Ecopoiesis and the Goldilox Archive

M.A.M.A. Thesis. University of Hawaiʻi at Mānoa 201

Subclinical Photoreceptor Disruption in Response to Severe Head Trauma

Commotio retinae is a transient opacification of the retina due to outer retinal disruption occurring in a contrecoup fashion after blunt trauma.Histological studies in animals and humans after ocular blunt trauma have revealed that disruption occurs at the level of the photoreceptor outer segments and retinal pigment epithelium.Recent reports using optical coherence tomography (OCT) have shown detectable disruption at the level of the photoreceptor inner segment/outer segment junction and retinal pigment epithelium and that these changes may be reversible over time with restoration of normal outer retinal architecture.However, the resolution of existing OCT technology may not be sensitive enough to detect photoreceptor disruption. Adaptive optics (AO) imaging systems enable cellular-resolution imaging of the human retina, and there is a growing number of cases where deficits have been visible on AO images but not on OCT. Herein, we report a case of subclinical photoreceptor disruption after head trauma as seen by an AO scanning ophthalmoscope (AOSO) but not apparent clinically or on spectral-domain OCT (SD-OCT)

Rolling the Dice and Playing With Numbers: Statistical Realities and Responses

Librarians invest time gathering numbers about collections for various entities, such as accrediting groups and organizations, as well as their user communities. Gathering collections-related statistics regarding the numbers of things our libraries subscribe to or purchase, as well as the items our users use, often requires a significant investment in time. Definitions can be difficult to apply, and some questions do not seem to reflect our current reality or demonstrate value. The authors explore the challenges of annually gathering and recording collections related statistics and offer suggestions for improving the process

Photoreceptor Inner Segment Morphology in Best Vitelliform Macular Dystrophy

PURPOSE To characterize outer retina structure in best vitelliform macular dystrophy (BVMD) and to determine the effect of macular lesions on overlying and adjacent photoreceptors. METHODS Five individuals with BVMD were followed prospectively with spectral domain optical coherence tomography and confocal and nonconfocal split-detector adaptive optics scanning light ophthalmoscopy (AOSLO). The AOSLO cone photoreceptor mosaic images were obtained within and around retinal lesions. Cone density was measured inside and outside lesions. In 2 subjects, densities were compared with published measurements acquired ∼2.5 years before. One subject was imaged 3 times over a 5-month period. RESULTS The AOSLO imaging demonstrated that photoreceptor morphology within BVMD retinal lesions was highly variable depending on the disease stage, with photoreceptor structure present even in advanced disease. The AOSLO imaging was repeatable even in severe disease over short-time and long-time intervals. Photoreceptor density was normal in retinal areas immediately adjacent to lesions and stable over ∼2.5 years. Mobile disk-like structures possibly representing subretinal macrophages were also observed. CONCLUSION Combined confocal and nonconfocal split-detector AOSLO imaging reveals substantial variability within clinical lesions in all stages of BVMD. Longitudinal cellular photoreceptor imaging could prove a powerful tool for understanding disease progression and monitoring emerging therapeutic treatment response in inherited degenerations such as BVMD

Effectiveness of Group Kickboxing as a Means to Improve Gait and Balance in Individuals with MS

In recent years, there has been a particular emphasis on identifying and delivering appropriate therapeutic interventions that address the significant balance and gait impairments that affect individuals with multiple sclerosis (MS). Group interventions implemented in community settings have been especially of interest, including tai chi classes. Recently, the authors conducted a preliminary study to examine whether group kick-boxing, which requires more vigorous movements, might be a feasible intervention. Initial findings showed promise and led the authors to pursue a more rigorous follow-up study, with the objective of determining whether a 5-week group kickboxing class improved clinical measures of balance and gait in individuals with MS. Eleven individuals completed the 5-week kickboxing program, which met three times a week for an hour each session. Clinical measures, including the Mini Balance Evaluation Systems Test (BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Dynamic Gait Index (DGI) outcomes, were collected at baseline, before the intervention, and after the intervention. Quiet-standing balance was also measured, and self-reported survey data were collected. Data were analyzed using a Friedman ANOVA-by-ranks test with a Wilcoxon signed rank test as the post hoc comparison. Statistically significant improvements were seen after the intervention in the Mini BESTest, TUG, DGI, and Activities of Balance Confidence. The largest improvements were observed on the Mini BESTest, with a mean of 21.9% improvement between pre- and post-test scores. Participants showed the majority of improvement on tasks that required reactive postural control movements. These movements were similar to skills that were practiced during kickboxing (ie, rapid change of base of support upon kicking). This supports the concept of task-specific transfer, and may indicate why more static-type measures like quiet standing did not indicate similar improvement. Overall, though improvements were not necessarily clinically significant, they did demonstrate the potential and feasibility of the kickboxing concept

Health Literacy and Women's Reproductive Health: A Systematic Review

Background: Health literacy is thought to impact women's reproductive health, yet no comprehensive systematic reviews have been conducted on the topic. Our objective was to systematically identify, investigate, and summarize research on the relationship between health literacy and women's reproductive health knowledge, behaviors, and outcomes

Outer Retinal Structure in Best Vitelliform Macular Dystrophy

Importance Demonstrating the utility of adaptive optics scanning light ophthalmoscopy (AOSLO) to assess outer retinal structure in Best vitelliform macular dystrophy (BVMD). Objective To characterize outer retinal structure in BVMD using spectral-domain optical coherence tomography (SD-OCT) and AOSLO. Design, Setting, and Participants Prospective, observational case series. Four symptomatic members of a family with BVMD with known BEST1 mutation were recruited at the Advanced Ocular Imaging Program research lab at the Medical College of Wisconsin Eye Institute, Milwaukee. Intervention Thickness of 2 outer retinal layers corresponding to photoreceptor inner and outer segments was measured using SD-OCT. Photoreceptor mosaic AOSLO images within and around visible lesions were obtained, and cone density was assessed in 2 subjects. Main Outcome and Measure Photoreceptor structure. Results Each subject was at a different stage of BVMD, with photoreceptor disruption evident by AOSLO at all stages. When comparing SD-OCT and AOSLO images from the same location, AOSLO images allowed for direct assessment of photoreceptor structure. A variable degree of retained photoreceptors was seen within all lesions. The photoreceptor mosaic immediately adjacent to visible lesions appeared contiguous and was of normal density. Fine hyperreflective structures were visualized by AOSLO, and their anatomical orientation and size were consistent with Henle fibers. Conclusions and Relevance The AOSLO findings indicate that substantial photoreceptor structure persists within active lesions, accounting for good visual acuity in these patients. Despite previous reports of diffuse photoreceptor outer segment abnormalities in BVMD, our data reveal normal photoreceptor structure in areas adjacent to clinical lesions. This study demonstrates the utility of AOSLO for understanding the spectrum of cellular changes that occur in inherited degenerations such as BVMD. Photoreceptors are often significantly affected at various stages of inherited degenerations, and these changes may not be readily apparent with current clinical imaging instrumentation