Mobile app reading speed test

Aim: To validate the accuracy and repeatability of a mobile app reading speed test compared with the traditional paper version. Method: Twenty-one subjects wearing their full refractive correction glasses read 14 sentences of decreasing print size between 1.0 and -0.1 logMAR, each consisting of 14 words (Radner reading speed test) at 40 cm with a paper-based chart and twice on iPad charts. Time duration was recorded with a stop watch for the paper chart and on the App itself for the mobile chart allowing critical print size (CPS) and optimal reading speed (ORS) to be derived objectively. Results: The ORS was higher for the mobile app charts (194±29 wpm; 195±25 wpm) compared with the paper chart (166±20 wpm; F=57.000, p<0.001). The CPS was lower for the mobile app charts (0.17±0.20 logMAR; 0.18±0.17 logMAR) compared with the paper chart (0.25±0.17 logMAR; F=5.406, p=0.009). The mobile app test had a mean difference repeatability of 0.30±22.5 wpm, r=0.917 for ORS, and a CPS of 0.0±0.2 logMAR, r=0.769. Conclusions: Repeatability of the app reading speed test is as good (ORS) or better (CPS) than previous studies on the paper test. While the results are not interchangeable with paper-based charts, mobile app tablet-based tests of reading speed are reliable and rapid to perform, with the potential to capture functional visual ability in research studies and clinical practice

Mobile app Aston contrast sensitivity test

BACKGROUND: Contrast detection is an important aspect of the assessment of visual function; however, clinical tests evaluate limited spatial frequencies and contrasts. This study validates the accuracy and inter-test repeatability of a swept-frequency near and distance mobile app Aston contrast sensitivity test, which overcomes this limitation compared to traditional charts. METHOD: Twenty subjects wearing their full refractive correction underwent contrast sensitivity testing on the new near application (near app), distance app, CSV-1000 and Pelli-Robson charts with full correction and with vision degraded by 0.8 and 0.2 Bangerter degradation foils. In addition repeated measures using the 0.8 occluding foil were taken. RESULTS: The mobile apps (near more than distance, p = 0.005) recorded a higher contrast sensitivity than printed tests (p  0.05). Although the coefficient of repeatability was lowest for the Pelli-Robson charts (0.14 log units), the mobile app charts measured more spatial frequencies, took less time and were more repeatable (near: 0.26 to 0.37 log units; distance: 0.34 to 0.39 log units) than the CSV-1000 (0.30 to 0.93 log units). The duration to complete the CSV-1000 was 124 ± 37 seconds, Pelli-Robson 78 ± 27 seconds, near app 53 ± 15 seconds and distance app 107 ± 36 seconds. CONCLUSIONS: While there were differences between charts in contrast levels measured, the new Aston near and distance apps are valid, repeatable and time-efficient method of assessing contrast sensitivity at multiple spatial frequencies

A novel algorithm for determining the contextual characteristics of movement behaviors by combining accelerometer features and wireless beacons: development and implementation

Background: Unfortunately, global efforts to promote “how much” physical activity people should be undertaking have been largely unsuccessful. Given the difficulty of achieving a sustained lifestyle behavior change, many scientists are re-examining their approaches. One such approach is to focus on understanding the context of the lifestyle behavior (i.e., where, when, and with whom) with a view to identifying promising intervention targets. Objective: The aim of this study was to develop and implement an innovative algorithm to determine “where” physical activity occurs using proximity sensors coupled with a widely used physical activity monitor. Methods: A total of 19 Bluetooth beacons were placed in fixed locations within a multilevel, mixed-use building. In addition, 4 receiver-mode sensors were fitted to the wrists of a roving technician who moved throughout the building. The experiment was divided into 4 trials with different walking speeds and dwelling times. The data were analyzed using an original and innovative algorithm based on graph generation and Bayesian filters. Results: Linear regression models revealed significant correlations between beacon-derived location and ground-truth tracking time, with intraclass correlations suggesting a high goodness of fit (R2=.9780). The algorithm reliably predicted indoor location, and the robustness of the algorithm improved with a longer dwelling time (>100 s; error <10%, R2=.9775). Increased error was observed for transitions between areas due to the device sampling rate, currently limited to 0.1 Hz by the manufacturer. Conclusions: This study shows that our algorithm can accurately predict the location of an individual within an indoor environment. This novel implementation of “context sensing” will facilitate a wealth of new research questions on promoting healthy behavior change, the optimization of patient care, and efficient health care planning (e.g., patient-clinician flow, patient-clinician interaction)

Cost-effectiveness of alternative methods of surgical repair of inguinal hernia

Objectives: To assess the relative cost-effectiveness of laparoscopic methods of inguinal hernia repair compared with open flat mesh and open non-mesh repair. Methods: Data on the effectiveness of these alternatives came from three systematic reviews comparing: (i) laparoscopic methods with open flat mesh or non-mesh methods; (ii) open flat mesh with open non-mesh repair; and (iii) methods that used synthetic mesh to repair the hernia defect with those that did not. Data on costs were obtained from the authors of economic evaluations previously conducted alongside trials included in the reviews. A Markov model was used to model cost-effectiveness for a five-year period after the initial operation. The outcomes of the model were presented using a balance sheet approach and as cost per hernia recurrence avoided and cost per extra day at usual activities. Results: Open flat mesh was the most cost-effective method of preventing recurrences. Laparoscopic repair provided a shorter period of convalescence and less long-term pain compared with open flat mesh but was more costly. The mean incremental cost per additional day back at usual activities compared with open flat mesh was €38 and €80 for totally extraperitoneal and transabdominal preperitoneal repair, respectively. Conclusions: Laparoscopic repair is not cost-effective compared with open flat mesh repair in terms of cost per recurrence avoided. Decisions about the use of laparoscopic repair depend on whether the benefits (reduced pain and earlier return to usual activities) outweigh the extra costs and intraoperative risks. On the evidence presented here, these extra costs are unlikely to be offset by the short-term benefits of laparoscopic repair.Luke Vale, Adrian Grant, Kirsty McCormack, Neil W. Scott and the EU Hernia Trialists Collaboratio

Tablet App halometer for the assessment of dysphotopsia

Purpose To assess the validity and repeatability of the Aston Halometer. Setting University clinic, United Kingdom. Design Prospective, repeated-measures experimental study. Methods The halometer comprises a bright light-emitting-diode (LED) glare source in the center of an iPad4. Letters subtending 0.21° (∼0.3 logMAR) were moved centrifugally from the LED in 0.05 degree steps in 8 orientations separated by 45 degrees for each of 4 contrast levels (1000, 500, 100, and 25 Weber contrast units [Cw]) in random order. Bangerter occlusion foils were inserted in front of the right eye to simulate monocular glare conditions in 20 subjects (mean age 27.7 ± 3.1 years). Subjects were positioned 2 meters from the screen in a dark room with the iPad controlled from an iPhone via Bluetooth operated by the researcher. The C-Quant straylight meter was also used with each of the foils to measure the level of straylight over the retina. Halometry and straylight repeatability was assessed at a second visit. Results Halo size increased with the different occlusion foils and target contrasts (F = 29.564, P <.001) as expected and in a pattern similar to straylight measures (F = 80.655, P <0.001). Lower contrast letters showed better sensitivity but larger glare-obscured areas, resulting in ceiling effects caused by the screen's field-of-view, with 500 Cw being the best compromise. Intraobserver and interobserver repeatability of the Aston Halometer was good (500Cw: 0.84 to 0.93 and 0.53 to 0.73) and similar to the straylight meter. Conclusion The halometer provides a sensitive, repeatable way of quantifying a patient-recognized form of disability glare in multiple orientations to add objectivity to subjectively reported discomfort glare

Indirect inguinal hernia masquerading as a Spigelian hernia

Inguinal hernia usually developed and descended into scrotum. The clinical presentation is inguinal or inguino-scrotal swelling. Abdominal wall weakness as it is frequently seen in African tropical zones produces often rare clinical case. We report a case of inguinal hernia presented as an abdominal wall swelling clinically suggestive of a Spigelian hernia and discuss the mechanism

Surgical Management of Inguinal Hernias at Bugando Medical Centre in Northwestern Tanzania: Our Experiences in a Resource-Limited Setting.

Inguinal hernia repair remains the commonest operation performed by general surgeons all over the world. There is paucity of published data on surgical management of inguinal hernias in our environment. This study is intended to describe our own experiences in the surgical management of inguinal hernias and compare our results with that reported in literature. A descriptive prospective study was conducted at Bugando Medical Centre in northwestern Tanzania. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Statistical data analysis was done using SPSS software version 17.0. A total of 452 patients with inguinal hernias were enrolled in the study. The median age of patients was 36 years (range 3 months to 78 years). Males outnumbered females by a ratio of 36.7:1. This gender deference was statistically significant (P=0.003). Most patients (44.7%) presented late (more than five years of onset of hernia). Inguinoscrotal hernia (66.8%) was the commonest presentation. At presentation, 208 (46.0%) patients had reducible hernia, 110 (24.3%) had irreducible hernia, 84 (18.6%) and 50(11.1%) patients had obstructed and strangulated hernias respectively. The majority of patients (53.1%) had right sided inguinal hernia with a right-to-left ratio of 2.1: 1. Ninety-two (20.4%) patients had bilateral inguinal hernias. 296 (65.5%) patients had indirect hernia, 102 (22.6%) had direct hernia and 54 (11.9%) had both indirect and direct types (pantaloon hernia). All patients in this study underwent open herniorrhaphy. The majority of patients (61.5%) underwent elective herniorrhaphy under spinal anaesthesia (69.2%). Local anaesthesia was used in only 1.1% of cases. Bowel resection was required in 15.9% of patients. Modified Bassini's repair (79.9%) was the most common technique of posterior wall repair of the inguinal canal. Lichtenstein mesh repair was used in only one (0.2%) patient. Complication rate was 12.4% and it was significantly higher in emergency herniorrhaphy than in elective herniorrhaphy (P=0.002). The median length of hospital stay was 8 days and it was significantly longer in patients with advanced age, delayed admission, concomitant medical illness, high ASA class, the need for bowel resection and in those with surgical repair performed under general anesthesia (P<0.001). Mortality rate was 9.7%. Longer duration of symptoms, late hospitalization, coexisting disease, high ASA class, delayed operation, the need for bowel resection and presence of complications were found to be predictors of mortality (P<0.001). Inguinal hernias continue to be a source of morbidity and mortality in our centre. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem

Bedside theatre performance and its effects on hospitalised children's well-being

This article reports on practice-based pilot research being undertaken at Birmingham Children's Hospital in England on the impact of bedside theatre performance on hospitalised children's well-being. It discusses the process of creating theatre for sick children, connecting with the hospital and working within the hospital tight routines, dealing with ethics, working with theatre artists and performing to children bedside. It also reports on evidence collected by questionnaire and interviews about the perceived benefits of bedside theatre by children and their parent/carers. This emphasis on the process is appropriate for theatre practitioners, arts therapists and clinical staff who work with hospitalised children