Vision screening in children:a retrospective study of social and demographic factors with regard to visual outcomes

BACKGROUND: Amblyopia and its risk factors have been demonstrated to be more common among children from low socioeconomic backgrounds. We sought to investigate this association in a region with orthoptic-delivered screening and whole population coverage, and to also examine the association of the Health Plan Indicator (HPI) with screening outcome. METHODS: Screening examination outcomes, postcodes and HPIs were extracted from the community child health database for every child who underwent preschool vision screening between March 2010 and February 2011 Tayside. We obtained the Scottish Index of Multiple Deprivation score for every child as a measure of area-based deprivation. We assessed the vulnerability/needs of the individual family through the HPI—‘Core’ (children and families receiving universal health visiting service), ‘Additional’ (receiving additional health/social support) and ‘Intensive’ (receiving high levels of support). The outcomes from follow-up examinations for those who failed screening were extracted from the orthoptic department database. RESULTS: 4365 children were screened during the year 2010–2011 of whom 523 (11.9%) failed. The odds of children from the least deprived socioeconomic group passing the visual screening test was 1.4 times higher than those from the most deprived socioeconomic group (OR 1.4, 95% CI 1.07 to 1.89, p=0.01). The odds of a child from a family assigned as ‘Intensive’ failing the preschool visual screening test was three times greater than the odds of a child from a family assigned as ‘Core’ (OR 3.59, 95% CI 1.6 to 7.8, p=0.001). CONCLUSIONS: We found that children from the most deprived backgrounds and those from unstable homes were more likely to fail preschool vision screening

Improving visual functions in adult amblyopia with combined perceptual training and transcranial random noise stimulation (tRNS): a pilot study

Amblyopia is a visual disorder due to an abnormal pattern of functional connectivity of the visual cortex and characterized by several visual deficits of spatial vision including impairments of visual acuity (VA) and of the contrast sensitivity function (CSF). Despite being a developmental disorder caused by reduced visual stimulation during early life (critical period), several studies have shown that extensive visual perceptual training can improve VA and CSF in people with amblyopia even in adulthood. With the present study we assessed whether a much shorter perceptual training regime, in association with high-frequency transcranial electrical stimulation (hf-tRNS), was able to improve visual functions in a group of adult participants with amblyopia. Results show that, in comparison with previous studies where a large number sessions with a similar training regime were used (Polat et al., 2004), here just eight sessions of training in contrast detection under lateral masking conditions combined with hf-tRNS, were able to substantially improve VA and CSF in adults with amblyopia

Exposure to animals and risk of oligoarticular juvenile idiopathic arthritis: a multicenter case-control study

<p>Abstract</p> <p>Background</p> <p>An inverse association between early contact with microbial compounds and respiratory allergies is well established. The protective effect of infant contact with animals was also shown for inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE). We aimed to test the association between animal contact in infancy and oligoarticular juvenile idiopathic arthritis (OA JIA).</p> <p>Methods</p> <p>Parents of children with OA JIA registered at the Hospital for Pediatric Rheumatology in Garmisch-Partenkirchen were asked to complete a questionnaire. Children who underwent strabismus surgery at six referral centers for ophthalmology served as controls. Children age 6 to 18 years born in Germany without malformations were included (238 cases; response 89% and 832 controls; response 86%). Data were analyzed using logistic regression models after adjusting for potential confounders.</p> <p>Results</p> <p>Neither place of living (urban vs. rural area), living on a farm, nor regular farm animal (adjusted odds ratio 0.79; 95% confidence interval 0.42-1.47) or pet contact (0.79; 0.55-1.14) during infancy were clearly related to case status. Allergic rhinitis was inversely related to OA JIA (0.57; 0.34-0.95).</p> <p>Neither place of living (urban vs. rural area), living on a farm, nor regular farm animal (adjusted odds ratio 0.79; 95% confidence interval 0.42-1.47) or pet contact (0.79; 0.55-1.14) during infancy were related to case status. Allergic rhinitis was inversely related to OA JIA (0.57; 0.34-0.95).</p> <p>Conclusions</p> <p>Contact with farm environments in infancy might not be associated with OA JIA. This finding is consistent with previous findings for diabetes mellitus type 1 but contradicts results for IBD and SLE.</p

Dorsal Visual Pathway Changes in Patients with Comitant Extropia

BACKGROUND: Strabismus is a disorder in which the eyes are misaligned. Persistent strabismus can lead to stereopsis impairment. The effect of strabismus on human brain is not unclear. The present study is to investigate whether the brain white structures of comitant exotropia patients are impaired using combined T1-weighted imaging and diffusion tensor imaging (DTI). PRINCIPAL FINDINGS: Thirteen patients with comitant strabismus and twelve controls underwent magnetic resonance imaging (MRI) with acquisition of T1-weighted and diffusion tensor images. T1-weighted images were used to analyze the change in volume of white matter using optimized voxel-based morphology (VBM) and diffusion tensor images were used to detect the change in white matter fibers using voxel-based analysis of DTI in comitant extropia patients. VBM analysis showed that in adult strabismus, white matter volumes were smaller in the right middle occipital gyrus, right occipital lobe/cuneus, right supramarginal gyrus, right cingulate gyrus, right frontal lobe/sub-gyral, right inferior temporal gyrus, left parahippocampa gyrus, left cingulate gyrus, left occipital lobe/cuneus, left middle frontal gyrus, left inferior parietal lobule, and left postcentral gyrus, while no brain region with greater white matter volume was found. Voxel-based analysis of DTI showed lower fractional anisotropy (FA) values in the right middle occipital gyrus and right supramarginal gyrus in strabismus patients, while brain region with increased FA value was found in the right inferior frontal gyrus. CONCLUSION: By combining VBM and voxel-based analysis of DTI results, the study suggests that the dorsal visual pathway was abnormal or impaired in patients with comitant exotropia

An update on Acanthamoeba

Free-living amoebae of the genus Acanthamoeba are causal agents of a severe sight-threatening infection of the cornea known as Acanthamoeba keratitis. Moreover, the number of reported cases worldwide is increasing year after year, mostly in contact lens wearers, although cases have also been reported in non-contact lens wearers. Interestingly, Acanthamoeba keratitis has remained significant, despite our advances in antimicrobial chemotherapy and supportive care. In part, this is due to an incomplete understanding of the pathogenesis and pathophysiology of the disease, diagnostic delays and problems associated with chemotherapeutic interventions. In view of the devastating nature of this disease, here we present our current understanding of Acanthamoeba keratitis and molecular mechanisms associated with the disease, as well as virulence traits of Acanthamoeba that may be potential targets for improved diagnosis, therapeutic interventions and/or for the development of preventative measures. Novel molecular approaches such as proteomics, RNAi and a consensus in the diagnostic approaches for a suspected case of Acanthamoeba keratitis are proposed and reviewed based on data which have been compiled after years of working on this amoebic organism using many different techniques and listening to many experts in this field at conferences, workshops and international meetings. Altogether, this review may serve as the milestone for developing an effective solution for the prevention, control and treatment of Acanthamoeba infections

Impact of visual acuity on developing literacy at age 4-5 years : a cohort-nested cross-sectional study

OBJECTIVES: To estimate the prevalence of poor vision in children aged 4-5 years and determine the impact of visual acuity on literacy. DESIGN: Cross-sectional study linking clinical, epidemiological and education data. SETTING: Schools located in the city of Bradford, UK. PARTICIPANTS: Prevalence was determined for 11 186 children participating in the Bradford school vision screening programme. Data linkage was undertaken for 5836 Born in Bradford (BiB) birth cohort study children participating both in the Bradford vision screening programme and the BiB Starting Schools Programme. 2025 children had complete data and were included in the multivariable analyses. MAIN OUTCOME MEASURES: Visual acuity was measured using a logMAR Crowded Test (higher scores=poorer visual acuity). Literacy measured by Woodcock Reading Mastery Tests-Revised (WRMT-R) subtest: letter identification (standardised). RESULTS: The mean (SD) presenting visual acuity was 0.14 (0.09) logMAR (range 0.0-1.0). 9% of children had a presenting visual acuity worse than 0.2logMAR (failed vision screening), 4% worse than 0.3logMAR (poor visual acuity) and 2% worse than 0.4logMAR (visually impaired). Unadjusted analysis showed that the literacy score was associated with presenting visual acuity, reducing by 2.4 points for every 1 line (0.10logMAR) reduction in vision (95% CI -3.0 to -1.9). The association of presenting visual acuity with the literacy score remained significant after adjustment for demographic and socioeconomic factors reducing by 1.7 points (95% CI -2.2 to -1.1) for every 1 line reduction in vision. CONCLUSIONS: Prevalence of decreased visual acuity was high compared with other population-based studies. Decreased visual acuity at school entry is associated with reduced literacy. This may have important implications for the children's future educational, health and social outcomes

Interventions for preventing ophthalmia neonatorum.

BACKGROUND: Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic or antibiotic medication is dispensed into the eyes of newborns, or dispensed systemically, soon after delivery to prevent neonatal conjunctivitis and potential vision impairment. OBJECTIVES: 1. To determine if any type of systemic or topical eye medication is better than placebo or no prophylaxis in preventing ophthalmia neonatorum. 2. To determine if any one systemic or topical eye medication is better than any other medication in preventing ophthalmia neonatorum. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, and three trials registers, date of last search 4 October 2019. We also searched references of included studies and contacted pharmaceutical companies.  SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials of any topical, systemic, or combination medical interventions used to prevent ophthalmia neonatorum in newborns compared with placebo, no prophylaxis, or with each other. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. Outcomes were: blindness or any adverse visual outcome at 12 months, conjunctivitis at 1 month (gonococcal (GC), chlamydial (CC), bacterial (BC), any aetiology (ACAE), or unknown aetiology (CUE)), and adverse effects.  MAIN RESULTS: We included 30 trials with a total of 79,198 neonates. Eighteen studies were conducted in high-income settings (the USA, Europe, Israel, Canada), and 12 were conducted in low- and middle-income settings (Africa, Iran, China, Indonesia, Mexico). Fifteen of the 30 studies were quasi-randomised. We judged every study to be at high risk of bias in at least one domain. Ten studies included a comparison arm with no prophylaxis. There were 14 different prophylactic regimens and 12 different medications in the 30 included studies. Any prophylaxis compared to no prophylaxis  Unless otherwise indicated, the following evidence comes from studies assessing one or more of the following interventions: tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%. None of the studies reported data on the primary outcomes: blindness or any adverse visual outcome at any time point. There was only very low-certainty evidence on the risk of GC with prophylaxis (4/5340 newborns) compared to no prophylaxis (5/2889) at one month (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.24 to 2.65, 3 studies). Low-certainty evidence suggested there may be little or no difference in effect on CC (RR 0.96, 95% CI 0.57 to 1.61, 4874 newborns, 2 studies) and BC (RR 0.84, 95% CI 0.37 to 1.93, 3685 newborns, 2 studies). Moderate-certainty evidence suggested a probable reduction in risk of ACAE at one month (RR 0.65, 95% 0.54 to 0.78, 9666 newborns, 8 studies assessing tetracycline 1%, erythromycin 0.5%, povidone-iodine 2.5%, silver nitrate 1%, colostrum, bacitracin-phenacaine ointment). There was only very low-certainty evidence on CUE  (RR 1.75, 95% CI 0.37 to 8.28, 330 newborns, 1 study). Very low-certainty evidence on adverse effects suggested no increased nasolacrimal duct obstruction (RR 0.93, 95% CI 0.68 to 1.28, 404 newborns, 1 study of erythromycin 0.5% and silver nitrate 1%) and no increased keratitis (single study of 40 newborns assessing silver nitrate 1% with no events).    Any prophylaxis compared to another prophylaxis Overall, evidence comparing different interventions did not suggest any consistently superior intervention. However, most of this evidence was of low-certainty and was extremely limited. AUTHORS' CONCLUSIONS: There are no data on whether prophylaxis for ophthalmia neonatorum prevents serious outcomes such as blindness or any adverse visual outcome. Moderate-certainty evidence suggests that the use of prophylaxis may lead to a reduction in the incidence of ACAE in newborns but the evidence for effect on GC, CC or BC was less certain. Comparison of individual interventions did not suggest any consistently superior intervention, but data were limited. A trial comparing tetracycline, povidone-iodine (single administration), and chloramphenicol for GC and CC could potentially provide the community with an effective, universally applicable prophylaxis against ophthalmia neonatorum

Advanced Stochastic Signal Processing and Computational Methods: Theories and Applications

Compressed sensing has been proposed as a computationally efficient method to estimate the finite-dimensional signals. The idea is to develop an undersampling operator that can sample the large but finite-dimensional sparse signals with a rate much below the required Nyquist rate. In other words, considering the sparsity level of the signal, the compressed sensing samples the signal with a rate proportional to the amount of information hidden in the signal. In this dissertation, first, we employ compressed sensing for physical layer signal processing of directional millimeter-wave communication. Second, we go through the theoretical aspect of compressed sensing by running a comprehensive theoretical analysis of compressed sensing to address two main unsolved problems, (1) continuous-extension compressed sensing in locally convex space and (2) computing the optimum subspace and its dimension using the idea of equivalent topologies using Köthe sequence. In the first part of this thesis, we employ compressed sensing to address various problems in directional millimeter-wave communication. In particular, we are focusing on stochastic characteristics of the underlying channel to characterize, detect, estimate, and track angular parameters of doubly directional millimeter-wave communication. For this purpose, we employ compressed sensing in combination with other stochastic methods such as Correlation Matrix Distance (CMD), spectral overlap, autoregressive process, and Fuzzy entropy to (1) study the (non) stationary behavior of the channel and (2) estimate and track channel parameters. This class of applications is finite-dimensional signals. Compressed sensing demonstrates great capability in sampling finite-dimensional signals. Nevertheless, it does not show the same performance sampling the semi-infinite and infinite-dimensional signals. The second part of the thesis is more theoretical works on compressed sensing toward application. In chapter 4, we leverage the group Fourier theory and the stochastical nature of the directional communication to introduce families of the linear and quadratic family of displacement operators that track the join-distribution signals by mapping the old coordinates to the predicted new coordinates. We have shown that the continuous linear time-variant millimeter-wave channel can be represented as the product of channel Wigner distribution and doubly directional channel. We notice that the localization operators in the given model are non-associative structures. The structure of the linear and quadratic localization operator considering group and quasi-group are studied thoroughly. In the last two chapters, we propose continuous compressed sensing to address infinite-dimensional signals and apply the developed methods to a variety of applications. In chapter 5, we extend Hilbert-Schmidt integral operator to the Compressed Sensing Hilbert-Schmidt integral operator through the Kolmogorov conditional extension theorem. Two solutions for the Compressed Sensing Hilbert Schmidt integral operator have been proposed, (1) through Mercer's theorem and (2) through Green's theorem. We call the solution space the Compressed Sensing Karhunen-Loéve Expansion (CS-KLE) because of its deep relation to the conventional Karhunen-Loéve Expansion (KLE). The closed relation between CS-KLE and KLE is studied in the Hilbert space, with some additional structures inherited from the Banach space. We examine CS-KLE through a variety of finite-dimensional and infinite-dimensional compressible vector spaces. Chapter 6 proposes a theoretical framework to study the uniform convergence of a compressible vector space by formulating the compressed sensing in locally convex Hausdorff space, also known as Fréchet space. We examine the existence of an optimum subspace comprehensively and propose a method to compute the optimum subspace of both finite-dimensional and infinite-dimensional compressible topological vector spaces. To the author's best knowledge, we are the first group that proposes continuous compressed sensing that does not require any information about the local infinite-dimensional fluctuations of the signal

EKG front end devre tasarımı ve gerçeklemesi.

Since the first electrocardiogram (ECG) was recorded by Eindhoven in 1903, examination of the electrical activity of the heart using surface electrodes obtained great clinical significance over the years. According to annual report of World Health Organization in 2013, cardiovascular diseases are counted as one of the four major reasons of 80% of deaths in the world. Therefore, the ability to acquire high quality recordings of electrical activity of the heart from surface of the body would be highly beneficial for diagnosis. For this purpose, invasive and noninvasive methods are used. Standard 12-lead ECG as one of the noninvasive methods is commonly used in the world at hospitals and clinics. In addition, more sophisticated methods are developed to measure the electrical activity of the heart from the surface of the body, using larger numbers of electrodes known as Body Surface Potential Measurement (BSPM). Invasive methods are also used in special cases to make in vivo measurements. In comparison to non-invasive methods, such as conventional 12-lead system and BSPM, invasive methods require surgical operation to implement the proper electrode network in the desired location. Standard 12-lead system is commonly used in clinical applications for diagnosing and monitoring because of its simplicity in use but it suffers from low spatial resolution of the acquired data. In contrast, BSPM as non-invasive technique, acquires data using large number of electrodes attached to the surface of the body. As a result, the acquired data has better spatial resolution than the 12-lead system. Data obtained from BSPM have significant importance in applications such as localization of the electrical sources in the heart. In this study, we aim to build an analog front end unit to detect the electrical activity of the heart using 10 electrodes connected to the surface of the body. These ten electrodes are recording measurements from the right arm (RA), left arm (LA), and left leg (LL) electrodes, six chest electrodes (V1~V6), and one RLD electrode. Unipolar measurements are used for chest channels (V1~V6). Also, lead I and lead II are constructed via bipolar measurements between (LA, RA) and (LL, RA) pairs, respectively. The analog front end proposed in this thesis is designed to be compatible with 24-bit Sigma Delta analog to digital converter (ADC), so we kept the channels as simple as possible to use the features recommended by the ADC. This unit can be used as the front end of any ECG recording device; it can be the first stage for a 12-lead ECG system, as well as for a BSPM system. Depending on the application requirements, either bipolar or unipolar measurements can be recorded.M.S. - Master of Scienc