strength was measured by isometric dynamometry; and decreased visual acuity and knee joint pain were evaluated by subjective judgment whether or not such factors created a hindrance during walking. Among older adults without vision problems and knee joint pain that affected walking, those with superior knee extension strength had significantly greater walking speed and step length than those with inferior knee extension strength (P pain in both knees showed slower walking speed and longer stance time and double support time. A decrease of knee extension strength and visual acuity and knee joint pain are factors affecting gait in the female older adults. Decreased knee extension strength and knee joint pain mainly affect respective distance and time parameters of the gait.

  17. Man with a Swollen Eye: Nonspecific Orbital Inflammation in an Adult in the Emergency Department.

    Science.gov (United States)

    Zhang, Xiao Chi; Statler, Brittney; Suner, Selim; Lloyd, Maureen; Curley, David; Migliori, Michael E

    2018-07-01

    Nonspecific orbital inflammation (NSOI) is a rare idiopathic ocular pathology characterized by unilateral, painful orbital swelling without identifiable infectious or systemic disorders, which can be complicated by optic nerve compromise. A 50-year-old man presented to the Emergency Department with recurring, progressive painless left eye swelling, decreased visual acuity, and binocular diplopia in the absence of trauma, infection, or known malignancy. His physical examination was notable for left-sided decreased visual acuity, an afferent pupillary defect, severe left eye proptosis and chemosis, and restricted extraocular movements; his dilatated funduscopic examination was notable for ipsilateral retinal folds within the macula, concerning for a disruption between the sclera and the retina. Ocular examination of the right eye was unremarkable. Laboratory data were unrevealing. Gadolinium-enhanced magnetic resonance imaging showed marked thickening of the left extraocular muscles associated with proptosis, dense inflammatory infiltration of the orbital fat, and characteristics consistent with perineuritis. The patient was diagnosed with NSOI with optic neuritis and admitted for systemic steroid therapy; he was discharged on hospital day 2 after receiving high-dose intravenous (i.v.) methylprednisolone with significant improvement. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: NSOI is a rare and idiopathic ocular emergency, with clinical mimicry resembling a broad spectrum of systemic diseases such as malignancy, autoimmune diseases, endocrine disorders, and infection. Initial work-up for new-onset ocular proptosis should include comprehensive laboratory testing and gadolinium-enhanced magnetic resonance imaging. Timely evaluation by an ophthalmologist is crucial to assess for optic nerve involvement. Signs of optic nerve compromise include decreased visual acuity, afferent pupillary defect, or decreased color saturation. Patients with optic nerve compromise

  18. Dream Catchers: "Margin Call," "Boss," and Climbing the Beanstalk

    Science.gov (United States)

    Beck, Bernard

    2012-01-01

    Two recent popular entertainments, "Margin Call" (Barnum, Dodson, Jenckes, Moosa, Quinto & Chandor, 2011) and "Boss" (Safinia, 2011), depict powerful and successful groups of bosses confronting sudden, extreme threats. They are forced to react quickly and sacrifice important values to achieve survival of their organizations. In these emergencies,…

  19. Temporary marked impairment of visual acuity in a case of intraocular malignant lymphoma during radiation therapy

    International Nuclear Information System (INIS)

    Miyao, Yoko; Tada, Rei; Koizumi, Noriko; Yamada, Hideaki; Kinoshita, Shigeru; Ikeda, Tsunehiko

    2000-01-01

    A 56-year-old female was referred to us for blurring of both eyes since 2 years before. She had been diagnosed as chronic uveitis and responded poorly to systemic and topical corticosteroid. Her corrected visual acuity was 0.8 right and 0.5 left. Systemic studies, including magnetic resonance imaging and gadolinium scintigraphy, were negative. Vitreous biopsy led to the diagnosis of malignant lymphoma originating from the eye. Seven days after initiation of radiation at the daily doses of 2 Gy, massive subretinal infiltration developed in her right eye forming a niveau. Systemic prednisolone induced resolution of exudate with improved visual acuity to 1.0 13 days later. This cases illustrates that radiation may induce temporary aggravation of intraocular malignant lymphoma and that it may undergo resolution following systemic corticosteroid. (author)

  20. Using patient acuity data to manage patient care outcomes and patient care costs.

    Science.gov (United States)

    Van Slyck, A; Johnson, K R

    2001-01-01

    This article describes actual reported uses for patient acuity data that go beyond historical uses in determining staffing allocations. These expanded uses include managing patient care outcomes and health care costs. The article offers the patient care executive examples of how objective, valid, and reliable data are used to drive approaches to effectively influence decision making in an increasingly competitive health care environment.

  1. The two sides of sensory-cognitive interactions: effects of age, hearing acuity, and working memory span on sentence comprehension

    Directory of Open Access Journals (Sweden)

    Renee eDeCaro

    2016-02-01

    Full Text Available Reduced hearing acuity is among the most prevalent of chronic medical conditions among older adults. An experiment is reported in which comprehension of spoken sentences was tested for older adults with good hearing acuity or with a mild-to-moderate hearing loss, and young adults with age-normal hearing. Comprehension was measured by participants’ ability to determine of the agent of an action in sentences that expressed this relation with a syntactically less complex subject-relative construction or a syntactically more complex object-relative construction. Agency determination was further challenged by inserting a prepositional phrase into sentences between the person performing an action and the action being performed. As a control, prepositional phrases of equivalent length were also inserted into sentences in a non-disruptive position. Effects on sentence comprehension of age, hearing acuity, prepositional phrase placement and sound level of stimulus presentations appeared only for comprehension of sentences with the more syntactically complex object-relative structures. Working memory as tested by reading span scores accounted for a significant amount of the variance in comprehension accuracy. Once working memory capacity and hearing acuity were taken into account, chronological age among the older adults contributed no further variance to comprehension accuracy. Results are discussed in terms of the positive and negative effects of sensory-cognitive interactions in comprehension of spoken sentences and lend support to a framework in which domain-general executive resources, notably verbal working memory, play a role in both linguistic and perceptual processing.

  2. When to use the emergency room - child

    Science.gov (United States)

    Emergency room - child; Emergency department - child; Urgent care - child; ER - when to use ... How quickly does your child need care? If your child could die or be permanently disabled, it is an emergency. Call 911 to have the ...

  3. Exploration of the perceptions of emergency physicians and interns regarding the medical documentation practices of interns.

    Science.gov (United States)

    Isoardi, Jonathon; Spencer, Lyndall; Sinnott, Michael; Nicholls, Kim; O'Connor, Angela; Jones, Fleur

    2013-08-01

    The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns. A qualitative design was adopted using semi-structured interviews in convenience samples drawn from both groups. Eighteen interviews were conducted with intern volunteers and 10 with EP volunteers. One (5%) intern and two (20%) EPs had received medical documentation training. Factors that encouraged interns' documentation included: patient acuity (the more critical the condition, the more comprehensive the documentation) and the support of senior colleagues. Inhibiting factors included uncertainty about how much to write, and the shift being worked (interns indicated they wrote less at night). Factors of consequence to senior personnel included the apparent reluctance of interns to document management plans. They noted that interns frequently confine their notes to assessment, investigations and treatments, whereas EPs preferred records that demonstrated intern thought processes and included such matters as future actions to follow immediate treatment. A positive theme that emerged included the high level of support interns received from their senior colleagues. Another theme, the influence of patient acuity, held both positive and negative implications for intern writing practices. The lack of formal training is an impediment to the production of useful medical records by ED interns. One solution proposed by both interns and senior personnel was the introduction of the subject into intern education programmes. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. Lawn mower injuries as a cause of serious visual acuity impairment – Case reports

    Directory of Open Access Journals (Sweden)

    Monika Jasielska

    2017-05-01

    Lawn mower induced eye injuries are a significant cause of serious visual acuity impairment or blindness. The presented study shows that lawn mower eye injuries are still a therapeutic, social and economic problem, yet are very preventable with proper eye protection and patients’ education. Current prevention strategies are inadequate, and therefore should be updated.

  5. Boarding admitted children in the emergency department impacts inpatient outcomes.

    Science.gov (United States)

    Bekmezian, Arpi; Chung, Paul J

    2012-03-01

    This study aimed to assess the relationship between boarding of admitted children in the emergency department (ED) and cost, inpatient length of stay (LOS), mortality, and readmission. This was a retrospective study of 1,792 pediatric inpatients admitted through the ED and discharged from the hospital between February 20, 2007 and June 30, 2008 at a major teaching hospital with an annual ED volume of 40,000 adult and pediatric patients.The main predictor variable was boarding time (time from admission decision to departure for an inpatient bed, in hours). Covariates were patient age, payer group, times of ED and inpatient bed arrival, ED triage acuity, type of inpatient service, intensive care unit admission, surgery, and severity of inpatient illness. The main outcome measures, cost (dollars) and inpatient LOS (hours), were log-transformed and analyzed using linear regressions. Secondary outcomes, mortality and readmission to the hospital within 72 hours of discharge, were analyzed using logistic regression. Mean ED LOS for admitted patients was 9.0 hours. Mean boarding time was 5.1 hours. Mean cost and inpatient LOS were $9893 and 147 hours, respectively. In general, boarding time was associated with cost (P boarding times were associated with greater inpatient LOS especially among patients triaged as low acuity (P = 0.008). In addition, longer boarding times were associated with greater probability of being readmitted among patients on surgical services (P = 0.01). Among low-acuity and surgical patients, longer boarding times were associated with longer inpatient LOS and more readmissions, respectively.

  6. A contralateral eye study comparing apodized diffrative and full diffrative lenses: wavefront analysis and distance and near uncorrected visual acuity

    Directory of Open Access Journals (Sweden)

    Marcony Rodrigues de Santhiago

    2009-01-01

    Full Text Available PURPOSE: To evaluate intraindividual visual acuity, wavefront errors and modulation transfer functions in patients implanted with two diffractive multifocal intraocular lenses. METHODS: This prospective study examined 40 eyes of 20 cataract patients who underwent phacoemulsification and implantation of a spherical multifocal ReSTOR intraocular lens in one eye and an aspheric Tecnis ZM900 multifocal intraocular lens in the other eye. The main outcome measures, over a 3-month follow-up period, were the uncorrected photopic distance and near visual acuity and the defocus curve. The visual acuity was converted to logMAR for statistical analysis and is presented in decimal scale. The wavefront error and modulation transfer function were also evaluated in both groups. RESULTS: At the 3-month postoperative visit, the mean photopic distance uncorrected visual acuity (UCVA was 0.74 ± 0.20 in the ReSTOR group and 0.76 ± 0.22 in the Tecnis group (p=0.286. The mean near UCVA was 0.96 ± 0.10 in the ReSTOR group and 0.93 ± 0.14 in the Tecnis group (p=0.963. The binocular defocus curve showed measurements between the peaks better than 0.2 logMAR. The total aberration, higher-order aberration and coma aberration were not significantly different between the groups. The spherical aberration was significantly lower in the Tecnis group than in the ReSTOR group. (p=0.004. Both groups performed similarly for the modulation transfer function. CONCLUSION: The ReSTOR SN60D3 and Tecnis ZM 900 intraocular lenses provided similar photopic visual acuity at distance and near. The diffractive intraocular lenses studied provided a low value of coma and spherical aberrations, with the Tecnis intraocular lens having a statistically lower spherical aberration compared to the ReSTOR intraocular lens. In the 5 mm pupil diameter analyses, both intraocular lens groups showed similar modulation transfer functions.

  7. Effect of magnetic resonance imaging on near visual acuity Efecto de la resonancia magnética sobre la agudeza visual cercana

    OpenAIRE

    José David Paulo Trujillo; Juan Carlos Vergara; Jorge Hernando Donado Gómez; Luz Marina Agudelo; Mercedes Cecilia Molina Betancur; Andrés Ignacio Arbeláez Medina; Carlos Andrés Molina Betancur

    2007-01-01

    Purpose: To determine the variation of near visual acuity, in patients exposed during short periods to intense magnetic fields in studies of magnetic resonance imaging. Methods: Descriptive study of a case series that included 40 healthy and literate individuals older than 40 years, nine of them men, submitted to a procedure of head and neck magnetic resonance imaging; all of them had near visual acuity better than 20/200 without glasses, and were not under the effects of ansiolytic medicatio...

  8. Experimental validation of a Bayesian model of visual acuity.

    LENUS (Irish Health Repository)

    Dalimier, Eugénie

    2009-01-01

    Based on standard procedures used in optometry clinics, we compare measurements of visual acuity for 10 subjects (11 eyes tested) in the presence of natural ocular aberrations and different degrees of induced defocus, with the predictions given by a Bayesian model customized with aberrometric data of the eye. The absolute predictions of the model, without any adjustment, show good agreement with the experimental data, in terms of correlation and absolute error. The efficiency of the model is discussed in comparison with image quality metrics and other customized visual process models. An analysis of the importance and customization of each stage of the model is also given; it stresses the potential high predictive power from precise modeling of ocular and neural transfer functions.

  9. Method and system for conserving power in a telecommunications network during emergency situations

    Energy Technology Data Exchange (ETDEWEB)

    Conrad, Stephen H [Algodones, NM; O' Reilly, Gerard P [Manalapan, NJ

    2011-10-11

    Disclosed is a method and apparatus for conserving power in a telecommunications network during emergency situations. A permissible number list of emergency and/or priority numbers is stored in the telecommunications network. In the event of an emergency or power failure, input digits of a call to the telecommunications network are compared to the permissible number list. The call is processed in the telecommunications network and routed to its destination if the input digits match an entry in the permissible number list. The call is dropped without any further processing if the input digits do not match an entry in the permissible number list. Thus, power can be conserved in emergency situations by only allowing emergency and/or priority calls.

  10. Post-treatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanoma: Dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Gillin, Michael; Albano, Katherine; Erickson, Beth

    1996-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1993, 63 patients underwent 125 I episcleral plaque application for the treatment of choroidal melanoma. Mean tumor height was 4.6 mm (range 1.7-8.3 mm). Plaques utilized were of COMS design. Doses and dose rates at the tumor apex, macula, and optic disc were obtained. Visual acuity data prior to and after plaque application was available for 52 patients. 9 patients were excluded from analysis secondary to co-morbidities or disease progression. 43 records were scored to assess if a decrease in visual acuity of ≥ 2 lines on a standard Snellen eye chart had occurred. Statistical analysis was performed using chi-square tests of significance. Results: Of the 63 total patients, 59 (93.7%) were alive at a median follow-up of 36 months. Local progression occurred in (7(63)) (11.1%). Median dose and dose rate to the tumor apex were 90 Gy and 97.2 cGy/hr, respectively. Of the 43 patients with post-treatment visual acuity analysis, 28 (65.1%) experienced visual loss of ≥ 2 lines on a standard eye chart. Median time to altered visual acuity was 20 months. Median dose and dose rates to the macula in patients with a significant visual loss were 123.3 Gy and 122.5 cGy/hr, respectively, compared with 38 Gy and 51.9 cGy/hr in those without notable visual change. These differences reached statistical significance at a dose and dose rate to the macula of 82.0 Gy (p 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of decreased visual acuity. Both total dose and dose rates to the macula and optic disc correlated strongly with post-treatment visual outcome. This information may be valuable in decisions about the dose and dose rates used to treat

  11. Post-treatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanoma: dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Murray, Kevin; Gillin, Michael; Albano, Katherine; Erickson, Beth

    1996-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1994, 63 patients underwent 125 I episcleral plaque application for the treatment of choroidal melanoma. Mean tumor height was 4.6 mm (range 1.7-8.3 mm). Plaques utilized were of COMS design. Doses and dose rates at the tumor apex, macula, and optic disc were obtained. Visual acuity data prior to and after plaque application was available for 52 patients. Nine patients were excluded from analysis secondary to co-morbidities or disease progression. Forty-three records were scored to assess if a decrease in visual acuity of ≥ 2 lines on a standard Snellen eye chart had occurred. Statistical analysis was performed using chi-square tests of significance. Results: Of the 63 total patients, 59 (93.7%) were alive at a median follow-up of 36 months. Local progression occurred in 7/63 (11.1%). Median dose and dose rate to the tumor apex were 90 Gy and 97.2 cGy/hr, respectively. Of the 43 patients with post-treatment visual acuity analysis, 28 (65.1%) experienced visual loss of ≥ 2 lines on a standard eye chart. Median time to altered visual acuity was 20 months. Median dose and dose rates to the macula in patients with a significant visual loss were 123.3 Gy and 122.5 cGy/hr, respectively, compared with 38 Gy and 51.9 cGy/hr in those without notable visual change. These differences reached statistical significance at a dose and dose rate to the macula of 82.0 Gy (p 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of decreased visual acuity. Both total dose and dose rates to the macula and optic disc correlated strongly with post-treatment visual outcome. This information may be valuable in decisions about the dose and dose rates used to

  12. CLINICAL PRESENTATION OF LENS INDUCED GLAUCOMA: STUDY OF EPIDEMIOLOGY, DURATION OF SYMPTOMS, INTRAOCULAR PRESSURE AND VISUAL ACUITY

    Directory of Open Access Journals (Sweden)

    Venkataratnam

    2015-10-01

    Full Text Available BACKGROUND: Lens Induced Glaucoma is a common cause of ocular morbidity. OBJECTIVES: Our study was to know the Epidemiological factors, Duration of Symptoms, Visual Acuity and Intraocular Pressure in the clinical Presentation of Lens Induced Glaucoma. MATERIALS AND METHODS : This w as a tertiary hospital based prospective study in the department of Glaucoma, Sarojini Devi Eye Hospital and Regional Institute of Ophthalmology (RIO, Osmania Medical College, Hyderabad over a period from March 2015 to August 2015. 50 Patients clinically diagnosed as Lens Induced Glaucoma (LIG were studied with the data of Age, Sex, literacy, Laterality and Rural / Urban status with the duration of symptoms, Intraocular pressure and Visual Acuity. The data was analyzed by simple statistical methods. RESULT S: 50 patients, clinically diagnosed as Lens Induced Glaucoma (LIG were studied. Age group distribution was 1(2.0% in 40 - 50yrs, 13 ( 26.0% in >50 - 60yrs, 26(52.0% in >60 - 70yrs and 10(20.0% in > 70 yrs. Sex distribution was 23(46.0% of Males and 27(54.0% of Females. Urban / Rural status was 15(30.0% of Urban and 35(70.0% of Rural. Literacy status was 7(14.0% of Literate and 43(86.0% of Illiterate. Laterality was RE in 24(48.0% and LE in 26(52.0%. Duration of the presenting symptoms before re porting to the Hospital was 12.0% in 2wks. Intraocular pressure (IOP in mm of Hg showed no case (0.0% in 20 – 40, 27(54.0% in >40 - 60 and 5(10.0% >60 wit h the Mean IOP of 42.12 mm of Hg. Visual Acuity (VA was PL +ve in 24(48.0 and HM - 3/60. CONCLUSIONS: Increasing age, female gender, rural, illiterate, and delayed reporting to the hospital after the pre senting symptoms were the common risk factors with increased Intraocular pressure and poor visual acuity in the clinical presentation of Lens induced Glaucoma.

  13. Short-Term Changes in Weather and Space Weather Conditions and Emergency Ambulance Calls for Elevated Arterial Blood Pressure

    Directory of Open Access Journals (Sweden)

    Jone Vencloviene

    2018-03-01

    Full Text Available Circadian rhythm influences the physiology of the cardiovascular system, inducing diurnal variation of blood pressure. We investigated the association between daily emergency ambulance calls (EACs for elevated arterial blood pressure during the time intervals of 8:00–13:59, 14:00–21:59, and 22:00–7:59 and weekly fluctuations of air temperature (T, barometric pressure, relative humidity, wind speed, geomagnetic activity (GMA, and high-speed solar wind (HSSW. We used the Poisson regression to explore the association between the risk of EACs and weather variables, adjusting for seasonality and exposure to CO, PM10, and ozone. An increase of 10 °C when T > 1 °C on the day of the call was associated with a decrease in the risk of EACs during the time periods of 14:00–21:59 (RR (rate ratio = 0.78; p < 0.001 and 22:00–7:59 (RR = 0.88; p = 0.35. During the time period of 8:00–13:59, the risk of EACs was positively associated with T above 1 °C with a lag of 5–7 days (RR = 1.18; p = 0.03. An elevated risk was associated during 8:00–13:59 with active-stormy GMA (RR = 1.22; p = 0.003; during 14:00–21:59 with very low GMA (RR = 1.07; p = 0.008 and HSSW (RR = 1.17; p = 0.014; and during 22:00–7:59 with HSSW occurring after active-stormy days (RR = 1.32; p = 0.019. The associations of environmental variables with the exacerbation of essential hypertension may be analyzed depending on the time of the event.

  14. Comparison of visual acuity in reduced lumination and facility of ocular accommodation in table tennis champions and non- players.

    Science.gov (United States)

    Jafarzadehpur, Ebrahim; Yarigholi, Mohammad R

    2004-03-01

    A table tennis player should fixate at different distances; track the objects with different speed, and in different visual environment. Their visual skills must be well developed for these capabilities. Therefore, visual acuity in reduced lumination and facility of ocular accommodation those are two criteria for visual skills have been compared in table tennis players and normal non-players. Twenty-nine young table tennis champions and 29 normal matched non-players (did not take part in any racket sports game) were evaluated. Basic visual and eye examinations were done for both of them. Normal results in basic examination were fundamental requirement for all the subjects. +/-2.00 sphere lenses for accommodation facility are used. An electrical current regulator changed the output light intensity of a conventional chart projector (Topcon). Light intensity decreased to 10 cd·m(-2) and visual acuity tested. In comparison of visual acuity in reduced lumination and facility of ocular accommodation in table tennis champions and non-players there are significant differences (p reflecting a better perceptual system of experts to the constraints encountered during table tennis and its use in practical settings for evaluating athletes or detecting sport talents. However some visual and perceptual training that usually used in orthoptics can be used for novice table tennis player to improve their abilities. Key PointsThat the ability of a champion depends on many sensory, motor and perceptual factors.Visual factors such as facility of accommodation and visual acuity in reduced lumination should be considered in table tennis players.Visual training may be useful for novice and also for experts.

  15. Football emergency medicine

    African Journals Online (AJOL)

    may be called upon to intervene medically when a football player succumbs to a severe ... including safety and security services, emergency and primary health care medical ..... of the European Resuscitation Council (ERC) guidelines 2005.

  16. Anticipatory Ethics for Emerging Technologies

    NARCIS (Netherlands)

    Brey, Philip A.E.

    2012-01-01

    In this essay, a new approach for the ethical study of emerging technology ethics will be presented, called anticipatory technology ethics (ATE). The ethics of emerging technology is the study of ethical issues at the R&D and introduction stage of technology development through anticipation of

  17. What Do Monkey Calls Mean?

    Science.gov (United States)

    Schlenker, Philippe; Chemla, Emmanuel; Zuberbühler, Klaus

    2016-12-01

    A field of primate linguistics is gradually emerging. It combines general questions and tools from theoretical linguistics with rich data gathered in experimental primatology. Analyses of several monkey systems have uncovered very simple morphological and syntactic rules and have led to the development of a primate semantics that asks new questions about the division of semantic labor between the literal meaning of monkey calls, additional mechanisms of pragmatic enrichment, and the environmental context. We show that comparative studies across species may validate this program and may in some cases help in reconstructing the evolution of monkey communication over millions of years. Copyright © 2016. Published by Elsevier Ltd.

  18. Evaluating the effect of clinical decision units on patient flow in seven Canadian emergency departments.

    Science.gov (United States)

    Schull, Michael J; Vermeulen, Marian J; Stukel, Therese A; Guttmann, Astrid; Leaver, Chad A; Rowe, Brian H; Sales, Anne

    2012-07-01

    To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). A retrospective analysis of unscheduled ED visits at seven CDU pilot and nine control sites was conducted using administrative data. The authors examined trends in CDU utilization and compared outcomes between pilot-CDU and control sites 1 year prior to implementation, with the first 18 months of CDU operation. Sites that were unsuccessful in their applications for CDU program funding served as controls. Outcomes included ED length of stay (LOS), admission rates, and ED revisit rates. At CDU sites, roughly 4% of ED patients were admitted to CDUs. The presence of a pilot-CDU was independently associated with a small reduction in ED LOS for all low-acuity patients (-0.14 hour, 95% confidence interval [CI]=-0.22 to -0.07) and nonadmitted patients (-0.11 hour, 95% CI=-0.16 to -0.07). A small independent effect on absolute hospital admission rate for all high-acuity patients (-0.8%, 95% CI=-1.5% to -0.03%) and moderate-acuity patients (-0.6%, 95% CI=-1.1% to -0.2%) was also observed. Pilot-CDUs were not associated with changes in ED revisit rates. With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate. © 2012 by the Society for Academic Emergency Medicine.

  19. A study of static, kinetic, and dynamic visual acuity in 102 Japanese professional baseball players

    Directory of Open Access Journals (Sweden)

    Hoshina K

    2013-03-01

    Full Text Available Kohji Hoshina,1 Yuichi Tagami,2 Osamu Mimura,3 Hiroshi Edagawa,4 Masao Matsubara,5 Teiichi Nakayama6 1Hoshina Eye Clinic, Nishinomiya, Japan; 2Department of Ophthalmology, Kobe Century Memorial Hospital, Kobe, Japan; 3Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan; 4Edagawa Eye Clinic, Tokyo, Japan; 5Department of Ophthalmology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan; 6Ritsumeikan University, Kyoto, Japan Background: It seemed that visual functions might have some effects on the performance of baseball players. We measured static, kinetic, and dynamic visual acuity (SVA, KVA, and DVA, respectively of Japanese professional baseball players to ascertain whether there would be any difference in SVA, KVA, and DVA among player groups stratified according to their performance level. Methods: The subjects were 102 male professional baseball players with a mean age of 26 years who were members of a Japanese professional baseball club from 2000 to 2009. They were stratified into three groups according to their performance level: A (players who were on the roster of the top-level team all the time throughout the study period, B (players who were on the roster of the top-level team sometimes but not all the time, and C (players who were never on the roster of the top-level team. They were interviewed for the use of corrective visual aids, and examined for SVA, KVA, and DVA. The measurements of these parameters were compared among groups A, B, and C. We also investigated and analyzed the association of KVA or DVA with player position (pitchers or fielders and with hand dominance for batting. KVA was compared between the pitchers and the fielders because they each require different playing skills. DVA was compared between the right-handed and the left-handed batters. Results: There was no statistically significant difference among groups A, B, and C. There was a statistically significant difference in

  20. Testbed for High-Acuity Imaging and Stable Photometry

    Science.gov (United States)

    Gregory, James

    This proposal from MIT Lincoln Laboratory (LL) accompanies the NASA/APRA proposal enti-tled THAI-SPICE: Testbed for High-Acuity Imaging - Stable Photometry and Image-Motion Compensa-tion Experiment (submitted by Eliot Young, Southwest Research Institute). The goal of the THAI-SPICE project is to demonstrate three technologies that will help low-cost balloon-borne telescopes achieve diffraction-limited imaging: stable pointing, passive thermal stabilization and in-flight monitoring of the wave front error. This MIT LL proposal supplies a key element of the pointing stabilization component of THAI-SPICE: an electronic camera based on an orthogonaltransfer charge-coupled device (OTCCD). OTCCD cameras have been demonstrated with charge-transfer efficiencies >0.99999, noise of 90%. In addition to supplying a camera with an OTCCD detector, MIT LL will help with integration and testing of the OTCCD with the THAI-SPICE payload’s guide camera.

  1. Wound center facility billing: A retrospective analysis of time, wound size, and acuity scoring for determining facility level of service.

    Science.gov (United States)

    Fife, Caroline E; Walker, David; Farrow, Wade; Otto, Gordon

    2007-01-01

    Outpatient wound center facility reimbursement for Medicare beneficiaries can be a challenge to determine and obtain. To compare methods of calculating facility service levels for outpatient wound centers and to demonstrate the advantages of an acuity-based billing system (one that incorporates components of facility work that is non-reimbursable by procedure codes and that represents an activity-based costing approach to medical billing), a retrospective study of 5,098 patient encounters contained in a wound care-specific electronic medical record database was conducted. Approximately 500 patient visits to the outpatient wound center of a Texas regional hospital between April 2003 and November 2004 were categorized by service level in documentation and facility management software. Visits previously billed using a time-based system were compared to the Centers for Medicare and Medicaid Services' proposed three-tiered wound size-based system. The time-based system also was compared to an acuity-based scoring system. The Pearson correlation coefficient between billed level of service by time and estimated level of service by acuity was 0.442 and the majority of follow-up visits were billed as Level 3 and above (on a time level of 1 to 5) , confirming that time is not a surrogate for actual work performed. Wound size also was found to be unrelated to service level (Pearson correlation = 0.017) and 97% of wound areas were billings than extremes; no other method produced this distribution. Hospital-based outpatient wound centers should develop, review, and refine acuity score-based models on which to determine billed level of service.

  2. Cultivating Perspectival Acuity: The Value and Cost of Integrating Theory, Craft, Research, and Practice

    Directory of Open Access Journals (Sweden)

    Joe Manganelli

    2016-10-01

    Full Text Available This paper presents reflections on integrating theory, craft, research, and practice to improve the accuracy and resiliency of each. The reflections build toward a set of statements about the value and the cost of integrating theory, craft, research, and practice. Specifically, the authors offer the Privileged Work / Non-Privileged Work Framework and concept of cultivating Perspectival Acuity.

  3. Emergent Behaviour

    NARCIS (Netherlands)

    Blom, H.A.P.; Everdij, M.H.C.; Bouarfa, S.; Cook, A; Rivas, D

    2016-01-01

    In complexity science a property or behaviour of a system is called emergent if it is not a property or behaviour of the constituting elements of the system, though results from the interactions between its constituting elements. In the socio-technical air transportation system these interactions

  4. Presentation patterns and outcomes of patients with cancer accessing care in emergency departments in Victoria, Australia.

    Science.gov (United States)

    van der Meer, Dania M; Weiland, Tracey J; Philip, Jennifer; Jelinek, George A; Boughey, Mark; Knott, Jonathan; Marck, Claudia H; Weil, Jennifer L; Lane, Heather P; Dowling, Anthony J; Kelly, Anne-Maree

    2016-03-01

    People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer. This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients. ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1). ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.

  5. The (lack of) relation between straylight and visual acuity. Two domains of the point-spread-function

    NARCIS (Netherlands)

    van den Berg, Thomas J T P

    2017-01-01

    PURPOSE: The effect of cataract and other media opacities on functional vision is typically assessed clinically using visual acuity. In both clinical and basic research, straylight (the functional result of light scattering in the eye) is commonly measured. The purpose of the present study was to

  6. The Prevalence of Visual Acuity Impairment among School Children at Arada Subcity Primary Schools in Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Haile Fentahun Darge

    2017-01-01

    Full Text Available Background. Visual impairment and blindness are major public health problems in developing countries where there is no enough health-care service. Objective. To determine the prevalence of visual impairment among school children. Materials and Methods. A school-based cross-sectional study was conducted between 15 June 2015 and 30 November 2015 at Arada subcity primary schools, Addis Ababa, Ethiopia. Two schools were selected randomly, and 378 students were screened from grades 1 to 8 using systematic random sampling method. Snellen chart was used for visual acuity test. Students who had visual acuity of ≤6/12 were further examined by an ophthalmologist to diagnose the reason for low vision. Data was analyzed using SPSS version 20. Results. A total of 378 students were screened, and 192 (50.8% were females and the remaining 186 (49.2% were males. The prevalence of visual impairment (VA of ≤6/12 on either eye was 5.8%, VA < 6/18 on either eye was 1.1%, and VA < 6/18 on the better eye was 0.53%. In this study, color blindness [OR: 19.65, 95% CI (6.01–64.33] was significantly associated with visual acuity impairment. Conclusion. The prevalence of visual impairment among school children in the study area was 5.8% and school screening is recommended.

  7. Effects of Milk vs Dark Chocolate Consumption on Visual Acuity and Contrast Sensitivity Within 2 Hours: A Randomized Clinical Trial.

    Science.gov (United States)

    Rabin, Jeff C; Karunathilake, Nirmani; Patrizi, Korey

    2018-04-26

    Consumption of dark chocolate can improve blood flow, mood, and cognition in the short term, but little is known about the possible effects of dark chocolate on visual performance. To compare the short-term effects of consumption of dark chocolate with those of milk chocolate on visual acuity and large- and small-letter contrast sensitivity. A randomized, single-masked crossover design was used to assess short-term visual performance after consumption of a dark or a milk chocolate bar. Thirty participants without pathologic eye disease each consumed dark and milk chocolate in separate sessions, and within-participant paired comparisons were used to assess outcomes. Testing was conducted at the Rosenberg School of Optometry from June 25 to August 15, 2017. Visual acuity (in logMAR units) and large- and small-letter contrast sensitivity (in the log of the inverse of the minimum detectable contrast [logCS units]) were measured 1.75 hours after consumption of dark and milk chocolate bars. Among the 30 participants (9 men and 21 women; mean [SD] age, 26 [5] years), small-letter contrast sensitivity was significantly higher after consumption of dark chocolate (mean [SE], 1.45 [0.04] logCS) vs milk chocolate (mean [SE], 1.30 [0.05] logCS; mean improvement, 0.15 logCS [95% CI, 0.08-0.22 logCS]; P chocolate (mean [SE], 2.05 [0.02] logCS) vs milk chocolate (mean [SE], 2.00 [0.02] logCS; mean improvement, 0.05 logCS [95% CI, 0.00-0.10 logCS]; P = .07). Visual acuity improved slightly after consumption of dark chocolate (mean [SE], -0.22 [0.01] logMAR; visual acuity, approximately 20/12) and milk chocolate (mean [SE], -0.18 [0.01] logMAR; visual acuity, approximately 20/15; mean improvement, 0.04 logMAR [95% CI, 0.02-0.06 logMAR]; P = .05). Composite scores combining results from all tests showed significant improvement after consumption of dark compared with milk chocolate (mean improvement, 0.20 log U [95% CI, 0.10-0.30 log U]; P chocolate bar compared with a

  8. Conduits to care: call lights and patients’ perceptions of communication

    Science.gov (United States)

    Montie, Mary; Shuman, Clayton; Galinato, Jose; Patak, Lance; Anderson, Christine A; Titler, Marita G

    2017-01-01

    Background Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients’ perceptions concerning call light use and communication. The specific aim of this study was to solicit patients’ perceptions regarding their call light use and communication with nursing staff. Methods Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated). Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Results Using qualitative descriptive methods, five major themes emerged from patients’ perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants’ perceptions of “nurse work”). Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Discussion Findings from this study extend the knowledge of patients’ understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery. PMID:29075125

  9. Conduits to care: call lights and patients' perceptions of communication.

    Science.gov (United States)

    Montie, Mary; Shuman, Clayton; Galinato, Jose; Patak, Lance; Anderson, Christine A; Titler, Marita G

    2017-01-01

    Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients' perceptions concerning call light use and communication. The specific aim of this study was to solicit patients' perceptions regarding their call light use and communication with nursing staff. Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated). Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Using qualitative descriptive methods, five major themes emerged from patients' perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants' perceptions of "nurse work"). Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Findings from this study extend the knowledge of patients' understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery.

  10. Visual acuity, self-reported vision and falls in the EPIC-Norfolk Eye study

    OpenAIRE

    Yip, Jennifer L Y; Khawaja, Anthony P; Broadway, David; Luben, Robert; Hayat, Shabina; Dalzell, Nichola; Bhaniani, Amit; Wareham, Nicholas; Khaw, Kay-Tee; Foster, Paul J

    2013-01-01

    Purpose To examine the relationship between visual acuity (VA) and self-reported vision (SRV) in relation to falls in 8317 participants of the European Prospective Investigation into Cancer-Norfolk Eye study. Methods All participants completed a health questionnaire that included a question regarding SRV and questions regarding the number of falls in the past year. Distance VA was measured using a logMAR chart for each eye. Poor SRV was defined as those reporting fair or poor distance vision....

  11. Hearing acuity as a predictor of walking difficulties in older women.

    Science.gov (United States)

    Viljanen, Anne; Kaprio, Jaakko; Pyykkö, Ilmari; Sorri, Martti; Koskenvuo, Markku; Rantanen, Taina

    2009-12-01

    To examine whether hearing acuity correlates with walking ability and whether impaired hearing at baseline predicts new self-reported walking difficulties after 3 years. Prospective follow-up. Research laboratory and community. Four hundred thirty-four women aged 63 to 76. Hearing was measured using clinical audiometry. A person was defined as having a hearing impairment if a pure-tone average of thresholds at 0.5 to 4 kHz in the better ear was 21 dB or greater. Maximal walking speed was measured over 10 m (m/s), walking endurance as the distance (m), covered in 6 minutes and difficulties in walking 2 km according to self-report. At baseline, women with hearing impairment (n=179) had slower maximal walking speed (1.7 +/- 0.3 m/s vs 1.8 +/- 0.3 m/s, P=.007), lower walking endurance (520 +/- 75 m vs 536 +/- 75 m, P=.08), and more selfreported major difficulties in walking 2 km (12.8% vs 5.5%, P=.02) than those without hearing impairment. During follow-up, major walking difficulties developed for 33 participants. Women with hearing impairment at baseline had a twice the age-adjusted risk for new walking difficulties as those without hearing impairment (odds ratio=2.04, 95% confidence interval=0.96-4.33). Hearing acuity correlated with mobility, which may be explained by the association between impaired hearing and poor balance and greater risk for falls, both of which underlie decline in mobility. Prevention of hearing loss is not only important for the ability to communicate, but may also have more wide-ranging influences on functional ability.

  12. Mental, physical and social health problems of call centre workers

    Directory of Open Access Journals (Sweden)

    P Bhuyar

    2008-01-01

    Full Text Available Background: Call centre workers in BPO face unique occupational hazards - mental, physical and psychosocial. Material & Method: A sample 100 call centre workers of both sexes and from two cities Pune and Mumbai were surveyed by both qualitative and quantitative methods for the above health problems. Results: A high proportion of workers faced sleep disturbances and associated mental stress and anxiety. Sleep disturbance and anxiety was significantly more in international call centres compared to domestic. There was also disturbance in circadian rhythms due to night shift. Physical problems such as musculoskeletal disorders, obesity, eye, and hearing problems were also present. Psychosocial problems included disruption in family life, use of tobacco and alcohol, and faulty eating habits. Conclusion: Better personal management, health education and more research is indicated to study the health problems in this emerging occupation.

  13. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    Science.gov (United States)

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  14. Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

    Directory of Open Access Journals (Sweden)

    Buylaert Walter

    2010-11-01

    Full Text Available Abstract Background Overuse of emergency departments (ED is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP on call or the ED. Methods Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services. Results 1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women. Conclusions Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.

  15. Reduction in laboratory turnaround time decreases emergency room length of stay

    Directory of Open Access Journals (Sweden)

    Kaushik N

    2018-04-01

    Full Text Available Nitin Kaushik,1 Victor S Khangulov,2 Matthew O’Hara,2 Ramy Arnaout3,4 1Becton, Dickinson and Company, Franklin Lakes, NJ, USA; 2Department of Health Economics and Outcomes Research, Boston Strategic Partners, Inc., Boston, MA, USA; 3Department of Pathology, 4Division of Biomedical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA Objective: Laboratory tests are an important contributor to treatment decisions in the emergency department (ED. Rapid turnaround of laboratory tests can optimize ED throughout by reducing the length of stay (LOS and improving patient outcomes. Despite evidence supporting the effect of shorter turnaround time (TAT on LOS and outcomes, there is still a lack of large retrospective studies examining these associations. Here, we evaluated the effect of a reduction in laboratory TAT on ED LOS using retrospective analysis of Electronic Health Records (EHR. Materials and methods: Retrospective analysis of ED encounters from a large, US-based, de-identified EHR database and a separate analysis of ED encounters from the EHR of an ED at a top-tier tertiary care center were performed. Additionally, an efficiency model calculating the cumulative potential LOS time savings and resulting financial opportunity due to laboratory TAT reduction was created, assuming other factors affecting LOS are constant. Results: Multivariate regression analysis of patients from the multisite study showed that a 1-minute decrease in laboratory TAT was associated with 0.50 minutes of decrease in LOS. The single-site analysis confirmed our findings from the multisite analysis that a positive correlation between laboratory TAT and ED LOS exists in the ED population as a whole, as well as across different patient acuity levels. In addition, based on the calculations from the efficiency model, for a 5-, 10- and 15-minute TAT reduction, the single-site ED can potentially admit a total of 127, 256 and 386 additional

  16. Anticipating ethical issues in emerging IT

    NARCIS (Netherlands)

    Brey, Philip A.E.

    2012-01-01

    In this essay, a new approach to the ethics of emerging information technology will be presented, called anticipatory technology ethics (ATE). The ethics of emerging technology is the study of ethical issues at the R&D and introduction stage of technology development through anticipation of possible

  17. Readers' Trust, Socio-Demographic, and Acuity Influences in Citizen Journalism Credibility for Disrupted Online Newspapers

    Science.gov (United States)

    Wester, Aaron Micah

    2013-01-01

    The purpose of this quantitative research study was to evaluate and determine if significant associations and linear correlations exist between reader socio-demographics, levels of trust and affinity in online citizen writer news story article content, brand loyalty, and acuity in newspaper organizations transitioning from print to online in a…

  18. UC3M Emergencies : health center search, first aid, defibrillators, emergency exits, last warnings and torch (iOS platform)

    OpenAIRE

    Martín Civiac, María

    2013-01-01

    This document contains Maria Martin’s bachelor thesis. The issues that this project wants to solve are emergencies-related: health centersand emergency exits location,emergency call, first aid instructions and information and latest emergency alerts at Carlos III University. It has been detected that members of Carlos III University currently have difficulties to find health centers, emergency exits and first aid information. Furthermore, the University itself did not have any mechanism to pu...

  19. Patterns of call communication between group-housed zebra finches change during the breeding cycle.

    Science.gov (United States)

    Gill, Lisa F; Goymann, Wolfgang; Ter Maat, Andries; Gahr, Manfred

    2015-10-06

    Vocal signals such as calls play a crucial role for survival and successful reproduction, especially in group-living animals. However, call interactions and call dynamics within groups remain largely unexplored because their relation to relevant contexts or life-history stages could not be studied with individual-level resolution. Using on-bird microphone transmitters, we recorded the vocalisations of individual zebra finches (Taeniopygia guttata) behaving freely in social groups, while females and males previously unknown to each other passed through different stages of the breeding cycle. As birds formed pairs and shifted their reproductive status, their call repertoire composition changed. The recordings revealed that calls occurred non-randomly in fine-tuned vocal interactions and decreased within groups while pair-specific patterns emerged. Call-type combinations of vocal interactions changed within pairs and were associated with successful egg-laying, highlighting a potential fitness relevance of calling dynamics in communication systems.

  20. Boarding inpatients in the emergency department increases discharged patient length of stay.

    Science.gov (United States)

    White, Benjamin A; Biddinger, Paul D; Chang, Yuchiao; Grabowski, Beth; Carignan, Sarah; Brown, David F M

    2013-01-01

    Boarding of inpatients in the Emergency Department (ED) has been widely recognized as a major contributor to ED crowding and a cause of adverse outcomes. We hypothesize that these deleterious effects extend to those patients who are discharged from the ED by increasing their length of stay (LOS). This study investigates the impact of boarding inpatients on the ED LOS of discharged patients. This retrospective, observational, cohort study investigated the association between ED boarder burden and discharged patient LOS over a 3-year period in an urban, academic tertiary care ED. Median ED LOS of 179,840 discharged patients was calculated for each quartile of the boarder burden at time of arrival, and Spearman correlation coefficients were used to summarize the relationship. Subgroup analyses were conducted, stratified by patient acuity defined by triage designation, and hour of arrival. Overall median discharged patient ED LOS increased by boarder burden quartile (205 [95% confidence interval (CI) 203-207], 215 [95% CI 214-217], 221 [95% CI 219-223], and 221 [95% CI 219-223] min, respectively), with a Spearman correlation of 0.25 between daily total boarder burden hours and median LOS. When stratified by patient acuity and hour of arrival (11:00 a.m.-11:00 p.m.), LOS of medium-acuity patients increased significantly by boarder burden quartile (252 [95% CI 247-255], 271 [95% CI 267-275], 285 [95% CI 95% CI 278-289], and 309 [95% CI 305-315] min, respectively) with a Spearman correlation of 0.18. In this retrospective study, increasing boarder burden was associated with increasing LOS of patients discharged from the ED, with the greatest effect between 11:00 a.m. and 11:00 p.m. on medium-acuity patients. This relationship between LOS and ED capacity limitation by inpatient boarders has important implications, as ED and hospital leadership increasingly focus on ED LOS as a measure of efficiency and throughput. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. 46 CFR 184.510 - Recommended emergency broadcast instructions.

    Science.gov (United States)

    2010-10-01

    ... NAME), (INSERT VESSEL'S NAME), (INSERT VESSEL'S CALL SIGN), OVER.” (5) Release the microphone button... VESSEL'S NAME & CALL SIGN).” (14) If your situation permits, stand by the radio to await further... 2182 kHz. (Channel 16 VHF and 2182 kHz on SSB are for emergency and calling purposes only.) (3) Press...

  2. Understanding the value of emergency care: a framework incorporating stakeholder perspectives.

    Science.gov (United States)

    Sharp, Adam L; Cobb, Enesha M; Dresden, Scott M; Richardson, Derek K; Sabbatini, Amber K; Sauser, Kori; Kocher, Keith E

    2014-09-01

    In the face of escalating spending, measuring and maximizing the value of health services has become an important focus of health reform. Recent initiatives aim to incentivize high-value care through provider and hospital payment reform, but the role of the emergency department (ED) remains poorly defined. To achieve an improved understanding of the value of emergency care, we have developed a framework that incorporates the perspectives of stakeholders in the delivery of health services. A pragmatic review of the literature informed the design of this framework to standardize the definition of value in emergency care and discuss outcomes and costs from different stakeholder perspectives. The viewpoint of patient, provider, payer, health system, and society is each used to assess value for emergency medical conditions. We found that the value attributed to emergency care differs substantially by stakeholder perspective. Potential targets to improve ED value may be aimed at improving outcomes or controlling costs, depending on the acuity of the clinical condition. The value of emergency care varies by perspective, and a better understanding is achieved when specific outcomes and costs can be identified, quantified, and measured. Using this framework can help stakeholders find common ground to prioritize which costs and outcomes to target for research, quality improvement efforts, and future health policy impacting emergency care. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Blended call center with idling times during the call service

    NARCIS (Netherlands)

    Legros, Benjamin; Jouini, Oualid; Koole, Ger

    We consider a blended call center with calls arriving over time and an infinitely backlogged amount of outbound jobs. Inbound calls have a non-preemptive priority over outbound jobs. The inbound call service is characterized by three successive stages where the second one is a break; i.e., there is

  4. Hearing in alpacas (Vicugna pacos): audiogram, localization acuity, and use of binaural locus cues.

    Science.gov (United States)

    Heffner, Rickye S; Koay, Gimseong; Heffner, Henry E

    2014-02-01

    Behavioral audiograms and sound localization abilities were determined for three alpacas (Vicugna pacos). Their hearing at a level of 60 dB sound pressure level (SPL) (re 20 μPa) extended from 40 Hz to 32.8 kHz, a range of 9.7 octaves. They were most sensitive at 8 kHz, with an average threshold of -0.5 dB SPL. The minimum audible angle around the midline for 100-ms broadband noise was 23°, indicating relatively poor localization acuity and potentially supporting the finding that animals with broad areas of best vision have poorer sound localization acuity. The alpacas were able to localize low-frequency pure tones, indicating that they can use the binaural phase cue, but they were unable to localize pure tones above the frequency of phase ambiguity, thus indicating complete inability to use the binaural intensity-difference cue. In contrast, the alpacas relied on their high-frequency hearing for pinna cues; they could discriminate front-back sound sources using 3-kHz high-pass noise, but not 3-kHz low-pass noise. These results are compared to those of other hoofed mammals and to mammals more generally.

  5. The Joint Effects of Spatial Cueing and Transcranial Direct Current Stimulation on Visual Acuity

    Directory of Open Access Journals (Sweden)

    Taly Bonder

    2018-02-01

    Full Text Available The present study examined the mutual influence of cortical neuroenhancement and allocation of spatial attention on perception. Specifically, it explored the effects of transcranial Direct Current Stimulation (tDCS on visual acuity measured with a Landolt gap task and attentional precues. The exogenous cues were used to draw attention either to the location of the target or away from it, generating significant performance benefits and costs. Anodal tDCS applied to posterior occipital area for 15 min improved performance during stimulation, reflecting heightened visual acuity. Reaction times were lower, and accuracy was higher in the tDCS group, compared to a sham control group. Additionally, in post-stimulation trials tDCS significantly interacted with the effect of precuing. Reaction times were lower in valid cued trials (benefit and higher in invalid trials (cost compared to neutrally cued trials, the effect which was pronounced stronger in tDCS group than in sham control group. The increase of cost and benefit effects in the tDCS group was of a similar magnitude, suggesting that anodal tDCS influenced the overall process of attention orienting. The observed interaction between the stimulation of the visual cortex and precueing indicates a magnification of attention modulation.

  6. Medical emergencies in the imaging department of a university hospital: event and imaging characteristics.

    Science.gov (United States)

    van Tonder, F C; Sutherland, T; Smith, R J; Chock, J M E; Santamaria, J D

    2013-01-01

    We aimed to describe the characteristics of medical emergencies that occurred in the medical imaging department (MID) of a university hospital in Melbourne, Australia. A database of 'Respond Medical Emergency Team (MET)' and 'Respond Blue' calls was retrospectively examined for the period June 2003 to November 2010 in relation to events that occurred in the MID. The hospital medical imaging database was also examined in relation to these events and, where necessary, patients' notes were reviewed. Ethics approval was granted by the hospital ethics review board. There were 124 medical emergency calls in the MID during the study period, 28% Respond Blue and 72% Respond MET. Of these 124 calls, 26% occurred outside of usual work hours and 12% involved cardiac arrest. The most common reasons for the emergency calls were seizures (14%) and altered conscious state (13%). Contrast anaphylaxis precipitated the emergency in 4% of cases. In 83% of cases the emergency calls were for patients attending the MID for diagnostic imaging, the remainder being for a procedure. Of the scheduled imaging techniques, 45% were for computed tomography. The scheduled imaging was abandoned due to the emergency in 12% of cases. When performed, imaging informed patient management in 34% of cases in diagnostic imaging and in all cases in the context of image-guided procedures. Medical emergency calls in the MID often occurred outside usual work hours and were attributed to a range of medical problems. The emergencies occurred in relation to all imaging techniques and imaging informed patient management in many cases. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

  7. SMARTPHONE-BASED DILATED FUNDUS PHOTOGRAPHY AND NEAR VISUAL ACUITY TESTING AS INEXPENSIVE SCREENING TOOLS TO DETECT REFERRAL WARRANTED DIABETIC EYE DISEASE.

    Science.gov (United States)

    Toy, Brian C; Myung, David J; He, Lingmin; Pan, Carolyn K; Chang, Robert T; Polkinhorne, Alison; Merrell, Douglas; Foster, Doug; Blumenkranz, Mark S

    2016-05-01

    To compare clinical assessment of diabetic eye disease by standard dilated examination with data gathered using a smartphone-based store-and-forward teleophthalmology platform. 100 eyes of 50 adult patients with diabetes from a health care safety-net ophthalmology clinic. All patients underwent comprehensive ophthalmic examination. Concurrently, a smartphone was used to estimate near visual acuity and capture anterior and dilated posterior segment photographs, which underwent masked, standardized review. Quantitative comparison of clinic and smartphone-based data using descriptive, kappa, Bland-Altman, and receiver operating characteristic analyses was performed. Smartphone visual acuity was successfully measured in all eyes. Anterior and posterior segment photography was of sufficient quality to grade in 96 and 98 eyes, respectively. There was good correlation between clinical Snellen and smartphone visual acuity measurements (rho = 0.91). Smartphone-acquired fundus photographs demonstrated 91% sensitivity and 99% specificity to detect moderate nonproliferative and worse diabetic retinopathy, with good agreement between clinic and photograph grades (kappa = 0.91 ± 0.1, P smartphone-based telemedicine system that demonstrated sensitivity and specificity to detect referral-warranted diabetic eye disease as a proof-of-concept. Additional studies are warranted to evaluate this approach to expanding screening for diabetic retinopathy.

  8. Outcomes of visual acuity in carbon ion radiotherapy: Analysis of dose-volume histograms and prognostic factors

    International Nuclear Information System (INIS)

    Hasegawa, Azusa; Mizoe, Jun-etsu; Mizota, Atsushi; Tsujii, Hirohiko

    2006-01-01

    Purpose: To analyze the tolerance dose for retention of visual acuity in patients with head-and-neck tumors treated with carbon ion radiotherapy. Methods and Materials: From June 1994 to March 2000, 163 patients with tumors in the head and neck or skull base region were treated with carbon ion radiotherapy. Analysis was performed on 54 optic nerves (ONs) corresponding to 30 patients whose ONs had been included in the irradiated volume. These patients showed no evidence of visual impairment due to other factors and had a follow-up period of >4 years. All patients had been informed of the possibility of visual impairment before treatment. We evaluated the dose-complication probability and the prognostic factors for the retention of visual acuity in carbon ion radiotherapy, using dose-volume histograms and multivariate analysis. Results: The median age of 30 patients (14 men, 16 women) was 57.2 years. Median prescribed total dose was 56.0 gray equivalents (GyE) at 3.0-4.0 GyE per fraction per day (range, 48-64 GyE; 16-18 fractions; 4-6 weeks). Of 54 ONs that were analyzed, 35 had been irradiated with max ]) resulting in no visual loss. Conversely, 11 of the 19 ONs (58%) irradiated with >57 GyE (D max ) suffered a decrease of visual acuity. In all of these cases, the ONs had been involved in the tumor before carbon ion radiotherapy. In the multivariate analysis, a dose of 20% of the volume of the ON (D 2 ) was significantly associated with visual loss. Conclusions: The occurrence of visual loss seems to be correlated with a delivery of >60 GyE to 20% of the volume of the ON

  9. Implementation of a model of emergency care in an Australian hospital.

    Science.gov (United States)

    Millichamp, Tracey; Bakon, Shannon; Christensen, Martin; Stock, Kate; Howarth, Sarah

    2017-11-10

    Emergency departments are characterised by a fast-paced, quick turnover and high acuity workload, therefore appropriate staffing is vital to ensure positive patient outcomes. Models of care are frameworks in which safe and effective patient-to-nurse ratios can be ensured. The aim of this study was to implement a supportive and transparent model of emergency nursing care that provides structure - regardless of nursing staff profile, business or other demands; improvement to nursing workloads; and promotes individual responsibility and accountability for patient care. A convergent parallel mixed-method approach was used. Quantitative data were analysed using descriptive statistics and the qualitative data used a thematic analysis to identify recurrent themes. Data post-implementation of the model of emergency nursing care indicate improved staff satisfaction in relation to workload, patient care and support structures. The development and implementation of a model of care in an emergency department improved staff workload and staff's perception of their ability to provide care. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  10. White-matter microstructure and hearing acuity in older adults: a population-based cross-sectional DTI study.

    Science.gov (United States)

    Rigters, Stephanie C; Cremers, Lotte G M; Ikram, M Arfan; van der Schroeff, Marc P; de Groot, Marius; Roshchupkin, Gennady V; Niessen, Wiro J N; Baatenburg de Jong, Robert J; Goedegebure, André; Vernooij, Meike W

    2018-01-01

    To study the relation between the microstructure of white matter in the brain and hearing function in older adults we carried out a population-based, cross-sectional study. In 2562 participants of the Rotterdam Study, we conducted diffusion tensor imaging to determine the microstructure of the white-matter tracts. We performed pure-tone audiogram and digit-in-noise tests to quantify hearing acuity. Poorer white-matter microstructure, especially in the association tracts, was related to poorer hearing acuity. After differentiating the separate white-matter tracts in the left and right hemisphere, poorer white-matter microstructure in the right superior longitudinal fasciculus and the right uncinate fasciculus remained significantly associated with worse hearing. These associations did not significantly differ between middle-aged (51-69 years old) and older (70-100 years old) participants. Progressing age was thus not found to be an effect modifier. In a voxel-based analysis no voxels in the white matter were significantly associated with hearing impairment. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. The Cost-effectiveness of Welcome to Medicare Visual Acuity Screening and a Possible Alternative Welcome to Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus

    Science.gov (United States)

    Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Hoerger, Thomas J.; Zhang, Ping; Klein, Barbara Eden Kobrin; Lee, Kris E.; Klein, Ronald; Saaddine, Jinan B.

    2013-01-01

    Objective To estimate the cost-effectiveness of visual acuity screening performed in primary care settings and of dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed eye disorders. Medicare currently reimburses visual acuity screening for new enrollees during their initial preventive primary care health check, but dilated eye evaluations may be a more cost-effective policy. Design Monte Carlo cost-effectiveness simulation model with a total of 50 000 simulated patients with demographic characteristics matched to persons 65 years of age in the US population. Results Compared with no screening policy, dilated eye evaluations increased quality-adjusted life-years (QALYs) by 0.008 (95% credible interval [CrI], 0.005–0.011) and increased costs by $94 (95% CrI, −$35 to $222). A visual acuity screening increased QALYs in less than 95% of the simulations (0.001 [95% CrI, −0.002 to 0.004) and increased total costs by $32 (95% CrI, −$97 to $159) per person. The incremental cost-effectiveness ratio of a visual acuity screening and an eye examination compared with no screening were $29 000 and $12 000 per QALY gained, respectively. At a willingness-to-pay value of $15 000 or more per QALY gained, a dilated eye evaluation was the policy option most likely to be cost-effective. Conclusions The currently recommended visual acuity screening showed limited efficacy and cost-effectiveness compared with no screening. In contrast, a new policy of reimbursement for Welcome to Medicare dilated eye evaluations was highly cost-effective. PMID:22232367

  12. Physician-staffed emergency helicopter reduces transportation time from alarm call to highly specialized centre

    DEFF Research Database (Denmark)

    Fjaeldstad, A.

    2013-01-01

    INTRODUCTION: Since 2007, the number of Danish emergency departments has decreased from 44 to 21. Longer distances to specialized treatment have increased the demand for advanced prehospital treatment. A Danish 24/7 Helicopter Emergency Medical System (HEMS) project in western Denmark was initiated......-to-centre) for patients with ST-elevation myocardial infarction (STEMI) or severe injury (Injury Severity Score > 15). MATERIAL AND METHODS: In this prospective study with a matched historical control group, the time-to-doctor and the time-to-centre for patients with STEMI or severe injury transported by HEMS were...

  13. Health issues amongst call center employees, an emerging occupational group in India.

    Science.gov (United States)

    Raja, Jeyapal Dinesh; Bhasin, Sanjiv Kumar

    2014-07-01

    Call center sector in India is a relatively new industry and one of the fastest growing sectors driving employment and growth in modern India today. While employment in the business process outsourcing (BPO) sector has meant that young adults are reaching their career milestones and financial goals much earlier than before, surveys and anecdotal evidence show that workers in the BPO sector experience high levels of stress and its related disorders, primarily due to its contemporary work settings. Safeguarding the health of youngsters employed in this new, growing economy becomes an occupational health challenge to public health specialists.

  14. Health issues amongst call center employees, an emerging occupational group in India

    Directory of Open Access Journals (Sweden)

    Jeyapal Dinesh Raja

    2014-01-01

    Full Text Available Call center sector in India is a relatively new industry and one of the fastest growing sectors driving employment and growth in modern India today. While employment in the business process outsourcing (BPO sector has meant that young adults are reaching their career milestones and financial goals much earlier than before, surveys and anecdotal evidence show that workers in the BPO sector experience high levels of stress and its related disorders, primarily due to its contemporary work settings. Safeguarding the health of youngsters employed in this new, growing economy becomes an occupational health challenge to public health specialists.

  15. Women and the Emergence of the NAACP

    Science.gov (United States)

    Moore, Linda S.

    2013-01-01

    This article discusses contributions of women to the emergence of the National Association for the Advancement of Colored People. Using network analysis, the author studied affiliations between African American and White women who signed "The Call," a petition calling for a national conference to obtain civil rights for African…

  16. Reminder: call 74444 also in case of a medical emergency

    CERN Multimedia

    2005-01-01

    What happened? A CERN colleague, suffering from heart trouble, went to the ‘infirmary' on the Prévessin site for medical aid. He was unaware that the ‘infirmary' was in fact no such thing, but the office of the French medical officer, and, on top of that, it was closed. He therefore took his own car and went to the CERN Fire Station on the Meyrin site (building 65). The firemen and the CERN infirmary took care of him and requested a helicopter transport to the Geneva cantonal hospital, where he received medical treatment.   What do we learn from this event?   You can call the CERN internal number 74444 also in case of serious and acute illness, not only in the event of an accident, pollution, fire, etc.   Professional aid (ambulance firemen and medical assistance, if needed) will be provided.   The CERN Fire station is located in building 65, on ‘Route Einstein', the first road on your right when you enter CERN entrance B on the Meyrin site. It is open permanently, 24 hours per day, 7 days per we...

  17. Information systems performance evaluation, introducing a two-level technique: Case study call centers

    Directory of Open Access Journals (Sweden)

    Hesham A. Baraka

    2015-03-01

    The objective of this paper was to introduce a new technique that can support decision makers in the call centers industry to evaluate, and analyze the performance of call centers. The technique presented is derived from the research done on measuring the success or failure of information systems. Two models are mainly adopted namely: the Delone and Mclean model first introduced in 1992 and the Design Reality Gap model introduced by Heeks in 2002. Two indices are defined to calculate the performance of the call center; the success index and the Gap Index. An evaluation tool has been developed to allow call centers managers to evaluate the performance of their call centers in a systematic analytical approach; the tool was applied on 4 call centers from different areas, simple applications such as food ordering, marketing, and sales, technical support systems, to more real time services such as the example of emergency control systems. Results showed the importance of using information systems models to evaluate complex systems as call centers. The models used allow identifying the dimensions for the call centers that are facing challenges, together with an identification of the individual indicators in these dimensions that are causing the poor performance of the call center.

  18. Quality of care using a multidisciplinary team in the emergency room

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Maaløe, Rikke; Jensen, Nanna Martin

    2011-01-01

    Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients re...... received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients....

  19. [Incidence of acute agitation and variation in acute agitation management by emergency services].

    Science.gov (United States)

    Casado Flórez, Isabel; Sánchez Santos, Luis; Rodríguez Calzada, Rafael; Rico-Villademoros, Fernando; Roset Arissó, Pere; Corral Torres, Ervigio

    2017-07-01

    To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. Observational descriptive study based on aggregate data from unpublished internal EMS reports. Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

  20. Off-site emergency planning

    International Nuclear Information System (INIS)

    Narrog, J.

    1980-01-01

    In the event of a nuclear accident, the actions taken to protect the public from off-site consequences must be effective. An effective organization of emergency actions is based on two components: the actions of the operator of the nuclear facility and the actions of the competent authorities. The measures of the operator are of special importance in the first hours after the beginning of the nuclear accident, because there is no other help. Therefore the operator of a nuclear facility shall be obliged under the nuclear licensing procedure to make provisions of his own and carry out protective measures which should be compiled in a so-called 'alarm-plan'. On the other hand the means of the operator are too small in many cases and there is a need for actions by the responsible authorities. The actions of the authorities should be compiled in a so-called 'emergency response plan'. The emergency response plan shall apply to all cases in which, as a result of occurrences in or at a nuclear facility, a damaging impact on the environment is expected or has occurred requiring the authorities in charge to intervene for its prevention or limitation. (orig./RW)

  1. Dynamic call center routing policies using call waiting and agent idle times

    NARCIS (Netherlands)

    Chan, W.; Koole, G.M.; L'Ecuyer, P.

    2014-01-01

    We study call routing policies for call centers with multiple call types and multiple agent groups. We introduce new weight-based routing policies where each pair (call type, agent group) is given a matching priority defined as an affine combination of the longest waiting time for that call type and

  2. Use of the Dynamic Visual Acuity Test as a screener for community-dwelling older adults who fall.

    Science.gov (United States)

    Honaker, Julie A; Shepard, Neil T

    2011-01-01

    Adequate function of the peripheral vestibular system, specifically the vestibulo-ocular reflex (VOR; a network of neural connections between the peripheral vestibular system and the extraocular muscles) is essential for maintaining stable vision during head movements. Decreased visual acuity resulting from an impaired peripheral vestibular system may impede balance and postural control and place an individual at risk of falling. Therefore, sensitive measures of the vestibular system are warranted to screen for the tendency to fall, alerting clinicians to recommend further risk of falling assessment and referral to a falling risk reduction program. Dynamic Visual Acuity (DVA) testing is a computerized VOR assessment method to evaluate the peripheral vestibular system during head movements; reduced visual acuity as documented with DVA testing may be sensitive to screen for falling risk. This study examined the sensitivity and specificity of the computerized DVA test with yaw plane head movements for identifying community-dwelling adults (58-78 years) who are prone to falling. A total of 16 older adults with a history of two or more unexplained falls in the previous twelve months and 16 age and gender matched controls without a history of falls in the previous twelve months participated. Computerized DVA with horizontal head movements at a fixed velocity of 120 deg/sec was measured and compared with the Dynamic Gait Index (DGI) a gold standard gait assessment measurement for identifying falling risk. Receiver operating characteristics (ROC) curve analysis and area under the ROC curve (AUC) were used to assess the sensitivity and specificity of the computerized DVA as a screening measure for falling risk as determined by the DGI. Results suggested a link between computerized DVA and the propensity to fall; DVA in the yaw plane was found to be a sensitive (92%) and accurate screening measure when using a cutoff logMAR value of >0.25.

  3. Femtosecond-Assisted LASIK Versus PRK: Comparison of 6-Month Visual Acuity and Quality Outcome for High Myopia.

    Science.gov (United States)

    Hashemi, Hassan; Miraftab, Mohammad; Ghaffari, Reza; Asgari, Soheila

    2016-11-01

    To compare the results of femtosecond-assisted laser in situ keratomileusis (femto-LASIK) and photorefractive keratectomy with mitomycin C (PRK-MMC) for the correction of myopia more than 7.0 diopters (D). In this comparative nonrandomized trial, 60 eyes (30 eyes in each group) were enrolled. Patients were tested for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, ocular and corneal aberrations, and contrast sensitivity (CS) before surgery and at 3 and 6 months postoperatively. Mean preoperative myopia was -8.65±1.51 and -8.04±1.70 D in the femto-LASIK and PRK-MMC groups, respectively (P=0.149). Intergroup differences in baseline indices were not statistically significant. At 6 months after surgery, UDVA showed an improving trend, but it was better in the femto-LASIK group (P=0.026). CDVA in the two groups remained similarly unchanged (P=0.170). For the femto-LASIK and PRK-MMC groups, the safety indices were 1.01±0.05 and 1.01±0.14 (P=0.949), respectively, and the efficacy indices were 0.99±0.07 and 0.93±0.22 (P=0.192), respectively. Comparing CS, only CS18 showed a significantly greater decrease in the femto-LASIK group compared with the PRK-MMC group (P=0.016). Intergroup differences were not statistically significant in other spatial frequencies. Changes in the ocular and corneal higher order aberrations were not statistically different between the two groups except ocular coma, which increased in the femto-LASIK group (P=0.041). Femto-LASIK improves UDVA better than PRK-MMC in high myopia. However, because of increased coma, the quality of vision is reduced. In other words, visual acuity outcome is better with femto-LASIK and visual quality outcome is better with PRK-MMC.

  4. Emergency management information system (EMINS)

    International Nuclear Information System (INIS)

    Desonier, L.M.

    1987-01-01

    In a time of crisis or in an emergency, a manager is required to make many decisions to facilitate the proper solution and conclusion to the emergency or crisis. In order to make these decisions, it is necessary for the manager to have correct up-to-date information on the situation, which calls for an automated information display and entry process. The information handling needs are identified in terms of data, video, and voice. Studies of existing Emergency Operations Centers and evaluations of hardware and software have been completed. The result of these studies and investigations is the design and implementation of an automated Emergency Management Information System. Not only is the system useful for Emergency Management but for any information management requirement

  5. Improvement of visual acuity and VEP after optic nerve contusion by NGF and its safety analysis

    Directory of Open Access Journals (Sweden)

    Ming Zhao

    2018-02-01

    Full Text Available AIM:To investigate the effect of neuropathic factor(NGFon visual acuity and visual evoked potential(VEPin patients with optic nerve contusion. METHODS:Totally 78 patients(78 eyeswith optic nerve contusion were selected. From January 2013 to June 2016, 39 cases(39 eyeswere divided into observation group and control group respectively according to the random number table method. Prednisone, vitamins and mecobalamin tablets treatment were given to both groups, based on that, the observation group was given NGF treatment, continuous treatment of 2 courses(21d for a course of treatment. RESULTS: There was no significant difference in visual field defect and visual field sensitivity between the observation group and the control group before treatment(P>0.05. After treatment, the visual field defect degree of the observation group was smaller, the visual field sensitivity was better than that of the control group(PP>0.05. After treatment, the P100 wave latency of the observation group was significantly shorter than that of the control group(PPPCONCLUSION: NGF treatment for optic nerve contusion can significantly improve the patient's visual acuity, VEP indicators, reduce visual field defects, improve visual field sensitivity.

  6. Higher-order aberrations and best-corrected visual acuity in Native American children with a high prevalence of astigmatism.

    Science.gov (United States)

    Miller, Joseph M; Harvey, Erin M; Schwiegerling, Jim

    2015-08-01

    To determine whether higher-order aberrations (HOAs) in children from a highly astigmatic population differ from population norms and whether HOAs are associated with astigmatism and reduced best-corrected visual acuity. Subjects were 218 Tohono O'odham Native American children 5-9 years of age. Noncycloplegic HOA measurements were obtained with a handheld Shack-Hartmann sensor (SHS). Signed (z06s to z14s) and unsigned (z06u to z14u) wavefront aberration Zernike coefficients Z(3,-3) to Z(4,4) were rescaled for a 4 mm diameter pupil and compared to adult population norms. Cycloplegic refraction and best-corrected logMAR letter visual acuity (BCVA) were also measured. Regression analyses assessed the contribution of astigmatism (J0) and HOAs to BCVA. The mean root-mean-square (RMS) HOA of 0.191 ± 0.072 μm was significantly greater than population norms (0.100 ± 0.044 μm). All unsigned HOA coefficients (z06u to z14u) and all signed coefficients except z09s, z10s, and z11s were significantly larger than population norms. Decreased BCVA was associated with astigmatism (J0) and spherical aberration (z12u) but not RMS coma, with the effect of J0 about 4 times as great as z12u. Tohono O'odham children show elevated HOAs compared to population norms. Astigmatism and unsigned spherical aberration are associated with decreased acuity, but the effects of spherical aberration are minimal and not clinically significant. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  7. Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records.

    Science.gov (United States)

    Ozkaynak, Mustafa; Dziadkowiec, Oliwier; Mistry, Rakesh; Callahan, Tiffany; He, Ze; Deakyne, Sara; Tham, Eric

    2015-10-01

    The purpose of this study was to describe a workflow analysis approach and apply it in emergency departments (EDs) using data extracted from the electronic health record (EHR) system. We used data that were obtained during 2013 from the ED of a children's hospital and its four satellite EDs. Workflow-related data were extracted for all patient visits with either a primary or secondary diagnosis on discharge of asthma (ICD-9 code=493). For each patient visit, eight different a priori time-stamped events were identified. Data were also collected on mode of arrival, patient demographics, triage score (i.e. acuity level), and primary/secondary diagnosis. Comparison groups were by acuity levels 2 and 3 with 2 being more acute than 3, arrival mode (ambulance versus walk-in), and site. Data were analyzed using a visualization method and Markov Chains. To demonstrate the viability and benefit of the approach, patient care workflows were visually and quantitatively compared. The analysis of the EHR data allowed for exploration of workflow patterns and variation across groups. Results suggest that workflow was different for different arrival modes, settings and acuity levels. EHRs can be used to explore workflow with statistical and visual analytics techniques novel to the health care setting. The results generated by the proposed approach could be utilized to help institutions identify workflow issues, plan for varied workflows and ultimately improve efficiency in caring for diverse patient groups. EHR data and novel analytic techniques in health care can expand our understanding of workflow in both large and small ED units. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. A cross-sectional examination of visual acuity by specific type of albinism.

    Science.gov (United States)

    Winsor, Caitlin Nosanov; Holleschau, Ann M; Connett, John E; Summers, C Gail

    2016-10-01

    Reports of best-corrected visual acuity (BCVA) in albinism are often based on overlapping clinical phenotypes. BCVA in albinism has been shown to improve with age. This study reports a large cross-sectional investigation to determine whether BCVA differs by specific type of albinism when age-corrected. This retrospective review identified 170 individuals with a specific type of albinism identified by mutation(s) in a gene known to cause albinism (for OCA1, OCA2, and Hermansky-Pudlak syndrome ([HPS]) or a specific phenotype (white hair and no melanin pigment in OCA1A; pigmentary mosaicism in the obligate carriers for males with OA1). We recorded optotype binocular BCVA at final follow-up. Patients were age-grouped (2-5 years, 6-14 years, and ≥15 years) for comparison. The greatest visual acuity deficit was found for OCA1A in all age groups. At age ≥15 years (n = 79), mean BCVA was 20/128 for OCA1A, 20/37 for OCA1B, 20/59 for OCA2, 20/63 for OA1, and 20/121 for HPS. Significant differences between BCVA at ≥15 years were found in the following: OCA1A vs OCA1B, OCA1A vs OCA2, OCA1A vs OA1, OCA1B vs HPS, OCA2 vs HPS, and OA1 vs HPS (P ≤ 0.02). This study provides a large sample size and includes only those with a specific type of albinism. BCVA varies by albinism type, and there is overlap in BCVA, particularly in the younger age groups. For ages ≥15 years, there are significant differences in BCVA between several types of albinism. Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  9. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit

    LENUS (Irish Health Repository)

    McGovern, M

    2017-02-01

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128\\/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114\\/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child’s illness but on educating and empowering the parent.

  10. Poison control center - emergency number

    Science.gov (United States)

    For a POISON EMERGENCY call: 1-800-222-1222 ANYWHERE IN THE UNITED STATES This national hotline number will let you ... is a free and confidential service. All local poison control centers in the United States use this ...

  11. Eight months of emergency services by ambulance (with doctor on board) of the Emergency Department of Prato, Italy.

    Science.gov (United States)

    Olia, P M; Mollica, T V; Querci, A

    2002-11-01

    The aim of the present study was to analyse the types of calls attended by the authors in their ambulance, assigned to one sector of the urban area of Prato. We analysed 1060 consecutive calls carried out by our ambulance; 33 calls (3.1%), cancelled for various reasons, were excluded from statistical analysis. The calls regarded 1027 patients, 549 (53.5%) males and 478 (46.5%) females. 46% of calls concerned non trauma cases, 17% trauma cases and 7.2% transfers between hospitals. Calls in the non trauma group were for dyspnea (16.7%), unconsciousness (16.6%), chest pain (11.8%), cerebrovascular pathology (7.7%), mental disorders (7.1%), abdominal pain (5.1%), use of psychotropic substances (4%) and convulsions (3.2%). Support to patients with terminal cancer accounted for 2.3% of cases, metabolic disorders 2.2%, hypertensive events 2.1%, tachycardia 1.9%, vertigo 1.9%, allergies 1%, obstetric pathology 0.5% and cardiorespiratory resuscitation 2,2%. Thirteen point seven percent were miscellaneous, including poisonings, migraines, haemorrhages and flu syndromes. Trauma cases included road accidents (62.6%), falls (27%), aggression (6.9%), work-related accidents (3.5%). The percentage of trauma cases (17%) was similar to that reported for a Swedish urban area (20%). Cases of cardiorespiratory resuscitation were 1.65% of our calls, compared to 1.73% and 1.8% reported in Northeastern Germany and Taiwan. Although prehospital emergency medical services are organised differently in different countries, our data suggest that emergency medical services in our area have a percentage distribution of case types similar to services in other countries.

  12. The contributions of numerical acuity and non-numerical stimulus features to the development of the number sense and symbolic math achievement.

    Science.gov (United States)

    Starr, Ariel; DeWind, Nicholas K; Brannon, Elizabeth M

    2017-11-01

    Numerical acuity, frequently measured by a Weber fraction derived from nonsymbolic numerical comparison judgments, has been shown to be predictive of mathematical ability. However, recent findings suggest that stimulus controls in these tasks are often insufficiently implemented, and the proposal has been made that alternative visual features or inhibitory control capacities may actually explain this relation. Here, we use a novel mathematical algorithm to parse the relative influence of numerosity from other visual features in nonsymbolic numerical discrimination and to examine the strength of the relations between each of these variables, including inhibitory control, and mathematical ability. We examined these questions developmentally by testing 4-year-old children, 6-year-old children, and adults with a nonsymbolic numerical comparison task, a symbolic math assessment, and a test of inhibitory control. We found that the influence of non-numerical features decreased significantly over development but that numerosity was a primary determinate of decision making at all ages. In addition, numerical acuity was a stronger predictor of math achievement than either non-numerical bias or inhibitory control in children. These results suggest that the ability to selectively attend to number contributes to the maturation of the number sense and that numerical acuity, independent of inhibitory control, contributes to math achievement in early childhood. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. A Detailed Analysis of Prehospital Interventions in Common Medical Priority Dispatch System Determinants

    Directory of Open Access Journals (Sweden)

    Sporer, Karl A

    2011-02-01

    Full Text Available Background: Medical Priority Dispatch System (MPDS is a type of Emergency Medical Dispatch (EMD system used to prioritize 9-1-1 calls and optimize resource allocation. Dispatchers use a series of scripted questions to assign determinants to calls based on chief complaint and acuity.Objective: We analyzed the prehospital interventions performed on patients with MPDS determinants for breathing problems, chest pain, unknown problem (man down, seizures, fainting (unconscious and falls for transport status and interventions.Methods: We matched all prehospital patients in complaint-based categories for breathing problems, chest pain, unknown problem (man down, seizures, fainting (unconscious and falls from January 1, 2004, to December 31, 2006, with their prehospital record. Calls were queried for the following prehospital interventions: Basic Life Support care only, intravenous line placement only, medication given, procedures or non-transport. We defined Advanced Life Support (ALS interventions as the administration of a medication or a procedure.Results: Of the 77,394 MPDS calls during this period, 31,318 (40% patients met inclusion criteria. Breathing problems made up 12.2%, chest pain 6%, unknown problem 1.4%, seizures 3%, falls 9% and unconscious/fainting 9% of the total number of MPDS calls. Patients with breathing problem had a low rate of procedures (0.7% and cardiac arrest medications (1.6% with 38% receiving some medication. Chest pain patients had a similar distribution; procedures (0.5%, cardiac arrest medication (1.5% and any medication (64%. Unknown problem: procedures (1%, cardiac arrest medication (1.3%, any medication (18%. Patients with Seizures had a low rate of procedures (1.1% and cardiac arrest medications (0.6% with 20% receiving some medication. Fall patients had a lower rate of severe illness with more medication, mostly morphine: procedures (0.2%, cardiac arrest medication (0.2%, all medications (28%. Unconscious

  14. Physician alert: the legal risks associated with 'on-call' duties in the USA.

    Science.gov (United States)

    Paterick, Zachary R; Patel, Nachiket J; Paterick, Timothy Edward

    2018-06-13

    On-call physicians encounter a diverse aggregate of interfaces with sundry persons concerning patient care that may surface potential legal peril. The duties and obligations of an on-call physician, who must act as a fiduciary to all patients, create a myriad of circumstances where there is a risk of falling prey to legal ambiguities. The understanding of the doctor-patient relationship, the obligations of physicians under the Emergency Medical Treatment and Labor Act, the meaning of medical informed consent and the elements of negligence will help physicians avoid the legal risk associated with the various encounters of being on call. After introducing the legal concepts, we will explore the interactions that may put physicians at legal risk and outline how to mitigate that risk. Being on call is time consuming and arduous. While on call, physicians have a duty to act morally and ethically in the best interest of the patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial

    Directory of Open Access Journals (Sweden)

    Cohen, Jason

    2010-02-01

    Full Text Available Objective: Glycemic control in the critically ill intensive care unit (ICU patient has been shown to improve morbidity and mortality. We sought to investigate the effect of early glycemic control in critically ill emergency department (ED patients in a small pilot trial.Methods: Adult non-trauma, non-pregnant ED patients presenting to a university tertiary referral center and identified as critically ill were eligible for enrollment on a convenience basis. Critical illness was determined upon assignment for ICU admission. Patients were randomized to either ED standard care or glycemic control. Glycemic control involved use of an insulin drip to maintain blood glucose levels between 80-140 mg/dL. Glycemic control continued until ED discharge. Standard patients were managed at ED attending physician discretion. We assessed severity of illness by calculation of APACHE II score. The primary endpoint was in-hospital mortality. Secondary endpoints included vasopressor requirement, hospital length of stay, and mechanical ventilation requirement.Results: Fifty patients were randomized, 24 to the glycemic group and 26 to the standard care cohort. Four of the 24 patients (17% in the treatment arm did not receive insulin despite protocol requirements. While receiving insulin, three of 24 patients (13% had an episode of hypoglycemia. By chance, the patients in the treatment group had a trend toward higher acuity by APACHE II scores. Patient mortality and morbidity were similar despite the acuity difference.Conclusion: There was no difference in morbidity and mortality between the two groups. The benefit of glycemic control may be subject to source of illness and to degree of glycemic control, or have no effect. Such questions bear future investigation. [West J Emerg Med. 2010; 11(1:20-23].

  16. 47 CFR 22.921 - 911 call processing procedures; 911-only calling mode.

    Science.gov (United States)

    2010-10-01

    ... programming in the mobile unit that determines the handling of a non-911 call and permit the call to be... CARRIER SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.921 911 call processing procedures; 911-only calling mode. Mobile telephones manufactured after February 13, 2000 that are capable of...

  17. Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times.

    Science.gov (United States)

    Cheng, Ivy; Lee, Jacques; Mittmann, Nicole; Tyberg, Jeffrey; Ramagnano, Sharon; Kiss, Alex; Schull, Michael; Kerr, Fergus; Zwarenstein, Merrick

    2013-11-11

    Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Pragmatic cluster randomized trial. From 131 weekday shifts (8:00-14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. The intervention's median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19-4:38] during comparator shifts. The intervention's median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02-2:14]. The intervention's median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention's left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43-4:16]) and low acuity patients (1:10 95th% CI: 0:58-1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23-0:26]). No patients returned to the emergency department after being discharged by the MDRNSTAT at triage. The intervention reduced delays

  18. Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Sejersten, Maria Sejersten; Baber, Usman

    2015-01-01

    Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials......, this study emphasizes the need for an efficient prehospital phase with focus on CV disease and proper triage of patients suitable for invasive evaluation if the outcomes of acute heart disease are to be improved further in the current international context of hospitals merging into highly specialized...

  19. 46 CFR 121.510 - Recommended emergency broadcast instructions.

    Science.gov (United States)

    2010-10-01

    ... Immediate Danger to Life or Property. (4) Say: “THIS IS (INSERT VESSEL'S NAME), (INSERT VESSEL'S NAME), (INSERT VESSEL'S NAME), (INSERT VESSEL'S CALL SIGN), OVER.” (5) Release the microphone button briefly and... 16 VHF and 2182 kHz on SSB are for emergency and calling purposes only.) (3) Press microphone button...

  20. Internet protocol-based emergency services

    CERN Document Server

    Schulzrinne, Henning

    2013-01-01

    Written by international experts in the field, this book covers the standards, architecture and deployment issues related to IP-based emergency services This book brings together contributions from experts on technical and operational aspects within the international standardisation and regulatory processes relating to routing and handling of IP-based emergency calls.  Readers will learn how these standards work, how various standardization organizations contributed to them and about pilot projects, early deployment and current regulatory situation. Key Featur

  1. Communication between residents and attending doctors on call after hours.

    Science.gov (United States)

    Novoselsky Persky, Michal A; Yinnon, Amos M; Freier-Dror, Yossi; Henshke-Bar-Meir, Ruth

    2013-12-01

    Off-hours medical care in hospitals is provided by residents, while attendings on call are available for assistance. This study evaluated the gap between residents' expectations and professional guidelines' requirements of attendings on call and what actually occurs during night shifts, while comparing surgical and medical specialties. Two questionnaires based on professional guidelines were filled by residents. The first queried about residents' expectations of attendings on call, and the second asked about communication with the attendings during actual night shifts. While 91 (100%) of residents expected the attending on call to be available by phone during the shift, only 44 (48%) expected the attending to initiate contact, and only 17 (19%) expected the attending to visit the ward or emergency department (ED) without being requested to do so. In 127 shifts (84%), some form of communication occurred. Residents called their attendings during 105 shifts (70%). However, attendings initiated contact with residents at the beginning or during the shift in only 67 (44%) and 62 (41%) shifts, respectively, and initiated a visit to the ward/ED during the shift in only 41 cases (27%). Surgical attendings initiated contact in these three ways significantly more frequently than medical attendings [21 (28%) versus 46 (61%), 20 (26%) versus 42 (56%) and 4 (5%) versus 37 (50%), respectively; P communication during night shifts between residents and attendings occurs in most shifts, attendings initiate far less contact with residents than is required by the guidelines. © 2013 John Wiley & Sons Ltd.

  2. "It's a Burden You Carry": Describing Moral Distress in Emergency Nursing.

    Science.gov (United States)

    Wolf, Lisa A; Perhats, Cydne; Delao, Altair M; Moon, Michael D; Clark, Paul R; Zavotsky, Kathleen E

    2016-01-01

    Moral distress in nursing has been studied in many settings, but there is a paucity of research on moral distress as it manifests in the emergency department. One study suggests a correlation between moral distress and aspects of burnout, and other researchers report that nurses have considered leaving their position or even their profession because of moral distress. Further exploration of these issues may provide insight into their effects on ED patient care and the emergency nursing profession. The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses. A qualitative, exploratory design was employed using semi-structured focus groups for data collection. Using an iterative process, transcripts were analyzed for emerging themes by the research team. Six researchers analyzed the transcripts using a thematic analysis approach. Themes from the data included dysfunctional practice arena, being overwhelmed, and adaptive/maladaptive coping. Participants described, overall, a profound feeling of not being able to provide patient care as they wanted to. Causes of moral distress in emergency nurses are environment driven, not incident driven, as is described in other settings, and include a high-acuity, high-demand, technical environment with insufficient resources. Interventions should be targeted to improve environmental factors that contribute to the moral distress of emergency nurses. Future research should focus on the development and validation of an instrument to measure moral distress in this setting. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  3. Conduits to care: call lights and patients’ perceptions of communication

    Directory of Open Access Journals (Sweden)

    Montie M

    2017-09-01

    Full Text Available Mary Montie,1 Clayton Shuman,1 Jose Galinato,1 Lance Patak,2 Christine A Anderson,1 Marita G Titler1 1Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, 2Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, Seattle, WA, USA Background: Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients’ perceptions concerning call light use and communication. The specific aim of this study was to solicit patients’ perceptions regarding their call light use and communication with nursing staff. Methods: Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated. Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Results: Using qualitative descriptive methods, five major themes emerged from patients’ perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants’ perceptions of “nurse work”. Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Discussion: Findings from this study extend the knowledge of patients’ understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery. Keywords: nurse–patient communication, medical technology, quality of care, qualitative research

  4. Ocular emergencies presenting to Menelik II Hospital.

    Science.gov (United States)

    Negussie, Dereje; Bejiga, Abebe

    2011-01-01

    Ocular conditions such as trauma, painful red eye of any cause, painless sudden visual loss and others are commonly seen as ocular emergencies, and can lead to ocular morbidity and visual loss. To determine types and causes of ocular emergencies seen at Menelik II hospital. A cross-sectional study was conducted from April to October, 2007. Consecutive patients who presented with ocular emergencies at any time of the day were prospectively evaluated and registered on a formatted questionnaire. Evaluation of the patients included history of presenting illness, visual acuity testing intraocular pressure measurement on non-perforated and non-infected eyes, and complete eye examination in order to arrive at the diagnosis. A total of 26,400 patients attended Menelik II hospital during the study period. Of these, 758 (3%) were persons with an ocular emergency. The majority of patients (n=551; 72.7%) were male, with a male to female ratio of 2.7:1. The age group of 16 to 30 years was the most affected (47.9%), followed by those aged 15 years or younger (27.3%). Ocular trauma and ocular infections accounted for 75.6% and 13.1% of cases, respectively. Of the total ocular emergencies, open globe injuries constituted 171 (22.6%), corneal foreign bodies and abrasion 125 (16.5%), and open adnexal injuries 119 (15.7%). Metal and wood were the commonest work-related causes of ocular injuries in adults, with both together accounting for 60% of all ocular injuries. Children, on the other hand, sustained ocular injury while playing with others in 128 (22.3%) of cases. This study was able to provide a more complete picture to improve understanding of the nature and circumstances of ocular emergencies in Ethiopia. Ocular emergencies were dominated by ocular trauma, particularly affecting males and working-age adults. Public education and use of protective safety measures are recommended to alleviate the problem.

  5. A conceptual framework for an ecosystem services-based assessment of the so-called "emergency stabilization" measures following wildfire

    Science.gov (United States)

    Valente, Sandra; Prats, Sergio; Ribeiro, Cristina; Verheijen, Frank; Fleskens, Luuk; Keizer, Jacob

    2015-04-01

    Wildfires have become a major environmental concern in many Southern European countries over the past few decades. This includes Portugal, where, on average, some 100 000 ha of rural lands are affected by wildfire every year. While policies, laws, plans and public expenditure in Portugal continue to be largely directed towards fire combat and, arguably, to a lesser extent fire prevention, there has only recently been increasing attention for post-fire land management. For example following frequent and several large wildfires during the summer of 2010, so-called emergency stabilization measures were implemented in 16 different burnt areas in northern and central Portugal, using funds of the EU Rural Development Plan in Portugal (PRODER). The measures that were implemented included mulching (i.e. application of a protective layer of organic material), seeding and the construction of log barriers. However, the effectiveness of the implemented measures has not been monitored or otherwise assessed in a systematic manner. In fact, until very recently none of the post-fire emergency stabilization measures contemplated under PRODER seem to have been studied in an exhaustive manner in Portugal, whether under laboratory or field conditions. Prats et al. (2012, 2013, 2014) tested two of these measures by field trials, i.e. hydro-mulching and forest residue mulching. The authors found both measures to be highly effective in terms of reducing overland flow and especially erosion. It remains a challenge, however, to assess the effectiveness of these and other measures in a broader context, not only beyond overland flow and sediment losses but also beyond the spatio-temporal scale that are typical for such field trials (plots and the first two years after fire). This challenge will be addressed in the Portuguese case study of the RECARE project. Nonetheless, the present study wants to be a first attempt at an ecosystem services-based assessment of mulching as a post

  6. High inter-observer agreement of observer-perceived pain assessment in the emergency department

    DEFF Research Database (Denmark)

    Hangaard, Martin Høhrmann; Malling, Brian; Mogensen, Christian Backer

    2018-01-01

    degree of inter-observer agreement. The aim of the present study was to assess the inter-observer agreement of perceived pain among emergency department nurses and to evaluate if it was influenced by predetermined factors like age and gender. Method: A project assistant randomly recruited two nurses, who...... of 0.05 and 95% limits of agreement of +/-1 category. Patient age, gender, localization of pain, examination room or presence of a significant other did not affect the inter-observer agreement. Conclusion: We found 70% agreement on pain category between the nurses and it is justified that nurse......Background: Triage is used to prioritize the patients in the emergency department. The majority of the triage systems include the patients' pain score to assess their level of acuity by using a combination of patient reported pain and observer-perceived pain; the latter therefore requires a certain...

  7. Human Response to Emergency Warning

    Science.gov (United States)

    Sorensen, J.

    2009-12-01

    Almost every day people evacuate from their homes, businesses or other sites, even ships, in response to actual or predicted threats or hazards. Evacuation is the primary protective action utilized in large-scale emergencies such as hurricanes, floods, tornados, tsunamis, volcanic eruptions, or wildfires. Although often precautionary, protecting human lives by temporally relocating populations before or during times of threat remains a major emergency management strategy. One of the most formidable challenges facing emergency officials is evacuating residents for a fast-moving and largely unpredictable event such as a wildfire or a local tsunami. How to issue effective warnings to those at risk in time for residents to take appropriate action is an on-going problem. To do so, some communities have instituted advanced communications systems that include reverse telephone call-down systems or other alerting systems to notify at-risk residents of imminent threats. This presentation examines the effectiveness of using reverse telephone call-down systems for warning San Diego residents of wildfires in the October of 2007. This is the first systematic study conducted on this topic and is based on interviews with 1200 households in the evacuation areas.

  8. Reproductive Health Outcomes of Insured Women Who Access Oral Levonorgestrel Emergency Contraception

    Science.gov (United States)

    Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W.; Goler, Nancy

    2015-01-01

    Objectives To assess the level of risk for women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. Methods This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among women aged 15-44 who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Results Of 21,421 prescriptions, 14,531(67.8%) were accessed through the call center. In the subsequent 12 months, 12,127(56.6%) women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264(10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for women who accessed it through the call center -1,569(10.8%) and office visits – 695(10.1%) (adjusted OR 1.02 95% confidence interval (CI) 0.93-1.13). In the subsequent 6 months, 2,056(9.6%) women became pregnant. Women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82 95% CI 0.72-0.94); however they were more likely to become pregnant within 4-6 months (adjusted OR 1.37 95%CI 1.16-1.60). Among women who were tested for chlamydia and gonorrhea, 689(7.8%) and 928(7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Conclusions Protocols to routinely address unmet need for contraception at every call for emergency contraception and all office visits including visits with primary care providers should be investigated. PMID:25751211

  9. Collaborative Educational Leadership: The Emergence of Human Interactional Sense-Making Process as a Complex System

    Science.gov (United States)

    Jäppinen, Aini-Kristiina

    2014-01-01

    The article aims at explicating the emergence of human interactional sense-making process within educational leadership as a complex system. The kind of leadership is understood as a holistic entity called collaborative leadership. There, sense-making emerges across interdependent domains, called attributes of collaborative leadership. The…

  10. Improving Emergency Department flow through optimized bed utilization.

    Science.gov (United States)

    Chartier, Lucas Brien; Simoes, Licinia; Kuipers, Meredith; McGovern, Barb

    2016-01-01

    Over the last decade, patient volumes in the emergency department (ED) have grown disproportionately compared to the increase in staffing and resources at the Toronto Western Hospital, an academic tertiary care centre in Toronto, Canada. The resultant congestion has spilled over to the ED waiting room, where medically undifferentiated and potentially unstable patients must wait until a bed becomes available. The aim of this quality improvement project was to decrease the 90th percentile of wait time between triage and bed assignment (time-to-bed) by half, from 120 to 60 minutes, for our highest acuity patients. We engaged key stakeholders to identify barriers and potential strategies to achieve optimal flow of patients into the ED. We first identified multiple flow-interrupting challenges, including operational bottlenecks and cultural issues. We then generated change ideas to address two main underlying causes of ED congestion: unnecessary patient utilization of ED beds and communication breakdown causing bed turnaround delays. We subsequently performed seven tests of change through sequential plan-do-study-act (PDSA) cycles. The most significant gains were made by improving communication strategies: small gains were achieved through the optimization of in-house digital information management systems, while significant improvements were achieved through the implementation of a low-tech direct contact mechanism (a two-way radio or walkie-talkie). In the post-intervention phase, time-to-bed for the 90th percentile of high-acuity patients decreased from 120 minutes to 66 minutes, with special cause variation showing a significant shift in the weekly measurements.

  11. The emerging nuclear suppliers

    International Nuclear Information System (INIS)

    Dunn, L.A.

    1990-01-01

    Since the early 1980s, a growing amount of attention has been paid to a small group of mostly developing countries that have come to be called the emerging nuclear suppliers. Argentina and Brazil, China and South Korea, India and Pakistan, Spain and Yugoslavia have frequently been mentioned in this category. Their actual and potential nuclear export dealings and policies have been the subject of academic writings and policy papers, of scholarly symposia and exchanges at meetings of the traditional nuclear suppliers. With foundation and other support, UCLA's Center for International and Strategic Affairs has begun a major project to develop a database on the transactions, policies, and export control institutions of the emerging suppliers. This chapter provides some guidelines for policy toward the emerging nuclear suppliers

  12. Changes in visual acuity in patients with wet age-related macular degeneration treated with intravitreal ranibizumab in daily clinical practice: the LUMIERE study.

    Science.gov (United States)

    Cohen, Salomon Y; Mimoun, Gerard; Oubraham, Hassiba; Zourdani, Alain; Malbrel, Christian; Queré, Stephane; Schneider, Véronique

    2013-03-01

    To survey compliance with recommended intravitreal ranibizumab treatment protocols in daily clinical practice in France, with reference to outcomes. A retrospective, descriptive, observational study in patients with subfoveal wet age-related macular degeneration treated with ranibizumab. All historical data for the study period, including demographic, treatment, and disease details and visual acuity measurements (baseline, Month 3, and Month 12), were recorded retrospectively at least 12 months after the beginning of treatment. In 551 patients followed by 16 ophthalmologists, 12 months of intravitreal ranibizumab treatment induced a mean visual acuity gain of 3.2 ± 14.8 Early Treatment Diabetic Retinopathy Study-equivalent letters. Fewer than 40% of patients received the recommended treatment of initial 3 monthly injections. More than 50% had to wait >8 days between diagnosis and treatment. At Month 3, visual acuity gain was greater in patients who had received recommended induction and in whom treatment was initiated quickly. At Month 12, the induction-related effect had largely disappeared but the time-to-treatment effect persisted. Patients had an average of 5.1 injections (2.6 during induction period). No patients were monitored monthly as stipulated in the guidelines. Although poor compliance with recommendations has been reflected in mediocre outcomes, there is evidence that practice is improving.

  13. Femtosecond laser-assisted LASIK versus PRK for high myopia: comparison of 18-month visual acuity and quality.

    Science.gov (United States)

    Hashemi, Hassan; Ghaffari, Reza; Miraftab, Mohammad; Asgari, Soheila

    2017-08-01

    To compare 18-month outcomes between femtosecond laser-assisted LASIK (femto-LASIK) and photorefractive keratectomy with mitomycin-C (PRK-MMC) for myopia of more than 7.0 D in terms of visual acuity and quality. In this comparative nonrandomized clinical trial, 60 eyes from 30 patients (30 eyes in each group) were enrolled. The two procedures were compared in terms of 18-month changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, ocular and corneal higher order aberrations (HOAs), and contrast sensitivity (CS). Mean myopia was -8.65 ± 1.51 and -8.04 ± 1.70 D (P = 0.149) and mean ablation depth was 109.37 ± 9.07 and 105.09 ± 12.59 µm (P = 0.138), in the femto-LASIK and PRK-MMC groups, respectively. Baseline parameters were not significantly different between the two groups (all P > 0.05). At 18 months postoperatively, 75 % in the femto-LASIK, versus 57.1 % in the PRK-MMC group, had 20/20 UDVA (P = 0.017). CDVA remained similarly unchanged in both groups (P = 0.616). No case had residual refractive error more than 1.0 D in the femto-LASIK group, while 33.5 % in the other group had more than 1.0 D residual error (P = 0.390). Changes in corneal HOA were not significantly different between the two groups (P = 0.260). Cases in the femto-LASIK group showed more increase in ocular HOA (P = 0.032) and coma (P = 0.083, power = 72 %). CS remained similarly unchanged in all spatial frequencies in both groups (all P > 0.05). Although femto-LASIK induces more HOA compared to PRK-MMC, considering outcomes in terms of 20/20 UDVA, residual refractive error, and CS stability, femto-LASIK provides more favorable results than PRK-MMC in high myopia.

  14. Contrast sensitivity measured by two different test methods in healthy, young adults with normal visual acuity.

    Science.gov (United States)

    Koefoed, Vilhelm F; Baste, Valborg; Roumes, Corinne; Høvding, Gunnar

    2015-03-01

    This study reports contrast sensitivity (CS) reference values obtained by two different test methods in a strictly selected population of healthy, young adults with normal uncorrected visual acuity. Based on these results, the index of contrast sensitivity (ICS) is calculated, aiming to establish ICS reference values for this population and to evaluate the possible usefulness of ICS as a tool to compare the degree of agreement between different CS test methods. Military recruits with best eye uncorrected visual acuity 0.00 LogMAR or better, normal colour vision and age 18-25 years were included in a study to record contrast sensitivity using Optec 6500 (FACT) at spatial frequencies of 1.5, 3, 6, 12 and 18 cpd in photopic and mesopic light and CSV-1000E at spatial frequencies of 3, 6, 12 and 18 cpd in photopic light. Index of contrast sensitivity was calculated based on data from the three tests, and the Bland-Altman technique was used to analyse the agreement between ICS obtained by the different test methods. A total of 180 recruits were included. Contrast sensitivity frequency data for all tests were highly skewed with a marked ceiling effect for the photopic tests. The median ICS for Optec 6500 at 85 cd/m2 was -0.15 (95% percentile 0.45), compared with -0.00 (95% percentile 1.62) for Optec at 3 cd/m2 and 0.30 (95% percentile 1.20) FOR CSV-1000E. The mean difference between ICSFACT 85 and ICSCSV was -0.43 (95% CI -0.56 to -0.30, p<0.00) with limits of agreement (LoA) within -2.10 and 1.22. The regression line on the difference of average was near to zero (R2=0.03). The results provide reference CS and ICS values in a young, adult population with normal visual acuity. The agreement between the photopic tests indicated that they may be used interchangeably. There was little agreement between the mesopic and photopic tests. The mesopic test seemed best suited to differentiate between candidates and may therefore possibly be useful for medical selection purposes.

  15. Elderly and Nonelderly Use of a Dedicated Ambulance Corps’ Emergency Medical Services in Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Chia Huang

    2016-01-01

    Full Text Available Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years and nonelderly (<65 years. Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05 fewer (28 (9.2% nontransport calls than did the nonelderly (136 (21.4%. In the transport calls, 276 (35.6% were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now.

  16. Elderly and Nonelderly Use of a Dedicated Ambulance Corps' Emergency Medical Services in Taiwan

    Science.gov (United States)

    Huang, Chien-Chia; Chen, Wei-Lung; Hsu, Chien-Chin; Lin, Hung-Jung; Su, Shih-Bin; Guo, How-Ran

    2016-01-01

    Backgrounds and Aim. Taiwan's population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly (<65 years). Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P < 0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson's disease, and Alzheimer's disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now. PMID:27478825

  17. Visual acuity after Ruthenium106 brachytherapy of choroidal melanomas

    International Nuclear Information System (INIS)

    Damato, Bertil; Patel, Imran M.; Campbell, Ian R.; Mayles, Helen M.; Errington, R. Douglas

    2005-01-01

    Purpose: To report on conservation of visual acuity after Ruthenium 106 (Ru-106) brachytherapy of choroidal melanoma. Methods and materials: This study was a noncomparative interventional case series of 458 patients with choroidal melanoma treated at a single center between January 1993 and December 2001. The intervention consisted of Ru-106 brachytherapy delivering minimum scleral and apex doses of 300 Gy and 80 Gy, respectively, using a 15-mm or 20-mm plaque. For discrete, posterior tumors, the plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin. To ensure correct plaque positioning, any overlying extraocular muscles were dis-inserted, and the locations of both tumor and plaque edges were confirmed by transillumination and indentation. The main outcome measures were conservation of vision of 20/40 or better, 20/200 or better, and Counting Fingers or better, according to baseline variables. Results: The actuarial rate of conservation of 20/40 or better was 55% at 9 years, loss of such vision correlating with posterior tumor extension (p 106 brachytherapy of posterior choroidal melanoma achieves good conservation of vision if the tumor does not extend close to the optic nerve or fovea

  18. Poison control center - Emergency number (image)

    Science.gov (United States)

    For a poison emergency call 1-800-222-1222 anywhere in the United States. This national hotline number will let you ... is a free and confidential service. All local poison control centers in the U.S. use this national ...

  19. VIDEOCARE: Decentralised psychiatric emergency care through videoconferencing

    Directory of Open Access Journals (Sweden)

    Trondsen Marianne V

    2012-12-01

    Full Text Available Abstract Background Today the availability of specialists is limited for psychiatric patients in rural areas, especially during psychiatric emergencies. To overcome this challenge, the University Hospital of North Norway has implemented a new decentralised on-call system in psychiatric emergencies, by which psychiatrists are accessible by videoconference 24/7. In September 2011, the new on-call system was established in clinical practice for patients and health staff at three regional psychiatric centres in Northern Norway. Although a wide variety of therapies have been successfully delivered by videoconference, there is limited research on the use of videoconferenced consultations with patients in psychiatric emergencies. The aim of this study is to explore the use of videoconference in psychiatric emergencies based on the implementation of this first Norwegian tele-psychiatric service in emergency care. Methods/design The research project is an exploratory case study of a new videoconference service in operation. By applying in-depth interviews with patients, specialists and local health-care staff, we will identify factors that facilitate and hinder use of videoconferencing in psychiatric emergencies, and explore how videoconferenced consultations matter for patients, professional practice and cooperation between levels in psychiatric care. By using an on-going project as the site of research, the case is especially well-suited for generating reliable and valid empirical data. Discussion Results from the study will be of importance for understanding of how videoconferencing may support proper treatment and high-quality health care services in rural areas for patients in psychiatric emergencies.

  20. COMPARISON OF VISUAL ACUITY IN REDUCED LUMINATION AND FACILITY OF OCULAR ACCOMMODATION IN TABLE TENNIS CHAMPIONS AND NON- PLAYERS

    Directory of Open Access Journals (Sweden)

    Ebrahim Jafarzadehpur

    2004-03-01

    Full Text Available A table tennis player should fixate at different distances; track the objects with different speed, and in different visual environment. Their visual skills must be well developed for these capabilities. Therefore, visual acuity in reduced lumination and facility of ocular accommodation those are two criteria for visual skills have been compared in table tennis players and normal non-players. Twenty-nine young table tennis champions and 29 normal matched non-players (did not take part in any racket sports game were evaluated. Basic visual and eye examinations were done for both of them. Normal results in basic examination were fundamental requirement for all the subjects. +/-2.00 sphere lenses for accommodation facility are used. An electrical current regulator changed the output light intensity of a conventional chart projector (Topcon. Light intensity decreased to 10 cd·m-2 and visual acuity tested. In comparison of visual acuity in reduced lumination and facility of ocular accommodation in table tennis champions and non-players there are significant differences (p < 0.001. In the preliminary visual tests there was not any significant different in the two groups but the results in the top level table tennis player was very uniform and in every test and the standard deviation was lesser in tennis player group than non-players. These results show that motor and sensorial functions of expert players are well developed. That is consistent with other researchers. This result was interpreted as reflecting a better perceptual system of experts to the constraints encountered during table tennis and its use in practical settings for evaluating athletes or detecting sport talents. However some visual and perceptual training that usually used in orthoptics can be used for novice table tennis player to improve their abilities

  1. Acuidade visual: Medidas e notações Visual acuity: Measurements and notations

    Directory of Open Access Journals (Sweden)

    Harley E. A. Bicas

    2002-06-01

    Full Text Available Avaliações da função visual são muito complexas por dependerem de mecanismos aferentes, eferentes e cognitivos, além de fatores externos à pessoa examinada, como o tipo de estímulo e o de sua apresentação. O exame da acuidade visual é discutido em seus aspectos formais de definições, quantificações (critérios de medição de um ângulo e tamanho dos optotipos, notações (decimal ou fracionárias, escalas (representando relações angulares, lineares, logarítmicas e unidades em que os valores são expressos (recíproca do minuto de arco, número puro, freqüência espacial, decibéis e oitavas. Como conseqüência, referências numéricas sobre a acuidade visual e operações que as envolvem (p.ex., cálculo de valores médios, determinação de variações, relações entre elas podem levar a interpretações muito diferentes e até opostas num mesmo estudo, dependendo dos critérios nele empregados.Evaluations of the visual function are very intricate since they depend on afferent, efferent and cognitive mechanisms, besides external factors of the examined subject, such as the type of the stimulus and of its presentation. Testing the visual acuity is discussed in its formal aspects related to definitions, quantifications (criteria for the measurements of an angle, size of optotypes, notations (decimal or fractionary, scales (representing angular, linear or logarithmic relationships and units in which the values are expressed (reciprocal of minutes of arc, pure number, spacial frequency, decibels, octaves. As a consequence, numerical references about visual acuity and respective operations (e.g., calculations of average values, determinations of variations, relationships between them may lead to very different interpretations of a study, sometimes even opposite, according to the criteria which are used.

  2. Perceiving a calling, living a calling, and job satisfaction: testing a moderated, multiple mediator model.

    Science.gov (United States)

    Duffy, Ryan D; Bott, Elizabeth M; Allan, Blake A; Torrey, Carrie L; Dik, Bryan J

    2012-01-01

    The current study examined the relation between perceiving a calling, living a calling, and job satisfaction among a diverse group of employed adults who completed an online survey (N = 201). Perceiving a calling and living a calling were positively correlated with career commitment, work meaning, and job satisfaction. Living a calling moderated the relations of perceiving a calling with career commitment and work meaning, such that these relations were more robust for those with a stronger sense they were living their calling. Additionally, a moderated, multiple mediator model was run to examine the mediating role of career commitment and work meaning in the relation of perceiving a calling and job satisfaction, while accounting for the moderating role of living a calling. Results indicated that work meaning and career commitment fully mediated the relation between perceiving a calling and job satisfaction. However, the indirect effects of work meaning and career commitment were only significant for individuals with high levels of living a calling, indicating the importance of living a calling in the link between perceiving a calling and job satisfaction. Implications for research and practice are discussed. (c) 2012 APA, all rights reserved.

  3. Call Center Capacity Planning

    DEFF Research Database (Denmark)

    Nielsen, Thomas Bang

    in order to relate the results to the service levels used in call centers. Furthermore, the generic nature of the approximation is demonstrated by applying it to a system incorporating a dynamic priority scheme. In the last paper Optimization of overflow policies in call centers, overflows between agent......The main topics of the thesis are theoretical and applied queueing theory within a call center setting. Call centers have in recent years become the main means of communication between customers and companies, and between citizens and public institutions. The extensively computerized infrastructure...... in modern call centers allows for a high level of customization, but also induces complicated operational processes. The size of the industry together with the complex and labor intensive nature of large call centers motivates the research carried out to understand the underlying processes. The customizable...

  4. Origins of Superior Dynamic Visual Acuity in Baseball Players: Superior Eye Movements or Superior Image Processing

    OpenAIRE

    Uchida, Yusuke; Kudoh, Daisuke; Murakami, Akira; Honda, Masaaki; Kitazawa, Shigeru

    2012-01-01

    Dynamic visual acuity (DVA) is defined as the ability to discriminate the fine parts of a moving object. DVA is generally better in athletes than in non-athletes, and the better DVA of athletes has been attributed to a better ability to track moving objects. In the present study, we hypothesized that the better DVA of athletes is partly derived from better perception of moving images on the retina through some kind of perceptual learning. To test this hypothesis, we quantitatively measured DV...

  5. Effect of ruboxistaurin (RBX) On visual acuity decline over a 6-year period with cessation and reinstitution of therapy

    DEFF Research Database (Denmark)

    Sheetz, Matthew J; Aiello, Lloyd Paul; Shahri, Nazila

    2011-01-01

    reduced the occurrence of sustained moderate visual loss (SMVL; ≥15-letter decline in visual acuity sustained for the last 6 months of study participation) from 9.1% in the PBO group (N = 340) to 5.5% in the RBX group (N = 345, P = 0.034). This study evaluates the primary end point of SMVL in a 2-year...

  6. Comparison of monochromatic aberrations in young adults with different visual acuity and refractive errors.

    Science.gov (United States)

    Yazar, Seyhan; Hewitt, Alex W; Forward, Hannah; McKnight, Charlotte M; Tan, Alex; Mountain, Jenny A; Mackey, David A

    2014-03-01

    To compare the monochromatic aberrations in a large cohort of 20-year-old Australians with differing levels of visual acuity and explore the relationship between these aberrations and refractive error. Lions Eye Institute, Perth, Western Australia, Australia. Cross-sectional analysis of a population-based cohort. Monochromatic aberrations were measured using a Zywave II wavefront aberrometer with natural pupils in a dark room. The logMAR corrected distance visual acuity (CDVA) was measured monocularly under normal illumination. Cycloplegic autorefraction was also performed. The study enrolled 2039 eyes of 1040 participants. Data from 1007 right eyes were analyzed. The median CDVA and spherical equivalent were -0.06 logMAR (interquartile range [IQR], -0.10 to 0.00) and +0.25 diopters (D) (IQR, -0.38 to 0.63), respectively. The median 6.0 mm higher-order aberration (HOA) was 0.58 μm (IQR, 0.44 to 0.79). Coma-like aberrations and 3rd-, 4th-, and 5th-order HOAs were significantly different between subjects with a CDVA of -0.10 logMAR or better and those with a CDVA worse than -0.10 logMAR. Fourth-order aberrations Z(4,-4) (P=.024) and Z(4,-2) (P=.029) and 2nd-order aberration Z(2,0) (Peyes, emmetropic eyes, and hyperopic eyes. Subjects with higher myopia had slightly higher total HOAs. The HOAs in this population were marginally higher than previously reported values. The findings confirm there is a difference in monochromatic aberrations between different vision and refractive groups. Results in this study will benefit decision-making processes in the clinical setting. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  7. Calle Blanco

    Directory of Open Access Journals (Sweden)

    Gonzalo Cerda Brintrup

    1988-06-01

    Full Text Available Importante arteria, que comunica el sector del puerto con la plaza. Las más imponentes construcciones se sucedían de un modo continuo, encaramándose a ambos lados de la empinada calle. Antes del gran incendio de 1936 grandes casonas de madera destacaban en calle Irarrázabal y en la esquina de ésta con calle Blanco, la más hermosa construcción pertenecía a don Alberto Oyarzún y la casa vecina hacia Blanco era de don Mateo Miserda, limitada por arriba con la casa de don Augusto Van Der Steldt y ésta era seguida de la casa de don David Barrientos provista de cuatro cúpulas en las esquinas y de un amplio corredor en el frontis. Todas estas construcciones de madera fueron destruidas en el gran incendio de 1936.

  8. Prehospital Emergencies in Illegal Gold Mining Sites in French Guiana.

    Science.gov (United States)

    Egmann, Gérald; Tattevin, Pierre; Palancade, Renaud; Nacher, Matthieu

    2018-03-01

    Illegal gold mining is flourishing in French Guiana, existing outside the law due to both the high cost of gold mining permits and the challenges of law enforcement within the Amazon forest. We report the characteristics of, and the medical responses to, medical emergencies in illegal gold mining sites. We performed a retrospective study of all medical emergencies reported from illegal gold mining sites to the centralized call office of SAMU 973 from 1998 through 2000 and from 2008 through 2010. According to the national health care system, any medical emergency within the territory is handled by the prehospital emergency medical service (SAMU 973), irrespective of the patients' legal status. Data were extracted from the SAMU 973 notebook registry (1998-2000) or the SAMU 973 computerized database (2008-2010) and werre collected using a standardized questionnaire. Of 71,932 calls for medical emergencies in French Guiana during the study periods, 340 (0.5%) originated from illegal gold mining sites. Of these, 196 (58%) led to medical evacuation by helicopter, whereas the overall rate of evacuation by helicopter after placing a call to SAMU 973 was only 4% (3020/71,932; PAmazon forest mostly include infectious diseases, followed by trauma, and often require medical evacuation by helicopter. Our study suggests that implementation of preventive medicine within gold mining sites, irrespective of their legal status, could be cost-effective and reduce morbidity. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  9. Key performance indicators' assessment to develop best practices in an Emergency Medical Communication Centre.

    Science.gov (United States)

    Penverne, Yann; Leclere, Brice; Labady, Julien; Berthier, Frederic; Jenvrin, Joel; Javaudin, Francois; Batard, Eric; Montassier, Emmanuel

    2017-05-17

    Emergency Medical Communication Centre (EMCC) represents a pivotal link in the chain of survival for those requiring rapid response for out-of-hospital medical emergencies. Assessing and grading the performance of EMCCs are warranted as it can affect the health and safety of the served population. The aim of our work was to describe the activity on an EMCC and to explore the associations between different key performance indicators. We carried out our prospective observational study in the EMCC of Nantes, France, from 6 June 2011 to 6 June 2015. The EMCC performance was assessed with the following key performance indicators: answered calls, Quality of Service 20 s (QS20), occupation rate and average call duration. A total of 35 073 h of dispatch activity were analysed. 1 488 998 emergency calls were answered. The emergency call incidence varied slightly from 274 to 284 calls/1000 citizens/year between 2011 and 2015. The median occupation rate was 35% (25-44). QS20 was correlated negatively with the occupation rate (Spearman's ρ: -0.78). The structural equation model confirmed that the occupation rate was highly correlated with the QS20 (standardized coefficient: -0.89). For an occupation rate of 26%, the target value estimated by our polynomial model, the probability of achieving a QS20 superior or equal to 95% varied between 56 and 84%. The occupation rate appeared to be the most important factor contributing towards the QS20. Our data will be useful to develop best practices and guidelines in the field of emergency medicine communication centres.

  10. Qualidade da avaliação da acuidade visual realizada pelos professores do programa " Olho no olho" da cidade de Marília, SP Assessment of visual acuity evaluation performed by teachers of the "Eye in eye" program in Marília-SP, Brazil

    Directory of Open Access Journals (Sweden)

    Lígia Issa De Fendi

    2008-08-01

    Full Text Available OBJETIVOS: Avaliar a qualidade e o ponto de corte (AV PURPOSE: To assess quality and cut-off point (VA <0.7 of the examinations performed by teachers to detect reduced visual acuity (VA in schoolchildren participants of the project called "Eye in eye " in Marilia-SP, Brazil. METHODS: Visual acuity measurements were performed by trained teachers using Snellen's chart. The children with VA <0.7 in one of the eyes were referred to an ophthalmic examination. The ophthalmic examination was considered gold standard to assess quality and cut-off point of the examinations performed by teachers. VA test was performed in 604 schoolchildren of state public schools (1,208 eyes. Analyses were based on examined eyes. We calculated sensitivity (S, specificity (E, positive predictive value (PPV, negative predictive value (NPV and likelihood rate (LR. We compared the means obtained by the teachers' examinations to means of the ophthalmologist's examinations. ROC curve was produced to evaluate whether VA lower than 0.7 is the best value for referral to an ophthalmic examination. RESULTS: VA means obtained by teachers and ophthalmologic examinations were 0.70 ± 0.16 and 0.88 ± 0.2 respectively. The difference between teachers' and ophthalmologists' examinations was 0.18 (p<0.0001. S, E, PPV, NPV e LR were: 82%, 40%, 27%, 89% and 1.37, respectively. False positive and negative rates were 59.5% and 18%. ROC curve evidenced that visual acuity of 0.7 was the best cut-off point to refer schoolchildren to an ophthalmic exam. CONCLUSIONS: We demonstrated the importance of the teachers' participation in improved schoolchildren ocular health. The examination performed by teachers obtained a satisfactory S with low E, NPV and high values of false positive results. The best cut-off point to refer schoolchildren to an ophthalmic examination was VA of 0.7.

  11. Are there high-risk groups among physicians that are more vulnerable to on-call work?

    Science.gov (United States)

    Heponiemi, Tarja; Aalto, Anna-Mari; Pekkarinen, Laura; Siuvatti, Eeva; Elovainio, Marko

    2015-05-01

    Work done in the emergency departments is one stressful aspect of physicians' work. Numerous previous studies have highlighted the stressfulness of on-call work and especially of night on call. In addition, previous studies suggest that there may be individual differences in adjusting to changes in circadian rhythms and on-call work. The objective of this study was to examine whether physicians' on-call work is associated with perceived work-related stress factors and job resources and whether there are groups that are more vulnerable to on-call work according to sex, age, and specialization status. This was a cross-sectional questionnaire study among 3230 Finnish physicians (61.5% women). The analyses were conducted using analyses of covariance adjusted for sex, age, specialization status, and employment sector. Physicians with on-call duties had more time pressure and stress related to team work and patient information systems compared with those who did not have on-call duties. In addition, they had less job control opportunities and experienced organization as less fair and team climate as worse. Older physicians and specialists seemed to be especially vulnerable to on-call work regarding stress factors, whereas younger and specialist trainees seemed vulnerable to on-call work regarding job resources. Focusing on team issues and resources is important for younger physicians and trainees having on-call duties, whereas for older and specialists, attention should be focused on actual work load and time pressure. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Low compliance with a validated system for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke

    2011-01-01

    Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have...... a "primary criterion" or a BEWS = 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

  13. CORRELATION OF CLINICAL AND STRUCTURAL PROGRESSION WITH VISUAL ACUITY LOSS IN MACULAR TELANGIECTASIA TYPE 2: MacTel Project Report No. 6-The MacTel Research Group.

    Science.gov (United States)

    Peto, Tunde; Heeren, Tjebo F C; Clemons, Traci E; Sallo, Ferenc B; Leung, Irene; Chew, Emily Y; Bird, Alan C

    2018-01-01

    To evaluate progression of macular telangiectasia Type 2 lesions and their correlation with visual acuity. An international multicenter prospective study with annual examinations including best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography, and optical coherence tomography images graded centrally. Mixed models were used to estimate progression rates, and a generalized linear model to compute the relative risk of BCVA loss, loss of ellipsoid zone (EZ) reflectivity, development of pigment plaques, or neovascularization. One thousand and fourteen eyes of 507 participants were followed for 4.2 ± 1.6 years. Best-corrected visual acuity decreased 1.07 ± 0.05 letters (mean ± SE) per year. Of all eyes, 15% lost ≥15 letters after 5 years. Of the eyes without EZ loss, 76% developed a noncentral loss. Of the eyes with noncentral loss, 45% progressed to central EZ loss. The rate of BCVA loss in eyes with noncentral EZ loss at baseline was similar to eyes without EZ loss. The rate of BCVA loss was significantly higher in eyes with central EZ loss at baseline (-1.40 ± 0.14 letters, P structural component reflecting visual function. Its presence in the fovea significantly correlates with worse visual prognosis.

  14. Communication between general practitioners and the emergency medical dispatch centre in urgent cases

    DEFF Research Database (Denmark)

    Mieritz, Hanne Beck; Rønnow, Camilla; Jørgensen, Gitte

    2018-01-01

    , and we found that these calls were more likely to contain problematic communication (odds ratio = 5.1). In 18% (n = 236) of the cases, there was not sufficient information to assess if the physician-manned mobile emergency care unit (MECU) should have been dispatched along with the ambulance......INTRODUCTION: When general practitioners (GPs) order an ambulance, their calls are handled by staff at the emergency medical dispatch centre (EMDC) who then select an appropriate response. There are currently no data evaluating this mode of communication between the GPs and the staff at the EMDC....... 
RESULTS: We found problematic communication in less than 2% (n = 25) of the evaluated calls. In 68% of the 25 problematic cases transactional analysis showed that the staff at the EMDC initiated the problematic communication. In 4% (n = 51) of the calls, the GP delegated the call to a secretary or nurse...

  15. Primary care patients in the emergency department: who are they? A review of the definition of the 'primary care patient' in the emergency department.

    Science.gov (United States)

    Bezzina, Andrew J; Smith, Peter B; Cromwell, David; Eagar, Kathy

    2005-01-01

    To review the definition of 'primary care' and 'inappropriate' patients in ED and develop a generally acceptable working definition of a 'primary care' presentation in ED. A Medline review of articles on primary care in ED and the definitions used. A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential 'primary care', 'general practice', or 'inappropriate' patients in ED. A representative definition was developed premised on the common factors in these papers: low urgency/acuity--triage categories four or five in the Australasian Triage Scale, self-referred--by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on, presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred), unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted. This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings.

  16. Perceiving a Calling, Living a Calling, and Job Satisfaction: Testing a Moderated, Multiple Mediator Model

    Science.gov (United States)

    Duffy, Ryan D.; Bott, Elizabeth M.; Allan, Blake A.; Torrey, Carrie L.; Dik, Bryan J.

    2012-01-01

    The current study examined the relation between perceiving a calling, living a calling, and job satisfaction among a diverse group of employed adults who completed an online survey (N = 201). Perceiving a calling and living a calling were positively correlated with career commitment, work meaning, and job satisfaction. Living a calling moderated…

  17. Effects of immigration enforcement legislation on Hispanic pediatric patient visits to the pediatric emergency department.

    Science.gov (United States)

    Beniflah, Jacob D; Little, Wendalyn K; Simon, Harold K; Sturm, Jesse

    2013-12-01

    To compare the visits by Hispanic patients to the pediatric emergency department (PED) before and after passage of Georgia House Bill 87 (HB87). This bill grants local law enforcement the authority to enforce immigration laws. A retrospective chart review of all Hispanic patients who presented to the PED in a 4-month period after implementation of HB87 in 2011 was conducted and compared with the same period in 2009 and 2010. Data compared included patient acuity score, disposition, payer status, and demographics. Fewer Hispanic patients presented to the ED after passage of the bill (18.3% vs 17.1%, P immigration legislation.

  18. Outcomes of medical emergencies on commercial airline flights.

    Science.gov (United States)

    Peterson, Drew C; Martin-Gill, Christian; Guyette, Francis X; Tobias, Adam Z; McCarthy, Catherine E; Harrington, Scott T; Delbridge, Theodore R; Yealy, Donald M

    2013-05-30

    Worldwide, 2.75 billion passengers fly on commercial airlines annually. When in-flight medical emergencies occur, access to care is limited. We describe in-flight medical emergencies and the outcomes of these events. We reviewed records of in-flight medical emergency calls from five domestic and international airlines to a physician-directed medical communications center from January 1, 2008, through October 31, 2010. We characterized the most common medical problems and the type of on-board assistance rendered. We determined the incidence of and factors associated with unscheduled aircraft diversion, transport to a hospital, and hospital admission, and we determined the incidence of death. There were 11,920 in-flight medical emergencies resulting in calls to the center (1 medical emergency per 604 flights). The most common problems were syncope or presyncope (37.4% of cases), respiratory symptoms (12.1%), and nausea or vomiting (9.5%). Physician passengers provided medical assistance in 48.1% of in-flight medical emergencies, and aircraft diversion occurred in 7.3%. Of 10,914 patients for whom postflight follow-up data were available, 25.8% were transported to a hospital by emergency-medical-service personnel, 8.6% were admitted, and 0.3% died. The most common triggers for admission were possible stroke (odds ratio, 3.36; 95% confidence interval [CI], 1.88 to 6.03), respiratory symptoms (odds ratio, 2.13; 95% CI, 1.48 to 3.06), and cardiac symptoms (odds ratio, 1.95; 95% CI, 1.37 to 2.77). Most in-flight medical emergencies were related to syncope, respiratory symptoms, or gastrointestinal symptoms, and a physician was frequently the responding medical volunteer. Few in-flight medical emergencies resulted in diversion of aircraft or death; one fourth of passengers who had an in-flight medical emergency underwent additional evaluation in a hospital. (Funded by the National Institutes of Health.).

  19. Research on Group Decision-Making Mechanism of Internet Emergency Management

    Science.gov (United States)

    Xie, Kefan; Chen, Gang; Qian, Wu; Shi, Zhao

    With the development of information technology, internet has become a popular term and internet emergency has an intensive influence on people's life. This article offers a short history of internet emergency management. It discusses the definition, characteristics, and factor of internet emergency management. A group decision-making mechanism of internet emergency is presented based on the discussion. The authors establish a so-called Rough Set Scenario Flow Graphs (RSSFG) of group decision-making mechanism of internet emergency management and make an empirical analysis based on the RSSFG approach. The experimental results confirm that this approach is effective in internet emergency decision-making.

  20. The role of visual acuity and segmentation cues in compound word identification

    Directory of Open Access Journals (Sweden)

    Jukka eHyönä

    2012-06-01

    Full Text Available Studies are reviewed that demonstrate how the foveal area of the eye constrains how compound words are identified during reading. When compound words are short, their letters can be identified during a single fixation, leading to the whole-word route dominating word recognition from early on. Hence, visually marking morpheme boundaries by hyphens slows down processing by encouraging morphological decomposition when holistic processing is a feasible option. In contrast, the decomposition route dominates the early stages of identifying long compound words. Thus, visual marking of morpheme boundaries facilitates processing of long compound words, unless the initial fixation made on the word lands very close to the morpheme boundary. The reviewed pattern of results is explained by the visual acuity principle (Bertram & Hyönä, 2003 and the dual-route framework of morphological processing.

  1. Behavioral Preferences for Individual Securities : The Case for Call Warrants and Call Options

    NARCIS (Netherlands)

    Ter Horst, J.R.; Veld, C.H.

    2002-01-01

    Since 1998, large investment banks have flooded the European capital markets with issues of call warrants.This has led to a unique situation in the Netherlands, where now call warrants, traded on the stock exchange, and long-term call options, traded on the options exchange, exist.Both entitle their

  2. Distribution and predictors of emergency department charges: the case of a tertiary hospital in Lebanon.

    Science.gov (United States)

    Saleh, Shadi; Mourad, Yara; Dimassi, Hani; Hitti, Eveline

    2016-03-18

    As health care costs continue to increase worldwide, health care systems, and more specifically hospitals are facing continuous pressure to operate more efficiently. One service within the hospital sector whose cost structure has been modestly investigated is the Emergency Department (ED). The study aims to report on the distribution of ED resource use, as expressed in charges, and to determine predictors of/contributors to total ED charges at a major tertiary hospital in Lebanon. The study used data extracted from the ED discharge database for visits between July 31, 2012 and July 31, 2014. Patient visit bills were reported under six major categories: solutions, pharmacy, laboratory, physicians, facility, and radiology. Characteristics of ED visits were summarized according to patient gender, age, acuity score, and disposition. Univariate and multivariate analyses were conducted with total charges as the dependent variable. Findings revealed that the professional fee (40.9 %) followed by facility fee (26.1 %) accounted for the majority of the ED charges. While greater than 80 % of visit charges went to physician and facility fee for low acuity cases, these contributed to only 52 and 54 % of the high acuity presentations where ancillary services and solutions' contribution to the total charges increased. The total charges for males were $14 higher than females; age was a predictor of higher charges with total charges of patients greater than 60 years of age being around $113 higher than ages 0-18 after controlling for all other variables. Understanding the components and determinants of ED charges is essential to developing cost-containment interventions. Institutional modeling of charging patterns can be used to offer price estimates to ED patients who request this information and ultimately help create market competition to drive down costs.

  3. Decline of tactile acuity in aging: a study of body site, blood flow, and lifetime habits of smoking and physical activity.

    Science.gov (United States)

    Stevens, Joseph C; Alvarez-Reeves, Marty; Dipietro, Loretta; Mack, Gary W; Green, Barry G

    2003-01-01

    Tactile acuity of 60 older subjects (> or = 65 years) and 19 younger subjects (18-28 years) was assessed by two-point gap thresholds at the upper and lower surfaces of the forefinger, at the upper and lower surfaces of the feet, and at the volar surface of the forearm. The older subjects were assigned to one of four groups of 15 subjects each, depending on reported lifetime habits of physical activity and smoking: (1) active smokers, (2) active nonsmokers, (3) inactive smokers, and (4) inactive nonsmokers. Peripheral blood flow was assessed at the forefinger, foot, and forearm by means of laser-Doppler imaging and skin temperature recordings, under resting conditions and during and after a 5-min exposure to mild cooling (28 degrees C). Consistent with previous studies, tactile acuity thresholds in the foot and finger averaged about 80% higher in the older subjects than in the younger subjects, but only about 22% higher in the forearm. Although the upper surface of the fingertip was more sensitive than the lower surface in both younger and older subjects, the age-related decline in tactile acuity was nearly identical on both sides of the finger and foot. The latter finding refutes the hypothesis that the larger effect of aging in the extremities results from greater physical wear and tear on the contact surfaces of the hands and feet. Self-reported lifetime histories of physical activity and smoking were not significantly associated with measures of cutaneous blood flow or tactile thresholds. Possible reasons for this lack of association are discussed, including the inherent limitations of testing only healthy older subjects, and the concept of "successful aging".

  4. Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India.

    Science.gov (United States)

    Lindquist, Benjamin; Strehlow, Matthew C; Rao, G V Ramana; Newberry, Jennifer A

    2016-07-08

    Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India. A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion. 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week. This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.

  5. The Fluid Reading Primer: Animated Decoding Support for Emergent Readers.

    Science.gov (United States)

    Zellweger, Polle T.; Mackinlay, Jock D.

    A prototype application called the Fluid Reading Primer was developed to help emergent readers with the process of decoding written words into their spoken forms. The Fluid Reading Primer is part of a larger research project called Fluid Documents, which is exploring the use of interactive animation of typography to show additional information in…

  6. Emergency medical service providers' experiences with traffic congestion.

    Science.gov (United States)

    Griffin, Russell; McGwin, Gerald

    2013-02-01

    The population's migration from urban to suburban areas has resulted in a more dispersed population and has increased traffic flow, possibly resulting in longer emergency response times. Although studies have examined the effect of response times on time to definitive care and survival, no study has addressed the possible causes of slowed response time from the point of view of emergency medical services (EMS) first responders. To assess the variables most commonly associated with increased emergency response time as described by the opinions and views of EMS first responders. A total of 500 surveys were sent to randomly selected individuals registered as first responders with the Alabama Department of Public Health, and 112 surveys were returned completed. The survey included questions regarding roadway design, response to emergency calls, in-vehicle technology aimed at decreasing travel time, and public education regarding emergency response. Respondents reported traveling on city streets most often during emergency calls, and encountering traffic more often on interstates and national highways. Traffic congestion, on average, resulted in nearly 10min extra response time. Most agreed that the most effective in-vehicle technology for reducing response time was a pre-emptive green light device; however, very few reported availability of this device in their emergency vehicles. Public education regarding how to react to approaching emergency vehicles was stated as having the greatest potential impact on reducing emergency response time. The results of the survey suggest that the best methods for reducing emergency response times are those that are easy to implement (e.g., public education). Copyright © 2013 Elsevier Inc. All rights reserved.

  7. A pilot trial of the iPad tablet computer as a portable device for visual acuity testing.

    Science.gov (United States)

    Zhang, Zhao-tian; Zhang, Shao-chong; Huang, Xiong-gao; Liang, Ling-yi

    2013-01-01

    We evaluated the accuracy of an app for the iPad tablet computer (Eye Chart Pro) as a portable method of visual acuity (VA) testing. A total of 120 consecutive patients (240 eyes) underwent visual acuity test with an iPad 2 and a conventional light-box chart. The logMAR VA results from the iPad were significantly higher than those from the light-box (P iPad chart and the light-box chart, with 95% limits of agreement of -0.14 to 0.19. Two groups of patients were defined: in Group 1 there were 182 eyes with VA better than 0.1 according to the light-box VA test. The median logMAR VA by the iPad was 0.54 and by the light-box chart it was 0.52; there was no significant difference between them (P = 0.69). In Group 2 there were 58 eyes with VA equal to or worse than 0.1 according to the light-box VA test. The median logMAR VA by the iPad was 1.26 and was 1.10 by the light box; the result from the iPad was significantly lower (P iPad is reliable for VA testing only when the Snellen VA is better than 0.1 (20/200).

  8. The Geek Perspective: Answering the Call for Advanced Technology in Research Inquiry Related to Pediatric Brain Injury and Motor Disability.

    Science.gov (United States)

    Wininger, Michael; Pidcoe, Peter

    2017-10-01

    The Academy of Pediatric Physical Therapy Research Summit IV issued a Call to Action for community-wide intensification of a research enterprise in inquiries related to pediatric brain injury and motor disability by way of technological integration. But the barriers can seem high, and the pathways to integrative clinical research can seem poorly marked. Here, we answer the Call by providing framework to 3 objectives: (1) instrumentation, (2) biometrics and study design, and (3) data analytics. We identify emergent cases where this Call has been answered and advocate for others to echo the Call both in highly visible physical therapy venues and in forums where the audience is diverse.

  9. EMERGENCY CONTRACEPTION

    Directory of Open Access Journals (Sweden)

    Dragana Pantić

    2007-10-01

    Full Text Available Emergency contraception refers to any device or drug that is used as an emergency procedure to prevent pregnancy after unprotected sexual intercourse.The first method of emergency contraception was high dose of estrogen. Concern about side effects led to subsequent development of the so-called Yuzpe regimen which combined ethinil estradiol with levonorgestrel and levonorgestrel alone. Less convenient to use is the copper intauterine contraceptive device.It is known that in some women sexual steroids may inhibit or delay ovulation and may interfere with ovum and sperm transport and implantation. Copper intrauterine device causes a foreign-body effect on the endometrium and a direct toxic effect to sperm and blastocyst.The Yuzpe regimen reduces the risk of pregnancy after a single act of sexual intercourse by about 75% and the levonorgestrel alone by about 85%. The copper intrauterine device is an extremely effective method for selected patients.Nausea and vomiting are common among women using the Yuzpe regimen and considerably less common among women using levonorgestrel alone regimen.Emergency contraception is relatively safe with no contraindications except pregnancy. It is ineffective if a woman is pregnant. There is no need for a medical hystory or a phisical examination before providing emergency contraceptive pills. They are taken long before organogenesis starts, so they should not have a teratogenic effect.Counseling should include information about correct use of the method, possible side effects and her preferences for regular contraception.Unintended pregnancy is a great problem. Several safe, effective and inexpensive methods of emergency contraception are available including Yuzpe regimen, levonorges-trel-only regimen and copper intrauterine device.

  10. Judicial Deference Allows European Consensus to Emerge

    DEFF Research Database (Denmark)

    Dothan, Shai

    2018-01-01

    jurisdiction. But the ECHR sometimes defers to countries, even if their policies fall short of the standard accepted by most of the countries in Europe. This deference is accomplished by using the so-called "margin of appreciation" doctrine. Naturally, emerging consensus and margin of appreciation are often......, the paper demonstrates that a correct application of the margin of appreciation doctrine actually helps emerging consensus reach optimal results, by giving countries an incentive to make their policies independently....

  11. The Advanced Glaucoma Intervention Study (AGIS): 12. Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma.

    Science.gov (United States)

    2002-10-01

    To examine the relationships between baseline risk factors and sustained decrease of visual field (SDVF) and sustained decrease of visual acuity (SDVA). Cohort study of participants in the Advanced Glaucoma Intervention Study (AGIS). This multicenter study enrolled patients between 1988 and 1992 and followed them until 2001; 789 eyes of 591 patients with advanced glaucoma were randomly assigned to one of two surgical sequences, argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) or trabeculectomy-ALT-trabeculectomy (TAT). This report is based on data from 747 eyes. Eyes were offered the next intervention in the sequence upon failure of the previous intervention. Failure was based on recurrent intraocular pressure elevation, visual field defect, and disk rim criteria. Study visits occurred every 6 months; potential follow-up ranged from 8 to 13 years. For each intervention sequence, Cox multiple regression analyses were used to examine the baseline characteristics for association with two vision outcomes: SDVF and SDVA. The magnitude of the association is measured by the hazard ratio (HR), where HR for binary variables is the relative change in the hazard (or risk) of the outcome in eyes with the factor divided by the hazard in eyes without the factor, and HR for continuous variables is the relative change in the hazard (or risk) of the outcome in eyes with a unit increase in the factor. Characteristics associated with increased SDVF risk in the ATT sequence are: less baseline visual field defect (hazard ratio [HR] = 0.86, P <.001, 95% CI = 0.82-0.90), male gender (HR = 2.23, P <.001, 1.54-3.23), and worse baseline visual acuity (HR = 0.96, P =.001, 0.94-0.98); in the TAT sequence: less baseline visual field defect (HR = 0.93, P =.001, 0.89-0.97) and diabetes (HR = 1.87, P =.007, 1.18-2.97). Characteristics associated with increased SDVA risk in both treatment sequences are better baseline acuity (ATT: HR = 1.05, P <.001, 1.02-1.09; TAT: HR = 1

  12. Reproductive health outcomes of insured adolescent and adult women who access oral levonorgestrel emergency contraception.

    Science.gov (United States)

    Raine-Bennett, Tina; Merchant, Maqdooda; Sinclair, Fiona; Lee, Justine W; Goler, Nancy

    2015-04-01

    To assess the level of risk for adolescents and women who seek emergency contraception through various clinical routes and the opportunities for improved care provision. This study looked at a retrospective cohort to assess contraception and other reproductive health outcomes among adolescents and women aged 15-44 years who accessed oral levonorgestrel emergency contraception through an office visit or the call center at Kaiser Permanente Northern California from 2010 to 2011. Of 21,421 prescriptions, 14,531 (67.8%) were accessed through the call center. In the subsequent 12 months, 12,127 (56.6%) adolescents and women had short-acting contraception (pills, patches, rings, depot medroxyprogesterone) dispensed and 2,264 (10.6%) initiated very effective contraception (intrauterine contraception, implants, sterilization). Initiation of very effective contraception was similar for adolescents and women who accessed it through the call center-1,569 (10.8%) and office visits-695 (10.1%) (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.13). In the subsequent 6 months, 2,056 (9.6%) adolescents and women became pregnant. Adolescents and women who accessed emergency contraception through the call center were less likely to become pregnant within 3 months of accessing emergency contraception than woman who accessed it through office visits (adjusted OR 0.82, 95% CI 0.72-0.94); however, they were more likely to become pregnant within 4-6 months (adjusted OR 1.37, 95% CI 1.16-1.60). Among adolescents and women who were tested for chlamydia and gonorrhea, 689 (7.8%) and 928 (7.9%) were positive in the 12 months before and after accessing emergency contraception, respectively. Protocols to routinely address unmet needs for contraception at every call for emergency contraception and all office visits, including visits with primary care providers, should be investigated.

  13. International legal framework for geoengineering: Managing the risks of an emerging technology

    NARCIS (Netherlands)

    Du, Haomiao

    2016-01-01

    The present book “International Legal Framework for Geoengineering – Managing the Risks of an Emerging Technology” is about international law and an emerging technology called geoengineering, which refers to the large-scale manipulation of the planetary environment for counteracting anthropogenic

  14. Acuidade visual em implantes bilaterais de lentes intra-oculares monofocais e multifocais Visual acuity of bilateral implants of monofocal and multifocal intraocular lenses

    Directory of Open Access Journals (Sweden)

    Leonardo Akaishi

    2003-01-01

    Full Text Available OBJETIVO: Comparar a acuidade visual de longe e perto de pacientes submetidos à facoemulsificação binocular não simultânea com implante de lentes multifocais ou monofocais. MÉTODOS: Foram selecionados 20 pacientes com lentes multifocais bilaterais e outros 20 pacientes com lentes monofocais também bilaterais, com acuidade visual sem correção melhor ou igual a 0,63 (20/30, medidos separadamente, nos três primeiros meses de pós-operatório. Foi medida a acuidade visual para longe e perto com e sem correção e testes de sensibilidade ao contraste e ofuscamento. RESULTADOS: A acuidade visual sem correção para longe no grupo das monofocais teve média de 0,82 (DP± 0,16 e no grupo das multifocais, 0,94 (DP±0,12, valor de p 0,001. Os dois grupos de lentes tiveram visão com correção para longe igual a 1. No grupo das multifocais, 75% tiveram J1 e 100% tiveram J3 ou melhor sem correção. No grupo das lentes monofocais, 10% tiveram J1 e 70% tiveram J3 ou melhor sem correção. Não houve diferença significante na avaliação com o teste de sensibilidade ao contraste entre os grupos pesquisados. No teste de ofuscamento, os dois grupos tiveram redução da visão, que foi mais acentuada no grupo dos pacientes com lentes multifocais. CONCLUSÃO: A acuidade visual para longe com correção nos pacientes com implante multifocal foi semelhante a dos pacientes com implantes monofocais, embora a acuidade visual para perto no grupo em que foi implantado lente multifocal foi bastante superior ao grupo da lente monofocal. A sensibilidade ao contraste manteve-se semelhante nos dois grupos, já o ofuscamento ("glare test" no grupo multifocal foi maior que no grupo monofocal.PURPOSE: To compare distant and near visual acuity between patients submitted to bilateral nonsimultaneous facoemulsification and implantation of multifocal or monofocal intraocular lenses (IOL. METHODS: Twenty patients with bilateral multifocal IOL and 20 patients with

  15. Diagnosis of dry eye disease and emerging technologies

    Science.gov (United States)

    Zeev, Maya Salomon-Ben; Miller, Darby Douglas; Latkany, Robert

    2014-01-01

    Dry eye is one of the most commonly encountered problems in ophthalmology. Signs can include punctate epithelial erosions, hyperemia, low tear lakes, rapid tear break-up time, and meibomian gland disease. Current methods of diagnosis include a slit-lamp examination with and without different stains, including fluorescein, rose bengal, and lissamine green. Other methods are the Schirmer test, tear function index, tear break-up time, and functional visual acuity. Emerging technologies include meniscometry, optical coherence tomography, tear film stability analysis, interferometry, tear osmolarity, the tear film normalization test, ocular surface thermography, and tear biomarkers. Patient-specific considerations involve relevant history of autoimmune disease, refractive surgery or use of oral medications, and allergies or rosacea. Other patient considerations include clinical examination for lid margin disease and presence of lagophthalmos or blink abnormalities. Given a complex presentation and a variety of signs and symptoms, it would be beneficial if there was an inexpensive, readily available, and reproducible diagnostic test for dry eye. PMID:24672224

  16. Visual acuity and refraction by age for children of three different ethnic groups in Paraguay

    Directory of Open Access Journals (Sweden)

    Marissa Janine Carter

    2013-04-01

    Full Text Available PURPOSE: To characterize refractive errors in Paraguayan children aged 5-16 years and investigate effect of age, gender, and ethnicity. METHODS:The study was conducted at 3 schools that catered to Mennonite, indigenous, and mixed race children. Children were examined for presenting visual acuity, autorefraction with and without cycloplegia, and retinoscopy. Data were analyzed for myopia and hyperopia (SE ≤-1 D or -0.5 D and ≥2 D or ≥3 D and astigmatism (cylinder ≥1 D. Spherical equivalent (SE values were calculated from right eye cycloplegic autorefraction data and analyzed using general linear modelling. RESULTS: There were 190, 118, and 168 children of Mennonite, indigenous and mixed race ethnicity, respectively. SE values between right/left eyes were nonsignificant. Mean visual acuity (VA without correction was better for Mennonites compared to indigenous or mixed race children (right eyes: 0.031, 0.090, and 0.102 logMAR units, respectively; P<0.000001. There were 2 cases of myopia in the Mennonite group (1.2% and 2 cases in the mixed race group (1.4% (SE ≤-0.5 D. The prevalence of hyperopia (SE ≥2 D was 40.6%, 34.2%, and 46.3% for Mennonite, indigenous and mixed race children. Corresponding astigmatism rates were 3.2%, 9.5%, and 12.7%. Females were slightly more hyperopic than males, and the 9-11 years age group was the most hyperopic. Mennonite and mixed race children were more hyperopic than indigenous children. CONCLUSIONS: Paraguayan children were remarkably hyperopic and relatively free of myopia. Differences with regard to gender, age, and ethnicity were small.

  17. European Society of Cardiology - Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department.

    Science.gov (United States)

    Miró, Òscar; Peacock, Frank W; McMurray, John J; Bueno, Héctor; Christ, Michael; Maisel, Alan S; Cullen, Louise; Cowie, Martin R; Di Somma, Salvatore; Martín Sánchez, Francisco J; Platz, Elke; Masip, Josep; Zeymer, Uwe; Vrints, Christiaan; Price, Susanna; Mebazaa, Alexander; Mueller, Christian

    2017-06-01

    Heart failure is a global public health challenge frequently presenting to the emergency department. After initial stabilization and management, one of the most important decisions is to determine which patients can be safely discharged and which require hospitalization. This is a complex decision that depends on numerous subjective factors, including both the severity of the patient's underlying condition and an estimate of the acuity of the presentation. An emergency department observation period may help select the correct option. Ideally, during an observation period, risk stratification should be carried out using parameters specifically designed for use in the emergency department. Unfortunately, there is little objective literature to guide this disposition decision. An objective and reliable definition of low-risk characteristics to identify early discharge candidates is needed. Benchmarking outcomes in patients discharged from the emergency department without hospitalization could aid this process. Biomarker determinations, although undoubtedly useful in establishing diagnosis and predicting longer-term prognosis, require prospective validation for emergency department disposition guidance. The challenge of identifying emergency department acute heart failure discharge candidates will only be overcome by future multidisciplinary research defining the current knowledge gaps and identifying potential solutions.

  18. Meaningful call combinations and compositional processing in the southern pied babbler

    Science.gov (United States)

    Engesser, Sabrina; Ridley, Amanda R.; Townsend, Simon W.

    2016-01-01

    Language’s expressive power is largely attributable to its compositionality: meaningful words are combined into larger/higher-order structures with derived meaning. Despite its importance, little is known regarding the evolutionary origins and emergence of this syntactic ability. Although previous research has shown a rudimentary capability to combine meaningful calls in primates, because of a scarcity of comparative data, it is unclear to what extent analog forms might also exist outside of primates. Here, we address this ambiguity and provide evidence for rudimentary compositionality in the discrete vocal system of a social passerine, the pied babbler (Turdoides bicolor). Natural observations and predator presentations revealed that babblers produce acoustically distinct alert calls in response to close, low-urgency threats and recruitment calls when recruiting group members during locomotion. On encountering terrestrial predators, both vocalizations are combined into a “mobbing sequence,” potentially to recruit group members in a dangerous situation. To investigate whether babblers process the sequence in a compositional way, we conducted systematic experiments, playing back the individual calls in isolation as well as naturally occurring and artificial sequences. Babblers reacted most strongly to mobbing sequence playbacks, showing a greater attentiveness and a quicker approach to the loudspeaker, compared with individual calls or control sequences. We conclude that the sequence constitutes a compositional structure, communicating information on both the context and the requested action. Our work supports previous research suggesting combinatoriality as a viable mechanism to increase communicative output and indicates that the ability to combine and process meaningful vocal structures, a basic syntax, may be more widespread than previously thought. PMID:27155011

  19. Emergency medical service in the stroke chain of survival.

    Science.gov (United States)

    Chenaitia, Hichem; Lefevre, Oriane; Ho, Vanessa; Squarcioni, Christian; Pradel, Vincent; Fournier, Marc; Toesca, Richard; Michelet, Pierre; Auffray, Jean Pierre

    2013-02-01

    The Emergency Medical Services (EMS) play a primordial role in the early management of adults with acute ischaemic stroke (AIS). The aim of this study was to evaluate the role and effectiveness of the EMS in the stroke chain of survival in Marseille. A retrospective observational study was conducted in patients treated for AIS or transient ischaemic attack in three emergency departments and at the Marseille stroke centre over a period of 12 months. In 2009, of 1034 patients ultimately presenting a diagnosis of AIS or transient ischaemic attack, 74% benefited from EMS activation. Dispatchers correctly diagnosed 57% of stroke patients. The symptoms most frequently reported included limb weakness, speech problems and facial paresis. Elements resulting in misdiagnosis by dispatchers were general discomfort, chest pain, dyspnoea, fall or vertigo. Stroke patients not diagnosed by emergency medical dispatchers but calling within 3 h of symptom onset accounted for 20% of cases. Our study demonstrates that public intervention programmes must stress the urgency of recognizing stroke symptoms and the importance of calling EMS through free telephone numbers. Further efforts are necessary to disseminate guidelines for healthcare providers concerning stroke recognition and the new therapeutic possibilities in order to increase the likelihood of acute stroke patients presenting to a stroke team early enough to be eligible for acute treatment. In addition, EMS dispatchers should receive further training about atypical stroke symptoms, and 'Face Arm Speech Test' tests must be included in the routine questionnaires used in emergency medical calls concerning elderly persons.

  20. Call Centre- Computer Telephone Integration

    Directory of Open Access Journals (Sweden)

    Dražen Kovačević

    2012-10-01

    Full Text Available Call centre largely came into being as a result of consumerneeds converging with enabling technology- and by the companiesrecognising the revenue opportunities generated by meetingthose needs thereby increasing customer satisfaction. Regardlessof the specific application or activity of a Call centre, customersatisfaction with the interaction is critical to the revenuegenerated or protected by the Call centre. Physical(v, Call centreset up is a place that includes computer, telephone and supervisorstation. Call centre can be available 24 hours a day - whenthe customer wants to make a purchase, needs information, orsimply wishes to register a complaint.

  1. Next Generation Public Safety and Emergency Technologies

    DEFF Research Database (Denmark)

    Bonde, Camilla; Tadayoni, Reza; Skouby, Knud Erik

    2014-01-01

    The paper researches the existing European standards for Public Safety and Emergency (PSE) services (also called Public Protection Disaster Relief “PPDR”), and identifies based on user studies in Denmark conflicts between the current deployments of the standards and the user requirements. The aim...

  2. Institutional dynamic of the call center industry in Denmark and France

    DEFF Research Database (Denmark)

    Sørensen, Ole H.; Beraud, Mathieu; Colin, Thierry

    2005-01-01

    The call centre development is substantially increasing in the most part of industrialized countries. Coming to the fore and seeking for staff, this sector is still looking for benchmarks, especially in terms of employment. Currently it can be said that the sector is under construction since its ...... to the specific micro and meso dynamic of this emerging industry. We base on a part of the first results obtained in a research on low wage initiated by the Russell Rage Foundation. More precisely we use the results from sectoral survey....

  3. Evaluation of the preparedness of the children's emergency rooms ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: The Children Emergency Room (CHER) is the first point of call for many sick children. ... limitation abounds with regards to personnel, high technology infrastructure, personnel ...

  4. Emergency residential care settings: A model for service assessment and design.

    Science.gov (United States)

    Graça, João; Calheiros, Maria Manuela; Patrício, Joana Nunes; Magalhães, Eunice Vieira

    2018-02-01

    There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Lrit1, a Retinal Transmembrane Protein, Regulates Selective Synapse Formation in Cone Photoreceptor Cells and Visual Acuity

    Directory of Open Access Journals (Sweden)

    Akiko Ueno

    2018-03-01

    Full Text Available Summary: In the vertebrate retina, cone photoreceptors play crucial roles in photopic vision by transmitting light-evoked signals to ON- and/or OFF-bipolar cells. However, the mechanisms underlying selective synapse formation in the cone photoreceptor pathway remain poorly understood. Here, we found that Lrit1, a leucine-rich transmembrane protein, localizes to the photoreceptor synaptic terminal and regulates the synaptic connection between cone photoreceptors and cone ON-bipolar cells. Lrit1-deficient retinas exhibit an aberrant morphology of cone photoreceptor pedicles, as well as an impairment of signal transmission from cone photoreceptors to cone ON-bipolar cells. Furthermore, we demonstrated that Lrit1 interacts with Frmpd2, a photoreceptor scaffold protein, and with mGluR6, an ON-bipolar cell-specific glutamate receptor. Additionally, Lrit1-null mice showed visual acuity impairments in their optokinetic responses. These results suggest that the Frmpd2-Lrit1-mGluR6 axis regulates selective synapse formation in cone photoreceptors and is essential for normal visual function. : Ueno et al. finds that Lrit1 plays an important role in regulating the synaptic connection between cone photoreceptors and cone ON-bipolar cells. The Frmpd2-Lrit1-mGluR6 axis is crucial for selective synapse formation in cone photoreceptors and for development of normal visual function. Keywords: retina, circuit, synapse formation, cone photoreceptor cell, ON-bipolar cell, visual acuity

  6. Pleural Effusion or Main Left Bronchus Mucus Obstruction: To Drain or Not to Drain? Decision-Making for Young Surgeon on Call

    Directory of Open Access Journals (Sweden)

    Danilo Coco

    2018-01-01

    Full Text Available Mucous plugs occur in a number of pulmonary conditions. Central right or left bronchus mucus plug causes complete pulmonary collapse making it an emergency life-threatening case. We describe the case of an 80-year-old man that, in postoperative period after a urological intervention, has had a progressive tachypnea and dyspnea during hospitalization for urological problems. Young surgeon on call was called.

  7. Which currency exchange regime for emerging markets?: Corner solutions under question

    Directory of Open Access Journals (Sweden)

    Allegret Jean-Pierre

    2007-01-01

    Full Text Available During the 90s, recurrent exchange rate crises in emerging markets have shown the extreme fragility of soft pegs, the so-called intermediate exchange rate regimes. As a result, numerous academic economists but also International institutions have promoted a new consensus: domestic authorities have to choose their exchange rate regime between only two solutions called corner solutions or extreme regimes: hard pegs or independent floating. This paper questions de relevance of this consensus. We stress the main advantages and costs of each corner solution. We conclude by stressing that intermediate regimes associated to an inflation targeting framework seem a better solution for emerging countries than corner solutions.

  8. Parafoveal magnification: visual acuity does not modulate the perceptual span in reading.

    Science.gov (United States)

    Miellet, Sébastien; O'Donnell, Patrick J; Sereno, Sara C

    2009-06-01

    Models of eye guidance in reading rely on the concept of the perceptual span-the amount of information perceived during a single eye fixation, which is considered to be a consequence of visual and attentional constraints. To directly investigate attentional mechanisms underlying the perceptual span, we implemented a new reading paradigm-parafoveal magnification (PM)-that compensates for how visual acuity drops off as a function of retinal eccentricity. On each fixation and in real time, parafoveal text is magnified to equalize its perceptual impact with that of concurrent foveal text. Experiment 1 demonstrated that PM does not increase the amount of text that is processed, supporting an attentional-based account of eye movements in reading. Experiment 2 explored a contentious issue that differentiates competing models of eye movement control and showed that, even when parafoveal information is enlarged, visual attention in reading is allocated in a serial fashion from word to word.

  9. FEMA's Integrated Emergency Management Information System (IEMIS)

    International Nuclear Information System (INIS)

    Jaske, R.T.; Meitzler, W.

    1987-01-01

    FEMA is implementing a computerized system for use in optimizing planning, and for supporting exercises of these plans. Called the Integrated Emergency Management Information System (IEMIS), it consists of a base geographic information system upon which analytical models are superimposed in order to load data and report results analytically. At present, it supports FEMA's work in offsite preparedness around nuclear power stations, but is being developed to deal with a full range of natural and technological accident hazards for which emergency evacuation or population movement is required

  10. Radiation Emergency Preparedness Tools: Psychological First Aid

    Centers for Disease Control (CDC) Podcasts

    2010-12-30

    This podcast is an overview of the Clinician Outreach and Communication Activity (COCA) Call: Practical Tools for Radiation Emergency Preparedness. A specialist working with CDC's Radiation Studies Branch describes Psychological First Aid and a newly developed multimedia training program, entitled "Psychological First Aid in Radiation Disasters.".  Created: 12/30/2010 by National Center for Environmental Health (NCEH) Radiation Studies Branch and Emergency Risk Communication Branch (ERCB)/Joint Information Center (JIC); Office of Public Health Preparedness and Response (OPHPR).   Date Released: 1/13/2011.

  11. Radiation Emergency Preparedness Tools: Psychological First Aid

    Centers for Disease Control (CDC) Podcasts

    This podcast is an overview of the Clinician Outreach and Communication Activity (COCA) Call: Practical Tools for Radiation Emergency Preparedness. A specialist working with CDC's Radiation Studies Branch describes Psychological First Aid and a newly developed multimedia training program, entitled "Psychological First Aid in Radiation Disasters."

  12. Planning for a radiological emergency in health care institutions

    International Nuclear Information System (INIS)

    Jerez Vegueria, S.F.; Jerez Vegueria, P.F.

    1998-01-01

    The possible occurrence of accidents involving sources of ionizing radiation calls for response plans to mitigate the consequences of radiological accidents. An emergency planning framework is suggested for institutions which use medical applications of ionizing radiation. Bearing in mind that the prevention of accidents is of prime importance in dealing with radioactive materials and other sources of ionizing radiation, it is recommended that emergency instructions and procedures address certain aspects of the causes of these radiological events. Issues such as identification of radiological events in medical practices and their consequences, protective measures, planning for an emergency response and maintenance of emergency capacity are considered. (author)

  13. Call cultures in orang-utans?

    Directory of Open Access Journals (Sweden)

    Serge A Wich

    Full Text Available BACKGROUND: Several studies suggested great ape cultures, arguing that human cumulative culture presumably evolved from such a foundation. These focused on conspicuous behaviours, and showed rich geographic variation, which could not be attributed to known ecological or genetic differences. Although geographic variation within call types (accents has previously been reported for orang-utans and other primate species, we examine geographic variation in the presence/absence of discrete call types (dialects. Because orang-utans have been shown to have geographic variation that is not completely explicable by genetic or ecological factors we hypothesized that this will be similar in the call domain and predict that discrete call type variation between populations will be found. METHODOLOGY/PRINCIPAL FINDINGS: We examined long-term behavioural data from five orang-utan populations and collected fecal samples for genetic analyses. We show that there is geographic variation in the presence of discrete types of calls. In exactly the same behavioural context (nest building and infant retrieval, individuals in different wild populations customarily emit either qualitatively different calls or calls in some but not in others. By comparing patterns in call-type and genetic similarity, we suggest that the observed variation is not likely to be explained by genetic or ecological differences. CONCLUSION/SIGNIFICANCE: These results are consistent with the potential presence of 'call cultures' and suggest that wild orang-utans possess the ability to invent arbitrary calls, which spread through social learning. These findings differ substantially from those that have been reported for primates before. First, the results reported here are on dialect and not on accent. Second, this study presents cases of production learning whereas most primate studies on vocal learning were cases of contextual learning. We conclude with speculating on how these findings might

  14. Correlation of visual acuity and central macular morphology in different types of diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Qiu-Ju Wu

    2016-02-01

    Full Text Available AIM:To observe the correlation of visual acuity and central macular morphology in patients with different types of diabetic macular edema(DME. METHODS: Presented study was single-center, uncontrolled retrospective clinical study. Sixty-two patients(103 eyeswith DME were included. Best corrected visual acuity(BCVAwas evaluated using early treatment diabetic retinopathy study(ETDRSvision test chart. All patients were examined by non-contact tonometer, slit lamp, indirect ophthalmoscope, and fundus fluorescein angiography(FFA. Central subfield mean thickness(CSMTin the macular area of diameter 1mm was measured by optical coherence tomography(OCT.And in the same time the integrity of inner segments/ outer segments(IS/OSand external limiting membrane(ELMreflecting light strip of 350μm center horizontal scanning line was investigated by OCT. BCVA and CSMT in different types of DME patients were analyzed using Kruskal- Wallis test. BCVA and CSMT between the two-two groups in different types of DME patients were analyzed using Nemenyi test, and multiple regression analysis was used to analyze the relative factors of BCVA. RESULTS: In the 103 eyes, 47 eyes(45.6%were focal DME, 35 eyes(34.0%were diffuse DME, 6 eyes(5.8%were ischemic DME and 15 eyes(14.6%were proliferative DME. The difference of mean BCVA(H=69.167, PH=57.113, Pχ2=14.982,Pχ2=14.537,Pχ2=15.596,Pχ2=15.393,Pχ2=16.567,Pχ2=15.687,Pχ2=12.974、P=0.008; CSMT:χ2=13.999,Pr=-0.064,-0.207,-0.082 and -0.160, respectively, Pr=-0.885, -2.522, -1.504, and-0.595, respectively, P>0.05. CONCLUSION: There are statistically significant differences on macular morphology and vision function among different types of DME patients.

  15. Does Controversial Science Call For Public Participation? The Case Of Gmo Skepticism

    Directory of Open Access Journals (Sweden)

    Andreas Christiansen

    2017-12-01

    Full Text Available Many instances of new and emerging science and technology are controversial. Although a number of people, including scientific experts, welcome these developments, a considerable skepticism exists among members of the public. The use of genetically modified organisms (GMOs is a case in point. In science policy and in science communication, it is widely assumed that such controversial science and technology require public participation in the policy-making process. We examine this view, which we call the Public Participation Paradigm, using the case of GMOs as an example. We suggest that a prominent reason behind the call for public participation is the belief that such participation is required for democratic legitimacy. We then show that the most prominent accounts of democratic legitimacy do not, in fact, entail that public participation is required in cases of controversial science in general, or in the case of GMOs in particular.

  16. Emergency department surge: models and practical implications.

    Science.gov (United States)

    Nager, Alan L; Khanna, Kajal

    2009-08-01

    Emergency Department crowding has long been described. Despite the daily challenges of managing emergency department volume and acuity; a surge response during a disaster entails even greater challenges including collaboration, intervention, and resourcefulness to effectively carry out pediatric disaster management. Understanding surge and how to respond with appropriate planning will lead to success. To achieve this, we sought to analyze models of surge; review regional and national data outlining surge challenges and factors that impact surge; and to outline potential solutions. We conducted a systemic review and included articles and documents that best described the theoretical and practical basis of surge response. We organized the systematic review according to the following questions: What are the elements and models that are delineated by the concept of surge? What is the basis for surge response based on regional and national published sources? What are the broad global solutions? What are the major lessons observed that will impact effective surge capacity? Multiple models of surge are described including public health, facility-based and community-based; a 6-tiered response system; and intrinsic or extrinsic surge capacity. In addition, essential components (4 S's of surge response) are described along with regional and national data outlining surge challenges, impacting factors, global solutions, and lesions observed. There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.

  17. The effect of work shift configurations on emergency medical dispatch center response.

    Science.gov (United States)

    Montassier, Emmanuel; Labady, Julien; Andre, Antoine; Potel, Gilles; Berthier, Frederic; Jenvrin, Joel; Penverne, Yann

    2015-01-01

    It has been proved that emergency medical dispatch centers (EMDC) save lives by promoting an appropriate allocation of emergency medical service resources. Indeed, optimal dispatcher call duration is pivotal to reduce the time gap between the time a call is placed and the delivery of medical care. However, little is known about the impact of work shift configurations (i.e., work shift duration and work shift rotation throughout the day) and dispatcher call duration. Thus, the objective of our study was to assess the effect of work shift configurations on dispatcher call duration. During a 1-year study period, we analyzed the dispatcher call durations for medical and trauma calls during the 4 different work shift rotations (day, morning, evening, and night) and during the 10-hour work shift of each dispatcher in the EMDC of Nantes. We extracted dispatcher call durations from our advanced telephone system, configured with CC Pulse + (Genesys, Alcatel Lucent), and collected them in a custom designed database (Excel, Microsoft). Afterward, we analyzed these data using linear mixed effects models. During the study period, our EMDC received 408,077 calls. Globally, the mean dispatcher call duration was 107 ± 45 seconds. Based on multivariate linear mixed effects models, the dispatcher call duration was affected by night work shift and work shift duration greater than 8 hours, increasing it by about 10 ± 1 seconds and 4 ± 1 seconds, respectively (both p work shift rotation and duration, with longer durations seen over night shifts and shifts over 8 hours. While these differences are small and may not have clinical significance, they may have implications for EMDC efficiency.

  18. Effects of emergency department expansion on emergency department patient flow.

    Science.gov (United States)

    Mumma, Bryn E; McCue, James Y; Li, Chin-Shang; Holmes, James F

    2014-05-01

    Emergency department (ED) crowding is an increasing problem associated with adverse patient outcomes. ED expansion is one method advocated to reduce ED crowding. The objective of this analysis was to determine the effect of ED expansion on measures of ED crowding. This was a retrospective study using administrative data from two 11-month periods before and after the expansion of an ED from 33 to 53 adult beds in an academic medical center. ED volume, staffing, and hospital admission and occupancy data were obtained either from the electronic health record (EHR) or from administrative records. The primary outcome was the rate of patients who left without being treated (LWBT), and the secondary outcome was total ED boarding time for admitted patients. A multivariable robust linear regression model was used to determine whether ED expansion was associated with the outcome measures. The mean (±SD) daily adult volume was 128 (±14) patients before expansion and 145 (±17) patients after. The percentage of patients who LWBT was unchanged: 9.0% before expansion versus 8.3% after expansion (difference = 0.6%, 95% confidence interval [CI] = -0.16% to 1.4%). Total ED boarding time increased from 160 to 180 hours/day (difference = 20 hours, 95% CI = 8 to 32 hours). After daily ED volume, low-acuity area volume, daily wait time, daily boarding hours, and nurse staffing were adjusted for, the percentage of patients who LWBT was not independently associated with ED expansion (p = 0.053). After ED admissions, ED intensive care unit (ICU) admissions, elective surgical admissions, hospital occupancy rate, ICU occupancy rate, and number of operational ICU beds were adjusted for, the increase in ED boarding hours was independently associated with the ED expansion (p = 0.005). An increase in ED bed capacity was associated with no significant change in the percentage of patients who LWBT, but had an unintended consequence of an increase in ED boarding hours. ED expansion alone does

  19. EDA-EMERGE : An FP7 initial training network to equip the next generation of young scientists with the skills to address the complexity of environmental contamination with emerging pollutants

    NARCIS (Netherlands)

    Brack, Werner; Govender, Selvan; Schulze, Tobias; Krauss, Martin; Hu, Meng; Muz, Melis; Hollender, Juliane; Schirmer, Kristin; Schollee, Jennifer; Hidasi, Anita; Slobodnik, Jaroslav; Rabova, Zuzana; Ait-Aissa, Selim; Sonavane, Manoj; Carere, Mario; Lamoree, Marja; Leonards, Pim; Tufi, Sara; Ouyang, Xiyu; Schriks, Merijn; Thomas, Kevin; De Almeida, Ana Catarina; Froment, Jean; Hammers-Wirtz, Monika; Ahel, Marijan; Koprivica, Sanja; Hollert, Henner; Seiler, Thomas Benjamin; Di Paolo, Carolina; Tindall, Andrew; Spirhanzlova, Petra

    2013-01-01

    The initial training network consortium novel tools in effect-directed analysis to support the identification and monitoring of emerging toxicants on a European scale (EDA-EMERGE) was formed in response to the seventh EU framework program call to train a new generation of young scientists (13 PhD

  20. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    Science.gov (United States)

    Dick, W

    1994-01-01

    Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

  1. On the ontological emergence from quantum regime

    Energy Technology Data Exchange (ETDEWEB)

    Luty, Damian [Adam Mickiewicz University, Poznan (Poland)

    2014-07-01

    There are several views on the relation between quantum physics and theory of relativity (especially General Relativity, GR). A popular perspective is this: GR with its macroscopic gravitational effects will turn out to be a limit of a more fundamental theory which should consider discrete physics and not deal with continuity (like theory of relativity). Thus, GR will emerge from a more basic theory, which should be quantum-like. One could call this an epistemic emergence view towards fundamental theories. The question is, given that scientific realism is valid: should emergence be a fundamental notion in our ontological view about the evolving, physical Universe? Is there an ontological emergence fully compatible with the notion of fundamentality? I argue that if we want to defend ontological emergence (from quantum to macroscopic regime) as something fundamental, we will arrive at the position of metaphysics of dispositions (and I argue, why this is undesirable), or conclude, that we cannot square fully fundamental ontology with the notion of emergence, and that we have to accept an ontological pluralism relativised to a certain scale. I defend the latter proposition, showing, that epistemic emergence doesn't entail (logically) ontological emergence.

  2. Habitual plate-waste of 6- to 9-year-olds may not be associated with lower nutritional needs or taste acuity, but undesirable dietary factors.

    Science.gov (United States)

    Baik, Ji-Yoon; Lee, Hongmie

    2009-12-01

    Efforts to reduce plate-waste (PW) are limited to those by a dietitian who serves the entire school rather than a better characterization of individuals who are served. We tested the hypothesis that children reporting habitual PW would have different physical or dietary characteristics compared with children without PW. Participants were 407 children aged 6 to 9 years in elementary schools in Kyeonggi, Korea. Information on eating behavior and food preference was collected using a questionnaire administered by parents. Among them, 91 students participated further in anthropometry, step counting, taste acuity tests, and nutrition intake from school lunches. Participants were divided into tertiles according to total frequency of leaving PW from each meal on a typical day: no PW, moderate PW, and habitual PW. Children with habitual PW showed several undesirable characteristics: consuming less of various vegetables, eating only what they like, poor table manners, and frequent consumption of street foods and cookies/beverages/fast foods. Whereas height, weight, and obesity index as well as taste acuity and daily steps in the habitual PW group were not significantly different, intakes of potassium, niacin, and folate were significantly lower compared with the other groups. Therefore, habitual PW did not seem to result from having a lower energy requirement or different taste acuity, or result in observed slowed growth, but it could place children at a risk for insufficient nutritional intake, consequently impairing growth and general health. The results emphasize the parental role in shaping children's diet and provide information for developing strategies to reduce PW of individual children.

  3. Assessing call centers’ success:

    Directory of Open Access Journals (Sweden)

    Hesham A. Baraka

    2013-07-01

    This paper introduces a model to evaluate the performance of call centers based on the Delone and McLean Information Systems success model. A number of indicators are identified to track the call center’s performance. Mapping of the proposed indicators to the six dimensions of the D&M model is presented. A Weighted Call Center Performance Index is proposed to assess the call center performance; the index is used to analyze the effect of the identified indicators. Policy-Weighted approach was used to assume the weights with an analysis of different weights for each dimension. The analysis of the different weights cases gave priority to the User satisfaction and net Benefits dimension as the two outcomes from the system. For the input dimensions, higher priority was given to the system quality and the service quality dimension. Call centers decision makers can use the tool to tune the different weights in order to reach the objectives set by the organization. Multiple linear regression analysis was used in order to provide a linear formula for the User Satisfaction dimension and the Net Benefits dimension in order to be able to forecast the values for these two dimensions as function of the other dimensions

  4. 78 FR 76218 - Rural Call Completion

    Science.gov (United States)

    2013-12-17

    ... calls to rural areas, and enforce restrictions against blocking, choking, reducing, or restricting calls... to alert the Commission of systemic problems receiving calls from a particular originating long... associated with completing calls to rural areas. These rules will also enhance our ability to enforce...

  5. To Further the Near-Vision Visual Acuity Tests (3): For a Test Which Saves Time, Labor, and Expenses

    OpenAIRE

    高橋, ひとみ; 川端, 秀仁; 衞藤, 隆

    2014-01-01

    The Ministry of Education, Culture, Sports, Science and Technology of Japan has its advisory board to review the list of medical checkup for school children every ten years. In August 2013 the board found that there was a considerable number of school children who had poor near vision and thus learn in the class less efficiently. The board recommended that the Ministry consider whether to include a near-vision visual acuity test in a regular medical examination at school. It may not be known ...

  6. Long-distance calls in Neotropical primates

    Directory of Open Access Journals (Sweden)

    Oliveira Dilmar A.G.

    2004-01-01

    Full Text Available Long-distance calls are widespread among primates. Several studies concentrate on such calls in just one or in few species, while few studies have treated more general trends within the order. The common features that usually characterize these vocalizations are related to long-distance propagation of sounds. The proposed functions of primate long-distance calls can be divided into extragroup and intragroup ones. Extragroup functions relate to mate defense, mate attraction or resource defense, while intragroup functions involve group coordination or alarm. Among Neotropical primates, several species perform long-distance calls that seem more related to intragroup coordination, markedly in atelines. Callitrichids present long-distance calls that are employed both in intragroup coordination and intergroup contests or spacing. Examples of extragroup directed long-distance calls are the duets of titi monkeys and the roars and barks of howler monkeys. Considerable complexity and gradation exist in the long-distance call repertoires of some Neotropical primates, and female long-distance calls are probably more important in non-duetting species than usually thought. Future research must focus on larger trends in the evolution of primate long-distance calls, including the phylogeny of calling repertoires and the relationships between form and function in these signals.

  7. Interaction Modes for Emergency Mobile Apps

    Directory of Open Access Journals (Sweden)

    Claudia Nass

    2018-01-01

    Full Text Available While seemingly irrational behaviors such as panicking or displaying antisocial behavior are the responses to emergency situations the media and movies lead us to believe, several studies show that people rather react based on decision-making such as acting altruistically and protectively. However, what can we really expect from people in a crowd in terms of participation in an emergency response system? In this paper, we present a mobile application called the RESCUER App, which allows civilians to participate in the emergency response process by providing information about the emergency to a command center and to receive instructions from this command center. We developed a human reaction model for emergencies to better understand the human–computer interaction capabilities of people in an emergency situation. Based on this model, we defined three different interaction modes: one-click interaction, guided interaction, and chat interaction. These interaction modes were implemented in an interactive prototype and evaluated in an experiment in which high cognitive load was induced to simulate a stress situation, similar to the stress experienced in an emergency. The experiment results showed that the three predefined interaction modes enabled people to interact with the RESCUER App even though they were in a stress situation.

  8. Radiation Emergency Preparedness Tools: Virtual Community Reception Center

    Centers for Disease Control (CDC) Podcasts

    This podcast is an overview of resources from the Clinician Outreach and Communication Activity (COCA) Call: Practical Tools for Radiation Emergency Preparedness. A specialist working with CDC's Radiation Studies Branch describes a web-based training tool known as a Virtual Community Reception Center (vCRC).

  9. Helicopter Emergency Medical Services: effects, costs and benefits

    NARCIS (Netherlands)

    A.N. Ringburg (Akkie)

    2009-01-01

    textabstractAdvanced prehospital medical care with air transport was introduced in the Netherlands in May 1995. The fi rst helicopter Mobile Medical Team, also called Helicopter Emergency Medical Service (HEMS) was a joint venture initiative of the VU Medical Center in Amsterdam and the Algemene

  10. The Use of Dynamic Visual Acuity as a Functional Test of Gaze Stabilization Following Space Flight

    Science.gov (United States)

    Peters, B. T.; Mulavara, A. P.; Brady, R.; Miller, C. A.; Richards, J. T.; Warren, L. E.; Cohen, H. S.; Bloomberg, J. J.

    2006-01-01

    After prolonged exposure to a given gravitational environment the transition to another is accompanied by adaptations in the sensorimotor subsystems, including the vestibular system. Variation in the adaptation time course of these subsystems, and the functional redundancies that exist between them make it difficult to accurately assess the functional capacity and physical limitations of astro/cosmonauts using tests on individual subsystems. While isolated tests of subsystem performance may be the only means to address where interventions are required, direct measures of performance may be more suitable for assessing the operational consequences of incomplete adaptation to changes in the gravitational environment. A test of dynamic visual acuity (DVA) is currently being used in the JSC Neurosciences Laboratory as part of a series of measures to assess the efficacy of a countermeasure to mitigate postflight locomotor dysfunction. In the current protocol, subjects visual acuity is determined using Landolt ring optotypes presented sequentially on a computer display. Visual acuity assessments are made both while standing and while walking at 1.8 m/s on a motorized treadmill. The use of a psychophysical threshold detection algorithm reduces the required number of optotype presentations and the results can be presented immediately after the test. The difference between the walking and standing acuity measures provides a metric of the change in the subject s ability to maintain gaze fixation on the visual target while walking. This functional consequence is observable regardless of the underlying subsystem most responsible for the change. Data from 15 cosmo/astronauts have been collected following long-duration (approx. 6 months) stays in space using a visual target viewing distance of 4.0 meters. An investigation of the group mean shows a change in DVA soon after the flight that asymptotes back to baseline approximately one week following their return to earth. The

  11. The emerging nuclear suppliers: some guidelines for policy (U)

    Energy Technology Data Exchange (ETDEWEB)

    Dunn, Lewis A.

    1988-04-01

    Lewis A. Dunn, a former Assistant Director of the US Arms Control and Disarmament Agency and now a senior analyst with Science Applications International Corporation, looks to the future to offer "The Emerging Nuclear Suppliers: Some Guidelines for Policy ." Mr. Dunn notes that although most emerging suppliers are cautious, many are not party to existing nonproliferation treaties. He calls upon the nonproliferation community to continue the present policy of not supporting unsafeguarded nuclear activities. He suggests that the nonproliferation community work within existing standards and infrastructures of nuclear suppliers to convince emerging supplier nations of the merits of nuclear export control.

  12. Visual training paired with electrical stimulation of the basal forebrain improves orientation-selective visual acuity in the rat.

    Science.gov (United States)

    Kang, Jun Il; Groleau, Marianne; Dotigny, Florence; Giguère, Hugo; Vaucher, Elvire

    2014-07-01

    The cholinergic afferents from the basal forebrain to the primary visual cortex play a key role in visual attention and cortical plasticity. These afferent fibers modulate acute and long-term responses of visual neurons to specific stimuli. The present study evaluates whether this cholinergic modulation of visual neurons results in cortical activity and visual perception changes. Awake adult rats were exposed repeatedly for 2 weeks to an orientation-specific grating with or without coupling this visual stimulation to an electrical stimulation of the basal forebrain. The visual acuity, as measured using a visual water maze before and after the exposure to the orientation-specific grating, was increased in the group of trained rats with simultaneous basal forebrain/visual stimulation. The increase in visual acuity was not observed when visual training or basal forebrain stimulation was performed separately or when cholinergic fibers were selectively lesioned prior to the visual stimulation. The visual evoked potentials show a long-lasting increase in cortical reactivity of the primary visual cortex after coupled visual/cholinergic stimulation, as well as c-Fos immunoreactivity of both pyramidal and GABAergic interneuron. These findings demonstrate that when coupled with visual training, the cholinergic system improves visual performance for the trained orientation probably through enhancement of attentional processes and cortical plasticity in V1 related to the ratio of excitatory/inhibitory inputs. This study opens the possibility of establishing efficient rehabilitation strategies for facilitating visual capacity.

  13. [Organization of clinical emergency units. Mission and environmental factors determine the organizational concept].

    Science.gov (United States)

    Genewein, U; Jakob, M; Bingisser, R; Burla, S; Heberer, M

    2009-02-01

    Mission and organization of emergency units were analysed to understand the underlying principles and concepts. The recent literature (2000-2007) on organizational structures and functional concepts of clinical emergency units was reviewed. An organizational portfolio based on the criteria specialization (presence of medical specialists on the emergency unit) and integration (integration of the emergency unit into the hospital structure) was established. The resulting organizational archetypes were comparatively assessed based on established efficiency criteria (efficiency of resource utilization, process efficiency, market efficiency). Clinical emergency units differ with regard to autonomy (within the hospital structure), range of services and service depth (horizontal and vertical integration). The "specialization"-"integration"-portfolio enabled the definition of typical organizational patterns (so-called archetypes): profit centres primarily driven by economic objectives, service centres operating on the basis of agreements with the hospital board, functional clinical units integrated into medical specialty units (e.g., surgery, gynaecology) and modular organizations characterized by small emergency teams that would call specialists immediately after triage and initial diagnostic. There is no "one fits all" concept for the organization of clinical emergency units. Instead, a number of well characterized organizational concepts are available enabling a rational choice based on a hospital's mission and demand.

  14. Sleep Quality of Call Handlers Employed in International Call Centers in National Capital Region of Delhi, India.

    Science.gov (United States)

    Raja, J D; Bhasin, S K

    2016-10-01

    Call center sector in India is a relatively new and fast growing industry driving employment and growth in modern India today. Most international call centers in National Capital Region (NCR) of Delhi operate at odd work hours corresponding to a time suitable fortheir international customers. The sleep quality of call handlers employed in these call centers is in jeopardy owing to their altered sleep schedule. To assess the sleep quality and determine its independent predictors among call handlers employed in international call centers in NCR of Delhi. A cross-sectional questionnaire-based study was conducted on 375 call handlers aged 18-39 years employed in international call centers in NCR of Delhi. Sleep quality was assessed using Athens Insomnia scale along with a pre-tested, structured questionnaire. The mean age of respondents was 24.6 (SD 2.4) years. 78% of participants were male. 83.5% of respondents were unmarried. 44.3% of call handlers were cigarette smokers. Physical ailments were reported by 37% call handlers. 77.6% of call handlers had somesuspicion of insomnia or suspected insomnia; the rest had no sleep problem. Smoking, poor social support, heavy workload, lack of relaxation facility at office, and prolonged travel time to office were independent predictors of sleep quality (pSafeguarding their health becomes an occupational health challenge to public health specialists.

  15. A qualitative content analysis of peer mentoring video calls in adolescents with chronic illness.

    Science.gov (United States)

    Ahola Kohut, Sara; Stinson, Jennifer; Forgeron, Paula; van Wyk, Margaret; Harris, Lauren; Luca, Stephanie

    2018-05-01

    This article endeavored to determine the topics of discussion during open-ended peer mentoring between adolescents and young adults living with chronic illness. This study occurred alongside a study of the iPeer2Peer Program. Fifty-two calls (7 mentor-mentee pairings) were audio recorded, transcribed verbatim, and analyzed using inductive coding with an additional 30 calls (21 mentor-mentee pairings) coded to ensure representativeness of the data. Three categories emerged: (1) illness impact (e.g., relationships, school/work, self-identity, personal stories), (2) self-management (e.g., treatment adherence, transition to adult care, coping strategies), and (3) non-illness-related adolescent issues (e.g., post-secondary goals, hobbies, social environments). Differences in discussed topics were noted between sexes and by diagnosis. Peer mentors provided informational, appraisal, and emotional support to adolescents.

  16. [Pre-hospital management of adults with life-threatening emergencies].

    Science.gov (United States)

    Wattel, Francis; Dubois, François

    2012-01-01

    In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas

  17. A comparison of two emergency medical dispatch protocols with respect to accuracy.

    Science.gov (United States)

    Torlén, Klara; Kurland, Lisa; Castrén, Maaret; Olanders, Knut; Bohm, Katarina

    2017-12-29

    Emergency medical dispatching should be as accurate as possible in order to ensure patient safety and optimize the use of ambulance resources. This study aimed to compare the accuracy, measured as priority level, between two Swedish dispatch protocols - the three-graded priority protocol Medical Index and a newly developed prototype, the four-graded priority protocol, RETTS-A. A simulation study was carried out at the Emergency Medical Communication Centre (EMCC) in Stockholm, Sweden, between October and March 2016. Fifty-three voluntary telecommunicators working at SOS Alarm were recruited nationally. Each telecommunicator handled 26 emergency medical calls, simulated by experienced standard patients. Manuscripts for the scenarios were based on recorded real-life calls, representing the six most common complaints. A cross-over design with 13 + 13 calls was used. Priority level and medical condition for each scenario was set through expert consensus and used as gold standard in the study. A total of 1293 calls were included in the analysis. For priority level, n = 349 (54.0%) of the calls were assessed correctly with Medical Index and n = 309 (48.0%) with RETTS-A (p = 0.012). Sensitivity for the highest priority level was 82.6% (95% confidence interval: 76.6-87.3%) in the Medical Index and 54.0% (44.3-63.4%) in RETTS-A. Overtriage was 37.9% (34.2-41.7%) in the Medical Index and 28.6% (25.2-32.2%) in RETTS-A. The corresponding proportion of undertriage was 6.3% (4.7-8.5%) and 23.4% (20.3-26.9%) respectively. In this simulation study we demonstrate that Medical Index had a higher accuracy for priority level and less undertriage than the new prototype RETTS-A. The overall accuracy of both protocols is to be considered as low. Overtriage challenges resource utilization while undertriage threatens patient safety. The results suggest that in order to improve patient safety both protocols need revisions in order to guarantee safe emergency medical

  18. Callings and Organizational Behavior

    Science.gov (United States)

    Elangovan, A. R.; Pinder, Craig C.; McLean, Murdith

    2010-01-01

    Current literature on careers, social identity and meaning in work tends to understate the multiplicity, historical significance, and nuances of the concept of calling(s). In this article, we trace the evolution of the concept from its religious roots into secular realms and develop a typology of interpretations using occupation and religious…

  19. Addressing the Emergence and Spread of Leishmaniasis in the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2018-04-19

    The border areas of Argentina, Brazil, and Paraguay have the highest burden of the disease in the region. Its emergence ... End Date. April 19, 2018 ... Call for proposals: Innovations for the economic inclusion of marginalized youth. IDRC and ...

  20. Uncertain call likelihood negatively affects sleep and next-day cognitive performance while on-call in a laboratory environment.

    Science.gov (United States)

    Sprajcer, Madeline; Jay, Sarah M; Vincent, Grace E; Vakulin, Andrew; Lack, Leon; Ferguson, Sally A

    2018-05-11

    On-call working arrangements are employed in a number of industries to manage unpredictable events, and often involve tasks that are safety- or time-critical. This study investigated the effects of call likelihood during an overnight on-call shift on self-reported pre-bed anxiety, sleep and next-day cognitive performance. A four-night laboratory-based protocol was employed, with an adaptation, a control and two counterbalanced on-call nights. On one on-call night, participants were instructed that they would definitely be called during the night, while on the other on-call night they were told they may be called. The State-Trait Anxiety Inventory form x-1 was used to investigate pre-bed anxiety, and sleep was assessed using polysomnography and power spectral analysis of the sleep electroencephalographic analysis. Cognitive performance was assessed four times daily using a 10-min psychomotor vigilance task. Participants felt more anxious before bed when they were definitely going to be called, compared with the control and maybe conditions. Conversely, participants experienced significantly less non-rapid eye movement and stage two sleep and poorer cognitive performance when told they may be called. Further, participants had significantly more rapid eye movement sleep in the maybe condition, which may be an adaptive response to the stress associated with this on-call condition. It appears that self-reported anxiety may not be linked with sleep outcomes while on-call. However, this research indicates that it is important to take call likelihood into consideration when constructing rosters and risk-management systems for on-call workers.