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Purpose To determine the prevalence and morphologic features of reticular pseudodrusen (RPD) and their association with participant demographics and age-related macular degeneration (AMD) status in the Carotenoids in Age-Related Eye Disease Study 2 (CAREDS2) sample, an ancillary study of the Women’s Health Initiative Observational Study. Design Cross-sectional, multicenter, natural history study. Participants Nine hundred and twenty-seven eyes from 466 postmenopausal women 69 to 101 years of age. Methods Multimodal imaging, including spectral-domain (SD) OCT and infrared reflectance (IR), were used to identify RPD characteristics, including location (within or outside the 6-mm diameter circle centered at the macula), presence of peripapillary RPD, pattern of RPD, and RPD area. Age-related macular degeneration features from SD OCT, IR, and color photographs also were assessed and AMD severity was categorized. Main Outcome Measures Reticular pseudodrusen prevalence using SD OCT and IR imaging and AMD status. Results Reticular pseudodrusen were present in 130 eyes (14% of eyes, 16% of participants), with increasing prevalence with age: 7% in those younger than 78 years, 14% in those 78 to 83 years of age, and 30% in those older than 83 years. Using clinical classification of AMD with color photography, RPD were seen in 2.4% of eyes with no AMD or aging changes, 11.5% in early AMD, 25.1% in intermediate AMD, and 51.1% in late AMD. Mean RPD area was 17.4 mm2 (standard deviation, 14.7 mm2). Ribbon morphologic RPD (53%) was more common than dot morphologic RPD (36%). Reticular pseudodrusen mostly were located both within and outside the 6-mm circle with primarily superior retinal distribution. Reticular pseudodrusen were visualized with corresponding color fundus photography in only 38 eyes (4% of total eyes). Participants with and without RPD had a visual acuity±standard error of 77.9 ± 1.4 letters and 81.3 ± 0.4 letters, respectively (P = 0.02). Conclusions The prevalence of RPD in CAREDS2 increased with age and was associated with AMD severity. Reticular pseudodrusen were detected in eyes without other features of AMD and could represent an earlier disease state. Multimodal imaging with SD OCT and IR has significantly greater sensitivity for visualizing RPD than color fundus photography.

Purpose The treatment of severe and chronic substance dependence is challenged by high rates of treatment attrition, highlighting the need to identify factors that hinder treatment retention. The paper aims to discuss this issue. Design/methodology/approach The present study examined certain neurocognitive and personality traits in relation to treatment retention in a sample of 46 residents of an Australian therapeutic community (TC). The traits examined were previously found to be associated with problematic substance use in non-clinical samples and were also previously shown to differentiate TC clients from social drinkers. The hypothesis was thus that traits that appear to be risk factors for addictions are also likely to impact on TC treatment retention. Findings Group comparisons of those retained for more than the recommended 90 days vs those who left treatment prematurely showed that after controlling for the influence of depression, those who left treatment prematurely reported significantly higher levels of trait impulsivity, punishment sensitivity and executive cognitive dysfunction. There was a very high rate of alexithymia in the sample (52 per cent), but alexithymia was unrelated to retention. Research limitations/implications The final sample size was less than planned but reflected the strict participation criteria and temporal limitations of this study. No statistical assumptions were violated and the reliability indices of the scales completed by clients ranged from acceptable to excellent. Another limitation was that dropout cannot be assumed to mean relapse, as the reasons for client dropout were not available. Originality/value Findings highlight the important roles of trait factors in TC treatment retention in addition to the motivational and interpersonal factors identified in previous work.

There has been limited research exploring the beliefs and attitudes of male patients regarding the gender of their nurses. These attitudes, as well as the factors affecting the gender-preference of male patients, must be explored in a flexible, holistic manner. The objective of our study was to explore key aspects of male patients’ beliefs and attitudes about the gender of their nurses in the hospital setting, as well as the factors that influenced those perceptions. We employed a descriptive, qualitative, cross-sectional design. Data were collected through one-on-one interviews, which were transcribed verbatim. A deductive and inductive approach using content analysis of each question was used to analyse the data. Ten male patients were interviewed. Initially, participants reported no gender preference for their nurses. The majority agreed that the nature of the task did not matter in their preference for a male or female nurse. Most suggested that females were inherently better suited to nursing than males due to their ability to be caring, nurturing, and detail-oriented. Bussey and Bandura’s Social Cognitive Theory of Gender Development and Differentiation was supported and provided a suitable framework for the study. There is a need for educational institutions to determine new ways to teach male nursing students to be caring, nurturing, and detail-oriented. Whether nurses are male or female, having a caring approach is important to patients, as well as possessing other ‘ideal’ characteristics.

A perioperative nurse leader's ability to effect positive change and inspire others to higher levels of achievement is related to his or her leadership style in the practice setting and the leadership style that is present across the organization. The American Nurses Credentialing Center's Magnet™ designation and redesignation process requires the demonstration of transformational leadership as one of the components of excellence. Transformational leadership can increase nurses' job satisfaction and commitment to the organization and organizational culture. Engaging staff members in the transition to transformational leadership and developing a common mission, vision, and goals are keys to success in the surgical setting. Bass's four interrelated leadership components-idealized influence, inspirational motivation, intellectual stimulation, and individual consideration-and associated behaviors were used by surgical services leaders in an East Coast, two-hospital system to successfully achieve redesignation as a Magnet facility.

The manufacturing inspection process of large composite surfaces a coordinated real-time control/acquisition system. Existing ultrasonic inspection systems use a single ultrasonic transducer or in some cases effectors containing two ultrasonic channels. The large amount of surface area presented by the fuselage barrels compels the use of ultrasonic arrays containing up to 102 elements (channels) in order to meet the scan times necessary to satisfy production rates. The exterior inspection system uses an array containing 64 elements and the interior system has a dedicated manipulator containing 96 array elements and an additional 6 channels to cover the radius of the hat stiffeners. The surface coverage rates necessary to meet the desired scan times are approximately 12 inches/sec. Digital waveform data will be acquired on each of the array elements and individual transducers at each 0.05 inch increment along the surface. This data acquisition rate will digitize approximately 24,500 waveforms per second. In addition to placing enormous data storage demands on the data system, waveforms must be moved from the digitizer module and written to disk at a very high rate. The system also has the requirement to retrieve waveforms from the storage system for signal analysis and display during the acquisition process, eliminating the possibility of using a stream-store or similar device. Current inspection systems use a hard real-time operating system (RTOS) to arm and fire the digitizer at each spatial position, and rely on interrupts from the digitizer hardware to efficiently move the digitized waveforms to memory in a deterministic time. The problem that arises from this methodology is that the hardware requires a driver written for the specific RTOS. This requires expensive and unique development environments including compilers, debuggers, and necessitates testing in the kernel mode. Developing a driver can be a very complex task and requires cooperation from the hardware vendor to provide low level register information. The solution under development by the Boeing Automated Systems Group uses a deep memory paradigm, consisting of a programmable digitizer capable of storing waveforms in system memory using direct memory access (DMA) and a circular buffer scheme. The digitizer can acquire more waveforms than the available on-board memory, requiring only that the controller offload data at a high rate, but eliminating the need for a deterministic response. The digitizer has an extremely fast rearm time and will not miss an event trigger even at the fastest rates. Software communication with the digitizer is through the provided Windows driver model (WDM) driver running on an embedded PC with standard embedded Windows XP, eliminating the need to develop a device driver. Initial testing produced waveform rates well in excess of specifications. This concept allows use of commercial off the shelf (COTS) hardware and software while leveraging many existing system components of the automated ultrasonic scanning system (AUSS) developed by the Automated Systems Group. Significant cost and development time savings were realized in addition to exceeding waveform analysis requirements. This newly developed system architecture will support the 787 manufacturing inspection process in the United States, Australia, and Italy.

Current generation implantable cardioverter defibrillators use monophasic, biphasic, or sequential pulse shocks, most of which truncate after a given time, dumping the remaining charge on the capacitor through an internal resistor. We hypothesized that having an additional current pathway, and delivering the majority of the remaining charge on a single capacitor to the two pathways using additional shock phases, would improve defibrillation efficacy. This hypothesis was tested by comparing DFTs using a simulated single capacitor, single-biphasic shock (two 5-ms pulses separated by 0.2 ms), delivered to coupled pairs of electrodes, to those using a sequential-biphasic shock (four 5-ms pulses separated by 0.2 ms) delivered to separate opposing electrodes, delivered from the same electrodes for both waveforms. In eight open-chest anesthetized pigs, four mesh electrodes (Medtronic TX-7, 6.5 cm2), were sutured on the epicardium of the anterior and posterior surfaces of each ventricle. Shocks were delivered from a 200-microF capacitor bank. Triplicate DFTs were obtained using each waveform in a randomized crossover design. Initial leading edge voltage (mean +/- SEM: 420 +/- 33 V vs 497 +/- 34 V; P < 0.05), initial peak current (4.8 +/- 0.4 A vs 13 +/- 1.1 A; P < 0.001), and delivered energy (16.9 +/- 2.6 J vs 30.4 +/- 5.3 J; P < 0.05) at the DFT were all significantly lower using sequential-biphasic shocks than those using single-biphasic shocks, respectively. We conclude that for direct heart defibrillation, it is worthwhile to combine sequential capability to biphasic shocks and deliver the remaining charge on the capacitor to the two different pathways.

A curvilinear relationship between extraversion and performance on an operant task for retarded adults was hypothesized. Following previous research with subjects with disturbed cognitive processes, the curve was hypothesized to be opposite from the usual Yerkes-Dodson relationship. The Eysenck-Withers Personality Inventory Extraversion scale was orally administered to 20 adult retardates. These subjects were then required to push a button on either the left or right side for M&M candies. The side that was reinforced changed five times. The number of errors made after the changes indicated the quality of performance. A significant curvilinear relationship between extraversion and errors was found, with moderately introverted subjects making more errors than either extremely introverted or extraverted subjects.