Suprachoroidal hemorrhage during femtosecond laser assisted cataract surgery.

Purpose:To describe a case of suprachoroidal hemorrhage that occurred during femtosecond laser assisted cataract surgery (FLACS). Observations:A 67-year-old woman with high myopia underwent FLACS. Following two unsuccessful attempts at docking due to interface air bubbles, the third attempt was successful. Laser treatment and cataract surgery proceeded uneventfully until intraocular lens (IOL) implantation. While positioning the IOL within the capsular bag, the anterior chamber began to shallow, intraocular pressure became high by palpation, and the optic of the IOL prolapsed partially out of the bag. A segmental suprachoroidal hemorrhage was identified in the superior peripheral retina by intraoperative indirect ophthalmoscopy. Following an hour of waiting in the recovery room, the anterior chamber deepened and the intraocular pressure was low enough to position the IOL centrally within the bag. Her subsequent postoperative course was uneventful. Conclusions and Importance:To our knowledge, this is the first report of suprachoroidal hemorrhage during FLACS. We speculate that repeated sudden drops in intraocular pressure associated with multiple undockings triggered the suprachoroidal hemorrhage in this case

In-Situ Colloidal MnO2 Deposition and Ozonation of 2,4-Dinitrotoluene

Laboratory experiments are presented that demonstrate a novel in situ semipassive reactive barrier for the degradation of 2,4 dinitrotoluene created by coating aquifer surfaces by deposition of colloidal MnO2, which catalyzes ozone degradation and enhances contaminant oxidation. Ozone is added to the reactive barrier and is transported through the zone with the contaminants by existing hydraulic gradients. The communication presents the preliminary laboratory investigation demonstrating the viability of this method. Studies were conducted by coating Ottawa sand with colloidal MnO2. Results show that concentrations of MnO2 in the range of 0.2 mg/g can be deposited with no measurable change in hydraulic conductivity, that there is significant coverage of the sand material by MnO2, and the deposition was not reversible under a wide range of chemical conditions. Ozonation of 2,4-dinitrotoluene in the presence of MnO2- coated sand was demonstrated to result in pseudo-first-order degradation kinetics with respect to DNT with half-lives ranging from 28 to 22 min (at pH 6 and 7, respectively), approximately 25% faster than experiments performed in the absence of MnO2

Strategies to Improve Care Transitions between Nursing Homes and Emergency Departments

OBJECTIVE To identify testable solutions that may improve the quality and safety of care transitions between nursing homes (NHs) and emergency departments (EDs). DESIGN Structured focus group interviews. SETTING Group interviews took place in Indianapolis, Indiana. PARTICIPANTS NH administrators, nurses, and physicians; emergency medical services (EMS) directors, paramedics, and emergency medicine technicians (EMTs); ED nurses and physicians; and a representative from the Indiana State Department of Health. MEASUREMENTS Opinions, perceptions, and insights of participants. RESULTS 18 participants were included. The central theme was the need for additional structure to support care transitions between NHs and EDs. Participants agreed that the structure afforded by hospital-to-hospital transfers would benefit patients and providers during transitions between NHs and EDs. Because transfer forms currently vary from NH to NH, participants recommended that the entire state use the same form. They recommended that the transfer form be useful in both directions by including a section for the ED provider to complete to support the ED-to-NH transition. Participants suggested that systems use a transfer checklist to help ensure that all processes occur as expected. They strongly recommended verbal communication across care settings to complement written communication and to improve on deficiencies that occur with transfer form-only strategies. Notably, participants suggested that the different care sites engage in relationship-building efforts to improve compliance with recommendations (e.g., form completion) and collaborative problem solving. CONCLUSION Participants advised additional structure to NH-ED care transitions, similar to hospital-to-hospital transfers, that includes a 2-way, statewide transfer form; a checklist; and verbal communication

Auditory grouping mechanisms reflect a sound's relative position in a sequence

The human brain uses acoustic cues to decompose complex auditory scenes into its components. For instance to improve communication, a listener can select an individual “stream,” such as a talker in a crowded room, based on cues such as pitch or location. Despite numerous investigations into auditory streaming, few have demonstrated clear correlates of perception; instead, in many studies perception covaries with changes in physical stimulus properties (e.g., frequency separation). In the current report, we employ a classic ABA streaming paradigm and human electroencephalography (EEG) to disentangle the individual contributions of stimulus properties from changes in auditory perception. We find that changes in perceptual state—that is the perception of one versus two auditory streams with physically identical stimuli—and changes in physical stimulus properties are reflected independently in the event-related potential (ERP) during overlapping time windows. These findings emphasize the necessity of controlling for stimulus properties when studying perceptual effects of streaming. Furthermore, the independence of the perceptual effect from stimulus properties suggests the neural correlates of streaming reflect a tone's relative position within a larger sequence (1st, 2nd, 3rd) rather than its acoustics. By clarifying the role of stimulus attributes along with perceptual changes, this study helps explain precisely how the brain is able to distinguish a sound source of interest in an auditory scene