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This study was designed to evaluate iVue Spectral-domain optical coherence tomography (SD-OCT) effectiveness in screening for eye disease compared to clinical examination. Subjects were recruited from the Casey Eye Community Outreach Program Mobile Clinic during its routinely scheduled outreach clinics to indigent, underserved populations throughout Oregon. Macular optical coherence tomography interpretation and automated optical coherence tomography analysis were compared to the clinical examination, with specific attention to findings indicative of retinal abnormalities, risks for glaucoma, and narrow angles. As a result, a total of 114 subjects were included in this study. In diabetics, optical coherence tomography and clinical exam were in fair agreement (kappa = 0.39), with 22% of eyes having abnormal findings on macular optical coherence tomography and 26% of eyes having diabetic retinopathy or diabetic macular edema on fundus exam. In non-diabetics, optical coherence tomography and clinical exam were in fair agreement (kappa = 0.28), with 11% of eyes having abnormal findings on macular optical coherence tomography and 9% on fundus exam. Using optical coherence tomography ganglion cell complex and retinal nerve fiber layer analysis, 18% of eyes were found to be glaucoma suspects, whereas clinical exam of cup-to-disc ratio detected 8% and intraocular pressure 5%. Agreements between optical coherence tomography and other methods were poor (kappa

The purpose of this study was to correct refractive error-associated bias in optical coherence tomography (OCT) and OCT angiography (OCTA) glaucoma diagnostic parameters.OCT and OCTA imaging were obtained from participants in the Hong Kong FAMILY cohort. The Avanti/AngioVue OCT/OCTA system was used to measure the peripapillary nerve fiber layer thickness (NFLT), peripapillary nerve fiber layer plexus capillary density (NFLP-CD), macular ganglion cell complex thickness (GCCT), and macular superficial vascular complex vascular density (SVC-VD). Healthy eyes, including ones with axial ametropia, were enrolled for analysis.A total of 1346 eyes from 792 participants were divided into 4 subgroups: high myopia (-6D), low myopia (-6D to -1D), emmetropia (-1D to 1D), and hyperopia (1D). After accounting for age, sex, and signal strength, multivariable regression showed strong dependence in most models for NFLT, GCCT, and NFLP-CD on axial eye length (AL), spherical equivalent (SE) refraction, and apparent optic disc diameter (DD). Optical analysis indicated that AL-related transverse optical magnification variations predominated over anatomic variations and were responsible for these trends. Compared to the emmetropic group, the false positive rates were significantly (Chi-square test P0.003) elevated in both myopia groups for NFLT, NFLP-CD, and GCCT. Regression-based adjustment of these diagnostic parameters with AL or SE significantly (McNemar test P0.03) reduced the elevated false positive rates.Myopic eyes are biased to have lower NFLT, GCCT, and NFLP-CD measurements. AL- and SE-based adjustments were effective in mitigating this bias.Adoption of these adjustments into commercial OCT systems may reduce false positive rates related to refractive error.

PurposeTo assess the effects of algorithms and covariates in glaucoma diagnosis with optical coherence tomography angiography (OCTA).MethodsIn this prospective cross-sectional study, one eye each of 36 normal controls and 64 patients with glaucoma underwent 4.5 mm disc-centred and 6 mm macula-centred OCTA scans. The peripapillary nerve fibre layer plexus capillary density (NFLP-CD) and macular superficial vascular complex vessel density (SVC-VD) were measured using both a commercial algorithm (AngioAnalytics) and a custom algorithm (Center for Ophthalmic Optics & Lasers Angiography Reading Toolkit (COOL-ART)). The nerve fibre layer and ganglion cell complex thicknesses were measured on structural OCT.ResultsThe overall peripapillary NFLP-CD and macular SVC-VD measured with the two algorithms were highly correlated but poorly agreed. Among the normal controls, the perfusion measurements made by both algorithms were significantly correlated with age. AngioAnalytics measurements were also correlated with signal strength index, while COOL-ART measurements were not. These covariates were adjusted. The diagnostic accuracy, measured as the area under the receiver operating characteristic curve for glaucoma detection, was not significantly different between algorithms, between structural and perfusion parameters and between the peripapillary and macular regions (All p>0.05). The macular SVC-VD in the 6 mm square had a significantly higher diagnostic accuracy than that of the central 3 mm square area (p=0.005).ConclusionsAngioAnalytics and COOL-ART vessel density measurements are not interchangeable but potentially interconvertible. Age and signal strength are significant covariates that need to be considered. Both algorithms and both peripapillary and macular perfusion parameters have similarly good diagnostic accuracy comparable to structural OCT. A larger macular analytic area provides higher diagnostic accuracy.

Accuracy of medication data in electronic health records (EHRs) is crucial for patient care and research, but many studies have shown that medication lists frequently contain errors. In contrast, physicians often pay more attention to the clinical notes and record medication information in them. The medication information in notes may be used for medication reconciliation to improve the medication lists’ accuracy. However, accurately extracting patient’s current medications from free-text narratives is challenging. In this study, we first explored the discrepancies between medication documentation in medication lists and progress notes for glaucoma patients by manually reviewing patients’ charts. Next, we developed and validated a named entity recognition model to identify current medication and adherence from progress notes. Lastly, a prototype tool for medication reconciliation using the developed model was demonstrated. In the future, the model has the potential to be incorporated into the EHR system to help with realtime medication reconciliation.

BACKGROUND: The COVID-19 pandemic has significantly affected health care institutions, introducing new challenges for nurse leaders and their colleagues. However, little is known about how the pandemic has specifically affected the lives of these leaders and what methods and strategies they are using to overcome pandemic-related challenges. OBJECTIVES: Examine the effect of the 2019 pandemic on emerging health care leaders and highlight methods and strategies they used to overcome pandemic-related challenges. METHODS: The participants in this study represent a diverse group of interprofessional health care faculty enrolled in a transformational leadership course (Paths to Leadership [PTL]) when the pandemic first appeared. Three months into the pandemic, the leadership cohort was invited to participate in this qualitative study, exploring four questions: Q1: How have you transformed your working styles in response to the pandemic? Q2: How have you adjusted your personal life in response to the pandemic? Q3: How have you used leadership skills learned from PTL during the pandemic? and Q4: What lessons have you learned from the pandemic? Participant narratives were analyzed by a team of nurse researchers using conventional qualitative content analysis. RESULTS: Themes for Q1 (Working Styles) included: shifted from face-to-face to telework, faced novel disease and decisions, worked more from home, and challenged to maintain contact with professional peers and team. Themes for Q2 (Personal Life) included: accommodate adults working and children learning from home, looked for and found the positive, and continue to struggle. Themes for Q3 (Leadership Skills) included: reflective practice, listening, holding, and reframing. Finally, themes for Q4 (Pandemic Lessons) included: leadership, human connection, be prepared, taking care of ourselves, and connecting with nature. DISCUSSION: The 2019 pandemic brought hardships and opportunities to faculty members enrolled in an interprofessional transformational leadership course. In conjunction with this course, the pandemic provided a unique opportunity for participants to apply newly acquired relationship building, positive organizational psychology, and reframing skills during a time of crisis. Nursing leaders, whose educational offerings may be immediately “put to the test,” may find our lessons learned are helpful as they develop strategies to cope with unanticipated future challenges.

Purpose: To evaluate nerve fiber layer (NFL) reflectance for glaucoma diagnosis. Methods: Participants were imaged with 4.5X4.5-mm volumetric disc scans using spectral-domain optical coherence tomography (OCT). The normalized NFL reflectance map was processed by an azimuthal filter to reduce directional reflectance bias due to variation of beam incidence angle. The peripapillary area of the map was divided into 160 superpixels. Average reflectance was the mean of superpixel reflectance. Low-reflectance superpixels were identified as those with NFL reflectance below the 5 percentile normative cutoff. Focal reflectance loss was measure by summing loss in low-reflectance superpixels. Results: Thirty-five normal, 30 pre-perimetric and 35 perimetric glaucoma participants were enrolled. Azimuthal filtering improved the repeatability of the normalized NFL reflectance, as measured by the pooled superpixel standard deviation (SD), from 0.73 to 0.57 dB (p, pages: 31; Tables: 6; Figures: 9

PURPOSE: To measure low perfusion areas (LPA) and focal perfusion loss (FPL) in the peripapillary retina using optical coherence tomographic angiography (OCTA) in glaucoma. DESIGN: Prospective observation study. PARTICIPANTS: Forty-seven primary open angle glaucoma (POAG) patients and 36 normal subjects were analyzed. METHODS: One eye of each subject was scanned using AngioVue 4.5-mm OCTA scan centered on the disc. En face nerve fiber layer plexus angiogram was generated. With the use of custom software, a capillary density map was obtained by computing the fraction of area occupied by flow pixels after low-pass filtering by local averaging 21×21 pixels. The low-perfusion map is defined by local capillary density below 0.5 percentile over a contiguous area above 98.5 percentile of the normal reference population. The LPA parameter is the cumulative area and FPL is the percent capillary density loss (relative to normal mean) integrated over the LPA. The retinal nerve fiber layer (NFL) thickness was measured from ONH scan on AngioVue. MAIN OUTCOME MEASURES: Peripapillary retinal LPA, FPL and NFL thickness. RESULTS: Among POAG patients, 3 had pre-perimetric glaucoma and 44 had perimetric glaucoma, with visual field (VF) mean deviation (MD) of −5.14 ± 4.25 dB. LPA was 3.40 ± 2.29 mm(2) in POAG and 0.11 ± 0.18 mm(2) among normal subjects (P < 0.001). FPL was 21.8 ± 17.0 % in POAG and 0.3 ± 0.7% in normal subjects (P < 0.001). The diagnostic accuracy as measured by the area under the receiver operating curve was 0.965 for both LPA and FPL, with sensitivity of 93.7% at 95% specificity. The repeatability as measured by intraclass correlation coefficient was 0.977 for LPA and 0.958 for FPL. FPL had an excellent correlation with VF MD (Spearman’s rho= −0.843) which was significantly (P = 0.008) better than the correlation between NFL thickness and VF MD (rho = 0.760). The hemispheric difference correlation between FPL and VF (Spearman’s rho=0.770) was significantly (P < 0.001) higher than the hemispheric difference correlation between LPA and VF (rho = 0.595). CONCLUSIONS: The low-perfusion map and the LPA and FPL parameters are able to assess the location and severity of focal glaucoma damage with good agreement with VF.

The ultrafiltration membrane technology as a new water treatment technology, can be used in large scale depends largely on the membrane material itself, also depends on the membrane production conditions and process. This paper reviews the development and research trends of preparing ultrafiltration membrane material, and analyzes its application prospect in water treatment of drinking water.

We describe a vision sparing surgical approach for optic nerve glioma. A 7-year-old girl experienced declining academic performance and social withdrawal attributed to progressive disfiguring proptosis. Three years earlier, she had undergone a limited biopsy, a course of chemotherapy, and orbital radiation therapy for a right optic nerve glioma with perineural arachnoidal gliomatosis (PAG). Because of marked proptosis, another surgery was performed via a lateral orbitotomy. After cutting a window in the thickened dura of the optic nerve, rouge colored spongy tissue was suctioned from the subarachnoid space. Small, more solidified areas were excised with unipolar cautery. Care was taken to avoid identifiable blood vessels and the optic nerve, and approximately 60%-70% of the tumor was removed. The dural window was approximated with interrupted sutures. Postoperatively, there was 9 mm reduction in right proptosis and visual acuity improved to from 20/70 to 20/60. This case illustrates the possibility of debulking optic nerve gliomas without sacrificing vision. It should be stressed that this technique is only applicable to gliomas with PAG and the durability of the surgical benefit is unknown.

Decolorization of an anthraquinone dye, Reactive Brilliant Blue KN-R by hydrogen peroxide was examined using Fe-containing Y and ZSM-5 zeolites as heterogeneous catalysts. Catalysts were prepared by ion-exchange and coprecipitation methods, and calcined at different temperatures. The surface morphologies, crystalline phases, and chemical-state of the catalysts were characterized by scanning electron microscopy, X-ray diffraction and X-ray photoelectron spectroscopy. Influences of reaction conditions, such as dye concentration, catalyst dosage and solution pH, were evaluated and the relations between catalytic capacity and surface microstructures were discussed. The results showed that Fe-containing Y and ZSM-5 zeolites generally exhibited similar or better catalytic efficiency compared with homogeneous Fenton reagent, with Fe-containing ZSM-5 being more efficient. Synthesis method and calcination temperature affected catalytic efficiency and the stability of catalysts. Fe-containing ZSM-5, which was prepared by coprecipitation and calcined at 450 °C, displayed the greatest decolorization capacity. Under the conditions of initial pH 2.5, 30.0 mmol/L H2O2 and 4.0 g/L catalyst, 250 mg/L KN-R could be decolorized over 90% within 20 min.

The neural mechanisms underlying recognition of familiar individuals and responses appropriate to them are not well known. Previous studies with male golden hamsters have shown that, after a series of brief aggressive encounters, a loser selectively avoids his own, familiar winner but does not avoid other males. Using this paradigm, we investigated activity in 20 areas of the brain using immunohistochemistry for c-Fos and Egr-1 during exposure to a familiar winner compared to control groups not exposed to another male. Behavioral data showed that 1 day after fights males that lost avoided the familiar winner, suggesting that they recognized this individual. The c-Fos and Egr-1 immunohistochemistry showed that the losers exposed to familiar winners had a greater density of stained cells in the basolateral amygdala, the CA1 region of anterior dorsal hippocampus and the dorsal subiculum than control groups had in these areas. These results suggest that these brain areas may be involved in the memory for other males, the learned fear of familiar winners, or related processes.

Rituximab, a monoclonal antibody to the B cell marker CD20, is becoming increasingly popular in the treatment of various orbital disorders. In this university-based interventional case series, we describe two patients with bilateral orbital and extra-orbital reactive lymphoid hyperplasia (RLH) treated with rituximab. Initially both had favorable responses; but roughly a year later recurrent disease necessitated maintenance therapy in both cases. Both again responded to additional courses of rituximab. Although recalcitrant disease may persist after treatment, rituxmab may play a role in the management of RLH with widespread involvement.

Objective: To describe the development and health claims of Asian herbal-tobacco cigarettes. Methods: Analysis of international news sources, company websites, and the transnational tobacco companies’ (TTC) documents. PubMed searches of herbs and brands. Results: Twenty-three brands were identified, mainly from China. Many products claimed to relieve respiratory symptoms and reduce toxins, with four herb-only products advertised for smoking cessation. No literature was found to verify the health claims, except one Korean trial of an herb-only product. Asian herbal-tobacco cigarettes were initially produced by China by the 1970s and introduced to Japan in the 1980s. Despite initial news about research demonstrating a safer cigarette, the TTC analyses of these cigarettes suggest that these early products were not palatable and had potentially toxic cardiovascular effects. By the late 1990s, China began producing more herbal-tobacco cigarettes in a renewed effort to reduce harmful constituents in cigarettes. After 2000, tobacco companies from Korea, Taiwan, and Thailand began producing similar products. Tobacco control groups in Japan, Taiwan, and Thailand voiced concern over the health claims of herbal-tobacco products. In 2005, China designated two herbal-tobacco brands as key for development. Conclusion: Asian herbal-tobacco cigarettes claim to reduce harm, but no published literature is available to verify these claims or investigate unidentified toxicities. The increase in Asian herbal-tobacco cigarette production by 2000 coincides with the Asian tobacco companies’ regular scientific meetings with TTCs and their interest in harm reduction. Asia faces additional challenges in tobacco control with these culturally concordant products that may discourage smokers from quitting.