scholarly journals Principles of Accommodation and Technology Update of Presbyopia Corrections using IR and UV Lasers

2021 ◽  
pp. 17-28
Author(s):  
Jui-Teng Lin
Keyword(s):  
Clinical Outcomes ◽  
Thermal Shrinkage ◽  
Key Factors ◽  
Improved Outcomes ◽  
New Directions ◽  
Taipei City ◽  
Key Issues ◽  
Property Changes ◽  
Uv Lasers ◽  
Index Size

Purpose: To update and review the technology and principles of laser presbyopia reversal (LAPR) via sclera ablation and thermal shrinkage using infrared and UV lasers. Recent clinical data and new methods are also summarized. Study Design: LAPR using laser sclera ablation for increased accommodation of presbyopic eyes. Place and Duration of Study: New Taipei City, Taiwan, between June, 2021 and July, 2021. Methodology: Accommodation gain was obtained by laser scleral ablation of an eye using Er:YAG laser (at 2.94 um) using either line-pattern or dots-pattern outside the limbus in the oblique quadrants of an eye. The principles of accommodation and the key factors influencing the outcomes are discussed. The accommodation gain (AG) after the surgery is mainly due the change in anterior curvature and anterior shift of the lens. The effectiveness of ciliary body contraction for lens relaxation (or accommodation) may be influenced by the combined aging factors, including lens property changes (index, size, thickness and curvature), tissue elastic changes (in sclera and ciliary) and the zonular tension change. Classical theories of accommodation include Helmholtz and Schachar hypothesis. The key issues and new directions to overcome the drawbacks of the existing LAPR procedure (based on scleral ablation) are proposed. Clinical outcomes from two major groups, SurgiLight and Ace Vision, with two years follow are summarized. Results: Clinical outcomes during 2000 to 2020 are summarized showing an average Accommodation gain about 2.0 D, and postoperative egression about 0.25 D (after two years). Conclusion: Laser presbyopia reversal (LAPR) via sclera ablation using infrared laser is safe and effective, but suffers drawbacks of being invasive and procedures are too slow. New directions are required for improved outcomes.

scholarly journals Portrait of the ‘Absent’ Father: The Impact of Non-Residency on Developing and Maintaining a Fathering Role

2005 ◽  
Vol 14 (2) ◽  
pp. 134-154 ◽  
Author(s):  
Mary P. Corcoran
Keyword(s):  
Exploratory Study ◽  
Active Role ◽  
Absent Father ◽  
Key Factors ◽  
Social Barriers ◽  
Institutional Economic ◽  
Key Issues ◽  
The Impact

This paper reports on an exploratory study conducted with non-resident fathers, to elucidate the key issues affecting the development and maintenance of a fathering role after a relationship has ended. In particular, the paper focuses on the contingent nature of fatherhood for young marginalised men in Dublin. The extent to which fathers identify with a fathering role is explored and comparisons are drawn between the experiences of estranged, committed and activist fathers. Key factors that militate against fathers maintaining an active role in their children's lives are identified. The paper concludes that while the experiences of fatherhood vary across different categories of fathers, the majority of them aspire toward and value their fathering role. However, their capacity to adopt a positive fathering role is affected by a range of institutional, economic and social barriers.

scholarly journals The relationship between preoperative predictive factors for clinical outcome in patients operated for lumbar spinal stenosis by decompressive laminectomy

2020 ◽  
Vol 11 ◽  
pp. 27 ◽  
Author(s):  
Dobran Mauro ◽  
Davide Nasi ◽  
Riccardo Paracino ◽  
Mara Capece ◽  
Erika Carrassi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Predictive Factors ◽  
Antidepressant Drugs ◽  
Decompressive Laminectomy ◽  
Pain Anxiety ◽  
Pain Medications ◽  
Improved Outcomes ◽  
Lumbar Spinal

Background: Our hypothesis was that by identifying certain preoperative predictive factors, we could favorably impact clinical outcomes in patients undergoing decompressive surgery for lumbar spinal stenosis (LSS). Methods: In this retrospective study, there were 65 patients (2016–2018) with symptomatic LSS who underwent decompressive laminectomy without fusion. Their clinical outcomes were assessed utilizing the Oswestry Disability Index (ODI). Multiple preoperative variables were studied to determine which ones would help predict improved outcomes: gender, age, body mass index (BMI), general/neurological examination, smoking, and drug therapies (anxiolytics and/or antidepressants). Results: All patients demonstrated statistically significant improvement on the ODI. Multivariate analysis revealed that those with higher preoperative BMI had significantly lower ODI on 1-year follow-up examinations, reflecting poorer outcomes. Postoperatively, 44 patients (67%) exhibited lower utilization of anxiolytic medications, 52 patients (80%) showed reduced use of antidepressant drugs, and pain medications utilization was reduced in 33 patients (50%). Conclusion: Decompressive laminectomy without fusion effectively managed LSS. It reduced patients’ use of pain, anxiety, and antidepressant medications. In addition, we found that increased preoperative BMIs contributed to poorer postoperative outcomes (e.g., ODI values).

BET 1: Is routine irrigation of a cutaneous abscess necessary?

2018 ◽  
Vol 35 (2) ◽  
pp. 126.2-127 ◽  
Author(s):  
Joshua Badour ◽  
Matt Singh ◽  
Jeffrey Jones
Keyword(s):  
Clinical Outcomes ◽  
Patient Group ◽  
Adult Patients ◽  
Abscess Cavity ◽  
Clinical Question ◽  
Incision And Drainage ◽  
Improved Outcomes ◽  
Study Type

A short cut review was carried out to establish whether the addition of irrigation of the abscess cavity improved outcomes after incision and drainage of a cutaneous abscess. One paper presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. It is concluded that in adult patients with cutaneous abscesses routine irrigation during incision and drainage does not improve clinical outcomes.

Abstract T P276: Calling Stroke Alert: Does It Make a Difference in the Chain of Survival?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Cristine W Small ◽  
Donald L Price ◽  
Jeffrey D Ferguson ◽  
Lawrence I Madubeze ◽  
Susan D Freeman
Keyword(s):  
Clinical Outcomes ◽  
Stroke Severity ◽  
Golden Hour ◽  
Discharge Disposition ◽  
Improved Outcomes ◽  
Stroke Team ◽  
Severity Scores ◽  
Response Team ◽  
Chain Of Survival ◽  
The Impact

Purpose: To determine whether the stroke alert process results in improved outcomes, as reflected in door to lytic times and other outcome measures. Introduction: The diagnosis and treatment of stroke is time-sensitive and should be inclusive of all seven D’s in the “chain of survival” - Detection, Dispatch, Delivery, Door, Data, Decision and Drug (Adams, Stroke, 2007). Early stroke activation is part of the “Delivery” which incorporates transport and management by Emergency Medical Services (EMS). Clinical suspicion of stroke by EMS resulted in a process of early activation which was labeled “Stroke Alert.” This expedited the code stroke process upon arrival, preparing the hospital based stroke team to provide immediate triage and evaluation. The goal was to improve clinical efficiency and possibly clinical outcomes. Methods: • Implementation of a notification process from EMS to ED - Stroke Alert • Incorporated Stroke Alert to include Stroke Response Team (SRT) nurses January 22, 2011 • Retrospective review of internal stroke database (January 22, 2011 to July 2013) for comparative analysis of Stroke Alerts called versus those where no stroke alert was called • Evaluate clinical outcomes directly related to Stroke Alert process Results: From January 22, 2011 to July 2013: Stroke Alert Called: • 37 t-PA patients and 14 of those, 37.8%, met the 60 minute benchmark • Average Door to Lytic time - 65 minutes Stroke Alert NOT Called: • 35 t-PA patients and 10 of those, 28.6% met the 60 minute benchmark • Average Door to Lytic time - 79 minutes Conclusions: The ability for a SRT to meet the golden hour of stroke benchmark occurs more frequently when a Stroke Alert is called to the SRT nurse. Future plans include review of stroke severity scores, length of stay (LOS), and discharge disposition, to determine the impact a Stroke Alert may have on clinical outcomes.

Abstract P488: The Impact of First Pass Effect on Acute Ischemic Stroke Clinical Outcomes: Why We Need to Continue to Improve Mechanical Thrombectomy?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Mahmoud Dibas ◽  
Amr Ehab El-Qushayri ◽  
Sherief Ghozy ◽  
Adam A Dmytriw ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Vessel Occlusion ◽  
First Pass Effect ◽  
Improved Outcomes ◽  
First Pass ◽  
The Impact

Background: Mechanical thrombectomy (MT) has significantly improved outcomes of acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). The first-pass effect (FPE), defined as achieving complete reperfusion (mTICI3/2c) with a single pass, was reported to be associated with higher functional independence rates following EVT and has been emphasized as an important procedural target. We compared MT outcomes in patients who achieved FPE to those who did not in a real world large database. Method: A retrospective analysis of LVO pts who underwent MT from a single center prospectively collected database. Patients were stratified into those who achieved FPE and non-FPE. The primary outcome (discharge and 90 day mRS 0-2) and safety (sICH, mortality and neuro-worsening) were compared between the two groups. Results: Of 580 pts, 261 (45%) achieved FPE and 319 (55%) were non-FPE. Mean age was (70 vs 71, p=0.051) and mean initial NIHSS (16 vs 17, p=0.23) and IV tPA rates (37% bs 36%, p=0.9) were similar between the two groups. Other baseline characteristics were similar. Non-FPE pts required more stenting (15% vs 25%, p=0.003), and angioplasty (19% vs 29%, p=0.01). The FPE group had significantly more instances of discharge (33% vs 17%, p<0.001), and 90-day mRS score 0-2 (29% vs 20%, p<0.001), respectively. Additionally, the FPE group had a significant lower mean discharge NIHSS score (12 vs 17, p<0.001). FPE group had better safety outcomes with lower mortality (14.2% vs 21.6%, p=0.03), sICH (5.7% vs 13.5, p=0.004), and neurological worsening (71.3% vs 78.4%, p=0.02), compared to the non-FPE group. Conclusion: Patients with first pass complete or near complete reperfusion with MT had higher functional independence rates, reduced mortality, symptomatic hemorrhage and neurological worsening. Improvement in MT devices and techniques is vital to increase first pass effect and improve clinical outcomes.

scholarly journals The use of product scarcity in marketing

2020 ◽  
Vol 54 (2) ◽  
pp. 380-418 ◽  
Author(s):  
Xiaohui Shi ◽  
Feng Li ◽  
Pattarin Chumnumpan
Keyword(s):  
Systematic Review ◽  
Design Methodology ◽  
Future Research ◽  
Key Factors ◽  
Research Papers ◽  
Diverse Range ◽  
Content Type ◽  
The Core ◽  
New Directions ◽  
Business And Management

Purpose As a frequently observed business phenomenon, the use of product scarcity to improve a product’s market performance has received increasing attention from both academics and practitioners. The resulting literature has covered a wide variety of issues based on various theories, using different research methods, in a diverse range of settings. However, this diversity also makes it difficult to grasp the core themes and findings, and to see the outstanding knowledge gaps. This paper aims to review previous studies on the use of product scarcity in marketing and identifies new directions for future research. Design/methodology/approach A systematic review was conducted to identify and analyse 66 research papers published in business and management journals between 1970 and 2017. Findings The authors examined the underlying theories of scarcity-based marketing, and developed a conceptual framework that describes the key factors of product scarcity and how they influence both consumers and the market. They also highlighted some key achievements in modelling the processes involved in using product scarcity in marketing. Originality/value This analysis of the identified papers suggests that there are substantial gaps in our knowledge of this field, which opens up new paths for future research. For future research, the authors identified three directions aimed at: addressing the practical needs of firms in understanding product scarcity; guiding the implementation of scarcity-based strategies; and measuring, monitoring and predicting the level of product scarcity and its impacts during implementation.

Students' Acceptance of Mobile Learning

2020 ◽  
pp. 354-373
Author(s):  
Xiaoqing Li
Keyword(s):  
Mobile Learning ◽  
Rapid Development ◽  
Learning Systems ◽  
Mobile Users ◽  
Learning Approach ◽  
Key Factors ◽  
Mobile Learn ◽  
Design And Implementation ◽  
Research Findings ◽  
Key Issues

With the rapid development of telecommunications, mobile learning is appearing as a promising learning approach for students to learn anytime anywhere. However, many key issues regarding the design and implementation of mobile learning are still unclear. This research investigates key factors leading to the acceptance of mobile learning based on students' use of Blackboard Mobile Learn. The research findings will help instructors to design courses for mobile users and system developers to design better mobile learning systems.

Students' Acceptance of Mobile Learning

2017 ◽  
Vol 9 (1) ◽  
pp. 52-69
Author(s):  
Xiaoqing Li
Keyword(s):  
Mobile Learning ◽  
Rapid Development ◽  
Learning Systems ◽  
Mobile Users ◽  
Learning Approach ◽  
Key Factors ◽  
Mobile Learn ◽  
Design And Implementation ◽  
Research Findings ◽  
Key Issues

With the rapid development of telecommunications, mobile learning is appearing as a promising learning approach for students to learn anytime anywhere. However, many key issues regarding the design and implementation of mobile learning are still unclear. This research investigates key factors leading to the acceptance of mobile learning based on students' use of Blackboard Mobile Learn. The research findings will help instructors to design courses for mobile users and system developers to design better mobile learning systems.

scholarly journals Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

2020 ◽  
Vol 37 (6) ◽  
pp. 488-494
Author(s):  
Carmen S.S. Latenstein ◽  
Sarah Z. Wennmacker ◽  
Stef Groenewoud ◽  
Mark W. Noordenbos ◽  
Femke Atsma ◽  
...  
Keyword(s):  
The Netherlands ◽  
Clinical Outcomes ◽  
Gallstone Disease ◽  
Practice Variation ◽  
Emergency Department Visits ◽  
Case Mix ◽  
Hospital Variation ◽  
Improved Outcomes ◽  
Related Group ◽  
Nationwide Observational Study

<b><i>Background:</i></b> Practice variation generally raises concerns about the quality of care. This study determined the longitudinal degree of hospital variation in proportion of patients with gallstone disease undergoing cholecystectomy, while adjusted for case-mix, and the effect on clinical outcomes. <b><i>Methods:</i></b> A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands in 2013–2015. Patients with gallstone disease were collected from the diagnosis-related group database. Hospital variation in case-mix-adjusted cholecystectomy rates was calculated per year. Clinical outcomes after cholecystectomy were compared between hospitals in the lowest/highest 20th percentile of the distribution of adjusted cholecystectomy rates in all 3 subsequent years. <b><i>Results:</i></b> In total, 96,673 patients with gallstones were included. The cholecystectomy rate was 73.6%. In 2013–2015, the case-mix-adjusted performance of cholecystectomies was in hospitals with high rates 1.5–1.6 times higher than in hospitals with low rates. Hospitals with a high adjusted cholecystectomy rate had a higher laparoscopy rate, shorter time to surgery, and less emergency department visits after a cholecystectomy compared to hospitals with a low-adjusted cholecystectomy rate. <b><i>Conclusion:</i></b> Hospital variation in cholecystectomies in the Netherlands is modest, cholecystectomy rates varies by &#x3c;2-fold, and variation is stable over time. Cholecystectomies in hospitals with high adjusted cholecystectomy rates are associated with improved outcomes.

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