Fundus Examination in Pediatric Patients Using Indirect Ophthalmoscopy

The goal of this chapter is to provide the clinician with an understanding of binocular indirect ophthalmoscopy (BIO) and helpful clinical techniques for success in examining the fundus of the pediatric patient, including scleral depression. The challenging technique to examine the premature infant at risk for retinopathy of prematurity will be explained in detail, including the standard classification of the disease with photos depicting the different location and stages of disease. BIO with the addition of scleral indentation helps the clinician diagnose and locate lesions that may otherwise go undetected, such as retinal holes, tears, or vitreoretinal adhesions. Complete examination of the fundus of a child is no less important than of any other patient who seeks eye care but often requires efficiency and precision (as well as many human arms). Time is a rate limiting aspect when examining children so preparation and experience will lead to success.

Eddy Current Testing Basics and Innovation

Eddy current testing is considered a theoretically challenging technique. Out of all the different nondestructive testing (NDT) methods, the electromagnetic testing (ET) method (of which eddy current testing is a technique) is probably the most difficult for understanding theory. This is perhaps why the last Materials Evaluation Back to Basics paper on eddy current testing is from 2006, which is a long time ago given the amount of innovation in the technique that has taken place since then (Hansen and Peoples 2006). In this paper we will show what has changed due to recent innovations. We first will present the physics, and then explain how modern equipment assists the user in distinguishing between different physical phenomena. Although this paper is on conventional eddy current testing, we will also mention some other ET techniques along with their advantages and disadvantages.

A SYSTEMATIC REVIEW OF MODIFICATIONS IN PREPARATION OF KSHARASUTRA AND ITS APPLICATION TECHNIQUES IN PATIENTS OF BHAGANDARA (FISTULA-IN-ANO)

Bhagandara (Fistula-in-ano) is well known cause of morbidity in all ages, gender and socio-economic status which has a promising treatment available with Ayurvedic practice of Ksharasutra (medicated setons). This is proven to have relatively lower rates of complications and recurrences. The standardised form of Apamarg Ksharasutra (Snuhi, Apamarg and Haridra churan) is been used for long and still considered the gold standard. However, difficulty in procurement, non-perennial availability of few of its constituents and challenging technique especially in complex cases has always encouraged the practitioners and researchers to come up with trial of other ingredients as per old literature like Sushruta Samhita and to modify the application techniques. This is an endeavour to venture into literature and compile such promising efforts.

Topological Ordering Signal Selection Technique for Internet of Things based on Combinational Gate for Visibility Enhancement

In modern System on Chip (SoC) design consist of intelligence of products, Internet of Things (IoT) based devices, mobile phones, laptops, servers etc. This shrinking market reduces the design automation validation process. Signal selection is the most effective and challenging technique in post-silicon validation and debug. The vital problem prevailing in this method is that it has limited observability and controllability due to the minimum number of storage space in the trace buffer. This tends to select the signals prudently in order to maximize the state reconstruction. To identify the trace signals, signal restoration is the extensive metric that has been used so far. Topology-based restoration method is proposed here to minimize the error detectionlatency which helps to select the trace signals with minimum error or even errorless. This method aid to detect more number of errors within limited number of clock cyclesthan the restoration only selection techniques.

Transpedicular Endoscopic Surgery for Highly Downmigrated L5-S1 Disc Herniation

Endoscopic surgery for highly downmigrated disc herniation at level L5-S1 is a challenging technique. Most surgeons prefer the interlaminar access because of the special anatomy of the L5-S1 disc level, i.e., narrow neuroforamen and large interlaminar window. Transforaminal access to the neuroforamen L5-S1 is difficult in cases with high iliac crest. Here, the access to the highly downmigrated disc herniation with the recently reported technique of transpedicular endoscopic surgery by Krzok et al. was described. In 3 cases with highly downmigrated disc herniation of L5-S1, the sequester was removed successfully through the bone hole of S1 pedicle. This technique is demanding for experienced endoscopic surgeons.

An Intraoperative Template Technique for Hemi-Hamate Bone Grafts in Reconstruction of the Proximal Interphalangeal Joint

The surgical management of proximal interphalangeal joint fracture subluxations is challenging. The hemi-hamate autograft is a useful but technically challenging technique for these injuries. We describe a simple technical note, using a bone wax template to help guide the harvest of a geometrically accurate hemi-hamate graft to facilitate accurate proximal interphalangeal joint reconstruction, while reducing donor site morbidity.

Exploring the precision of femtosecond laser-assisted descemetorhexis in Descemet membrane endothelial keratoplasty

ObjectiveDescemet membrane endothelial keratoplasty (DMEK) remains a challenging technique. We compare the precision of femtosecond laser-assisted DMEK to manual DMEK.Methods and AnalysisA manual descemetorhexis (DR) of 8 mm diameter was compared with a femtosecond laser-assisted DR of the same diameter (femto-DR) in 22 pseudophakic patients requiring DMEK. We used OCT images with a centred xy-diagram to measure the postoperative precision of the DR and the amount of endothelial denuded area. Endothelial cell loss (ECL) and best corrected visual acuity were measured 3 months after surgery.ResultsIn the manual group, the median error of the DR was 7% (range 3%–16%) in the x-diameter and 8% (range 2%–17%) in the y-diameter. In the femto group, the median error in the respective x and y-diameters was 1% (range 0.4%–3%) and 1% (range 0.006%–2.5%), smaller than in the manual group (p=0.001). Endothelial denuded areas were larger in the manual group (11.6 mm2, range 7.6–18 mm2) than in the femto group (2.5 mm2, range 1.2–5.9 mm2) (p<0.001). The ECL was 21% (range 5%–78%) in the manual DR and 17% (range 6%–38%) in the femto-DR group (p=0.351). The median visual acuity increased from 0.4 logMAR (range 0.6–0.4 logMAR) in both groups to 0.1 logMAR (range 0.4–0 logMAR) in the manual group and to 0.1 logMAR (range 0.3–0 logMAR) in the femto group (p=0.461). Three rebubblings were required in the manual group, whereas the femto group required only one.ConclusionThe higher precision of the femto-DR bears the potential to improve DMEK surgery.

Interdisciplinary Teaching in Physical Education

The interdisciplinary approach has risen in the modern curricula as it is considered an important and challenging technique. Physical education is a prime content area for interdisciplinary learning. In order to integrate different subject areas into Physical Education lessons, the specialist needs to learn more about the academic curriculum. Integrating core subjects with physical activity can easily be done and can be very beneficial to student learners in all levels of Education. A great effort is done in addition to be integrated with other subjects. Over the last twenty years there have been frequent internal changes at international level, which also affect pre-school curricula. This trend has been intensified in recent years, with unprecedented mobility being observed, to the point of demanding a fundamental reform of the educational mission of the kindergarten. An interdisciplinary approach has been at the core of attention in primary and secondary school education recently.In this approach, teachers collaborate to invent and apply more effective means of teaching by associating the subjects and activities of a school subject in the curriculum with other subjects. The basic aim and purpose is to cultivate skills and values such as cooperatives, flexibility, adaptability, solidarity, but above all to provide basic knowledge, exploration, classification, selection, evaluation, resolution, and observation.