About vital staining of the eye and eyelids. I. The anatomy, physiology, and pathology of the eyelid margins and the lacrimal puncta by E. Marx. 1924.

This article is a translation of the original article authored by Eugen Marx and published in 1924.1 Amazingly, many of the issues addressed in the 1924 publication are now, >80 years later, of prime interest for both understanding the lid margin and ocular surface and thus for dry eye diagnosis and treatment. To assist the reader and possibly to provoke further contemplation on a particular section of the translation, we have inserted comments, identified throughout the text. All references, in their original format, have been included in this translation, except those referred to in a few paragraphs that were not readily understood in today's technical language and which were omitted. The first figure of the original article is not included in this translation because it was referred to in one of the few omitted paragraphs.

[Multisite validation study of questionnaire assessing out-patient satisfaction with care questionnaire in ambulatory chemotherapy or radiotherapy treatment]. / Validation multicentrique d'un questionnaire de satisfaction des soins lors d'un traitement de chimiothérapie ou radiothérapie ambulatoire.

Patient satisfaction is now recognised as an important quality of care outcome which is particularly relevant in oncology. Adapted from the EORTC In-Patsat32, the Out-Patsat35 is a 35-item satisfaction with care questionnaire measuring cancer outpatients' perception of hospital doctors and nurses, as well as aspects of care organisation and services. This study assessed the psychometric properties of this scale. Patients undergoing ambulatory chemotherapy (CT) or radiotherapy (RT) in 7 cancer centres in France were invited to complete at home the Out-Patsat35 as well as EORTC QLQ-C30 for psychometric testing. Of 416 eligible patients recruited, 96% returned the questionnaire. Most patients (71% in CT; 69% in RT) completed this scale within 15 minutes and the mean rate of item omission was only 4.4%. Confirmatory analyses revealed good convergent validity and excellent internal consistency, although some subscales within the Out-Patsat35 were relatively highly correlated. Items and subscales of the Out-Patsat35 and of the QLQ-C30 were not significantly correlated, underlying that the two questionnaires are assessing quite distinct concepts. The subscales of the Out-Patsat35 were not related to age, gender and education, suggesting a cultural evolution in French cancer patients towards a greater homogeneity in their opinion toward care. This study supports the acceptability to patients, and the psychometric properties of the EORTC Out-Patsat35 questionnaire.

Asymmetric modulation of human visual cortex activity during 10 degrees lateral gaze (fMRI study).

We used BOLD fMRI to study the differential effects of the direction of gaze on the visual and the ocular motor systems. Fixation of a target straight ahead was compared to fixation of a target 10 degrees to the right and 10 degrees to the left from gaze straight ahead, and to eyes open in complete darkness in thirteen healthy volunteers. While retinotopic coordinates remained the same in all fixation conditions, the fixation target shifted with respect to a head-centered frame of reference. During lateral fixation, deactivations in higher-order visual areas (one ventral cluster in the lingual and fusiform gyri and one dorsal cluster in the postero-superior cuneus) and, as a trend, activations in early visual cortical areas were found predominantly in the hemisphere contralateral to the fixation target. We propose that visual processing is performed predominantly in the hemisphere contralateral to gaze direction, even during small gaze shifts into one visual hemifield. The excitability of visual neurons may be modulated depending on eye position to construct a head-centered frame of reference from a retinotopic input, thus allowing perceptual stability of space during eye movements. A further finding was that BOLD signal increases in fronto-parietal ocular motor and attentional structures were more pronounced during lateral than central fixation.

[Burn out syndrome in oncology]. / Le point sur le syndrome d'épuisement professionnel des soignants ou burn out, en cancérologie.

SEPS or burnout syndrome was described among health care workers. Oncology care givers--physicians and nurses--can be concerned. Burnout is a chronical stress reaction. Emotional exhaustion and depersonalisation are more prevalent than low personal accomplishment. Burnout is essentially assessed by questionnaires. Oncologists report an higher level of burnout, than AIDS medical or palliative care staff. Causes of burn out are numerous: insufficient personal time, sense of failure,... followed by poorly management and difficulties in staff or institution relationships. Prevention and therapy of burn out can be considered on three levels: personal, (psychotherapy, advices on health way of life), team (improvement in communication) and institution (support meetings and talking groups).

A consciência: algumas concepções atuais sobre sua natureza, função e base neuroanatômica / Consciousness: some current conceptions on its nature, function and neuroanatomic basis

Após um século da ênfase nos processos mentais inconscientes dada por Freud, estes se tornaram largamente aceitos, e, nos últimos anos, na verdade tem se verificado que o maior mistério reside na natureza da consciência. A distinção entre a consciência no sentido de coma/vigília, no sentido de consciência moral e no sentido da sensação de existir e estar vivenciando algo, encontrou respaldo nos avanços da neurociência. Esta última acepção, o "sentimento do que acontece" nas palavras de Damásio, presente durante o sonhar e ausente em certos estados de vigília como nas crises de ausência, é a propriedade de certos processos mentais que mais tem sido alvo de estudo. Evidências recentes sugerem que tanto a sensação de continuidade da consciência quanto a impressão de que ela preceda a tomada de decisão seriam ilusórias. Também a antiga crença de que a consciência fosse uma função dependente de um funcionamento cortical global tem sido questionada. A evolução da consciência a partir dos mecanismos de homeostase, como um feed-back sofisticado dos processos mentais que permite a detecção de erros nas predições realizadas pelo cérebro sobre o self e o ambiente, com a possibilidade de correções em partes do processo mental sem a necessidade de descartá-lo por inteiro, são exemplos das modernas compreensões sobre este tema, e que têm importantes implicações para a clínica psicoterápica. Neste trabalho, os autores revisam algumas das principais teorias recentes sobre a consciência, sua natureza, funções, aspectos evolucionistas, relação com a linguagem, com os sistemas de memória e com a questão da integração dos diferentes inputs e registros mnêmicos numa cena unificada do self interagindo com o ambiente, salientando que, embora já tenhamos alguns desenvolvimentos muito interessantes, a compreensão do tema ainda está nos seus primórdios.

Electrical and optical properties of semiconductor nanocrystals.

Application of semiconductor nanocrystals in optoelectronic devices requires an understanding not only of their emission and absorption properties, but also of the processes of charge injection and transport in nanocrystalline films. Here, we present measurements of the electrical properties of nanocrystalline films and of blends of nanocrystals with conjugated polymers. We also describe the attachment of nanocrystals to semiconductor surfaces, and we investigate the emission of nanocrystalline films in microcavity structures and at high excitation intensities.

Measurements and predictions of light scattering by clear coatings.

Comparisons are made between calculated and measured angle-resolved light-scattering distributions from clear dielectric isotropic epoxy coatings over a range of rms roughness conditions, resulting in strongly specular scattering to diffuse scattering characteristics. Calculated distributions are derived from topography measurements performed with interferometric microscopes. Two methods of calculation are used. One determines the intensity of scattered light waves with a phase integral in the Kirchhoff approximation. The other is based on the reflection of light rays by locally flat surfaces. The angle-resolved scattering distributions for the coatings are measured with the spectral trifunction automated reference reflectometer (STARR) developed by the National Institute of Standards and Technology. Comparisons between measured and calculated results are shown for three surfaces with rms roughness values of approximately 3, 150, and 800 nm for an angle of incidence of 20 degrees .

Achieving restraint-free care of acutely confused older adults.

Restraint-free care has emerged as an indicator of quality care for older adults in all settings. The most difficult challenges to achieving this goal are care of hospitalized older adults who are functionally dependent and cognitively impaired. The purpose of this article is to report findings from a descriptive study of restrained hip fracture patients, and discuss approaches to achieving restraint-free care. Rate of restraint use was 33.2% among hospitalized hip fracture patients during an 11-year period in 20 metropolitan teaching hospitals. Restrained patients were older men who resided in nursing homes prior to hospitalization. Clinically, restrained patients had a diagnosis of dementia, were noted to be confused or disoriented by nursing staff, and were dependent in activities of daily living. An individualized approach to care is the best method to avoid use of physical restraints for patients with acute confusion and cognitive impairment.

Comparison of nurse practitioner and family physician relative work values.

PURPOSE: With the enactment of the Balanced Budget Act of 1997, American nurse practitioners were granted direct Medicare reimbursement for Part B services. Payment structures in fee-for-service and managed care systems are physician-based, leading to difficulties in constructing payments for other health care professionals. The purpose of this pilot study was to examine the feasibility of using nurse practitioner data for specifying relative work values in the Medicare Fee Schedule for three office-visit codes. DESIGN: An exploratory survey was designed to establish relative work values using magnitude-estimation scaling. Nurse practitioners (N = 43) responded to a structured questionnaire in a national mail survey. Physician data (N = 46) were obtained from a computerized database from the American Academy of Family Physicians. METHODS: The methods used in this study were the same as the process used by the American Medical Association and the Health Care Financing Administration to establish relative work values in the Medicare Fee Schedule. Respondents established relative work values for three Current Procedural Terminology (CPT) codes for office visits (99203, 99213, 99215) commonly billed in primary care practice. Each CPT code descriptor and associated vignette were compared with reference services germane to the practice of nurse practitioners and family physicians, using magnitude-estimation scaling. To establish relative work values for each code, respondents were asked to consider the time to provide the service and intensity of the work involved for each CPT code. FINDINGS: No significant differences between nurse practitioners and family physicians were found in the three CPT codes for relative work values and intensity. Nurse practitioners estimated significantly (p < .01) higher intraservice (face to face) time with patients than did family physicians, and family physicians estimated significantly (p < .05) higher pre-service time for two codes and significantly (p < .05) higher postservice times for three codes. CONCLUSIONS: Nurse practitioner relative work values did not differ significantly from family physician relative work values. Although the sample sizes were small, the significance of the findings support the need for further research with large data sets and additional CPT codes. Such studies could then be used as a basis for decisions about Medicare payment and public policy.

Reimbursement for acute care nurse practitioner services.

Until the passage of the Balanced Budget Act of 1997, acute care nurse practitioners could not be directly reimbursed for inpatient services provided to Medicare patients. With the enactment of this legislation, acute care nurse practitioners may now be directly compensated for care provided. The historical and contextual issues that surround reimbursement for nursing and advanced practice nursing services are reviewed to serve as a foundation for understanding the current Medicare reimbursement regulations. The implications of the Balanced Budget Act of 1997 for acute care nurse practitioners and their professional colleagues are critically examined. The language of the Balanced Budget Act of 1997 and the subsequent rules and regulations issued by the Health Care Financing Administration are reviewed with specific focus on implications for acute care nurse practitioners. The opportunities for reimbursement for services provided by acute care nurse practitioners are more extensive than ever before. Acute care nurse practitioners and their physician colleagues will be wise to become fully conversant with the changes in Medicare reimbursement regulations.

Nurse practitioner services: content and relative work value.

The resource-based relative value scale is used to quantify work for reimbursement of services in the Medicare Fee Schedule. This pilot study explored use of the resource-based relative value scale for services provided by nurse practitioners. Estimation of relative work values for office visits by nurse practitioners was consistent with the Medicare Fee Schedule. Content analysis revealed that nurse practitioners provide additional services including comprehensive patient evaluation and education and attendance to social factors. Future research is needed to examine systems that identify and reimburse nurse practitioners for their services.

Angular distribution of light scattered from a sinusoidal grating.

The angular distributions of light scattered by gold-coated and aluminum-coated gratings with amplitudes of approximately 90 nm and periods of 6.67 microm were measured and calculated for light incident from a He-Ne laser at an angle of 6 degrees. Experimental results are compared with predictions of Beckmann's scalar theory and Rayleigh's vector theory. The measured scattering pattern has a background of scattered light due mainly to residual surface roughness. Also the power in the higher-order peaks is larger by several orders of magnitude than the computed one, which can be attributed mainly to the low-order contributions of the harmonics in the profile.

Initiation of physical restraint in nursing home residents following restraint reduction efforts.

In this pilot study a one group pretest posttest design was employed to identify resident characteristics and environmental factors associated with initiation of physical restraint. Predictors of restraint initiation for older adults were examined using secondary analysis of an existing data set of nursing home residents who were subjected to a federal mandate and significant restraint reduction efforts. Lower cognitive status (OR = 1.5 [for every 7-point decrease in Mini-Mental State Examination], 95% CI = 1.0, 2.1) and a higher ratio of licensed nursing personnel (OR = 3.7, 95% CI = 1.2, 11.9) were predictive of restraint initiation. Key findings suggest that restraint initiation occurs, despite significant restraint reduction efforts, when a nursing home resident is cognitively impaired or when more licensed nursing personnel (predominantly licensed practical nurses) are available for resident care. Achievement of restraint-free care in nursing homes requires specific and individualized approaches for residents who are cognitively impaired, as well as greater attention to staff mix of registered nurses, licensed practical nurses, and nursing aides.

Representational abilities and the hearing status of child/mother dyads.

Two representational abilities, expressive and receptive language and symbolic play, were assessed in multiple formats in hearing and deaf 2-year-old children of hearing and deaf mothers. Based on maternal report, hearing children of hearing and deaf mothers produced more words than deaf children of hearing mothers, hearing children of hearing mothers more words than deaf children of deaf mothers, and deaf children of deaf mothers more words than deaf children of hearing mothers. Based on experimenter assessments, hearing children in both groups produced and comprehended more words than deaf children in both groups. By contrast, no differences emerged among these groups in child solitary symbolic play or in child-initiated or mother-initiated child collaborative symbolic play; all groups also increased equivalently in symbolic play between solitary and collaborative play. Representational language and symbolic play were unrelated in hearing children of hearing mothers and in deaf children of deaf mothers, but the 2 abilities were associated in children in the 2 child/mother mismatched hearing status groups. These findings are placed in the context of a proposed developing modularity of verbal and nonverbal symbol systems, and the implications of hearing status in communicative exchanges between children and their mothers in diverse hearing and deaf dyads are explored.

Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts.

OBJECTIVES: To examine predictors of continued restraint use in nursing home residents following efforts aimed at restraint reduction. DESIGN: Secondary analysis of data from a clinical trial using a one-group, pre-test post-test design. SETTING: Three nonprofit, religion-affiliated nursing homes in a metropolitan area. PARTICIPANTS: The sample consisted of 201 physically restrained nursing home residents. Following restraint reduction efforts, 135 of the sample were still restrained. Mean age of participants was 83.9 years. MEASUREMENTS: Physical restraint use was measured by observation and included any chest/vest, wrist, mitt, belt, crotch, suit, or harness restraint plus any sheet used as restraint or a geriatric chair with fixed tray table. Nursing home residents were subjected to any one of three conditions aimed at restraint reduction, including adherence to the mandate of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), staff education, and education with consultation from a gerontological clinical nurse specialist. Resident characteristics including dependency, health status, mental status, depression, behavior, fall risk; presence of treatment devices and institutional factors were determined. RESULTS: Physical dependency, lower cognitive status, behavior, presence of treatment devices, presence of psychiatric disorders, fall risk, and fall risk as staff rationale for restraint were associated (P < .10) with continued restraint use. Nursing hours, staff mix, prevalence of restraint use by unit, and site were also associated (P < .10) with continued use of physical restraints. Following bivariate analysis, associated resident characteristics were subjected to logistic regression. Lower cognitive status (OR = 2.4 (for every 7-point decrease in MMSE), 95% CI, 1.7, 3.3) and fall risk as staff rationale for restraint (OR = 3.5, 95% CI., 1.5, 8.0) were predictive of continued restraint use. Adding nursing hours, staff mix, and prevalence of restraint use by unit to the logistic regression model was not statistically significant (partial chi-square = 2.79, df = 6, P = .834). Nursing home site was added to the model without changing the significance (P < .05) of cognitive status or fall risk as a staff rationale for restraint use. CONCLUSION: Continued restraint use in nursing home residents in this study most often occurred with severe cognitive impairment and/or when fall risk was considered by staff as a rationale for restraint. Efforts to reduce or eliminate physical restraint use with these groups will require greater efforts to educate staff in the assessment and analysis of fall risk, along with targeted interventions, particularly when cognition is also impaired.

The preparedness of students to discuss end-of-life issues with patients.

PURPOSE: To explore how well medical schools prepare students to address end-of-life issues with their patients. METHOD: In 1997, the authors surveyed 226 fourth-year students at Georgetown University School of Medicine and Mayo Medical School, assessing relevant knowledge, experiences, and attitudes, and the students' sense of preparedness to address end-of-life issues. RESULTS: Seventy-two percent (162) of the eligible students responded. Almost all (99%) recognized the importance of advance directives and anticipated discussing end-of-life issues with patients in their practices (84%). However, only 41% thought their education regarding end-of-life issues had been adequate, only 27% had ever discussed end-of-life issues with a patient themselves, and only 35% thought they had had adequate exposure and education regarding advance directives. Eighty percent favored more education about end-of-life issues. Educational exposure to end-of-life issues and to role models, ability to correctly define an advance directive, number of end-of-life discussions witnessed, and age all were associated the students' sense of preparedness to discuss advance directives with patients. CONCLUSION: Most of the students felt unprepared to discuss end-of-life issues with their patients, but wanted to learn more. The factors associated with a sense of preparedness suggest several possible, easily made, educational interventions, but further research is required to understand the scope of the problem and to implement curricular modifications.

Ethics education for medical house officers: long-term improvements in knowledge and confidence.

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions.