Identification of increased blue light reflectivity in macular telangiectasia type 2 using scanning laser ophthalmoscopy versus red-free fundus photography

PURPOSE: To compare two modalities used for detection of the characteristic parafoveal hyperreflective area seen in macular telangiectasia Type 2. METHODS: Scanning laser ophthalmoscope blue light reflectance was compared with red-free fundus photography imaging. Images were obtained as part of the international Natural History Study of Macular Telangiectasia (MacTel Study). RESULTS: The hyperreflective area can more frequently be seen with scanning laser ophthalmoscope blue light reflectance than with red-free imaging. CONCLUSION: Detection of the hyperreflective area might help to identify macular telangiectasia in earlier disease stages. Scanning laser ophthalmoscope blue light reflectance should be preferred as a diagnostic tool when the suspicion of macular telangiectasia arises. However, red-free imaging offers a viable option to scanning laser ophthalmoscope blue light reflectance when good quality is achieved

Household food insecurity positively associated with increased hospital charges for infants

Objective: To test whether household food insecurity (HFI) was associated with total annual hospitalization charges, annual days hospitalized, and charges per day, among low-income infants (months) with any non-neonatal hospital stays. Methods: Administrative inpatient hospital charge data were matched to survey data from infants\u27 caregivers interviewed 1998-2005 in emergency departments in Boston and Little Rock. All study infants had been hospitalized at least once since birth; infants whose diagnoses were not plausibly related to nutrition were excluded from both groups. Log-transformed hospitalization charges were analyzed, controlling for site fixed effects. Results: 24% of infants from food-insecure households and 16% from food-secure households were hospitalized \u3e2 times (P=0.02). Mean annual inpatient hospital charges ($6,707 vs$5,735; P Conclusion: HFI was positively associated with annual inpatient charges among hospitalized low income infants. Average annual inpatient charges were almost $2,000 higher (inflation adjusted) for infants living in food-insecure households. Reducing or eliminating food insecurity could reduce health services utilization and expenditures for infants in low-income families, most of whom are covered by public health insurance

Speaker discrimination as a function of vowel realization: does focus affect perception?

The acoustic-phonetic characteristics of speech sounds are influenced by their linguistic position in an utterance. Because of acoustic-phonetic differences between different speech sounds, sounds vary in the amount of speaker information they contain. However, do spectral and durational differences between various realizations of the same sound that were sampled from different linguistic positions also impact speaker information? We investigated speaker discrimination in [-focus] versus [+focus] word realizations. Twenty-one Dutch listeners participated in a same-different speaker discrimination task, using stimuli varying in focus, vowel ([a.], [u]), and word context ([._k], [v_t]), spoken by 11 different speakers. Results show that an effect of focus on speaker-dependent information was present, but limited to words containing [u]. Moreover, performance on [u] words was influenced by (interactions of) word context and trial type (same- vs. different-speaker). Context-dependent changes in a speech sound’s acoustics may affect its speaker-dependent information, albeit under specific conditions only.NWOTheoretical and Experimental Linguistic

Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine

Cures agudes; Medicina d'urgències; GeriatriaCuidados agudos; Medicina de urgencias; GeriatríaAcute care; Emergency medicine; GeriatricsPurpose: Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Methods: A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. Results: Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/ . Conclusion: Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe

A geospatial variable rate irrigation control scenario evaluation methodology based on mining root zone available water capacity

Increasing concern for sustainable water use has the agriculture industry working toward higher efficiency in use of irrigation water. Recent advancements have improved the capabilities of center pivot irrigation systems to vary water application depths across the field, a technology known as variable rate irrigation (VRI). The goal of this study was to provide a geospatial method for potential VRI technology adopters to evaluate control scenarios and potential water savings using freely available datasets. Root zone available water capacity (R) was estimated spatially across two case study fields using the Natural Resources Conservation Service Gridded Soil Survey Geographic Database. The difference in application depth between conventional irrigation (CI) and both sector and zone control VRI was then estimated based on R. Prescription maps were developed to mine undepleted soil water from each irrigation management zone based on a soil water balance approach with a management-allowed depletion of 50%. For CI management, the areal 10th percentile (PCTL) of R for the field was used, while for VRI the 10th PCTL of R for each management zone was used. The highest reduction in irrigation depth was 18 mm where higher values of R were estimated; however, field average reductions ranged from 0 to 12 mm. The greatest improvements in pumpage reduction resulted from converting from sector control to zone control, while increasing the angular resolution only had a minor impact. Energy savings generally increased with higher VRI control resolution. Conclusions support previous notions that VRI may result in small pumping water reductions for some fields; however, improved water distribution may be achieved throughout the field

A geospatial variable rate irrigation control scenario evaluation methodology based on mining root zone available water capacity

Increasing concern for sustainable water use has the agriculture industry working toward higher efficiency in use of irrigation water. Recent advancements have improved the capabilities of center pivot irrigation systems to vary water application depths across the field, a technology known as variable rate irrigation (VRI). The goal of this study was to provide a geospatial method for potential VRI technology adopters to evaluate control scenarios and potential water savings using freely available datasets. Root zone available water capacity (R) was estimated spatially across two case study fields using the Natural Resources Conservation Service Gridded Soil Survey Geographic Database. The difference in application depth between conventional irrigation (CI) and both sector and zone control VRI was then estimated based on R. Prescription maps were developed to mine undepleted soil water from each irrigation management zone based on a soil water balance approach with a management-allowed depletion of 50%. For CI management, the areal 10th percentile (PCTL) of R for the field was used, while for VRI the 10th PCTL of R for each management zone was used. The highest reduction in irrigation depth was 18 mm where higher values of R were estimated; however, field average reductions ranged from 0 to 12 mm. The greatest improvements in pumpage reduction resulted from converting from sector control to zone control, while increasing the angular resolution only had a minor impact. Energy savings generally increased with higher VRI control resolution. Conclusions support previous notions that VRI may result in small pumping water reductions for some fields; however, improved water distribution may be achieved throughout the field

Macular telangiectasia type 2 - Visual acuity, disease endstage and the MacTel Area. MacTel Project Report No. 8

Purpose: To report the visual acuity measures from the MacTel registry study and to investigate and describe phenotypic findings in eyes with substantial vision loss due to MacTel type 2 Design: Cross-sectional multi-center study. Subjects: Participants of the Natural History Observation (and Registry) of MacTel Study. Methods: Best–corrected visual acuity (BCVA) data, retinal imaging data and clinical data were accessed from the MacTel study databases in May 2019. Main Outcome Measures: Frequency distribution of BCVA and its relation to age. Morphological changes in eyes with very late disease stages, defined by a BCVA ≤ 20/200. Average retinal thickness of ETDRS fields on OCT. Dimensions of the area affected by MacTel (MacTel area). Results: BCVA was ≤20/50 in 37.3% and ≤20/200 in 3.8% of 4449 eyes of 2248 patients. 18.4% and 0.7% of all patients had bilateral BCVA ≤20/50 and ≤20/200, respectively. There was an asymmetry between right and left eyes (median BCVA 71 versus 74 letters), a finding supported by more advanced morphological changes in right eyes. BCVA correlated with participant’s age, but the effect size was small. If a neovascularization or macular hole was present, bilateral occurrence was frequent (33% or 17%, respectively), and BCVA was >20/200 (79% or 78% respectively) or ≥20/50 (26% or 13%, respectively). Eyes with advanced disease (BCVA ≤20/200) showed the following characteristics: 1) Atrophy of the foveal photoreceptor layer with or without associated subretinal fibrosis; 2) an affected area, termed here the “MacTel area”, limited to a horizontal diameter not exceeding the distance between the temporal optic disc margin and foveal center, and the vertical diameter not exceeding approximately 0.85 times this distance. Exceptions were eyes with large active or inactive neovascular membranes; 3) reduced retinal thickness measures within the MacTel area; and 4) less frequent retinal greying and more frequent hyperpigmentations compared to eyes with better BCVA. Conclusions: Severe vision loss is rare in MacTel and is related to photoreceptor atrophy in most people. Results indicate disease asymmetry with slightly worse vision and more advanced disease manifestation in right eyes. MacTel-related neurodegeneration does not spread beyond the limits of the “MacTel area”

Investigating the effect of proactive interference control training on intrusive memories = Investigando el efecto del entrenamiento de control de interferencias proactivas en las memorias intrusivas = 研究主动干扰控制训练对闯入性记忆的影响

Intrusive re-experiencing is a hallmark symptom of Posttraumatic Stress Disorder (PTSD). According to prominent models of intrusive phenomena, intrusive memories may result from impairments in the efficiency of working memory capacity (WMC), more specifically proactive interference control. Yet, experimental research is scarce. Therefore, the present study aimed to investigate experimentally the role of proactive interference control in intrusive memories. We randomly assigned 57 healthy participants to either receive a high interference control training or a low interference control training. Participants were then exposed to highly distressing film clips. WMC was assessed before and after the training. Intrusion symptoms were assessed directly post-training and after one week using an Intrusion Provocation Task (IPT), a one-week intrusions diary, and the retrospective intrusion subscale of the Impact of Event Sale – Revised (IES-R). Results indicated that both groups reported improvements in WMC and fewer intrusions on the second IPT post-training, with no differences between groups. Similarly, no group differences on intrusions were found at one-week follow-up (i.e., intrusion diary and IES-R). To conclude, these data are not consistent with the hypothesis that WMC plays a role in intrusive re-experiencing. Implications for future research are discussed. / La re-experiencia intrusiva es un síntoma distintivo del trastorno por estrés postraumático (TEPT). De acuerdo con los prominentes modelos de fenómenos intrusivos, las memorias intrusivas pueden resultar en deterioros en la eficiencia de la capacidad de memoria de trabajo (CMT), más específicamente del control proactivo de interferencias. Sin embargo, la investigación experimental a este respecto es escasa. Por lo tanto, el presente estudio tuvo como objetivo investigar experimentalmente el papel del control proactivo de interferencias en las memorias intrusivas. Asignamos aleatoriamente 57 participantes sanos a recibir, ya sea, un entrenamiento de control de alta interferencia o un entrenamiento de control de baja interferencia. Luego, los participantes fueron expuestos a videoclips de películas altamente angustiantes. La CMT fue evaluada antes y después del entrenamiento. Los síntomas de intrusión se evaluaron directamente después del entrenamiento y después de una semana utilizando una Tarea de Provocación de Intrusión (IPT), registro diario de intrusiones (por una semana), y la subescala de intrusión retrospectiva de la Escala del Impacto del Evento - Revisada (IES-R). Los resultados indicaron que ambos grupos experimentaron mejoras en la CMT y reducción de intrusiones en la segunda IPT posterior al entrenamiento, sin diferencias entre los grupos. De manera similar, no se encontraron diferencias de grupo en las intrusiones en el seguimiento de una semana (es decir, en el diario de intrusiones y la IES-R). Para concluir, estos datos no son consistentes con la hipótesis de que la CMT desempeña un papel en la re-experiencia intrusiva. Se discuten las implicaciones para futuras investigaciones. / 闯入性再体验是创伤后应激障碍（PTSD）的标志性症状。根据闯入现象的经典模型，闯入性记忆可能是由工作记忆容量（WMC）效率的损害引起的，更具体地说是主动干扰控制。然而，这方面实验研究很少。因此，本研究通过实验研究主动干扰控制在闯入性记忆中的作用。我们随机分配了57名健康被试，以接受高干扰控制训练或低干扰控制训练。然后被试接触到令人非常痛苦的电影片段。在训练前后对WMC进行了评估。在训练后和一周后随访使用闯入激发任务（IPT），一周闯入症状日记以及事件影响量表修订版（IES－R）的回顾性闯入子量表直接评估闯入症状。结果表明，两组均报告WMC改善，第二次IPT训练后闯入较少，两组间无差异。同样，在一周的随访中没有发现闯入的群体差异（即闯入日记和IES-R）。总之，这些数据与WMC在闯入性再体验中发挥作用的假设不一致。文中讨论了对未来研究的启示

Canonical Forms in Interactive Exercise Assistants

Interactive exercise assistants support students in practicing exercises, and acquiring procedural skills. Many mathematical topics can be practiced in such assistants. Ideally, an interactive exercise assistant not only validates final answers, but also comments on intermediate steps submitted by a student, provides hints on how to proceed, and presents worked-out examples. For these purposes, fine control over the symbolic simplification procedures of the underlying mathematical machinery is needed. In this paper, we introduce views for mathematical expressions. A view defines an equivalence relation by choosing a canonical form of mathematical expressions. We use views to track and recognize intermediate answers, to help in presenting expressions to a user, and to control the granularity of the steps in worked-out examples. We develop the concept of a view, discuss the laws it satisfies, and show how views are composed, which means that they can be used for multiple exercise classes.