Search

Objective: To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill. Design: Retrospective, observational cohort study. Setting: Medical Intensive Care Unit (MICU). Participants: Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU. Interventions: Not applicable. Measurements and Main Results: Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, P

Proglacial forefields commonly include highly dynamic fluvial systems associated with the fundamental instability between topography, flow hydraulics and sediment transport. However, there is limited knowledge of how these systems respond to changing subglacial hydrology and sediment supply. We investigated this relationship using the first continuous field‐collected data sets for both suspended and bedload sediment export and proglacial river dynamics for an Alpine glacier forefield, the Glacier d'Otemma, Switzerland. The results show a strong sensitivity of fluvial morphodynamics to the balance between sediment transport capacity and supply. When subglacial bedload export rates exceeded fluvial transport capacity, we found bar construction leading to net forefield aggradation and surficial coarsening, especially on bar heads. This intensified braiding buffered the downstream transport of coarse sediment. When subglacial bedload export rates were lower than transport capacity, incision occurred, with reduced braiding intensity, net erosion and important amounts of bedload leaving the proglacial system. We found a net fining of surficial deposits except for very isolated coarsening patterns on bar heads. Thus, proglacial forefield morphodynamics are strongly conditioned by subglacial hydrology and sediment supply, but this conditioning is also influenced by the response of the forefield itself. Proglacial forefields have an important influence on the longitudinal connectivity of sediment flux in regions sensitive to climate change, such as recently deglaciated high mountain areas. The linkages we report between subglacial processes and river morphodynamics are critical for understanding the development of embryonic forefield ecosystems. Plain Language Summary: This study focuses on Alpine proglacial forefields, braided fluvial streams flowing in deglaciated terrains, and their geomorphic response to both sediment and water exported from retreating glaciers. This is achieved using the first continuous field‐collected data sets combining sediment flux quantifications at the glacier terminus and downstream changes of the river over time collected in the Glacier d'Otemma forefield (Switzerland). Results show that the fluvial landscape in recently deglaciated terrains changes rapidly, influenced by the balance between the amount of sediment being transported from under the glacier and the river's capacity to carry it. When the released amount of sediment matches the river's capacity, the deposition of coarser material dominates and the stream becomes more complex with increasing braiding intensity. However, when the river carries more sediment than supplied by the glacier, flow becomes more confined into fewer channels, promoting the erosion of previously deposited material, particularly for the coarser sediment fractions. The study emphasizes how both the river configuration and the landscape near a melting glacier depend on whether the river itself can transport the quantities of sediment delivered by the glacier. This balance can affect the downstream sediment flux from glaciered catchments and the development of ecosystems following climate change‐induced glacier retreat. Key Points: First study combining continuous subglacial sediment export rates and proglacial forefield geomorphic change at the melt season scaleStrong sensitivity of proglacial forefield morphodynamics to subglacial bedload export rates and fluvial transport capacityBar construction processes filter the downstream transport of bedload particles buffering the longitudinal connectivity of sediment flux [ABSTRACT FROM AUTHOR]

Helga P Sandoval,1 Stephen Lane,2 Stephen Slade,3 Eric D Donnenfeld,4 Richard Potvin,5 Kerry D Solomon1 1Carolina Eyecare Physicians, LLC, Mt. Pleasant, SC, USA; 2Associated Eye Care, Stillwater, MN, USA; 3Slade & Baker Vision, Houston, TX, USA; 4Ophthalmic Consultants of Long Island, Long Island, NY, USA; 5Science in Vision, Bend, OR, USACorrespondence: Kerry D SolomonCarolina Eyecare Physicians, LLC, 1101 Clarity Road, Suite 100, Mt Pleasant, SC 29464, USAEmail kerry.solomon@carolinaeyecare.comPurpose: To evaluate the rotational stability of a toric extended depth of focus (EDOF) intraocular lens (IOL), using either slit lamp evaluation or image-processing software.Setting: Three clinical practices in the USA.Design: Prospective unmasked randomized clinical trial.Methods: Subjects presenting for routine cataract surgery that were interested in improved near vision received toric EDOF lenses (TECNIS Symfony® Toric) in both eyes. The measures of interest in the current analysis were the change in orientation of the IOL between 1 day, 1 month and 3 months postoperative. Orientation was measured at the microscope on the day of surgery, and with the slit lamp at all other visits. Day 1, 1-month and 3-month images of the lens orientation were captured with a slit lamp camera. Differences in orientation were recorded and analyzed.Results: A total of 150 eyes had IOL orientation data available. Image analysis showed mean absolute lens orientation changes from 1 day to 1 month and 3 months of less than 2 degrees. The percentage of lenses exhibiting rotation of ≤ 5 degrees between any measured time points was 97% or higher. Results were similar, but significantly more variable, when IOL orientation was measured at the slit lamp.Conclusion: The toric EDOF lens evaluated here demonstrated rotational stability that exceeded the prior ANSI standard. The best method to determine IOL orientation changes was through image analysis.  Keywords: TECNIS symfony toric, toric IOL, rotational stability

Helga P Sandoval,1 Stephen Lane,2 Stephen G Slade,3 Eric D Donnenfeld,4 Richard Potvin,5 Kerry D Solomon1 1Carolina Eyecare Physicians, LLC, Mt. Pleasant, SC, USA; 2Associated Eye Care, Stillwater, MN, USA; 3Slade & Baker Vision, Houston, TX, USA; 4Ophthalmic Consultants of Long Island, Long Island, NY, USA; 5Science in Vision, Akron, NY, USACorrespondence: Kerry D SolomonCarolina Eyecare Physicians, LLC, 1101 Clarity Road, Suite 100, Mt Pleasant, SC 29464, USAEmail kerry.solomon@carolinaeyecare.comPurpose: To evaluate the defocus curve and patient satisfaction after implantation of an extended depth of focus (EDOF) toric IOL when both eyes were targeted for emmetropia and when the non-dominant eye was targeted for mini monovision (− 0.50D).Methods: A prospective unmasked randomized clinical trial in three clinical practices in the USA. Subjects presenting for routine cataract surgery were assigned to one of two groups, both receiving bilateral toric EDOF lenses. One group had the non-dominant eye targeted for slight myopia (− 0.50D). Measures of interest were the postoperative defocus curve and reported patient satisfaction and visual disturbances.Results: Questionnaire and defocus curve data were available from 37 subjects in the Emmetropia group, while the mini monovision group included questionnaire data from 39 subjects and valid defocus curve data from 14 subjects. Mini monovision subjects had significantly better VA (a half line to a line better, p < 0.05), from a defocus of − 1.50 D to − 3.00 D. Reported spectacle wear and satisfaction were not significantly different between groups at any distance, but more patients in the mini monovision group reported the ability to function comfortably without glasses at near and overall (near p = 0.02, overall p < 0.01). Halos and starbursts were the two phenomena reported most often for both groups, with reported starbursts slightly more common in the mini monovision group.Conclusions: A slightly myopic correction in the non-dominant eye improved binocular near vision by 0.5 to 1.0 lines based on defocus curve data. Patients reported better functional vision, but with a slight increase in reported starbursts in the mini monovision group.Keywords: symfony, extended depth of focus, intraocular lens, cataract surgery, monovision

Background: Suicide is a major public health concern and one of the leading causes of mortality worldwide. People with an at‐risk‐mental‐state (ARMS) for psychosis are more vulnerable to psychiatric co‐morbidity and suicide, however, there are limited data from low‐middle‐income countries. The present study aimed to identify the prevalence of depressive symptoms and suicidal ideation along with sociodemographic and clinical correlates of suicidal ideation in individuals with ARMS from Pakistan. Method: Participants between the age of 16 and 35 years who met the criteria for ARMS based on the Comprehensive Assessment of At‐Risk Mental State (CAARMS), were recruited from the community, general practitioner clinics and psychiatric units across Pakistan (n = 326). Montgomery and Asberg Depression Rating Scale (MADRS) and Social‐Occupational‐Functional‐Assessment‐Scale (SOFAS) were administered to participants. Results: The prevalence of depressive symptoms and suicidal thoughts in the sample at baseline were 91.1% (n = 297) and 61.0% (n = 199), respectively. There were significant mean differences between groups (mean difference [95% CI]; p‐value) without suicidal ideation and with suicidal ideation on measures of MADRS (−5.47 [−7.14, −3.81]; p <.001), CAARMS non‐bizarre ideas (−0.29 [−0.47, −0.11]; p =.002) and perceptual abnormalities (−0.23 [−0.41, −0.04]; p =.015). Conclusion: These findings indicate that suicidal ideation and depressive symptoms are highly prevalent in individuals with ARMS in Pakistan. Given the pivotal developmental stages that ARMS presents, and the poor outcomes associated with co‐morbid depression, there is an urgent need to prioritize the development of low‐cost and scalable evidence‐based interventions to address psychiatric comorbidity and suicidality in the ARMS population in Pakistan. [ABSTRACT FROM AUTHOR]

Introduction: Interprofessional education (IPE) is advocated by governments, health professional bodies and universities as key to health professional education and improvement in patient safety. Although many universities have implemented scaffolded IPE curricular models across multiple disciplines, few have reported on faculty perception of this approach. This study sought to explore faculty perception in response to a new IPE curriculum model using the theoretical lens of social capital theory. Methods: In 2021, 24 key University of Sydney Faculty of Medicine and Health (FMH) academics (from nursing, medical imaging, pharmacy, oral health, dentistry, applied science, health science, dietetics, medical science and occupational therapy) involved in the delivery of IPE were invited to participate in individual interviews. Using the conceptual lens of social capital theory, framework analysis was used to categorise themes in the data. Results: In total, 46% (n = 11) of invited FMH faculty were interviewed. Positive elements to the implementation of the curriculum model included a feeling of connectedness, recognition of a scaffolded approach to IPE integrated in existing coursework and growing interest of early career academics in IPE. However, a number of challenges were revealed, including structural barriers in course design, timetabling, misunderstanding regarding the IPE curricula and inequity in distribution of workload. Conclusion: Social capital theory provided a useful framework to consider the perceived enablers and barriers to the newly established IPE curriculum. Although the findings indicate that faculty felt positive about implementing the IPE curriculum, a number of barriers were identified, highlighting the need for increased faculty training and broader engagement in development of IPE curricula. [ABSTRACT FROM AUTHOR]