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Background The COVID-19 pandemic catalyzed the adoption of telerehabilitation in various healthcare settings. However, there was neither a pre-existing national guideline in the Philippines nor an internationally agreed standard on telerehabilitation. The literature lacks nationwide studies documenting how physiatrists perceived and experienced telerehabilitation during the pandemic. Objective To determine the perceptions and experiences of physiatrists in the Philippines regarding telerehabilitation. Design Online survey originally developed by the authors with inputs from local experts in telehealth or telerehabilitation. Setting Nationwide, involving board-certified physiatrists practicing in the Philippines. Participants Fellows of the Philippine Academy of Rehabilitation Medicine (PARM) (N = 259) with Internet access. Main outcomes Self-reported telerehabilitation knowledge, skills, and experience; key concerns; preferred clients, service offerings, and methods (technology, duration, charging). Results The respondents (n = 161; 62.2% response-rate) had a mean age of 48.1±9.6 years, were mostly females (57.8%), and mostly practiced in private hospitals and urban settings. The majority reported inadequate telerehabilitation knowledge (61.5%), skills (58.4%), and experience (72.1%). The most common sources of telerehabilitation knowledge were colleagues (52.8%), PARM (51.6%), and telemedicine-related websites (41.6%). Most of the respondents preferred to conduct telerehabilitation with former patients over new ones, and prescribe telerehabilitation programs for physical, occupational, psychological, and speech-language therapy, but not for swallowing therapy. Videoconferencing was the most common telerehabilitation method. More than half of the respondents charged lesser fees for telerehabilitation compared to in-person consultations. While the majority recognized the need for telerehabilitation, their key concerns included the lack of thorough patient examination, and medicolegal liability issues. Conclusion Despite their limited baseline knowledge, skills and experience regarding telerehabilitation, many physiatrists in the Philippines learned to adopt this service delivery method during the pandemic. Their perceptions and experiences could be used in formulating practice-based guidelines and strategies to improve the conduct of telerehabilitation in the country. This article is protected by copyright. All rights reserved.

espanolEn los ultimos anos, la prevalencia de la miopia en el mundo ha aumentado significativamente. El objetivo de este trabajo fue identificar la prevalencia combinada de la miopia en America segun las siguientes categorias: edad, raza, genero y region. Se realizo una revision sistematica de la literatura en las bases de datos Medline, Embase y Lilacs, con el objetivo de buscar estudios transversales con informacion sobre la prevalencia de miopia. Para encontrar la prevalencia combinada se utilizo el metodo de doble arco sinusoidal de efectos fijos o aleatorios de Freeman-Tukey. Se analizaron 15 estudios que incluyeron a 45.349 personas de Estados Unidos, Brasil y Paraguay, de 0 a 96 anos. El rango de prevalencia vario del 1,2 % al 48 % con diferencias entre hombres y mujeres del 18,4 % [IC del 95 %: 13,9-22,8] y el 19,8 % [IC del 95 %: 18,9-20,7], respectivamente. La prevalencia global en las zonas rurales fue del 1,4% [IC del 95 %: 1,3-1,5] y en las zonas urbanas del 14,3 % [IC del 95 %: 13,3-15,2]. Al mismo tiempo, se identificaron algunas diferencias basadas en la raza. En el caso de la raza blanca 15,4 % [IC 95 %: 14,4-16,3], raza negra 20,6 % [IC 95 %: 19,6-21,5] y otras razas (espanola, no espanola y afroamericana) 2,9 % [95 % CI: 1,97-3,82]. Las cifras mas bajas de prevalencia de miopia se identificaron en areas rurales en ninos en edad preescolar; Es probable que exista una relacion en el uso y el tiempo de exposicion a elementos electronicos como pantallas en contraste con el desarrollo de otras actividades en interiores. EnglishIn recent years, prevalence of myopia in the world has increased significantly. The aim of this research work is to consider the combined prevalence of myopia in America, according to the following categories: age, race, gender, and region. Such research will be done also in harmony with the reports found in scientific literature. A systematic review of the literature found in the following databases was carried out: medline, embase, and lilacs. The aim was searching cross-sectional studies containing myopia prevalence information. To find the combined prevalence, the double arc sine method of fixed or random effects by Freeman-Tukey was used. 15 research studies that included 45.349 individuals from the United States, Brazil, and Paraguay, were identified in the literature; studies of subjects aged 0-96 years old. The prevalence of myopia varied from 1,2% to 48% with differences between male and female of 18,4% [95% CI: 13,9-22,8] and 19,8% [95% CI: 18,9-20,7], respectively. The global prevalence of myopia in rural areas was 1,4% [95% CI: 1,3-1,5], and in urban areas 14,3% [95% CI: 13,3-15,2]. At the same time, some differences were identified based on race. In the case of the white race 15,4% [95% CI: 14,4-16,3], Afrodescendants 20,6% [95% CI: 19,6-21,5] and other races (Spanish, non-Spanish, and African American) 2,9% [95% CI: 1,97-3,82]. The lowest figures of myopia prevalence were identified in rural areas in pre-school children (14,1%). There is, probably, a relationship in use and exposure time to electronic items such as screens, in contrast with the development of other indoor activities as outdoor exposure as an environmental factor to slow myopia.

Objective: To know the frequency and characteristics of contact lens use in professionals and patients during the COVID-19 pandemic. Method: A digital questionnaire was used to obtain demographic information, use and frequency of contact lenses in professionals and fitting or refitting in patients before and during the COVID-19 pandemic. Results: 172 professionals participated in the survey, of which 70.3% were women. There were refractive errors in 74.4%, and only 32.0% have used contact lenses during the COVID-19 pandemic. The lenses most used by professionals are silicone hydrogel, 99.9%. The replacement modality has been 69.0% biweekly or monthly. Optometrists (63.4%) reported that the frequency of fitting and/ or refitting contact lenses decreased during the pandemic. Before and during the pandemic, the lens material used more frequently was silicone hydrogel with 79.7% and 76.7%, respectively.The replacement modality was biweekly or monthly, with 76.2% before and 73.3% during the pandemic. Of all the participants, 58.1% consider that the sale of contact lenses has decreased. Conclusions: During the pandemic, the fitting, refitting, and sale of contact lenses have decreased. The lenses most used by professionals and patients are silicone hydrogels replaced every two weeks or monthly.

ResumenLa prevalencia de miopía varía en las diferentes poblaciones del mundo y la incidencia aumenta de una forma acelerada, motivo por el cual los defectos refractivos se convierten en un problema de salud pública, con un impacto económico y social.La progresión de la miopía puede desencadenar cambios patológicos en el globo ocular que afectan estructuras como el cristalino, la retina, la coroides y la mácula. Estos cambios degenerativos constituyen la causa más frecuente de pérdida de visión y se relacionan con un incremento en los valores refractivos, que ascienden desde la infancia hasta la adultez.El desarrollo y progresión se relacionan con un componente genético y hereditario, sin embargo, hay una compleja interacción con factores externos, los cuales podrían explicar el incremento de casos en algunas poblaciones, en donde se perciben aumentos de urbanización y la necesidad por alcanzar altos niveles de educación. Además, otros factores ambientales como destinar mayor tiempo a actividades al aire libre puede ser un hábito favorable para evitar la aparición de la enfermedad.AbstractThe prevalence of myopia varies in different populations in the world and the incidence increases in an accelerated manner, why refractive defects becomes a public health problem, with an economic and social impact.The progression of myopia can trigger pathological changes in the eyeball, affecting structures such as the lens, retina, choroid and macula. These degenerative changes are the most common cause of vision loss and are associated with an increase in refractive values that rise from childhood to adulthood.The development and progression are related to a genetic and hereditary component, however there is a complex interaction with external factors, which could explain the increase in cases among some populations, where increased urbanization and the need is perceived to achieve high levels of education. In addition, other environmental factors such as spend more time in the outdoors can be a favorable habit to prevent the onset of disease.

A coupled-mode model is developed for treating the wave–current–seabed interaction problem, with application to wave scattering by non-homogeneous, sheared current with linear vertical velocity profile, over general bottom topography. The wave potential is represented by a series of local vertical modes containing the propagating and evanescent modes, plus additional terms accounting for the satisfaction of the boundary conditions. Using the above representation, in conjunction with a variational principle, a coupled system of differential equations on the horizontal plane is derived, with respect to the unknown modal amplitudes. In the case of small-amplitude waves, a linearized version of the above coupled-mode system is obtained, extending previous analysis by Belibassakis et al. (2011) to the propagation of water waves over variable bathymetry regions in the presence of vertically sheared currents. Keeping only the propagating mode in the vertical expansion of the wave potential, the present system reduces to a one-equation model, that is shown to extend known mild-slope mild vertical shear equation concerning wave–current interaction over slowly varying topography. After additional simplifications, the latter model is shown to be compatible with the extended mild-slope mild-shear equation by Touboul et al. (2016). Results are presented for various representative test cases demonstrating the usefulness of the present coupled mode system and the importance of various terms in the modal expansion, and compared against experimental data collected in wave flume validating the present method. The analytical structure of the present system facilitates extensions to model non-linear effects and applications concerning wave scattering by inhomogeneous currents in coastal regions with general 3D bottom topography.

A form of encephalitis associated with anti– N -methyl-d-aspartate receptor (anti–NMDA-R) antibodies has recently been described.1 Reported patients are mainly young women, presenting with severe encephalitis and additional distinctive neurological features. Around 60% have an ovarian teratoma.1 The severe course of the disease does not rule out favourable prognosis. Immunotherapy is advocated1–3 and appears to be associated with improved outcome. We present a patient with anti–NMDA-R encephalitis and serial [18F]-fluorodeoxyglucose–positron emission tomography (FDG-PET) examinations showing markedly increased activity in the basal ganglia as compared with that in the cortex when extrapyramidal features were prominent, which normalised after improvement of this movement disorder. A 25-year old woman developed language difficulties, followed by repeated complex-partial seizures with rare secondary generalisations. On admission 3 weeks later (day 0), the patient had developed fluctuating obtundation, mutism and episodic laughter with dysautonomia (bilateral mydriasis, tachycardia and facial flush), catatonia and progressive limb rigidity with plantar flexor response. The findings of an extended etiological workup (blood cell counts; routine serum chemical analysis and cerebrospinal fluid analysis of infectious, inflammatory, metabolic and paraneoplastic parameters) and a body computed tomographic …

Les lesions cerebrales fœtales et neonatales liees a une hemorragie secondaire a une thrombocytopenie par allo-immunisation necessitent une evaluation precise en imagerie, afin de permettre une prise en charge optimale foetomaternelle et postnatale. Un conseil genetique parental et familial, un diagnostic de risque d’allo-immunisation et un traitement gestationnel ulterieur codifie doivent permettre de prevenir la survenue d’hemorragies fœtales.

Contexte et but de l'etude :Le statut socio-economique est suspecte d'avoir une influence significative sur l'incidence des attaques cerebrales (AVC), sur les facteurs de risque cardio-vasculaire, ainsi que sur le pronostic. L'influence de ce statut socio-economique sur la severite de l'AVC et sur les mecanismes physiopathologiques sous-jacents est moins connue.Methode :Sur une periode de 4 ans, nous avons collecte de maniere prospective (dans un registre) des donnees concernant tous les patients avec AVC aigus admis a l'Unite Cerebrovasculaire du CHUV. Les donnees comprenaient le statut assecurologique du patient (assurance privee ou generale), les donnees demographiques, les facteurs de risque cerebrovasculaires, l'utilisation de traitements aigus de recanalisation vasculaire, le delai avant l'admission a l'hopital, ainsi que la severite et le pronostic de l'AVC en phase aigue, a 7 jours et a 3 mois des symptomes. Les patients avec assurance privee ont ete compares a ceux avec assurance generale.Resultats :Sur 1062 patients avec AVC, 203 avaient une assurance privee et 859 avaient une assurance generale. Il y a avait 585 hommes et 477 femmes. Les deux populations etaient similaires en âge. Les facteurs de risque cardio-vasculaire, la medication preventive, le delai d'arrivee a l'hopital, l'incidence du taux de thrombolyse et l'etiologie de l'AVC ne differaient pas dans les deux populations. Le score de gravite de l'AVC en phase aigue, mesure par le NIHSS, etait significativement plus eleve chez les patients avec assurance generale. Un pronostic favorable, mesure par le score de Rankin modifie (mRS), etait plus frequemment obtenu a 7 jours et a 3 mois chez les patients avec assurance privee.Commentaires :Un statut socio-economique bas est associe a une incidence plus elevee de maladies cerebrovasculaires ainsi qu'a un plus mauvais pronostic, comme cela a ete demontre dans differents pays. Il a ete suspecte que l'acces a une prise en charge specialisee en phase aigue ou en reeducation soit different selon le statut socio-economique. Comme la Suisse a un systeme de sante universel, avec une couverture assecurologique obligatoire pour chaque habitant, il y a la une occasion unique de comparer l'influence de l'aspect socio-economique sur la severite et le pronostic de l'AVC. De plus, les patients ont ete admis dans la meme Unite Cerebrovasculaire et pris en charge par la meme equipe medicale.Conclusion et perspectives :Le lien entre le statut assecurologique et le statut socio-economique a deja ete prouve par le passe dans d'autres pays. Nous avons mis en evidence une severite plus importante et un plus mauvais pronostic chez les patients avec assurance generale dans la population etudiee. L'etiologie de cette difference dans un systeme de sante a couverture universelle comme celui de la Suisse reste peu claire. Elle devrait etre etudiee a plus grande echelle.

The most frequent clinical manifestation of borreliosis in Switzerland is erythema migrans, with about 2500 patients each year. Neurological manifestations are rare, mostly hyperalgesic radiculitis (Bannwarth syndrome), aseptic meningitis or cranial nerve involvement. We report the first Swiss patient with meningovasculitis due to neuroborreliosis, with recurrent multiple ischemic strokes in multiple vascular territories. The treatment with ceftriaxone stopped the progression, but the patient is still suffering from severe invalidating cognitive disorders. We also comment on the pathophysiology and review the literature of other clinical cases.

Previous recreational sports employees and participants represent a tremendous source of history, knowledge, insight, collaborative potential, and life experiences. Connecting prior generations of personnel and participants can acknowledge the past, be beneficial to the present, and energize the future. The rationale for establishing an alumni network within a recreational sports department is that such a network can provide a multitude of morale, business, communication, and qualitative benefits. The development of an alumni network can also help create a sense of pride, tradition, and excellence in a recreational sports department. Finally, it can provide guest instructors with specialized expertise, open the door for sponsorship opportunities, and allow for a productive partnership with the alumni office. Good alumni relations start with the experience that is provided to individuals while they are at the institution. Once the decision is made to introduce alumni programming, the recreational sports administrator must then determine objectives, define the target group, and collect and categorize data. Dates and times for programs and services must then be selected, communication methods identified, and specific media must be chosen. Plans for this endeavor will also be greatly influenced by the level of funding and amount of resources allotted. Examples of techniques that have been successfully implemented at various institutions include newsletters, group functions, philanthropic activities, and recognition.

This high precision parallel manipulator is a well‐adapted support for optical instrumentation in synchrotron radiation beamlines. It consists of a single moving element that obtains its six degrees‐of‐freedom from the combined movement of six independent actuators. This arrangement offers new control possibilities, together with fewer constraints for instrument mounting and alignment. Control of this kind of manipulator requires a special approach in order to exploit its full capabilities while keeping a reasonable simplicity of operation. In this paper the details of the control procedure and associated software package are presented. Special emphasis is given to the geometry: definition and ability to follow smooth trajectories, optimized calculations and special interface features like the possibility of defining virtual axes: logical motors associated with any particular rotation or translation of the instrument. By defining adequate virtual axes, it is now simple to execute a sequence of movements that were difficult with serial manipulators. The program includes special help for the alignment and calibration process and global instrument security features. It was written in a modular way, so that it can be easily adapted to different geometries, motor controllers and other site‐dependent parameters. At present three ESRF beamlines have installed and used these programs and around ten new installations are foreseen.

The topographical scattering of gravity waves is investigated using a spectral energy balance equation that accounts for first order wave-bottom Bragg scattering. This model represents the bottom topography and surface waves with spectra, and evaluates a Bragg scattering source term that is theoretically valid for small bottom and surface slopes and slowly varying spectral properties. The robustness of the model is tested for a variety of topographies uniform along one horizontal dimension including nearly sinusoidal, linear ramp and step profiles. Results are compared with reflections computed using an accurate method that applies integral matching along vertical boundaries of a series of steps. For small bottom amplitudes, the source term representation yields accurate reflection estimates even for a localized scatterer. This result is proved for small bottom amplitudes $h$ relative to the mean water depth $H$. Wave reflection by small amplitude bottom topography thus depends primarily on the bottom elevation variance at the Bragg resonance scales, and is insensitive to the detailed shape of the bottom profile. Relative errors in the energy reflection coefficient are found to be typically $2h/H$., Second revision for Journal of Waterways Ports and Coastal Engineering

A 42-year-old woman who smoked had a right middle cerebral artery (MCA) stroke of undetermined origin (initial NIHSS 19). CT and perfusion-CT after 7 h (fig 1B) showed no mass effect. Between 7 and 20 h, she suffered five episodes of asystolia of 10 s duration (fig 1C ), each accompanied by brief loss of …

Wave scattering over a sinusoidal bottom in the presence of an ambient current is investigated experimentally. Waves were generated in a flume with and without current and propagated over a patch of four sinusoidal bars before dissipating on a beach. A Doppler shift of the resonant Bragg frequency and an amplification of the wave reflection are observed in the presence of the current. Weak reflections over the beach are found to have a significant influence on the wave reflection over the bars.

Since 1992, 18 ESRF beamlines are open to users. Although the data acquisition requirements vary a lot from one beamline to another, we are trying to implement a modular data acquisition system architecture that would fit with the maximum number of acquisition projects at ESRF. Common to all of these systems are large acquisition memories and the requirement to visualize the data during an acquisition run and to transfer them quickly after the run to safe storage. We developed a general memory API handling the acquisition memory and its organization and another library that provides calls for transferring the data over TCP/IP sockets. Interesting utility programs using these libraries are the ‘online display’ program and the ‘data transfer’ program. The data transfer program as well as an acquisition control program rely on our well‐established ‘device server model’, which was originally designed for the machine control system and then successfully reused in beamline control systems. In the second half of this paper, the acquisition system for a 2D gas‐filled detector is presented, which is one of the first concrete examples using the proposed modular data acquisition architecture.

SUMMARY The acoustic microscope is used to visualize the acoustic microstructure of wet soya beans. The microacoustic patterns are correlated with their corresponding scanning electron microscopic and light microscopic images. The results show that the acoustic microscope is convenient for rapid and precise studies of thick specimens and gives structural information on a tissular and on a subcellular scale.