Perceived difficulty of various steps of manual small incision cataract surgery among trainees in rural China

Background: The perceived difficulty of steps of manual small incision cataract surgery among trainees in rural China was assessed. Design: Cohort study. Participants: Fifty-two trainees at the end of a manual small incision cataract surgery training programme. Methods: Participants rated the difficulty of 14 surgical steps using a 5-point scale, 1 (very easy) to 5 (very difficult). Demographic and professional information was recorded for trainees. Main Outcome Measure: Mean ratings for surgical steps. Results: Questionnaires were completed by 49 trainees (94.2%, median age 38 years, 8 [16.3%] women). Twenty six (53.1%) had performed ≤50 independent cataract surgeries prior to training. Trainees rated cortical aspiration (mean score±standard deviation=3.10±1.14) the most difficult step, followed by wound construction (2.76±1.08), nuclear prolapse into the anterior chamber (2.74±1.23) and lens delivery (2.51±1.08). Draping the surgical field (1.06±0.242), anaesthetic block administration (1.14±0.354) and thermal coagulation (1.18±0.441) were rated easiest. In regression models, the score for cortical aspiration was significantly inversely associated with performing >50 independent manual small incision cataract surgery surgeries during training (P=0.01), but not with age, gender, years of experience in an eye department or total number of cataract surgeries performed prior to training. Conclusions: Cortical aspiration, wound construction and nuclear prolapse pose the greatest challenge for trainees learning manual small incision cataract surgery, and should receive emphasis during training. Number of cases performed is the strongest predictor of perceived difficulty of key steps. © 2013 Royal Australian and New Zealand College of Ophthalmologists.

Dissection of the early steps in the assembly of the 20S proteasome in Saccharomyces cerevisiae

Tese de dout., Bioquímica (Biologia Celular e Molecular), Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2010

Steps of Memorial Hall, Chapman College, Orange

Students on the entrance steps of Memorial Hall, Chapman College, Orange.

Steps of Waltmar Theatre, Moulton Hall, Chapman College, Orange, California

Steps of Waltmar Theatre, Moulton Hall, Chapman College, Orange, California. Completed in 1975 (2 floors, 44,592 sq.ft.), Moulton Hall is named in memory of an artist and patroness of the arts, Nellie Gail Moulton. Within this structure are the departments of Art, Communications, and Theatre/Dance as well as the Guggenheim Gallery and Waltmar Theatre. Waltmar Theatre was a gift from the late Walter and Margaret Schmid.

Empowering Nursing Leaders to Facilitate Healthy Work Environments: First Steps

The purpose of this project was to examine the literature for perspectives on healthy work environments (HWE). HWEs have been identified as important factors in the nursing profession to enhance recruitment, retention, job satisfaction, and accountability. This paper identifies that the front line manager is an essential role within organizations, and directly impacts work environments. Within this paper it has been pointed out that professional organizations have provided some general recommendations for improving work environments which include increasing nurses’ accountability and teamwork, providing opportunities for shared decision making, having supportive leadership, providing recognition, educational support, and adequate staffing. However, enacting them all can be difficult due to front line manager capacity, the impending nursing shortage, organizational resources and barriers. Based on the literature, conclusions have been drawn and recommendations for future research have been identified. HWE strategies have been developed with implementation plans for my practice area.

Photograph - Charles W. Band, Jessie Shaw Band and a child sitting on the Steps of a House

A photograph of Charles W. Band, Jessie Shaw Band , and a child sitting together on the steps of a house.

Photograph - Group Photo on Rock Steps

A photograph of a large group/family photo on the rock steps of an outdoors location. There are nine individuals and one dog in the photograph.

Preparing Students with ASD for Inclusive Classrooms: A Case Study of Giant Steps

Giant Steps is a therapeutic school for children with Autism Spectrum Disorder (ASD) founded in 1995 by a group of parents who felt that the public school system was not fully able to meet the needs of their children. While the education system has progressed through the years to offer all students with access to public education, many educators still are not adequately prepared to provide inclusive learning environments for students with ASD. Given the prevalence of ASD in southern Ontario (1 in every 42 boys and 1 in every 189 girls), research on ASD and inclusive practices is both vital and timely. The purpose of this qualitative case study is to understand how the Giant Steps program prepares and transitions students with ASD for inclusive classrooms. Data was collected through two rounds of in-depth interviews, and was subsequently analyzed and interpreted into research findings that are presented through three major themes (i.e., unique program aspects, holistic approach, inclusion not integration). Collectively, the themes provide insights about how students at Giant Steps are prepared for inclusion, as well as how different stakeholders within the Giant Steps program perceive inclusion and their role in preparing students for inclusive classrooms.

Letter to S.D. Woodruff regarding resolution #5 of the Board of Directors. Mr. Woodruff is requested to take steps to ensure the early completion of the Port Dalhousie and Thorold macadamized road

Letter to S.D. Woodruff regarding resolution #5 of the Board of Directors. Mr. Woodruff is requested to take steps to ensure the early completion of the Port Dalhousie and Thorold macadamized road. This is signed by James McCoppen, president. The letter is stained and worn torn in spots. This does not affect the text, July 11, 1857.

First Steps in the history of our country

UANL

Elementary steps in aqueous proton transfer reactions : a first principles molecular dynamics study

La nature des acides dans un environnement aqueux est primordiale dans de nombreux aspects de la chimie et de la biologie. La caractéristique principale d'un acide est sa capacité à transférer un proton vers une molécule d'eau ou vers n'importe quelle base, mais ce procédé n'est pas aussi simple qu'il y paraît. Il peut au contraire être extrêmement complexe et dépendre de manière cruciale de la solvatation des différents intermédiaires de réaction impliqués. Cette thèse décrit les études computationnelles basées sur des simulations de dynamique moléculaire ab initio qui ont pour but d'obtenir une description à l'échelle moléculaire des divers procédés de transferts de proton entre acide et bases dans un milieu aqueux. Pour cela, nous avons étudié une serie de système, dont l'acide hydrofluorique aqueux, l'acide trifluoroacétique aqueux, et un système modèle constitué d'un phénol et d'une entité carboxylate reliés entre eux par une molécule d'eau en solution aqueuse. Deux états intermédiaires ont été identifiés pour le transfert d'un proton depuis un acide. Ces intermédiaires apparaissent stabilisés par un motif local de solvatation via des ponts H. Leurs signatures spectroscopiques ont été caractérisées au moyen de la spectroscopie infrarouge, en utilisant le formalisme de la dynamique moléculaire ab initio, qui inclut l'effet quantique nucléaire de manière explicite. Cette étude a aussi identifié trois chemins de réaction élémentaire, qui sont responsable pour le transfert d'un proton d'un acide à une base, ainsi que leurs échelles de temps caractéristiques. Les conclusions tirées de ces études sont discutées dans les détails, au niveau moléculaire, avec une emphase sur les comparaisons entre les résultats théoriques et les mesures expérimentales obtenues dans a littérature ou via des collaborateurs.

Optimization in the Technological Steps for the Fabrication of Large Area Micromirror Arrays

Micromirror arrays are a very strong candidate for future energy saving applications. Within this work, the fabrication process for these micromirror arrays has been optimized and some steps for the large area fabrication of micromirror modules were performed. At first the surface roughness of the insulation layer of silicon dioxide (SiO2) was investigated. This SiO2 thin layer was deposited on three different type of substrates i.e. silicon, glass and Polyethylene Naphthalate (PEN) substrates. The deposition techniques which has been used are Plasma Enhanced Chemical Vapor Deposition (PECVD), Physical Vapor Deposition (PVD) and Ion Beam Sputter Deposition (IBSD). The thickness of the SiO2 thin layer was kept constant at 150nm for each deposition process. The surface roughness was measured by Stylus Profilometry and Atomic Force Microscopy (AFM). It was found that the layer which was deposited by IBSD has got the minimum surface roughness value and the layer which was deposited by PECVD process has the highest surface roughness value. During the same investigation, the substrate temperature of PECVD was varied from 80° C to 300° C with the step size of 40° C and it was found that the surface roughness keeps on increasing as the substrate holder temperature increases in the PECVD process. A new insulation layer system was proposed to minimize the dielectric breakdown effect in insulation layer for micromirror arrays. The conventional bilayer system was replaced by five layer system but the total thickness of insulation layer remains the same. It was found that during the actuation of micromirror arrays structure, the dielectric breakdown effect was reduced considerably as compared to the bilayer system. In the second step the fabrication process of the micromirror arrays was successfully adapted and transferred from glass substrates to the flexible PEN substrates by optimizing the conventional process recipe. In the last section, a large module of micromirror arrays was fabricated by electrically interconnecting four 10cm×10cm micromirror modules on a glass pane having dimensions of 21cm×21cm.

10 easy steps to ease on-line communication

There are many different ways to communicate on-line now days from chat rooms, forums to e-mail, instant messaging, blogs and personal spaces. Some have clearly stated rules and some depend on unwritten codes of behaviour. Here are a few general tips provided that will hopefully make those occasions where learning and teaching are taking place more worthwhile.