2,154 research outputs found

    Accommodative dysfunction in patients with cerebral palsy: Appropriate nearpoint prescribing

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    This study was designed to inform the eyecare practitioner of accommodative dysfunction in patients with Cerebral Palsy (CP), and more importantly, to give guidelines for successful prescribing of nearpoint lenses. Files were obtained from the Oregon School for the Blind, in association with the Oregon Lions Statewide Low Vision Clinic. Inclusion criteria included a diagnosis of CP, a Monocular Estimate Method (MEM) retinoscopy finding indicating an accommodative dysfunction, and a nearpoint lens prescription prescribed. Surveys were sent to the vision teachers of these patients to assess the effect of the nearpoint lenses on daily activities. The results were analyzed and discussed; two successful examples were presented. It was found that patients who had the greatest success functioned on a higher cognitive level, received initial training with the prescription and continued support, and in addition, were given adequate time to adapt to the prescription. It was also shown that even though the patient may not appear to appreciate the aid a near prescription provides, a nearpoint lens should be attempted for those who are found to have CP with accommodative dysfunction

    Development and validation of a deep learning model to quantify glomerulosclerosis in kidney biopsy specimens

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    Importance: A chronic shortage of donor kidneys is compounded by a high discard rate, and this rate is directly associated with biopsy specimen evaluation, which shows poor reproducibility among pathologists. A deep learning algorithm for measuring percent global glomerulosclerosis (an important predictor of outcome) on images of kidney biopsy specimens could enable pathologists to more reproducibly and accurately quantify percent global glomerulosclerosis, potentially saving organs that would have been discarded. Objective: To compare the performances of pathologists with a deep learning model on quantification of percent global glomerulosclerosis in whole-slide images of donor kidney biopsy specimens, and to determine the potential benefit of a deep learning model on organ discard rates. Design, Setting, and Participants: This prognostic study used whole-slide images acquired from 98 hematoxylin-eosin-stained frozen and 51 permanent donor biopsy specimen sections retrieved from 83 kidneys. Serial annotation by 3 board-certified pathologists served as ground truth for model training and for evaluation. Images of kidney biopsy specimens were obtained from the Washington University database (retrieved between June 2015 and June 2017). Cases were selected randomly from a database of more than 1000 cases to include biopsy specimens representing an equitable distribution within 0% to 5%, 6% to 10%, 11% to 15%, 16% to 20%, and more than 20% global glomerulosclerosis. Main Outcomes and Measures: Correlation coefficient (r) and root-mean-square error (RMSE) with respect to annotations were computed for cross-validated model predictions and on-call pathologists\u27 estimates of percent global glomerulosclerosis when using individual and pooled slide results. Data were analyzed from March 2018 to August 2020. Results: The cross-validated model results of section images retrieved from 83 donor kidneys showed higher correlation with annotations (r = 0.916; 95% CI, 0.886-0.939) than on-call pathologists (r = 0.884; 95% CI, 0.825-0.923) that was enhanced when pooling glomeruli counts from multiple levels (r = 0.933; 95% CI, 0.898-0.956). Model prediction error for single levels (RMSE, 5.631; 95% CI, 4.735-6.517) was 14% lower than on-call pathologists (RMSE, 6.523; 95% CI, 5.191-7.783), improving to 22% with multiple levels (RMSE, 5.094; 95% CI, 3.972-6.301). The model decreased the likelihood of unnecessary organ discard by 37% compared with pathologists. Conclusions and Relevance: The findings of this prognostic study suggest that this deep learning model provided a scalable and robust method to quantify percent global glomerulosclerosis in whole-slide images of donor kidneys. The model performance improved by analyzing multiple levels of a section, surpassing the capacity of pathologists in the time-sensitive setting of examining donor biopsy specimens. The results indicate the potential of a deep learning model to prevent erroneous donor organ discard

    In vivo killing of Staphylococcus aureus using a light-activated antimicrobial agent

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    Background: The widespread problem of antibiotic resistance in pathogens such as Staphylococcus aureus has prompted the search for new antimicrobial approaches. In this study we report for the first time the use of a light-activated antimicrobial agent, methylene blue, to kill an epidemic methicillin-resistant Staphylococcus aureus (EMRSA-16) strain in two mouse wound models.Results: Following irradiation of wounds with 360 J/cm(2) of laser light (670 nm) in the presence of 100 mu g/ml of methylene blue, a 25-fold reduction in the number of viable EMRSA was seen. This was independent of the increase in temperature of the wounds associated with the treatment. Histological examination of the wounds revealed no difference between the photodynamic therapy (PDT)-treated wounds and the untreated wounds, all of which showed the same degree of inflammatory infiltration at 24 hours.Conclusion: The results of this study demonstrate that PDT is effective at reducing the total number of viable EMRSA in a wound. This approach has promise as a means of treating wound infections caused by antibiotic-resistant microbes as well as for the elimination of such organisms from carriage sites

    Implicit motor learning promotes neural efficiency during laparoscopy

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    Background An understanding of differences in expert and novice neural behavior can inform surgical skills training. Outside the surgical domain, electroencephalographic (EEG) coherence analyses have shown that during motor performance, experts display less coactivation between the verbal-analytic and motor planning regions than their less skilled counterparts. Reduced involvement of verbal-analytic processes suggests greater neural efficiency. The authors tested the utility of an implicit motor learning intervention specifically devised to promote neural efficiency by reducing verbal-analytic involvement in laparoscopic performance. Methods In this study, 18 novices practiced a movement pattern on a laparoscopic trainer with either conscious awareness of the movement pattern (explicit motor learning) or suppressed awareness of the movement pattern (implicit motor learning). In a retention test, movement accuracy was compared between the conditions, and coactivation (EEG coherence) was assessed between the motor planning (Fz) region and both the verbal-analytic (T3) and the visuospatial (T4) cortical regions (T3-Fz and T4-Fz, respectively). Results Movement accuracy in the conditions was not different in a retention test (P = 0.231). Findings showed that the EEG coherence scores for the T3-Fz regions were lower for the implicit learners than for the explicit learners (P = 0.027), but no differences were apparent for the T4-Fz regions (P = 0.882). Conclusions Implicit motor learning reduced EEG coactivation between verbal-analytic and motor planning regions, suggesting that verbal-analytic processes were less involved in laparoscopic performance. The findings imply that training techniques that discourage nonessential coactivation during motor performance may provide surgeons with more neural resources with which to manage other aspects of surgery. © 2011 The Author(s).published_or_final_versio

    NGC 7582: The Prototype Narrow-Line X-ray Galaxy

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    NGC 7582 is a candidate prototype of the Narrow Line X-ray Galaxies (NLXGs) found in deep X-ray surveys. An ASCA observation shows the hard (> 3 keV) X-ray continuum of NGC 7582 drops 40% in ~6 ks, implying an AGN, while the soft band (< 3 keV) does not drop in concert with the hard continuum, requiring a separate component. The X-ray spectrum of NGC 7582 also shows a clear 0.5-2 keV soft (kT = 0.8 (+0.9,-0.3) keV or Gamma = 2.4 +/- 0.6; L(X) = 6 x 10**40 ergs s**-1) low--energy component, in addition to a heavily absorbed [N(H) = (6 +/- 2)\times 10**22 cm**-2 ] and variable 2-10 keV power law [Gamma = 0.7 (+0.3,-0.4); L(X) = (1.7-2.3) x 10**42 ergs s**-1]. This is one of the flattest 2-10 keV slopes in any AGN observed with ASCA. (The ROSAT HRI image of NGC 7582 further suggests extent to the SE.) These observations make it clear that the hard X-ray emission of NGC 7582, the most "narrow-line" of the NLXGs, is associated with an AGN. The strong suggestion is that all NLXGs are obscured AGNs, as hypothesized to explain the X-ray background spectral paradox. The separate soft X-ray component makes NGC 7582 (and by extension other NLXGs) detectable as a ROSAT source.Comment: text: Latex2e 10 pages, including 1 table, and 2 postscript figures via psfi

    Beaver-Dredged Canals and their Spacial Relationship to Beaver-Cut Stumps

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    Castor canadensis Kuhl (North American beavers) are central place foragers whocollect woody plants and building materials from their surroundings and return to a main body of water containing a lodge or food cache. It has been suggested that beavers dredge water-filled canals to extend access to foraging areas; however, the possibility that these engineered transportation routes function as extensions to the beavers\u27 central place has yet to be considered. Our objective in this study was to gain a better understanding of the formation and utilization of canals by beavers and thus further elucidate the complex foraging behavior of these ecosystem engineers. During 2004–2011, we mapped beaver ponds, canals, and cut stumps in eight groundwater-fed wetlands, from at least four separate colonies, in Indianapolis, IN. We found that the mean length, depth, and width of the beaver-dredged canals were 604.3 6 493.1 m, 28.0 6 22.2 cm, and 107.7 6 107.1 cm respectively. Two of the canal systems were mapped for multiple years and their length, depth, and width increased over time and supported the prediction that beavers continuously engineer these canal systems to extend their foraging area into new locations. In addition, and in contrast to previous studies, we found that the number of beaver-cut stumps was negatively related to distance from canals, but not from the body of water containing their lodges. We recommend that studies of optimal foraging in beavers take canals into account, where applicable, when relating foraging to distance from the central place

    Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup

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    Agitation is an acute behavioral emergency requiring immediate intervention. Traditional methods of treating agitated patients, ie, routine restraints and involuntary medication, have been replaced with a much greater emphasis on a noncoercive approach. Experienced practitioners have found that if such interventions are undertaken with genuine commitment, successful outcomes can occur far more often than previously thought possible. In the new paradigm, a 3-step approach is used. First, the patient is verbally engaged; then a collaborative relationship is established; and, finally, the patient is verbally de-escalated out of the agitated state. Verbal de-escalation is usually the key to engaging the patient and helping him become an active partner in his evaluation and treatment; although, we also recognize that in some cases nonverbal approaches, such as voluntary medication and environment planning, are also important. When working with an agitated patient, there are 4 main objectives: (1) ensure the safety of the patient, staff, and others in the area; (2) help the patient manage his emotions and distress and maintain or regain control of his behavior; (3) avoid the use of restraint when at all possible; and (4) avoid coercive interventions that escalate agitation. The authors detail the proper foundations for appropriate training for de-escalation and provide intervention guidelines, using the “10 domains of de-escalation.

    The Apache Point Observatory Galactic Evolution Experiment: First Detection of High Velocity Milky Way Bar Stars

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    Commissioning observations with the Apache Point Observatory Galactic Evolution Experiment (APOGEE), part of the Sloan Digital Sky Survey III, have produced radial velocities (RVs) for ~4700 K/M-giant stars in the Milky Way bulge. These high-resolution (R \sim 22,500), high-S/N (>100 per resolution element), near-infrared (1.51-1.70 um; NIR) spectra provide accurate RVs (epsilon_v~0.2 km/s) for the sample of stars in 18 Galactic bulge fields spanning -1-32 deg. This represents the largest NIR high-resolution spectroscopic sample of giant stars ever assembled in this region of the Galaxy. A cold (sigma_v~30 km/s), high-velocity peak (V_GSR \sim +200 km/s) is found to comprise a significant fraction (~10%) of stars in many of these fields. These high RVs have not been detected in previous MW surveys and are not expected for a simple, circularly rotating disk. Preliminary distance estimates rule out an origin from the background Sagittarius tidal stream or a new stream in the MW disk. Comparison to various Galactic models suggests that these high RVs are best explained by stars in orbits of the Galactic bar potential, although some observational features remain unexplained.Comment: 7 pages, 4 figures, accepted for publication in ApJ Letter

    High-resolution, H band Spectroscopy of Be Stars with SDSS-III/APOGEE: I. New Be Stars, Line Identifications, and Line Profiles

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    APOGEE has amassed the largest ever collection of multi-epoch, high-resolution (R~22,500), H-band spectra for B-type emission line (Be) stars. The 128/238 APOGEE Be stars for which emission had never previously been reported serve to increase the total number of known Be stars by ~6%. We focus on identification of the H-band lines and analysis of the emission peak velocity separations (v_p) and emission peak intensity ratios (V/R) of the usually double-peaked H I and non-hydrogen emission lines. H I Br11 emission is found to preferentially form in the circumstellar disks at an average distance of ~2.2 stellar radii. Increasing v_p toward the weaker Br12--Br20 lines suggests these lines are formed interior to Br11. By contrast, the observed IR Fe II emission lines present evidence of having significantly larger formation radii; distinctive phase lags between IR Fe II and H I Brackett emission lines further supports that these species arise from different radii in Be disks. Several emission lines have been identified for the first time including ~16895, a prominent feature in the spectra for almost a fifth of the sample and, as inferred from relatively large v_p compared to the Br11-Br20, a tracer of the inner regions of Be disks. Unlike the typical metallic lines observed for Be stars in the optical, the H-band metallic lines, such as Fe II 16878, never exhibit any evidence of shell absorption, even when the H I lines are clearly shell-dominated. The first known example of a quasi-triple-peaked Br11 line profile is reported for HD 253659, one of several stars exhibiting intra- and/or extra-species V/R and radial velocity variation within individual spectra. Br11 profiles are presented for all discussed stars, as are full APOGEE spectra for a portion of the sample.Comment: accepted in A

    The Open Cluster Chemical Analysis and Mapping Survey: Local Galactic Metallicity Gradient with APOGEE using SDSS DR10

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    The Open Cluster Chemical Analysis and Mapping (OCCAM) Survey aims to produce a comprehensive, uniform, infrared-based dataset for hundreds of open clusters, and constrain key Galactic dynamical and chemical parameters from this sample. This first contribution from the OCCAM survey presents analysis of 141 members stars in 28 open clusters with high-resolution metallicities derived from a large uniform sample collected as part of the SDSS-III/Apache Point Observatory Galactic Evolution Experiment (APOGEE). This sample includes the first high-resolution metallicity measurements for 22 open clusters. With this largest ever uniformly observed sample of open cluster stars we investigate the Galactic disk gradients of both [M/H] and [alpha/M]. We find basically no gradient across this range in [alpha/M], but [M/H] does show a gradient for R_{GC} < 10 kpc and a significant flattening beyond R_{GC} = 10 kpc. In particular, whereas fitting a single linear trend yields an [M/H] gradient of -0.09 +/- 0.03$ dex/kpc --- similar to previously measure gradients inside 13 kpc --- by independently fitting inside and outside 10 kpc separately we find a significantly steeper gradient near the Sun (7.9 <= R_{GC} <= 10) than previously found (-0.20 +/- 0.08 dex/kpc) and a nearly flat trend beyond 10 kpc (-0.02 +/- 0.09 dex/kpc).Comment: 6 pages, 4 figures, ApJ letters, in pres