The Computer-Vision Symptom Scale (CVSS17): Development and Initial Validation

Purpose.: To develop a questionnaire (in Spanish) to measure computer-related visual and ocular symptoms (CRVOS). Methods.: A pilot questionnaire was created by consulting the literature, clinicians, and video display terminal (VDT) workers. The replies of 636 subjects completing the questionnaire were assessed using the Rasch model and conventional statistics to generate a new scale, designated the Computer-Vision Symptom Scale (CVSS17). Validity and reliability were determined by Rasch fit statistics, principal components analysis (PCA), person separation, differential item functioning (DIF), and item–person targeting. To assess construct validity, the CVSS17 was correlated with a Rasch-based visual discomfort scale (VDS) in 163 VDT workers, this group completed the CVSS17 twice in order to assess test-retest reliability (two-way single-measure intraclass correlation coefficient [ICC] and their 95% confidence intervals, and the coefficient of repeatability [COR]). Results.: The CVSS17 contains 17 items exploring 15 different symptoms. These items showed good reliability and internal consistency (mean square infit and outfit 0.88–1.17, eigenvalue for the first residual PCA component 1.37, person separation 2.85, and no DIF). Pearson's correlation with VDS scores was 0.60 (P < 0.001). Intraclass correlation coefficient for test–retest reliability was 0.849 (95% confidence interval [CI], 0.800–0.887), and COR was 8.14. Conclusions.: The Rasch-based linear-scale CVSS17 emerged as a useful tool to quantify CRVOS in computer workers

Complemento audiovisual para el aprendizaje de procedimientos clínicos optométricos de visión binocular no estrábica

El resultado de este proyecto consta de 35 vídeotutoriales de exploración a pacientes, que complementan el aprendizaje de procedimientos clínicos relacionados con la visión binocular no estrábica. Sirven como guía previa a la realización de las prácticas y de complemento para el estudio de los procedimientos

Selección de nuevas variedades de vid resistentes a enfermedades fúngicas, generadas mediante cruzamientos con Monastrell

La viticultura y la vinicultura han sido tradicionales desde la antigüedad en Murcia (España), siendo la vid un cultivo de gran importancia económica en esta zona. Sin embargo, las enfermedades causadas por hongos afectan gravemente al rendimiento, el coste y la calidad de la producción de la vid. Estas enfermedades se controlan en la actualidad mediante tratamientos con fungicidas, repetidos durante cada temporada de cultivo. La obtención de nuevas variedades resistentes de alta calidad reduce tanto el coste de producción de la vid como el riesgo ambiental. Basándonos únicamente en los datos de evaluación fenotípica, es poco factible conseguir la acumulación de genes de resistencia en una nueva línea mejorada. El uso de marcadores moleculares proporciona una nueva herramienta para los mejoradores y puede ayudar a superar este problema. En este trabajo, se presentan las actividades de investigación en el IMIDA orientadas a establecer una selección asistida por marcadores (MAS) para la resistencia a las enfermedades por hongos en la vid, mediante cruzamientos de 'Monastrell', una variedad de vinificación muy bien adaptada a las condiciones secas del clima mediterráneo, con plantas resistentes a enfermedades fúngicas.Los autores desean agradecer el apoyo financiero del Fondo Europeo de Desarrollo Regional y de la Consejería de Agricultura y Agua de la Región de Murcia. Este trabajo está financiado por el proyecto PO07‐37 cofinanciado al 80% por fondos FEDER

Five levels of performance and two subscales identified in the computer-vision symptom scale (CVSS17) by Rasch, factor, and discriminant analysis

Purpose: To quantify the levels of performance (symptom severity) of the computer-vision symptom scale (CVSS17), confirm its bifactorial structure as detected in an exploratory factor analysis, and validate its factors as subscales. Methods: By partial credit model (PCM), we estimated CVSS17 measures and the standard error for every possible raw score, and used these data to determine the number of different performance levels in the CVSS17. In addition, through discriminant analysis, we checked that the scale's two main factors could classify subjects according to these determined levels of performance. Finally, a separate Rasch analysis was performed for each CVSS17 factor to assess their measurement properties when used as isolated scales. Results: We identified 5.8 different levels of performance. Discriminant functions obtained from sample data indicated that the scale's main factors correctly classified 98.4% of the cases. The main factors: Internal symptom factor (ISF) and external symptom factor (ESF) showed good measurement properties and can be considered as subscales. Conclusion: CVSS17 scores defined five different levels of performance. In addition, two main factors (ESF and ISF) were identified and these confirmed by discriminant analysis. These subscales served to assess either the visual or the ocular symptoms attributable to computer use

Extraocular motoneurons of the adult rat show higher levels of vascular endothelial growth factor and its receptor Flk-1 than other cranial motoneurons

Recent studies show a relationship between the deficit of vascular endothelial growth factor (VEGF) and motoneuronal degeneration, such as that occurring in amyotrophic lateral sclerosis (ALS). VEGF delivery protects motoneurons from cell death and delayed neurodegeneration in animal models of ALS. Strikingly, extraocular motoneurons show lesser vulnerability to neurodegeneration in ALS compared to other cranial or spinal motoneurons. Therefore, the present study investigates possible differences in VEGF and its main receptor VEGFR-2 or Flk-1 between extraocular and non-extraocular brainstem motoneurons. We performed immunohistochemistry and Western blot to determine the presence of VEGF and Flk-1 in rat motoneurons located in the three extraocular motor nuclei (abducens, trochlear and oculomotor) and to compare it to that observed in two other brainstem nuclei (hypoglossal and facial) that are vulnerable to degeneration. Extraocular motoneurons presented higher amounts of VEGF and its receptor Flk-1 than other brainstem motoneurons, and thus these molecules could be participating in their higher resistance to neurodegeneration. In conclusion, we hypothesize that differences in VEGF availability and signaling could be a contributing factor to the different susceptibility of extraocular motoneurons, when compared with other motoneurons, in neurodegenerative diseases

Evaluation of a New Digital Automated Glycemic Pattern Detection Tool

Background: Blood glucose meters are reliable devices for data collection, providing electronic logs of historical data easier to interpret than handwritten logbooks. Automated tools to analyze these data are necessary to facilitate glucose pattern detection and support treatment adjustment. These tools emerge in a broad variety in a more or less nonevaluated manner. The aim of this study was to compare eDetecta, a new automated pattern detection tool, to nonautomated pattern analysis in terms of time investment, data interpretation, and clinical utility, with the overarching goal to identify early in development and implementation of tool areas of improvement and potential safety risks. Methods: Multicenter web-based evaluation in which 37 endocrinologists were asked to assess glycemic patterns of 4 real reports (2 continuous subcutaneous insulin infusion [CSII] and 2 multiple daily injection [MDI]). Endocrinologist and eDetecta analyses were compared on time spent to analyze each report and agreement on the presence or absence of defined patterns. Results: eDetecta module markedly reduced the time taken to analyze each case on the basis of the emminens eConecta reports (CSII: 18 min; MDI: 12.5), compared to the automatic eDetecta analysis. Agreement between endocrinologists and eDetecta varied depending on the patterns, with high level of agreement in patterns of glycemic variability. Further analysis of low level of agreement led to identifying areas where algorithms used could be improved to optimize trend pattern identification. Conclusion: eDetecta was a useful tool for glycemic pattern detection, helping clinicians to reduce time required to review emminens eConecta glycemic reports. No safety risks were identified during the study

Extraocular Motor System Exhibits a Higher Expression of Neurotrophins When Compared with Other Brainstem Motor Systems

Extraocular motoneurons resist degeneration in diseases such as amyotrophic lateral sclerosis. The main objective of the present work was to characterize the presence of neurotrophins in extraocular motoneurons and muscles of the adult rat. We also compared these results with those obtained from other cranial motor systems, such as facial and hypoglossal, which indeed suffer neurodegeneration. Immunocytochemical analysis was used to describe the expression of nerve growth factor, brain-derived neurotrophic factor and neurotrophin-3 in oculomotor, trochlear, abducens, facial, and hypoglossal nuclei of adult rats, and Western blots were used to describe the presence of neurotrophins in extraocular, facial (buccinator), and tongue muscles, which are innervated by the above-mentioned motoneurons. In brainstem samples, brain-derived neurotrophic factor was present both in extraocular and facial motoneuron somata, and to a lesser degree, in hypoglossal motoneurons. Neurotrophin-3 was present in extraocular motor nuclei, while facial and hypoglossal motoneurons were almost devoid of this protein. Finally, nerve growth factor was not present in the soma of any group of motoneurons, although it was present in dendrites of motoneurons located in the neuropil. Neuropil optical density levels were higher in extraocular motoneuron nuclei when compared with facial and hypoglossal nuclei. Neurotrophins could be originated in target muscles, since Western blot analyses revealed the presence of the three molecules in all sampled muscles, to a larger extent in extraocular muscles when compared with facial and tongue muscles. We suggest that the different neurotrophin availability could be related to the particular resistance of extraocular motoneurons to neurodegeneration.MINECO BFU2012-33975MINECO BFU2015-64515-P

Spanish Cross-Cultural Adaptation and Rasch Analysis of the Convergence Insufficiency Symptom Survey (CISS)

Purpose: To culturally and linguistically adapt the Convergence Insufficiency Symptom Survey (CISS) to Spanish and assess the psychometric performance of the new version through Rasch analysis and classical test theory methods. Methods: The Spanish version of the CISS (CISSVE ) was completed by 449 subjects (9– 30 years old) from the general population. The validity and reliability of CISSVE were assessed through Rasch statistics (precision, targeting, item fit, unidimensionality, and differential item functioning). To test construct validity, we calculated the coefficients of correlation between the CISSVE and the Computer-Vision Symptom Scale (CVSS17) or Warwick–Edinburgh Mental Well-Being Scale (WEMWBS). We determined test–retest reliability in a subset of 229 subjects. We used differential item functioning (DIF) to compare the CISSSVE and the CISS after administering the CISS to 216 English children. Results: After applying exclusion criteria, the responses of 420 participants (mean age, 18.62 years; female, 54.95%) revealed good Rasch model fit, good precision (person separation = 2.33), and suboptimal targeting (–1.37). There was some evidence of multidimensionality, but disattenuated correlations between the Rasch dimension and a possible secondary dimension were high, suggesting they were measuring similar constructs. No item bias according to gender or age was detected. Spearman’s correlation was 0.34 (P < 0.001) for CISSVE –CVSS17 and non-significant for CISSVE –WEMWBS. The limits of agreement for test–retest reliability were 9.67 and –8.71. Rasch analysis results indicated no difference between CISS and CISSVE. Conclusions: According to our results, CISSVE is a valid and reliable tool for measuring the symptoms assessed by CISS in Spanish people 9 to 30 years of age. Translational Relevance: CISSVE can measure convergence insufficiency symptoms in Spanish-speaking subjects

Caso Clínico De Síndrome De Cinturón De Seguridad De Dos Puntos: Síndrome de Cinturón de Seguridad.

A case is presented of an 18-year-old male with a lumbar bone lesion included in the so-called "two-point seat belt syndrome". The patient was seen for low back pain following a traffic accident, being the occupant of the middle rear seat of the vehicle. He assessed the pain as 7/10 on the VAS scale before analgesia. Immobilisation of the neck and spine was carried out and he was transferred to the nearest reference hospital, where an imaging test (CT scan) confirmed the lumbar vertebra L3. Seatbelt syndrome still occurs in cases of high-speed trauma where a two-point seatbelt is used. The scrupulous management of such patients is a challenge for out-of-hospital medical staff.Se muestra un caso de un varón de 18 años con lesión ósea lumbar englobada dentro del denominado “Síndrome de cinturón de seguridad de dos puntos”. El paciente es atendido por presentar dolor lumbar tras un accidente de tráfico, siendo ocupante del asiento medio trasero del vehículo. Valora el dolor como 7/10 en escala EVA antes de la analgesia. Se realiza inmovilización de cuello y columna vertebral siendo trasladado al hospital de referencia más cercano, en el que por medio de una prueba de imagen (TAC), se confirma la factura de la vértebra lumbar L3. El síndrome de cinturón de seguridad sigue apareciendo en aquellos casos en que se produce un traumatismo de alta velocidad y se emplea cinturón de seguridad de dos puntos. El manejo escrupuloso de este tipo de pacientes supone un reto para el personal sanitario de medicina extrahospitalaria