"On Arrival Block"-Management of Upper Extremity Trauma with Resuscitation in the Operating Room.

"On Arrival Block," wherein a brachial block is given to a severely injured upper extremity as the first step of the management protocol in the main operating room, bypassing the emergency department, has been found to be a "game changer" in trauma care. Immediate pain relief on arrival builds confidence in the system, allows pain-free initial examination, facilitates use of tourniquet if there are major bleeding wounds, and allows us to obtain good radiographs without an overlap of bones, which usually happens when the radiographs are taken within a bandage. Using the "On Arrival Block" system, emergency room assessment and resuscitation is bypassed. The patient is resuscitated only once, instead of twice. This avoids much duplication of effort, wasted time, patient suffering, unnecessary costs, and mistakes generated by miscommunication between 2 resuscitation teams. This can be done only in the place where all the resuscitative equipment and drugs are available. A senior anesthesiologist and surgeon must be available. The only contraindication is the suspicion of a brachial plexus injury, which can cause the local anesthetic to seep in through the open dural sleeve and cause total spinal anesthesia. "On Arrival Block" was set up at Ganga Hospital, Coimbatore, India, during the early 90s by the anesthesiologist Ravindra Bhat and the plastic surgeon Raja Sabapathy out of necessity, who recognized its value and made it the standard of care.

Two models of experimental myopia in the mouse.

PURPOSE: The purpose of this study was to test the response of the mouse eye to two methods for the induction of experimental myopia. METHODS: Growth patterns of eyes were determined by axial length measurements from birth to adult in eyes of both sexes of normal mice examined on post-natal day 1 to 6 months and at 1 year. For the induction of experimental myopia, Balb/cJ mice were prepared with either unilateral lid suture or by a -10D spectacle lens placed over one eye at post-natal day 10. Other mice received a plano lens as a control for lens wear. Refraction was carried out at post-natal days of 28, 42 and 56 in lid suture and spectacle lens wear group by streak retinoscopy. Axial length was measured by a combination of video image photography, digital caliper, or Optical Low Coherence Interferometry (OLCI). Corroborative optical modeling of the mouse eye was carried out using ZEMAX ray tracing software. RESULTS: Axial length (AL) increased linearly between post-natal day 1 to day 56, plateauing at about 140 days. After 18 days of unilateral lid suture initiated 10 days after birth, the AL of experimental eyes was 3.032+/-0.003 mm, while AL in contra-lateral control eyes was 2.981+/-0.005 mm (mean+/-sem, p<0.05, n=40), after 32 days, the AL of experimental eyes was 3.290+/-0.004 mm, and the AL of control eyes was 3.104+/-0.002 mm (p<0.001, n=60). After 46 days of lid closure AL of experimental eyes was 3.592+/-0.003 mm, while AL of control eyes was 3.363+/-0.003 mm (p<0.001, n=80). Spectacle lens wear of 46 days duration increased AL in experimental eyes to 3.721+/-0.002 mm, while AL in control eyes was 3.354+/-0.003 mm (p<0.001, n=100). Refraction and ray tracing analysis substantiated the dimensional changes to be consistent with increased AL. CONCLUSIONS: Two procedures to induce experimental myopia, initiated at eye opening, produced significant myopic shifts corresponding to increases in axial lengths after 32 and 46 days of lid suture and after 46 days wearing a -10D spectacle lens.

Enhancement of far-field spatial coherence of a partially coherent light source by source masking.

The role of a sharp autocorrelation phase mask, called the bleached uniformly redundant array, for improving the spatial coherence in the far-field of partially coherent light sources is studied. It is shown both theoretically and experimentally that the input source correlation plays an important role in determining the amount of enhancement introduced by the phase mask.

Coherent optical processing using noncoherent light after source masking.

Coherent optical processing starting with spatially noncoherent illumination is described. Good spatial coherence is introduced in the far field by modulating a noncoherent source when masks with sharp autocorrelation are used. The far-field mutual coherence function of light is measured and it is seen that, for the masks and the source size used here, we get a fairly large area over which the mutual coherence function is high and flat. We demonstrate traditional coherent processing operations such as Fourier transformation and image deblurring when coherent light that is produced in the above fashion is used. A coherence-redundancy merit function is defined for this type of processing system. It is experimentally demonstrated that the processing system introduced here has superior blemish tolerance compared with a traditional processor that uses coherent illumination.