On-road driving performance by persons with hemianopia and quadrantanopia.

PURPOSE: This study was designed to examine the on-road driving performance of drivers with hemianopia and quadrantanopia compared with age-matched controls. METHODS: Participants included persons with hemianopia or quadrantanopia and those with normal visual fields. Visual and cognitive function tests were administered, including confirmation of hemianopia and quadrantanopia through visual field testing. Driving performance was assessed using a dual-brake vehicle and monitored by a certified driving rehabilitation specialist. The route was 14.1 miles of city and interstate driving. Two "back-seat" evaluators masked to drivers' clinical characteristics independently assessed driving performance using a standard scoring system. RESULTS: Participants were 22 persons with hemianopia and 8 with quadrantanopia (mean age, 53+/-20 years) and 30 participants with normal fields (mean age, 52+/-19 years). Inter-rater agreement for back-seat evaluators was 96%. All drivers with normal fields were rated as safe to drive, while 73% (16/22) of hemianopic and 88% (7/8) of quadrantanopic drivers received safe ratings. Drivers with hemianopia or quadrantanopia who displayed on-road performance problems tended to have difficulty with lane position, steering steadiness, and gap judgment compared to controls. Clinical characteristics associated with unsafe driving were slowed visual processing speed, reduced contrast sensitivity and visual field sensitivity. CONCLUSIONS: Some drivers with hemianopia or quadrantanopia are fit to drive compared with age-matched control drivers. Results call into question the fairness of governmental policies that categorically deny licensure to persons with hemianopia or quadrantanopia without the opportunity for on-road evaluation.

Development of a nursing home vision-targeted health-related quality of life questionnaire for older adults.

PURPOSE: To develop a questionnaire assessing vision-targeted health-related quality of life in older adults residing in nursing homes. METHODS: Using content previously identified through structured interviews with nursing home residents, the 57-item Nursing Home Vision-Targeted Health-Related Quality of Life questionnaire (NHVQoL) was drafted with nine subscales - general vision, reading, ocular symptoms, mobility, psychological distress, activities of daily living, activities/hobbies, adaptation/coping and social interaction. Construct validity and internal consistency and test-retest reliability of subscales were evaluated in a sample of adults >or=60 years old residing in nursing homes in Birmingham, Alabama, who had Mini Mental State Exam (MMSE) scores of >or=13. RESULTS: Participants (n=189) had a mean age of 82 years (SD=7.7), were 84% women and 16% men, 24% African-American and 76% Caucasian and had resided in a nursing home for two years on average. All NHVQoL subscales were correlated with subscales from other vision-targeted and generic health-related quality of life instruments (ADVS, 0.43 to 0.85; VF-14, 0.46 to 0.84; SF-36, 0.19 to 0.43). Lower scores were associated with increased depressive symptomatology by the Geriatric Depression Scale (-0.23 to -0.59), increased mobility problems (-0.17 to -0.54), worse distance and near acuity (-0.21 to -0.51) and worse contrast sensitivity (0.20 to 0.50). All subscales had Cronbach alpha>0.95. Test-retest reliability (two-week period) for subscales ranged from 0.57 to 0.84. Subscale scores did not differ as a function of MMSE scores. CONCLUSIONS: The NHVQoL has subscales with good internal consistency reliability and validity. Test-retest reliability is comparable to other questionnaires designed for the nursing home population. This questionnaire may ultimately be useful in understanding the personal burden of visual impairment and eye disease on quality of life and mental health in older nursing home residents and for evaluating the impact of psychosocial and eye care interventions on health-related quality of life in this population.

Effect of refractive error correction on health-related quality of life and depression in older nursing home residents.

OBJECTIVE: To examine the effect of treating uncorrected refractive error through spectacle correction on vision-targeted health-related quality of life and depressive symptoms in nursing home residents. METHODS: Persons aged 55 years or older residing in nursing homes in Birmingham, Alabama, having uncorrected refractive error were randomly assigned to either immediate spectacle correction of uncorrected refractive error or delayed correction (after the 2-month follow-up visit). MAIN OUTCOME MEASURES: Vision-targeted health-related quality of life (measured with the Nursing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire and the VF-14) and depressive symptoms (measured with the Geriatric Depression Scale), assessed at baseline and at 2 months. RESULTS: At the 2-month follow-up, the immediate refractive error correction group as compared with the delayed correction group had higher scores on the Nursing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire subscales of general vision, reading, psychological distress, activities and hobbies, and social interaction (all P < .04) and the VF-14 (P < .001) as well as fewer depressive symptoms on the Geriatric Depression Scale (P = .003), adjusting for mental status and baseline outcome variables. CONCLUSIONS: Dispensing spectacles to treat uncorrected refractive error in nursing home residents leads to improved quality of life and decreased symptoms of depression. APPLICATION TO CLINICAL PRACTICE: This study demonstrates that older adults residing in nursing homes can personally benefit from access to the most basic of eye care services. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00347620.

The visual status of older persons residing in nursing homes.

OBJECTIVE: To characterize habitual visual acuity, contrast sensitivity, spectacle use, and eye care utilization in a large sample of older adults residing in nursing homes. METHODS: Of 33 nursing homes identified in Birmingham, Alabama, 17 served as sites. Eligibility criteria included age 55 years or older, English-speaking, and Mini-Mental State Examination score of 13 or higher. Habitual distance and near visual acuity and contrast sensitivity were measured for each eye and binocularly. Residents and a family member/guardian were interviewed about spectacle use and eye care utilization. Medical records provided information on demographics, chronic medical conditions, date of last eye examination, duration of residence in the nursing home, and health insurance. RESULTS: Of 380 enrollees, 57% had distance visual acuity in the better eye worse than 20/40; 10% had visual acuity of 20/200 or worse. Near visual acuity was slightly worse on average by a line than distance acuity. Three-fourths of residents had abnormal binocular contrast sensitivity. The medical record had no record of or reference to an eye examination for 66% of enrollees despite 90% having health insurance. CONCLUSION: The high rate of visual impairment in nursing homes underscores the need to understand its causes and to evaluate interventions to address this public health challenge.

Impact of cataract surgery on health-related quality of life in nursing home residents.

AIM: To assess the impact of cataract surgery in nursing home residents on health-related quality of life, as compared to those who have cataracts but who do not undergo surgery. METHODS: A prospective cohort study enrolled 30 nursing home residents (>or=60 years old) who had cataracts and underwent cataract surgery, and evaluated vision-targeted and generic health-related quality of life and depressive symptoms before and approximately 4 months after surgery. This cataract surgery group was compared to 15 nursing home residents who had cataracts but who did not have surgery, over the same timeframe. RESULTS: Visual acuity for near and distance and contrast sensitivity improved following cataract surgery (p<0.001). Adjusting for age differences in the two groups, the cataract surgery group exhibited significant score improvement in the general vision (p = 0.005), reading (p = 0.001), psychological distress (p = 0.015), and social interaction (p = 0.033) subscales of the Nursing Home Vision-targeted Health-Related Quality of Life Questionnaire and the VF-14 (p = 0.004). There were no group differences in the SF-36, Geriatric Depression Scale or the Cataract Symptom Score. CONCLUSION: Nursing home residents who underwent cataract surgery because of functional problems experienced significant improvements in their vision-targeted health-related quality of life, in addition to dramatically improved vision.

Plasma cleaning of dental instruments.

The theoretical risk of prion transmission via surgical instruments is of current public and professional concern. These concerns are further heightened by reports of the strong surface affinity of the prion protein, and that the removal of organic material by conventional sterilization is often inadequate. Recent reports of contamination on sterilized endodontic files are of particular relevance given the close contact that these instruments may make with peripheral nerve tissue. In this paper, we report the effective use of a commercial gas plasma etcher in the cleaning of endodontic files. A representative sample of cleaned, sterilized, files was screened, using scanning electron microscopy and energy-dispersive X-ray analysis, to determine the level of contamination before plasma cleaning. The files were then exposed for a short-term to a low-pressure oxygen-argon plasma, before being re-examined. In all cases, the amount of organic material (in particular that which may have comprised protein) was reduced to a level below the detection limit of the instrument. This work suggests that plasma cleaning offers a safe and effective method for decontamination of dental instruments, thus reducing the risk of iatrogenic transmission of disease during dental procedures. Furthermore, whilst this study focuses on dental files, the findings indicate that the method may be readily extended to the decontamination of general surgical instruments.

Oclusión arterial aguda del miembro inferior simultáneo con embolismo pulmonar, manifestados tardíamente / Acute arterial occlusion of inferior simultaneous limb with pulmonar embolism

Los autores presentan un caso de un paciente joven con antecedente de trauma abdominal cerrado en accidentes de tránsito, quien después de tres semanas de hospitalización inició cuadro simultáneo de embolismo pulmonar e isquemia aguda del miembro inferior izquierdo. En el contexto se presenta el caso y se revisa la literatura.

Evaluation of commercial enzyme immunoassays compared to immunofluorescence and double diffusion for autoantibodies associated with autoimmune diseases.

A commercially available enzyme immunoassay system for detecting autoantibodies to double-stranded DNA, deoxyribonucleoprotein, Smith, ribonuclearprotein, Sjögren's syndrome-associated antigens A and B, and scleroderma-associated antigen 70 was compared to the conventional immunofluorescence assay for double-stranded DNA and double diffusion assays for extractable nuclear antigens. There was excellent correlation between methods, but it appears that the enzyme immunoassays are more sensitive. Based on the results of this study, the authors recommend performing anti-nuclear antibody screening at two dilutions, with enzyme immunoassay follow-up of appropriate patient sera that are positive on anti-nuclear antibody testing. Nucleolar and centromere pattern anti-nuclear antibodies are diagnostic for variants of scleroderma and need no further evaluation. Negative anti-nuclear antibody tests performed using HEp-2 tissue culture cells require no further evaluation.

Stereological analyses of the structure of mitochondria in pigeon skeletal muscle.

The mitochondria in type-I and -II muscle fibres in the pectoralis major muscle of the pigeon (Columba livia) have been analysed using stereological techniques not previously applied in muscle biology. Mitochondrial volume fractions (VV) were estimated in different regions of each type of muscle fibre using randomly orientated sampling sectors within fibre profiles. These sectors were sub-divided into smaller sampling regions to provide accurate data on the intracellular distribution of mitochondria. Estimates of the external surface densities of mitochondria per unit volume of fibre, SV total surface, and also the densities of mitochondrial cristae, SV total cristae, were obtained using a specific technique derived for analysing anisotropic structures (Saltykov, 1958). The relative amounts of the random and orientated mitochondrial membranes were also estimated. Significant differences were found to exist between the different types of muscle fibres and considerable though constant variations in the intracellular arrangement of mitochondria were also found.

Ultrastructure of muscle spindles in C57BL/6J dy2J/dy2J dystrophic mice.

The sensory organs of skeletal muscles, the muscle spindles, were examined using electron microscopy in dy2J/dy2J dystrophic mice. Despite widespread damage to the extrafusal (skeletomotor) fibres the intrafusal (spindle) fibres appeared normal and seemed resistant to the aetiological factors for murine dystrophy.