Think globally, act locally: Quality improvement as a catalyst for COVID-19 related care during the transitional years.

The COVID-19 pandemic has posed distinctive challenges to adolescents and young adults living with spina bifida, especially those from ethic minority populations. With this public health challenge in mind, developing a customized electronic health record to leverage registry data to promote and quantify COVID-19 vaccination uptake among this population is feasible. We provide a brief description of our activities in customizing an electronic health record to track vaccination uptake among adolescents and young adults with spina bifida (AYASB); and the lessons learned, in hopeful support of those scaling-up vaccination delivery across the globe for AYASB as they transition to adult-centered care. Thus, as providers think globally and act locally, COVID-19 immunization efforts can be implemented while providing culturally appropriate transition policies and services for individuals with neurodevelopmental disabilities.

Zernike coefficients from wavefront curvature data.

The concept of curvature sensing is reviewed, and a comprehensive derivation of the curvature polynomials is given, whose inner products with the wavefront curvature data yield the Zernike aberration coefficients of an aberrated circular wavefront. The data consist of the Laplacian of the wavefront across its interior and its outward normal slope at its circular boundary. However, we show that the radial part of the curvature polynomials and their slopes at the boundary of the wavefront have a value of zero, except when the angular frequency of the corresponding Zernike polynomial is equal to its radial degree. As a result, the effect of noise on the corresponding Zernike coefficients is lower because the noisy data at the boundary of the wavefront is not used to determine their values. The use of the curvature polynomials to determine the Zernike coefficients is demonstrated with simulated noisy curvature data of an aberration function consisting of 10 Zernike coefficients, namely defocus, primary, secondary, and tertiary astigmatism, coma, and spherical aberrations.

Wavefront coding with Jacobi-Fourier phase masks for retinal imaging.

Wavefront coding is a technique that combines optical phase elements and digital signal processing in order to increase the effective depth of focus of optical systems. The success of wavefront coding lies in the design of a suitable phase mask placed at the system's aperture. This element allows for image formation invariant under the effects of different second-order optical aberrations. In optical systems limited by temporally or spatially varying high-order aberrations, the use of wavefront coding has not been fully demonstrated. Here we propose the choice of Jacobi-Fourier shaped phase masks to produce sharp and clear retinal images of living eyes. To demonstrate the potential use of the technique, we analyze the performance of the Jacobi-Fourier phase masks through experimental simulations to alleviate aberrations for different eye aberrations. We will show that the best mask choice is robust to noise while keeping acceptable resolution and reducing image artefacts.

Central blood pressure variability is increased in hypertensive patients with target organ damage.

We aimed to evaluate the association of aortic and brachial short-term blood pressure variability (BPV) with the presence of target organ damage (TOD) in hypertensive patients. One-hundred seventy-eight patients, aged 57 ± 12 years, 33% women were studied. TOD was defined by the presence of left ventricular hypertrophy on echocardiogram, microalbuminuria, reduced glomerular filtration rate, or increased aortic pulse wave velocity. Aortic and brachial BPV was assessed by 24-hour ambulatory BP monitoring (Mobil-O-Graph). TOD was present in 92 patients (51.7%). Compared to those without evidence of TOD, they had increased night-to-day ratios of systolic and diastolic BP (both aortic and brachial) and heart rate. They also had significant increased systolic BPV, as measured by both aortic and brachial daytime and 24-hours standard deviations and coefficients of variation, as well as for average real variability. Circadian patterns and short-term variability measures were very similar for aortic and brachial BP. We conclude that BPV is increased in hypertensive-related TOD. Aortic BPV does not add relevant information in comparison to brachial BPV.

Pupil size stability of the cubic phase mask solution for presbyopia.

Presbyopia correction involves different types of studies such as lens design, clinical study, and the development of objective metrics, such as the visual Strehl ratio. Different contact lens designs have been proposed for presbyopia correction, but performance depends on pupil diameter. We will analyze the potential use of a nonsymmetrical element, a cubic phase mask (CPM) solution, to develop a contact or intraocular lens whose performance is nearly insensitive to changes in pupil diameter. We will show the through focus optical transfer function of the proposed element for different pupil diameters ranging from 3 to 7 mm. Additionally, we will show the images obtained through computation and experiment for a group of eye charts with different visual acuities. Our results show that a CPM shaped as 7.07 µm*(Z33-Z3-3)-0.9 µmZ20 is a good solution for a range of clear vision with a visual acuity of at least 0.1 logMar from 0.4 to 6 m for pupil diameters in the 3- to 7-mm range. Our results appear to be a good starting point for further development and study of this kind of CPM solution for presbyopia.

Vector polynomials for direct analysis of circular wavefront slope data: erratum.

We provide a correction to Eq. (4) in J. Opt. Soc. Am. A34, 1908 (2017)JOAOD60740-323210.1364/JOSAA.34.001908.

Vector polynomials for direct analysis of circular wavefront slope data: publisher's note.

This publisher's note corrects two text errors in J. Opt. Soc. Am. A34, 1908 (2017)JOAOD60740-323210.1364/JOSAA.34.001908.

Vector polynomials for direct analysis of circular wavefront slope data.

In the aberration analysis of a circular wavefront, Zernike circle polynomials are used to obtain its wave aberration coefficients. To obtain these coefficients from the wavefront slope data, we need vector functions that are orthogonal to the gradients of the Zernike polynomials, and are irrotational so as to propagate minimum uncorrelated random noise from the data to the coefficients. In this paper, we derive such vector functions, which happen to be polynomials.

Utilidad del índice FEV1/FEV6 en pacientes pluripatológicos hospitalizados para detectar la prevalencia de obstrucción pulmonar / Usefulness of the FEV1/FEV6 ratio to detect the prevalence of lung obstruction in hospitalised patients with multiple morbidities

Introducción. La prevalencia de obstrucción pulmonar aumenta con la edad y la presencia de comorbilidades. Aunque para confirmar su diagnóstico es necesario completar una espirometría, esta puede ser difícil de realizar en ancianos con deterioro cognitivo o dependencia funcional. Recientemente el uso de dispositivos portátiles que utilizan el índice FEV1/FEV6 han demostrado su utilidad para evaluar la presencia de obstrucción pulmonar, con una mayor facilidad de uso, aunque su utilidad en población anciana con pluripatología no ha sido establecida. Metodología. Estudio transversal, realizado en pacientes ingresados en la Unidad de pacientes crónicos complejos del Hospital Universitario Mútua de Terrassa. A todos ellos se les realizó un cuestionario que incluía -entre otras- medidas de dependencia funcional y deterioro cognitivo y se intentaron completar previamente al alta 3 maniobras válidas de FEV1/FEV6 con el aparato Piko-6, considerándose criterio de obstrucción un FEV1/FEV6≤0,75. Se analizaron las características de la población que fue capaz de realizar las pruebas, y la prevalencia de obstrucción pulmonar. Resultados. Se estudiaron 54 pacientes, de los cuales 35 (64,81%) realizaron las maniobras correctamente. Los pacientes que no completaron las maniobras tenían más dependencia funcional (Barthel 19 vs. 72, p<0,0001) y más deterioro cognitivo (Pfeiffer 1 vs. 9, p<0,0001; MEC 3/35 vs. 28/35, p<0,010). La prevalencia de obstrucción fue del 71,43%, con un 72% de infradiagnóstico. Conclusiones. En un 35,18% de los pacientes no se consiguió determinar el FEV1/FEV6, por deterioro cognitivo o dependencia funcional. Tanto la prevalencia de obstrucción como el infradiagnóstico superaron el 70% (AU)

Background. The prevalence of lung obstruction increases with age and the presence of comorbidities. Although a complete spirometry is necessary to confirm the diagnosis, this may be impractical in elderly patients with cognitive impairment or functional dependence. Recently, the use of portable devices using the FEV1/FEV6 ratio have shown to be useful for assessing the presence of lung obstruction, with greater ease of use, but its usefulness has not been established in the elderly population with multiple morbidities. Methods. A cross-sectional study was conducted on patients hospitalised in the complex chronic patients Unit of the University Hospital Mútua de Terrassa. All of them completed a questionnaire that included -among other things- measurements of functional dependence and cognitive impairment. Three manoeuvres validated with the Piko-6 device were attempted before discharge, and considering an FEV1/FEV6<0.75 as criteria for obstruction. An analysis was performed on the characteristics of the population that was able to perform the tests, as well as the prevalence of pulmonary obstruction. Results. A total of 54 patients were included in the study, of which 35 (64.81%) performed the manoeuvres correctly. Patients who were unable to complete the manoeuvres of the Piko-6 had more functional dependence (Barthel 19 vs. 72, P<.0001) and cognitive impairment (Pfeiffer 1 vs. 9, P<.0001; MEC 28/35 vs. 3/35, P<.010). The prevalence of obstruction was 71.43%, with an underdiagnosis of 72%. Conclusions. The FEV1/FEV6 ratio was not determined in 35.18% of the patients due to cognitive impairment or functional dependence. The prevalence of obstruction and underdiagnosis exceeded 70% (AU)

Twenty-four-hour central blood pressure is not better associated with hypertensive target organ damage than 24-h peripheral blood pressure.

BACKGROUND AND AIM: Central blood pressure (BP) is increasingly considered as a better estimator of hypertension associated risks. We aimed to evaluate the association of 24-h central BP, in comparison with 24-h peripheral BP, with the presence of target organ damage (TOD). METHODS: Cross-sectional study of 208 hypertensive patients, aged 57 ±â€Š12 years, 34% women. Office (mean of 4 measurements) and 24-h central and peripheral BP were measured by the oscillometric Mobil-O-Graph device. TOD was assessed at cardiac (left ventricular hypertrophy by echocardiography), renal (reduction of glomerular filtration rate and/or microalbuminuria), and arterial (increased aortic pulse wave velocity) levels. RESULTS: A total of 107 patients (51.4%) had TOD (77, 35% patients left ventricular hypertrophy; 54, 25.9% renal abnormalities; and 40, 19.2% arterial stiffness). All SBP and pulse BP estimates (office, 24-h, daytime, and night-time) were associated with the presence of TOD, after adjustment for age, sex, and antihypertensive treatment, with higher odds ratios for ambulatory-derived values. Odds ratios for central and peripheral BP were similar for all office, 24-h, daytime, and night-time BP. After simultaneous adjustment, peripheral, but not central, 24-h and night-time SBP and pulse pressures were associated with the presence of TOD. CONCLUSION: TOD in hypertension is associated with BP elevation, independently of the type of measurement (office or ambulatory, central or peripheral). Central BP, even monitored during 24 h, is not better associated with TOD than peripheral BP. These results do not support a routine measurement of 24-h central BP.

Potential use of cubic phase masks for extending the range of clear vision in presbyopes: initial calculation and simulation studies.

PURPOSE: In this paper we analyse the potential use of a non-symmetrical optical element, a cubic phase mask, for extending the range of clear vision of presbyopic eyes. Additionally, we will discuss the appropriateness of the visual Strehl ratio to analyse this sort of presbyopic solution based on non-symmetrical phase masks contrasted with through-focus retinal images. METHODS: In order to evaluate the performance of the cubic phase mask we employed computational Fourier Optics to compute the different visual Strehl criteria as well as simulate the retinal images. The through focus real part of the modulation transfer functions and retinal images were computed for four object distances 6.0, 1.0, 0.6 and 0.4 m which correspond to far, intermediate and near vision conditions for optotypes of visual acuity of 0.1 and 0.0 logMAR (Snellen 6/7.5 and 6/6; 0.8 and 1 in decimal Snellen). For the experimental validation we built an artificial eye consisting of a plano-convex lens with a focal length of 25.4 mm and 0.5 numerical aperture, a variable diaphragm, a 3× objective and an ORCA 285 Hamamatsu Photonics camera 8.1 µm pixel size (resulting in an effective pixel size of 2.7 µm). A set of four different VA charts adapted to monitor different visual acuities (ranging between 0.0 and 0.20 logMAR) were placed at different object distances 6, 1.0, 0.6 and 0.4 m from the artificial eye. RESULTS: Both numerical and experimental validation showed the suitability of the cubic phase mask for extending the range of clear vision of presbyopic eyes, providing at least a visual acuity of 0.1 logMAR (6/7.5 Snellen, 0.8 decimal Snellen) at all distances. The results show that it is possible to choose between promoting far or near vision by changing the magnitude of the defocus component. It is also possible to extend the range of clear vision, by increasing the magnitude of the cubic component. But this increment will cause a reduction in the contrast of the images as it can be observed from the Visual Strehl values and the retinal images generated numerically. CONCLUSIONS: A cubic phase mask in the shape 7.07 µm × (Z9 -Z6 )-0.9 µm × Z4 is a good solution for obtaining a range of clear vision with at least 0.1 logMAR visual acuity (and close to 0.0 logMAR, 6/6, 20/20 and decimal Snellen 1.0) between 6.0 and 0.4 m for a pupil diameter of 5.0 mm. Our results seem to be a good starting point for future studies of this type of cubic phase mask solutions for presbyopia.

[Usefulness of the FEV1/FEV6 ratio to detect the prevalence of lung obstruction in hospitalised patients with multiple morbidities]. / Utilidad del índice FEV1/FEV6 en pacientes pluripatológicos hospitalizados para detectar la prevalencia de obstrucción pulmonar.

BACKGROUND: The prevalence of lung obstruction increases with age and the presence of comorbidities. Although a complete spirometry is necessary to confirm the diagnosis, this may be impractical in elderly patients with cognitive impairment or functional dependence. Recently, the use of portable devices using the FEV1/FEV6 ratio have shown to be useful for assessing the presence of lung obstruction, with greater ease of use, but its usefulness has not been established in the elderly population with multiple morbidities. METHODS: A cross-sectional study was conducted on patients hospitalised in the complex chronic patients Unit of the University Hospital Mútua de Terrassa. All of them completed a questionnaire that included -among other things- measurements of functional dependence and cognitive impairment. Three manoeuvres validated with the Piko-6 device were attempted before discharge, and considering an FEV1/FEV6<0.75 as criteria for obstruction. An analysis was performed on the characteristics of the population that was able to perform the tests, as well as the prevalence of pulmonary obstruction. RESULTS: A total of 54 patients were included in the study, of which 35 (64.81%) performed the manoeuvres correctly. Patients who were unable to complete the manoeuvres of the Piko-6 had more functional dependence (Barthel 19 vs. 72, P<.0001) and cognitive impairment (Pfeiffer 1 vs. 9, P<.0001; MEC 28/35 vs. 3/35, P<.010). The prevalence of obstruction was 71.43%, with an underdiagnosis of 72%. CONCLUSIONS: The FEV1/FEV6 ratio was not determined in 35.18% of the patients due to cognitive impairment or functional dependence. The prevalence of obstruction and underdiagnosis exceeded 70%.

Interferometric Local Measurements of High-Order Aberrations in Progressive Addition Lenses.

PURPOSE: The main goal of this work is to show the principles, design, and performance of a modified point diffraction interferometer (PDI) for evaluating the local higher-order aberrations of progressive addition lenses (PALs). Because aberrations have different impacts in visual perception, we propose a device to provide a customized solution with the best permissible amounts and combinations of aberrations for improving a subject's vision. METHODS: A PDI has been adapted to measure local high-order aberrations in PALs. RESULTS: High-order aberrations in three different PALs within four relevant circular regions of interest (ROIs) with a radius ranging from 0.4 to 2.4 mm were measured with an accuracy of λ/10 within the ROI using the tailored PDI. The interferometer also allows for easily choosing the position and number of the ROIs. CONCLUSIONS: The interferometric device is compact, robust, and accurate. The operational principle is very simple, and it provides the local high-order aberrations directly without adding additional parts to the interferometer. As expected, the amount of high-order aberrations depends on the chosen ROI of the PAL; the corridor is the more critical region. We found, in accordance with the literature, that, in the corridor, second- and third-order aberrations are dominant and spherical aberration is negligible.

Wavefront-coding technique for inexpensive and robust retinal imaging.

We propose a hybrid optical-digital imaging system that can provide high-resolution retinal images without wavefront sensing or correction of the spatial and dynamic variations of eye aberrations. A methodology based on wavefront coding is implemented in a fundus camera in order to obtain a high-quality image of retinal detail. Wavefront-coded systems rely simply on the use of a cubic-phase plate in the pupil of the optical system. The phase element is intended to blur images in such a way that invariance to optical aberrations is achieved. The blur is then removed by image postprocessing. Thus, the system can provide high-resolution retinal images, avoiding all the optics needed to sense and correct ocular aberration, i.e., wavefront sensors and deformable mirrors.

Generation of spherical aberration with axially translating phase plates via extrinsic aberration.

We show that spherical aberration of all orders can be generated as an extrinsic aberration in a system of axially translating plates. Some practical examples are provided. In particular for two phase plates that are 10 mm in diameter it is possible to generate from -10 to 10 waves of fourth-order spherical aberration with an axial displacement of +/- 0.65 mm. We also apply the phenomenon of extrinsic aberration for the generation of a conical wavefront and other non-axially symmetric wavefronts, in other words we propose what can be called a generalized zoom plate.

Lens aberrations and their relationship with lens sutures for species with Y-suture branches.

Work remains to be done to understand the origins of ocular aberrations. We analyze lens aberrations of several species with Y-suture branches (bovine, ovine, and porcine) and their relationship with suture distribution. Aberrations are measured in vitro with a point diffraction interferometer in 10 different eyes of each species. The minimum number of Zernike polynomials minimizing the root mean square error of the wavefront is estimated by processing the interferograms. Through this we find significant amounts of astigmatism, coma, spherical aberration, and trefoil in the lenses of the three species. Moreover, we observe a high degree of correlation between the orientation of the lens sutures and the axis of nonrotationally symmetric aberrations. Our results point to lens sutures as the histological origin of the most significant lens aberrations: astigmatism, coma, and trefoil, but we are unable to find a major suture governing all the axes.

Progressive addition lens measurement by point diffraction interferometry.

PURPOSE: Design a device for accurate measurements of local optical properties of progressive addition lenses (PALs). METHODS: A point diffraction interferometer has been adapted to measure local prescriptions of PALs. RESULTS: The most basic configuration of the interferometer for the measurement of PALs showed in this work presents high dynamic range and accuracy as well as the possibility of choosing the number and position of measurement points. Measurements are taken within a region of interest within a radius of about 0.4 to 1.5 mm. Different PAL designs are measured by the method proposed here and compared with results by a last generation commercial lens mapper. With the point diffraction interferometer we also compared several PAL designs in order to analyze their properties in the progression zone. CONCLUSIONS: The device is compact, robust, and fairly accurate, and the operational principle is very simple. By direct measurements it provides the local dioptric power, i.e., the second order wavefront properties, of the lens for selected regions of interest. The position and area can be chosen by the user. The only mobile part of the setup allows for the selection of the measurement points without any additional prismatic correction or movement of the PAL.

Optical pressure sensor based on the combined system of a variable liquid lens and a point diffraction interferometer.

We propose an experimental efficient optical pressure sensor based on a variable liquid lens and a modified point diffraction interferometer. The working principle of the sensor is based on the fact that a variation in pressure induces a change in lens curvature and hence in its focal length, which can be tracked and measured with the interferometer. The pressure is then measured by recording and processing the interferometric images. The sensor in this proposal can change its dynamic range by the simple axial movement of one of the components of the optical system. In this work we show the performance of the system within three working ranges: from 0 to 1 kPa with accuracy of approximately 0.01 kPa, from 0 to 7 kPa with 0.05 kPa accuracy, and from 0 to 30 kPa with 0.3 kPa accuracy.