An assessment of the iPad as a testing platform for distance visual acuity in adults.

OBJECTIVES: Visual acuity is a common measurement in general practice, and the advent of new technology such as tablet computers offers a change in the way in which these tests are delivered. The aim of this study was to assess whether measurements of distance visual acuity using LogMAR letter charts displayed on an iPad tablet computer were in agreement with standard clinical tests of visual acuity in adults with normal vision. DESIGN: Blinded, diagnostic test study. SETTING: Single centre (University) in Auckland, New Zealand. PARTICIPANTS: University staff and students (n=85). Participants were required to have visual acuity better than 6/60 and wear habitual refractive correction during testing. Participants were excluded if there was any history of ocular pathology. PRIMARY AND SECONDARY OUTCOME MEASURES: Visual acuity measured under a number of conditions. RESULTS: The iPad tablet with its glossy screen was highly susceptible to glare resulting in acuity measurements that were significantly poorer (approximately 2 LogMAR lines) than those made using an ETDRS chart and a standard computerised testing system (n=56). However, fitting the iPad with an antiglare screen and positioning the device away from sources creating reflected (veiling) glare resulted in acuity measurements that were equivalent those made using gold standard charts (n=29). CONCLUSIONS: Tablet computers are an attractive option for visual acuity measurement due to portability, the ability to randomise letters, automated scoring of acuity and the ability to select from a range of charts. However, these devices are only suitable for use in situations where sources of glare can be eliminated.

An iPod treatment of amblyopia: an updated binocular approach.

We describe the successful translation of computerized and space-consuming laboratory equipment for the treatment of suppression to a small handheld iPod device (Apple iPod; Apple Inc., Cupertino, California). A portable and easily obtainable Apple iPod display, using current video technology offers an ideal solution for the clinical treatment of suppression. The following is a description of the iPod device and illustrates how a video game has been adapted to provide the appropriate stimulation to implement our recent antisuppression treatment protocol. One to 2 hours per day of video game playing under controlled conditions for 1 to 3 weeks can improve acuity and restore binocular function, including stereopsis in adults, well beyond the age at which traditional patching is used. This handheld platform provides a convenient and effective platform for implementing the newly proposed binocular treatment of amblyopia in the clinic, home, or elsewhere.

Infected pressure ulcers in the long-term-care facility.

Pressure ulcers occur with some frequency in the elderly, debilitated population in long-term-care facilities. Pressure ulcers cause morbidity and mortality and, by virtue of breaking the integumentary barrier, predispose to skin and soft-tissue infections. The latter often are deep and require lengthy medical and surgical therapy. Prevention depends on avoidance of pressure, as well as providing adequate nutrition and meticulous skin care.

Professional preparation of elementary teachers in Ohio: status of K-6 health education.

Improving the health status of children and youth depends to an extent on the adequate preparation of elementary teachers to teach health education. This survey: 1) examined the status of health education preparation that preservice elementary education majors receive from Ohio colleges and universities (n = 50); 2) determined the type of health education courses that Ohio colleges and universities require for elementary education majors; and 3) assessed the extent to which Ohio colleges and universities incorporate health and pedagogy-related content in their courses for elementary education majors. Results showed that 40 of the 50 institutions offered a health course. Twelve different textbooks were used in the courses. Coverage of course content ranged from much to none for 10 survey items ranging from the National Health Education Standards to the K-6 Health Instruction Responsibilities and Competencies.

Surgical options in wound healing.

This article addresses methods of reconstruction for major acquired and traumatic soft-tissue defects in adults. The reconstructive ladder is used as a basis for discussing the various options for surgical closure. Conditions such as facial trauma, head and neck cancer, median sternotomy, sternal osteomyelitis, bronchopleural fistula, necrotizing fascitis, pressure ulcers, and degloving injuries are used as examples of reconstruction. Nursing aspects, including postoperative flap monitoring, are reviewed. Outcomes of reconstruction, including flap failure, are addressed.

Surgical management of pressure ulcers.

This article describes how debridement and dressings are used to clean wounds prior to closure with myocutaneous flaps. Post-operative care focuses on promoting flap perfusion, especially by reducing pressure on the flap and by promoting wound drainage. Rehabilitation of the patient is imperative to reduce recidivism.

Dietary level of maize oil affects growth and lipid composition of Walker 256 carcinosarcoma.

Walker 256 carcinosarcoma cells (1 x 10(4)) were injected into the right thigh muscle of Sprague-Dawley rats (125 g) consuming isoenergetic (200 g fat/kg) diets containing 20, 100 and 200 g maize oil/kg and 180, 100 or 0 g hydrogenated lard/kg respectively. Ten rats from each dietary regimen were killed every 4th day. Tumours grew rapidly from day 0 to day 8 post-transplant regardless of dietary regimen. However, after 8 d more tumours regressed and there were fewer deaths in animals fed on 200 g maize oil/kg compared with animals fed on 20 or 100 g maize oil/kg. Linoleic acid (LA) levels were higher in phospholipids (PL) of growing tumours than in regressing tumours whereas arachidonic acid levels in PL were lower in growing tumours indicating a possible alteration in the desaturation and elongation of LA. Serum prostaglandin E2 levels were slightly lower in rats with regressing tumours than in rats with growing tumours.

Effects of polyunsaturated fatty acids on the efficacy of antineoplastic agents toward L5178Y lymphoma cells.

Modification of cultured lymphoma cells (L5178Y) with individual unsaturated fatty acids [oleic acid (OA), linoleic acid (LA), alpha-linolenic acid (alpha-LNA), arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA)] influenced cell growth and the responses of the cells to the chemotherapeutic agents doxorubicin (DRN), dexamethasone (DEX) and mitomycin-C (MTC). Cell proliferation generally decreased following modification with highly unsaturated fatty acids (> 10 microM). The effects of drugs on growth varied with the type of fatty acid. Preincubation with alpha-LNA enhanced survival of L5178Y cells exposed to DRN. Modification with AA, EPA or DHA (> 10 microM) reduced cell proliferation, particularly when cells were subsequently exposed to 50 or 100 nM DRN. There was no consistent relationship between fatty acid chain length, degree of unsaturation, and survival of cells when exposed to DEX or MTC. The data showed that modification of cultured L5178Y cells with highly unsaturated fatty acids, particularly DHA, enhances the toxic action of chemotherapeutic agents.

Dietary n-3 fatty acids alter murine peritoneal macrophage cytotoxicity.

Male CD-1 mice were fed diets containing 10 wt% fat composed of a constant amount of n-6 polyunsaturated fatty acids (PUFA; safflower oil, 1.5 wt%) and increasing levels of n-3 PUFA (up to 1.5 wt%); the remaining fat was a 50:50 mixture of tripalmitin and triolein. Four days prior to sacrifice, the animals were injected intraperitoneally with sterile thioglycollate. Peritoneal macrophages were analyzed for phospholipid fatty acids, prostaglandin E2 (PGE2) synthesis and cytotoxicity towards L929 target cells. Increasing dietary n-3 PUFA increased macrophage phospholipid n-3 PUFA from 4.4 to 11.0 mol% with a concomitant decline in n-6 PUFA from 15.5 to 10.9 mol%, and PGE2 synthesis declined from 2.6 to 1.5 pmol/million cells in thioglycollate-elicited macrophages. Macrophage cytotoxicity toward target L929 cells declined by approximately 50% with increasing n-3 PUFA concentration.

Continuing hospital care in Scotland: a survey of consultant geriatricians.

We report a survey of Consultant Geriatricians in Scotland with regard to the provision of continuing geriatric care. There are wide variations in the numbers of patients that individual consultants are responsible for, the type and geographical site on which a service is provided, and also in views on the adequacy of staffing levels. Quality of physical surroundings and nursing care are generally thought to be more than adequate. Consultants believed their main contribution was providing expert medical advice, and felt their patients' quality of life could most be improved by increased diversional therapy. There are wide geographical differences in the number of private nursing and residential homes in Scotland but they have had some influence on the criteria for placement of patients in continuing hospital care.

The suppression of eicosanoid synthesis by peritoneal macrophages is influenced by the ratio of dietary docosahexaenoic acid to linoleic acid.

The efficacy of docosahexaenoic acid (DHA) in suppressing eicosanoid synthesis by peritoneal macrophages in vivo was influenced by the relative amount of dietary DHA when linoleic acid (LA) was held constant. Increasing DHA from 0 to 37% of the fatty acids in diets containing 10 weight % fat (of which LA was 40%) caused an eleven-fold increase in the DHA content of macrophages. Limited retroconversion of DHA to eicosapentaenoic acid was observed. Macrophages in animals consuming DHA synthesized significantly lower amounts of leukotriene E4, prostaglandin E2 and 6-keto prostaglandin F1 alpha in vivo upon stimulation with zymosan. The maximum inhibition of eicosanoid synthesis was observed when the dietary DHA/LA ratio was 0.16 and no further inhibition occurred when the ratio was increased up to 0.81.

Effects of dietary n-3 polyunsaturated fatty acids on phospholipid composition and calcium transport in mouse cardiac sarcoplasmic reticulum.

The effects of dietary n-3 and n-6 polyunsaturated fatty acids on the fatty acid composition of phospholipid, Ca++. Mg++ ATPase and Ca++ transport activities of mouse sarcoplasmic reticulum were investigated. Mice were fed a 2 weight percent fat diet containing either 0.5 weight percent ethyl esters of 18:3n-3, 20:5n-3 or 22:6n-3 as a source of n-3 polyunsaturated fatty acid or 0.5 weight percent safflower oil as a source of n-6 polyunsaturated fatty acid for 10 days. Olive oil (2 weight percent) was used as a control diet. Although feeding n-6 polyunsaturated fatty acid induced very little modifications of the phospholipid sarcoplasmic reticulum fatty acid composition, feeding n-3 polyunsaturated fatty acid altered it markedly. Inclusion of 18:3n-3, 20:5n-3 or 22:6n-3 in the diet caused an accumulation of 22:6n-3, which replaced 20:4n-6 and 18:2n-6 in phospholipid sarcoplasmic reticulum. The saturated fatty acids were significantly increased with a concurrent reduction of 18:1n-9. These changes in the fatty acid composition resulted in a decrease in the values of the n-6/n-3 polyunsaturated fatty acid ratio and a decrease in the ratio of 20 carbon to 22 carbon fatty acids esterified in the phospholipid sarcoplasmic reticulum. This was associated with a decrease in Ca++ uptake by n-3 polyunsaturated fatty acid enriched sarcoplasmic reticulum vesicles as compared with n-6 fatty acid and control diet sarcoplasmic reticulum vesicles. However, neither the affinity for Ca++ nor the maximal velocity of ATP hydrolysis activity of Ca++.MG++ATPase were altered by the different diets.(ABSTRACT TRUNCATED AT 250 WORDS)

Docosahexaenoic acid and other dietary polyunsaturated fatty acids suppress leukotriene synthesis by mouse peritoneal macrophages.

The efficacy of individual omega-3 polyunsaturated fatty acids (PUFA) in altering eicosanoid synthesis in peritoneal macrophages was studied by feeding mice for 10 days a diet containing 2 wt % fat, which included 0.5 wt % ethyl esters of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) or linolenic acid (LNA). Upon stimulation with calcium ionophore A23187, macrophages from these animals produced significantly lower amounts of leukotriene C4, leukotriene B4 and 12-hydroxyeicosatetraenoic acid, prostaglandin E2 and 6-keto prostaglandin F1 alpha compared with those obtained from animals on the diets containing olive oil or safflower oil. The decrease in leukotriene synthesis was similar in the animals fed DHA, EPA or LNA diets. This depression of eicosanoids by DHA and EPA was associated with decreased levels of arachidonic acid (AA); however, LA that altered eicosanoids did not have the same effect on AA levels.

Dietary menhaden oil: effects on the rate and magnitude of modification of phospholipid fatty acid composition of mouse heart and brain.

1. Male CD-1 white mice, 18-20 g body-weight, were given semi-purified diets containing 100 g menhaden oil (MO) or hydrogenated coconut oil (HCO)/kg for 23 d. Mice were killed on days 0, 3, 5, 7, 14, 23. After 23 d of MO supplementation the remaining mice were switched to the HCO diet for an additional 10 d. 2. The progressive change(s) in the polyunsaturated fatty acid (PUFA) composition of cardiac and brain phospholipid classes were followed during the MO supplementation and depletion periods. 3. The content of fatty acids 20:5n-3, 22:5n-3 and 22:6n-3 increased immediately following ingestion of the MO diet and continued to increase at a steady rate in both heart and brain phospholipid classes. 4. In general, the period required to reach steady-state was 1 week for n-3 PUFA and 18:2n-6, and 2 weeks for 20:4n-6. 5. Cessation of MO consumption for 10 d resulted in marked decreases in the content of n-3 PUFA and increases in n-6 PUFA in cardiac phospholipids in particular. Brain phospholipids were less responsive. 6. The results suggest that dietary fish oil must be consumed for at least 1 week before maximum changes in PUFA composition are observed, and fish oil ingestion must be continuous to maintain elevated n-3 PUFA levels in heart and brain phospholipids.

Surgical management of pressure ulcers.

Prior to closure of pressure ulcers, the patient's wound must be clean, and he must be in a stable condition. Closure involves rotating flaps of muscle and skin into the wound. Maintaining adequate blood supply to the flap and teaching the patient how to prevent new ulcers are the foci of post-operative care.