Pikemiranda1679

To evaluate the influence of anterior capsule rhexis shape, dimension and eccentricity on IntraOcular Lens (IOL) position.

laboratory investigation.

Computational modelMethods a finite element model of the human crystalline lens capsule and zonule was created and the anterior capsule opened to simulate centred and decentred circular and elliptic rhexis. The model calculated capsular bag stress, IOL rotation, tilt, decentration and vaulting, related to both capsular landmarks (absolute) and to a reference IOL position defined as that obtained with a 5 mm circular and centred rhexis.

Average Von Mises stress along IOL major axis Z was significantly higher than along the perpendicular X-axis in all cases (p<0.001) both at the equator and rhexis edge. Stress at the equator was always greater than at the rhexis edge (p<0.001) regardless of rhexis shape and position. As rhexis eccentricity rose the stress difference between the Z and X axes increased. Absolute IOL tilt (range 10-1-10-7 degrees), decen biologic processes of capsular bag shrinking and further IOL tilting or decentration.

To compare clinical outcomes of a new monofocal intraocular lens (IOL) with enhanced intermediate function and an extended-depth-of-focus (EDOF) IOL.

Asan Medical Center, Seoul, Korea.

Nonrandomized prospective comparative case series.

Patients presenting for cataract surgery and meeting all inclusion and exclusion criteria were implanted with new monofocal IOLs with enhanced intermediate function (Tecnis Eyhance ICB00) or EDOF IOLs (Tecnis Symfony ZXR00) bilaterally. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), defocus curves, and contrast sensitivity were compared after 3 months. Patients were administered questionnaires regarding visual symptoms, spectacle independence, overall satisfaction, and lens recommendations.

Twenty-four patients (48 eyes) were enrolled in the Eyhance group and 20 patients (40 eyes) in the Symfony group. Monocular and binocular UDVA, UIVA, and CDVA los.

Although most patient-clinician interactions occur in ambulatory care, little research has addressed measuring ambulatory patient safety or how primary care redesign such as the patient-centered medical home (PCMH) addresses patient safety. Our objectives were to identify PCMH standards relevant to patient safety, construct a measure of patient safety activity implementation, and examine differences in adoptions of these activities by practice and community characteristics. Using a consensus process, we selected elements among a widely adopted, nationally representative PCMH program representing activities that, according to a physician panel, represented patient safety overall and in four domains (diagnosis, treatment delays, medications, and communication and coordination) and generated a score for each. We then evaluated this score among 5,007 practices with the highest PCMH recognition level. Implementation of patient safety activities varied; the few military practices (2.4%) had the highest, and commucian panel, represented patient safety overall and in four domains (diagnosis, treatment delays, medications, and communication and coordination) and generated a score for each. We then evaluated this score among 5,007 practices with the highest PCMH recognition level. Implementation of patient safety activities varied; the few military practices (2.4%) had the highest, and community clinics the lowest, patient safety score, both overall (82.0 and 72.0, respectively, p less then .001) and across specific domains. Other practice and community characteristics were not associated with the patient safety score. Understanding better what factors are associated with implementation of patient safety activities may be a key step in improving ambulatory patient safety.

Amiodarone-induced thyroid dysfunction is well established. Selleckchem Estradiol The present review discusses recent literature related to the effects of amiodarone on the thyroid gland and thyroid function in pediatrics.

Current guidelines in adults treated with amiodarone recommend baseline thyroid function testing followed by initiation of thyroid hormone monitoring after 3 months on therapy. Two retrospective studies to evaluate amiodarone-induced thyroid dysfunction in children and young adults reveal thyroid dysfunction as soon as 2 weeks after amiodarone initiation with a greater percentage of pediatric patients developing amiodarone-induced hypothyroidism rather than thyrotoxicosis. Although additional studies are needed to determine if AIH is associated with negative impact on growth and neurocognitive development, what is clear is that in both adults and pediatrics, there is low compliance with recommended side effect-monitoring guidelines.

Pediatric patients are at similarly high risk to develop amiodarone-induced thyroid dysfunction as are adults. It is hoped that through improved education of providers and patients further research into the incidence, the potential risks of amiodarone therapy and the potential benefits of thyroid hormone replacement therapy in patients with AIH will be investigated and reported.

Pediatric patients are at similarly high risk to develop amiodarone-induced thyroid dysfunction as are adults. It is hoped that through improved education of providers and patients further research into the incidence, the potential risks of amiodarone therapy and the potential benefits of thyroid hormone replacement therapy in patients with AIH will be investigated and reported.

Severe burn injury results in profound catabolic deterioration. Although burn-related catabolism has been well stated, it is unclear when the catabolic response begins. This study characterized acute changes of muscle protein breakdown at the admission and the day after in severely burned adults.

Twelve patients (43 ± 19 years old) with 40% ± 21% total body surface area burns were prospectively enrolled into an observational study approved by institutional review board. Urinary samples were collected on admission day and the day after (day 1). Patient demographic and clinical data of vital signs, blood gas and chemistry, and coagulation status were collected. Catabolic changes of muscle breakdown were quantified by urinary excretion of 3-methylhisitidine, determined by gas chromatography and mass spectrometry analysis.

Compared with admission day, burned patients had elevated mean ± SD arterial pressure (from 90 ± 5 mm Hg to 108 ± 7 mm Hg) and heart rate (from 102 ± 7 beats per minute to 119 ± 4 beats pstudy, level II.

Prospective and observational study, level II.

In military trauma, temporary vascular shunts restore arterial continuity until delayed vascular reconstruction, often for a period of hours. A novel US Air Force-developed trauma-specific vascular injury shunt (TS-VIS) incorporates an accessible side port for intervention or monitoring, which may improve patency under adverse hemodynamic conditions. Our objective was to evaluate TS-VIS patency in the setting of volume-limited resuscitation from hemorrhagic shock.

Female swine (70-90 kg) underwent 30% hemorrhage and occlusion of the left external iliac artery for 30 minutes. Animals were allocated to one of three groups (n = 5 per group) by left external iliac artery treatment Sundt shunt (SUNDT), TS-VIS with arterial pressure monitoring (TS-VIS), or TS-VIS with heparin infusion (10 μ/kg per hour, TS-VISHep). Animals were resuscitated with up to 3 U of whole blood to maintain a mean arterial pressure (MAP) of >60 mm Hg and were monitored for 6 hours. Bilateral femoral arterial flow was continuously monncy superior to the Sundt under adverse hemodynamic conditions. No benefit was observed by the addition of localized heparin therapy over arterial pressure monitoring by the TS-VIS side port.

Virtual representations of human internal anatomy are important for military applications such as protective equipment design, injury severity prediction, thermal analysis, and physiological simulations. High-fidelity volumetric models based on imaging data are typically in static postures and difficult to use in simulations of realistic mission scenarios. This study aimed to investigate a hybrid approach to reposition medical avatars that preserves internal anatomy but allows rapid repositioning of full three-dimensional (3D) meshes.

A software framework that accepts a medical avatar in a 3D tetrahedral mesh format representing 72 organs and tissues with an articulated skeleton was developed. The skeleton is automatically resized and associated to the avatar using rigging and skinning algorithms inspired by computer animation techniques. Military relevant motions were used for animations. A motion retargeting algorithm was implemented to apply animation to avatars of various sizes, and a motion blending ontaining a complete anatomy representation. The workflow is largely automated, enabling rapid evaluation of new mission scenarios.

The developed software leverages techniques from various disciplines to create a hybrid approach enabling real-time 3D mesh repositioning appropriate for use in simulated military missions using avatars containing a complete anatomy representation. The workflow is largely automated, enabling rapid evaluation of new mission scenarios.Quality measurement is an intrinsic component of value-based purchasing, yet the quality measures currently in use for Value-Based Purchasing Programs (VBPs) are generally derived from a potpourri of measures originally built for other purposes. Only a handful of VBPs have definitively shown savings or expanded nationally. We suggest that to shift the health care reimbursement system in the United States to paying for value, quality measures used in VBPs should be vetted as "fit for purpose." We advocate that quality measures deemed "fit" for VBPs be defined primarily by the impact of the quality measures on providers, patients, the provider-patient relationship and what matters to patients. We define 5 attributes of quality measures we believe necessary to link the actions of providers and patients and lead to value for our health care system. "Fit for purpose" quality measures should focus health care delivery on value improvement and create a culture of value in our health care system.

Spinal decompression with or without fusion is one of the most commonly performed procedures in spine surgery. However, there is limited evidence on the effect of discharge environment on outcomes after surgery. The purpose of this study is to identify the effects of discharge disposition setting on clinical outcomes after spine surgery.

Patients who underwent lumbar decompression, lumbar decompression and fusion, or posterior cervical decompression and fusion surgery were retrospectively identified. All clinical and demographic data were obtained from electronic health records. Surgical outcomes included wound complications, revision surgery, "30-day" readmission (0-30 d), and "90-day" readmission (31-90 d). Discharge disposition was stratified into home/self-care, acute inpatient rehabilitation, and subacute rehabilitation. Patient-reported outcome measures including VAS Back, VAS Leg, VAS Neck, VAS Arm, PCS-12 and MCS-12, ODI, and NDI were compared between patient discharge disposition settings using the Mann-Whitney U test.