How do I manage functional visual loss

Functional visual loss is a subtype of functional neurological disorder (FND) and is a common cause of visual impairment seen in both general and neuro-ophthalmological practice. Ophthalmologists can generally diagnose functional visual loss reasonably confidently but often find it harder to know what to say to the patient, how to approach, or even whether to attempt, treatment. There is little evidence-based treatment despite studies showing up to 60% of adults having impactful symptoms on long-term follow-up. The last 20 years has seen large changes in how we understand, approach, and manage FND more widely. In this article, we set out our practical approach to managing functional visual loss which includes : 1) Make a positive diagnosis based on investigations that demonstrate normal vision in the presence of subjectively impaired vision, not just because tests or ocular exam is normal; 2) Explain and label the condition with an emphasis on these positive diagnostic features, not reassurance; 3) Consider eye or brain comorbidities such as migraine, idiopathic intracranial hypertension or amblyopia; 4) Consider working with an orthoptist using diagnostic tests in a positive way to highlight the possibility of better vision; 5) Develop simple treatment strategies for photophobia; 6) Consider psychological factors and comorbidity as part of assessment and therapy, but keep a broader view of aetiology and don't use this to make a diagnosis; 7) Other treatment modalities including hypnotherapy, transcranial magnetic stimulation and more advanced forms of visual feedback are promising candidates for functional visual loss treatment in the future.</p

Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/1/jgs16109-sup-0001-TableS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/2/jgs16109_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153191/3/jgs16109.pd

Synthesis and antimicrobial activity of (Z)-3-(1H-imidazol-1-yl)-2-phenylpropenenitrile and its metal complexes: X-ray crystal structures of the Zn(II) and Ag(I) complexes.

(Z)-3-(1H-imidazol-1-yl)-2-phenylpropenenitrile (imppn) reacts with Cu(ClO4)2 �/6H2O, Zn(CH3CO2)2 �/2H2O and AgClO4 producing [Cu(imppn)4](ClO4)2 �/H2O (1), [Zn(imppn)2(CH3CO2)2] �/2H2O (2) and [Ag2(imppn)4(ClO4)2] (3), respectively. Complexes 2 and 3 were characterised by X-ray crystallography. In 2 the metal lies in a pseudo-tetrahedral environment and is ligated by the imine nitrogens of two imppn ligands and an oxygen atom from each of two monodentate acetate anions. In the dimeric Ag(I) complex 3 each metal is coordinated to the imine nitrogens of two imppn ligands in an almost linear fashion and the two [Ag(imppn)2]� units are linked by an Ag�/Ag bond, supported by two trans bridging bidentate perchlorate groups and by p�/p interactions between the ligands. In vitro tests on the ability of the compounds to inhibit the growth of the pathogenic yeast Candida albicans showed that imppn and its metal complexes were markedly less effective than the prescription drug, ketoconazole

Fort Collins Flood 1997: lessons from an extreme event

Includes bibliographical references.The July 28, 1997 flood disaster in Fort Collins, Colorado is generally called a "500-year event" and offers insight into the causes and impacts of extreme urban flooding. Although it hurt and traumatized many people, the flood provided valuable lessons for civil engineers, managers of government agencies, political leaders, counselors, and citizens. Representing several disciplines and entities, the authors present a cross-cutting view of the flood emergency and its lessons. The paper also includes a synthesis of a post-flood conference at Colorado State University which featured reports from all major entities involved in the flood. The remarkable storm that caused the flood produced the heaviest rains ever documented to have fallen over an urbanized area in this state in the recorded history of Colorado. The storm occurred in stages, and dropped 10 to 14 inches in 31 hours in a large area around Fort Collins. The heaviest hourly precipitation occurred at the storm's end, which is different from most storms, and may have exacerbated the flooding. Runoff was dramatic and some peak discharges greatly exceeded projected 100-year and 500-year flows. The City Manager's report showed five people dead, 54 people injured, loss of about 200 homes, and 1500 homes and businesses damaged throughout the City. Fort Collins was more prepared than most cities because it has a nationally-recognized Stormwater Utility and good emergency response capabilities, but it still learned much from the event. Damages at Colorado State University were unusually severe, totaling in the range of $100 million, including building damages, about 425,000 library volumes inundated, loss of a semester's textbooks in the bookstore, and many other losses-both personal and professional. Although the university was surprisingly vulnerable, it responded well with no delay in opening school a month later, but only as a result of tremendous efforts. Emergency response in the City by the Poudre Fire Authority was outstanding, and although the flood had tremendous impacts on the community, not one firefighter or police officer was injured. Within three months after the flood, the local paper, the Coloradoan, had published 282 stories about the flood, and the event received broad coverage in the United States and abroad. After the flood, Fort Collins has tried to focus beyond the physical issues to recognize the multi-faceted losses and the ensuing grief experienced by many people. Lessons are presented in the paper about complacency, protecting vulnerable areas, flood frequency analysis, stress and trauma, the importance of organizational mobilization, the vulnerability of universities, growth management in a hazardous environment, mitigation versus response, communicating risk to officials and the public, and handling large influxes of donations

Predicting Adverse Outcomes for Shiga Toxin–Producing Escherichia coli Infections in Emergency Departments

Objective: To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. The score has not been previously evaluated in a North American acute care setting. Study design: We reviewed medical records of children \u3c18 years old infected with STEC and treated in 1 of 38 participating emergency departments in North America between 2011 and 2015. The HUS severity score (hemoglobin [g/dL] plus 2-times serum creatinine [mg/dL]) was calculated using first available laboratory results. Children with scores \u3e13 were designated as high-risk. We assessed score performance to predict severe adverse events (ie, dialysis, neurologic complication, respiratory failure, and death) using discrimination and net benefit (ie, threshold probability), with subgroup analyses by age and day-of-illness. Results: A total of 167 children had HUS, of whom 92.8% (155/167) had relevant data to calculate the score; 60.6% (94/155) experienced a severe adverse event. Discrimination was acceptable overall (area under the curve 0.71, 95% CI 0.63-0.79) and better among children \u3c5 years old (area under the curve 0.77, 95% CI 0.68-0.87). For children \u3c5 years, greatest net benefit was achieved for a threshold probability \u3e26%. Conclusions: The HUS severity score was able to discriminate between high- and low-risk children \u3c5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold

A demonstration of a service oriented virtual environment for complex system analysis

Distributed virtual simulation is increasingly in demand within the automotive industry. A distributed and networked approach to system level design and simulation stands to benefit from a unifying relational oriented modeling and simulation framework. This will permit innovative use of existing independent simulations for increased concurrency in design and verification and validation. This paper demonstrates an analysis of the vehicle as a complex system through the combination of a relational framework, high level syntax and semantics for representing models and distributed simulation. This promises to provide a rigorous, traceable and agile approach to conceptual vehicle design and analysis

Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football

IMPORTANCE: Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE). OBJECTIVE: To determine the neuropathological and clinical features of deceased football players with CTE. DESIGN, SETTING, AND PARTICIPANTS: Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history. EXPOSURES: Participation in American football at any level of play. MAIN OUTCOMES AND MEASURES: Neuropathological diagnoses of neurodegenerative diseases, including CTE, based on defined diagnostic criteria; CTE neuropathological severity (stages I to IV or dichotomized into mild [stages I and II] and severe [stages III and IV]); informant-reported athletic history and, for players who died in 2014 or later, clinical presentation, including behavior, mood, and cognitive symptoms and dementia. RESULTS: Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre–high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia. CONCLUSIONS AND RELEVANCE: In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football.This study received support from NINDS (grants U01 NS086659, R01 NS078337, R56 NS078337, U01 NS093334, and F32 NS096803), the National Institute on Aging (grants K23 AG046377, P30AG13846 and supplement 0572063345-5, R01 AG1649), the US Department of Defense (grant W81XWH-13-2-0064), the US Department of Veterans Affairs (I01 CX001038), the Veterans Affairs Biorepository (CSP 501), the Veterans Affairs Rehabilitation Research and Development Traumatic Brain Injury Center of Excellence (grant B6796-C), the Department of Defense Peer Reviewed Alzheimer’s Research Program (grant 13267017), the National Operating Committee on Standards for Athletic Equipment, the Alzheimer’s Association (grants NIRG-15-362697 and NIRG-305779), the Concussion Legacy Foundation, the Andlinger Family Foundation, the WWE, and the NFL

TeV Particle Astrophysics II: Summary comments

A unifying theme of this conference was the use of different approaches to understand astrophysical sources of energetic particles in the TeV range and above. In this summary I review how gamma-ray astronomy, neutrino astronomy and (to some extent) gravitational wave astronomy provide complementary avenues to understanding the origin and role of high-energy particles in energetic astrophysical sources.Comment: 6 pages, 4 figures; Conference summary talk for "TeV Particle Astrophysics II" at University of Wisconsin, Madison, 28-31 August 200