Peripheral refraction with eye and head rotation with contact lenses

Purpose: To evaluate the impact of eye and head rotation in the measurement of peripheral refraction with an open-field autorefractometer in myopic eyes wearing two different center-distance designs of multifocal contact lenses (MFCLs). Methods: Nineteen right eyes from 19 myopic patients (average central M ± SD = −2.67 ± 1.66 D) aged 20–27 years (mean ± SD = 23.2 ± 3.3 years) were evaluated using a Grand-Seiko autorefractometer. Patients were fitted with one multifocal aspheric center-distance contact lens (Biofinity Multifocal D®) and with one multi-concentric MFCL (Acuvue Oasys for Presbyopia). Axial and peripheral refraction were evaluated by eye rotation and by head rotation under naked eye condition and with each MFCL fitted randomly and in independent sessions. Results: For the naked eye, refractive pattern (M, J0 and J45) across the central 60◦ of the horizontal visual field values did not show significant changes measured by rotating the eye or rotating the head (p > 0.05). Similar results were obtained wearing the Biofinity D, for both testing methods, no obtaining significant differences to M, J0 and J45 values (p > 0.05). For Acuvue Oasys for presbyopia, also no differences were found when comparing measurements obtained by eye and head rotation (p > 0.05). Multivariate analysis did not showed a significant interaction between testing method and lens type neither with measuring locations (MANOVA, p > 0.05). There were significant differences in M and J0 values between naked eyes and each MFCL. Conclusion: Measurements of peripheral refraction by rotating the eye or rotating the head in myopic patients wearing dominant design or multi-concentric multifocal silicone hydrogel contact lens are comparable.

The impact of urban noise on primary schools: perceptive evaluation and objective assessment

This paper aims to assess the impact of environmental noise in the vicinity of primary schools and to analyze its influence in the workplace and in student performance through perceptions and objective evaluation. The subjective evaluation consisted of the application of questionnaires to students and teachers, and the objective assessment consisted of measuring in situ noise levels. The survey covered nine classes located in three primary schools. Statistical Package for Social Sciences was used for data processing and to draw conclusions. Additionally, the relationship of the difference between environmental and background noise levels of each classroom and students with difficulties in hearing the teacherâ s voice was examined. Noise levels in front of the school, the schoolyard, and the most noise-exposed classrooms (occupied and unoccupied) were measured. Indoor noise levels were much higher than World Health Organization (WHO) recommended values: LAeq,30min averaged 70.5 dB(A) in occupied classrooms, and 38.6 dB(A) in unoccupied ones. Measurements of indoor and outdoor noise suggest that noise from the outside (road, schoolyard) affects the background noise level in classrooms but in varying degrees. It was concluded that the façades most exposed to road traffic noise are subjected to values higher than 55.0 dB(A), and noise levels inside the classrooms are mainly due to the schoolyard, students, and the road traffic. The difference between background (LA95,30min) and the equivalent noise levels (LAeq,30min) in occupied classrooms was 19.2 dB(A), which shows that studentsâ activities are a significant source of classroom noise.

Metabolic engineering with multi-objective optimization of kinetic models

Kinetic models have a great potential for metabolic engineering applications. They can be used for testing which genetic and regulatory modifications can increase the production of metabolites of interest, while simultaneously monitoring other key functions of the host organism. This work presents a methodology for increasing productivity in biotechnological processes exploiting dynamic models. It uses multi-objective dynamic optimization to identify the combination of targets (enzymatic modifications) and the degree of up- or down-regulation that must be performed in order to optimize a set of pre-defined performance metrics subject to process constraints. The capabilities of the approach are demonstrated on a realistic and computationally challenging application: a large-scale metabolic model of Chinese Hamster Ovary cells (CHO), which are used for antibody production in a fed-batch process. The proposed methodology manages to provide a sustained and robust growth in CHO cells, increasing productivity while simultaneously increasing biomass production, product titer, and keeping the concentrations of lactate and ammonia at low values. The approach presented here can be used for optimizing metabolic models by finding the best combination of targets and their optimal level of up/down-regulation. Furthermore, it can accommodate additional trade-offs and constraints with great flexibility.

Objective function based fuzzy clustering in air traffic management

Data analysis, fuzzy clustering, fuzzy rules, air traffic management

The effect of structural fund spending on the spanish regions: an assessment of the 1994-99 objective 1 CSF

This paper analyzes the growth and employment effects of the 1994-99 Community Support Framework (CSF) for the Objective 1 Spanish regions using a simple supply-side model estimated with a panel of regional data. The results suggest that the impact of the Structural Funds in Spain has been quite sizable, adding around a percentage point to annual output growth in the average Objective 1 region and 0.4 points to employment growth. Over the period 1994-2000, the Framework has resulted in the creation of over 300,000 new jobs and has eliminated 20% of the initial gap in income per capita between the assisted regions and the rest of the country.

Objective analysis of gait coordination for total knee arthroplasty outcome

Introduction: Coordination is a strategy chosen by the central nervous system to control the movements and maintain stability during gait. Coordinated multi-joint movements require a complex interaction between nervous outputs, biomechanical constraints, and pro-prioception. Quantitatively understanding and modeling gait coordination still remain a challenge. Surgeons lack a way to model and appreciate the coordination of patients before and after surgery of the lower limbs. Patients alter their gait patterns and their kinematic synergies when they walk faster or slower than normal speed to maintain their stability and minimize the energy cost of locomotion. The goal of this study was to provide a dynamical system approach to quantitatively describe human gait coordination and apply it to patients before and after total knee arthroplasty. Methods: A new method of quantitative analysis of interjoint coordination during gait was designed, providing a general model to capture the whole dynamics and showing the kinematic synergies at various walking speeds. The proposed model imposed a relationship among lower limb joint angles (hips and knees) to parameterize the dynamics of locomotion of each individual. An integration of different analysis tools such as Harmonic analysis, Principal Component Analysis, and Artificial Neural Network helped overcome high-dimensionality, temporal dependence, and non-linear relationships of the gait patterns. Ten patients were studied using an ambulatory gait device (Physilog®). Each participant was asked to perform two walking trials of 30m long at 3 different speeds and to complete an EQ-5D questionnaire, a WOMAC and Knee Society Score. Lower limbs rotations were measured by four miniature angular rate sensors mounted respectively, on each shank and thigh. The outcomes of the eight patients undergoing total knee arthroplasty, recorded pre-operatively and post-operatively at 6 weeks, 3 months, 6 months and 1 year were compared to 2 age-matched healthy subjects. Results: The new method provided coordination scores at various walking speeds, ranged between 0 and 10. It determined the overall coordination of the lower limbs as well as the contribution of each joint to the total coordination. The difference between the pre-operative and post-operative coordination values were correlated with the improvements of the subjective outcome scores. Although the study group was small, the results showed a new way to objectively quantify gait coordination of patients undergoing total knee arthroplasty, using only portable body-fixed sensors. Conclusion: A new method for objective gait coordination analysis has been developed with very encouraging results regarding the objective outcome of lower limb surgery.

An objective anisotropic elastic plastic model and Algorithm applicable to bone mechanics

The implicit projection algorithm of isotropic plasticity is extended to an objective anisotropic elastic perfectly plastic model. The recursion formula developed to project the trial stress on the yield surface, is applicable to any non linear elastic law and any plastic yield function.A curvilinear transverse isotropic model based on a quadratic elastic potential and on Hill's quadratic yield criterion is then developed and implemented in a computer program for bone mechanics perspectives. The paper concludes with a numerical study of a schematic bone-prosthesis system to illustrate the potential of the model.

Family doctors' consultations with people suffering from chronic pain without objective findings: Which protective practices might they develop in these challenging medical encounters?

Introduction: Consultations with patients suffering from chronic pain without objective findings represent a challenge fo r family doctors (FDs). A mutual lack of understanding may arise, which threatens the doctor-patient relationship and may lead to dissatisfaction of both patient and doctor and to a breakdown of the therapeutic alliance. Objectives: This study aims to investigate FDs' potential protective practices to preserve the doctor-patient relationship during this type of consultation. Method: In the first step of this qualitative research, I carried out a range of 10 se- mi-structured interviews with FDs to explore their reported practices and repre- sentations during consultations with people suffering from chronic pain without objective findings. The interviews' transcripts were integrally analysed with computer-assisted thematic content analysis (QSR NVivo ® ) to highlight the main themes related to the topic in the participants' talk. Results: At this point of the research, two types of FDs' protective practices can be identified: first the use of complementary sources of knowledge in addition to the medical model to provide explanations to patients, second the collaboration with multidisciplinary teams or support gr oups that allow them to share profes- sional expertise and emotional experiences. Conclusion: The findings could be useful to develop ways to improve the follow- up of patients suffering from chronic pain without objective findings and conse- quently the FDs' work satisfaction.

Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

Background Delirium is an independent predictor of increased length of stay, mortality, and treatment costs in critical care patients. Its incidence may be underestimated or overestimated if delirium is assessed by using subjective clinical impression alone rather than an objective instrument. Objectives To determine frequency of discrepancies between subjective and objective delirium monitoring. Methods An observational cohort study was performed in a surgical-cardiosurgical 31-bed intensive care unit of a university hospital. Patients' delirium status was rated daily by bedside nurses on the basis of subjective individual clinical impressions and by medical students on the basis of scores on the objective Confusion Assessment Method for the Intensive Care Unit. Results Of 160 patients suitable for analysis, 38.8% (n = 62) had delirium according to objective criteria at some time during their stay in the intensive care unit. A total of 436 paired observations were analyzed. Delirium was diagnosed in 26.1% of observations (n = 114) with the objective method. This percentage included 6.4% (n = 28) in whom delirium was not recognized via subjective criteria. According to subjective criteria, delirium was present in 29.4% of paired observations (n = 128), including 9.6% (n = 42) with no objective indications of delirium. A total of 8 patients with no evidence of delirium according to the objective criteria were prescribed haloperidol and lorazepam because the subjective method indicated they had delirium. Conclusions Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition.

Objective comparison of image quality and dose between conventional and synchrotron radiation mammography.

The shape of the energy spectrum produced by an x-ray tube has a great importance in mammography. Many anode-filtration combinations have been proposed to obtain the most effective spectrum shape for the image quality-dose relationship. On the other hand, third generation synchrotrons such as the European Synchrotron Radiation Facility in Grenoble are able to produce a high flux of monoenergetic radiation. It is thus a powerful tool to study the effect of beam energy on image quality and dose in mammography. An objective method was used to evaluate image quality and dose in mammography with synchrotron radiation and to compare them to standard conventional units. It was performed systematically in the energy range of interest for mammography through the evaluation of a global image quality index and through the measurement of the mean glandular dose. Compared to conventional mammography units, synchrotron radiation shows a great improvement of the image quality-dose relationship, which is due to the beam monochromaticity and to the high intrinsic collimation of the beam, which allows the use of a slit instead of an anti-scatter grid for scatter rejection.

Iowa Adult Basic Education Program Benchmark Objective for Program Year, 2002

The benchmark objectives for Program Year 2002 are designed to improve Iowa's basic skills literacy program in those instructional programs, educational functioning levels, and follow-up categories which did not achieve the negotiated benchmark levels for Program Year 2001. The instructional programs, educational functioning levels and follow-up categories in which the attained benchmarks met or exceeded the negotiated benchmarks for Program Year 2001 should not be allowed to fall below the Program Year 2001 levels for Program Year 2002.

A multi-objective model for a multi-period distribution management problem

The problems arising in commercial distribution are complex and involve several players and decision levels. One important decision is relatedwith the design of the routes to distribute the products, in an efficient and inexpensive way.This article deals with a complex vehicle routing problem that can beseen as a new extension of the basic vehicle routing problem. The proposed model is a multi-objective combinatorial optimization problemthat considers three objectives and multiple periods, which models in a closer way the real distribution problems. The first objective is costminimization, the second is balancing work levels and the third is amarketing objective. An application of the model on a small example, with5 clients and 3 days, is presented. The results of the model show the complexity of solving multi-objective combinatorial optimization problems and the contradiction between the several distribution management objective.