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Diabetic Retinopathy: Assessing Risk and Preventing Vision Loss
No full textIntroduction/Background: Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of blindness among working-age adults in the United States. In 2021, an estimated 9.60 million people were living with diabetic retinopathy in the United States and this number is projected to triple by 2050 (Lundeen et al., 2023). Early detection and timely treatment can prevent 95% of diabetes related eye disease, however many patients are unaware that they have this preventable, vision-threatening disease and between 50-60% of patients with diabetes do not adhere to the recommended yearly eye screening exam (National Eye Institute, 2024).
Problem: An 8-day practice assessment of a primary care clinic revealed a low diabetic retinopathy screening rate, with only 44% of patients with type 2 diabetes completing an eye exam within the past year. Lack of standardized patient education and missing documentation of optometrist/ophthalmology consultations was also identified. Subsequently, a protocol intervention was implemented and fifty-five patients with type 2 diabetes were evaluated. Only twenty-three patients had a documented diabetic retinopathy screening exam, resulting in a baseline screening rate of 41.8%. These findings revealed gaps in screening compliance, documentation, and patient education, emphasizing the need for improved processes to enhance diabetic retinopathy screening rates.
Method/Interventions: This quality improvement (QI) project aimed to improve annual diabetic eye exams in patients with type 2 diabetes by implementing a revision of the current diabetic screening program in a primary care clinic. The new protocol entailed education sessions to practice staff, incorporation of Diabetes Related Retinopathy Risk Test (DRRRT) into patient education, and re-emphasis on the importance of documentation and capture of optometrist and ophthalmologist consultations. Thirteen patients received education using the DRRRT, six patients were missing documentation of their eye exams, and thirteen patients were excluded from the education intervention as they were evaluated via telehealth which impeded the online use of the DRRRT. Pre and post intervention screening rates were evaluated. A Plan-Do-Study-Act (PDSA) quality improvement framework was used to implement and evaluate the intervention.
Results: Post-intervention data demonstrated that seven of the thirteen patients educated with the DRRRT completed the recommended eye exam within the project timeline, and clinic staff captured four out of six missing documents, resulting in an improved screening rate of 61.8%.
Conclusion/Implications for Practice: This project demonstrates the effectiveness of a multifaceted protocol intervention in improving annual diabetic retinopathy screening rates within a primary care clinic. Interventions that incorporate targeted staff education, personalized patient education, and improved documentation practices can significantly increase screening uptake, enabling early detection of diabetic retinopathy and timely treatment which prevents vision loss
3D Printing Metal Horn Antennas Using Periodic and Aperiodic Perforated Designs for Directed Energy Applications
No full textIn the past decade, Additive Manufacturing (AM) has proven to be groundbreaking yet reliable technology. Not only has it revolutionized the way we approach problems in research, design, and production but it has enabled burgeoning discoveries and methods due to the technologyâ??s efficiency, speed, and low manufacturing cost. One area that benefits greatly from this includes radio frequency (RF) devices like horn antennas. At the moment, most horn antennas produced by conventional manufacturing are expensive, heavy, and limited in customization, yet they are necessary for various systems like satellite communication, radar, radio astronomy, and more. 3D printing technology would alleviate some of these issues since they can be constructed at varying levels of complexity at lower the cost, mass, and amount of time. One type of customization that has already been explored in previous research includes metal printing perforation patterns on the walls of the horn antenna using Powder Bed Fusion (PBF) technology. The purpose of this design reduces mass and surface roughness of the material without significantly altering the signal. However, this research aims to study the effects of various geometric periodic perforations and compare them to an aperiodic design known as Einstein Tiles. By comparing the electrical performances and mechanical robustness, we can determine which design is best while also analyzing how much the predicted 3D model matches the physical antenna
Neuropsychological characteristics of children with the 22q11 deletion syndrome: a descriptive analysis
No full textPrevious reports of cognitive functioning in children with the 22q11 Deletion Syndrome have reported marked variability in IQ and achievement subtest scores. Studies have begun to explore neuropsychological function in 22q11 DS however results are inconsistent and the profile incomplete. We assessed 40 children ages 5–12 with 22q11 DS. Consistent with past results, visual-spatial memory was significantly lower than verbal memory. Differentially lowered scores were found only in visual attention, working memory and motor function. Contrary with some past results quantitative, verbal ability, and visual spatial memory scores were within 1 SD from the standardization sample mean. Motor behavior, not typically discussed with regard to 22q11 DS school-age children, may be critical to incorporate in neurocognitive studies of children with 22q11 DS. Implications of these findings are considered with regard to past results
Microglial Disruption in Young Mice with Early Chronic Exposure to Lead
Full text linkThe mechanisms by which early chronic lead (Pb) exposure alters brain development have not been identified. We examined neuroimmune system effects in C57BL/6J mice with Pb exposure, including levels that may be common among children in lower socioeconomic income environments. Pups were exposed via dams’ drinking water from birth to post-natal day 28 to low, high or no Pb conditions. We compared gene expression of neuroinflammatory markers (study 1); and microglial mean cell body volume and mean cell body number in dentate gyrus, and dentate gyrus volume (study 2). Blood Pb levels in exposed animals at sacrifice (post-natal day 28) ranged from 2.66 to 20.31 micrograms/deciliter. Only interleukin-6 (IL6) differed between groups and reductions were dose-dependent. Microglia cell body number also differed between groups and reductions were dose-dependent. As compared with controls, microglia cell body volume was greater but highly variable in only low-dose animals; dentate gyri volumes in low- and high-dose animals were reduced. The results did not support a model of increased neuroinflammation. Instead, early chronic exposure to Pb disrupted microglia via damage to, loss of, or lack of proliferation of microglia in the developing brains of Pb-exposed animals
A comparison study of early non-psychotic deviant behavior in Afrikaner and US patients with schizphrenia and schizoaffective disorder
No full textUnfortunately, the Universal Predictor Cannot Be Made Constructive
No full textA recent article in the Notices of the American Mathematical Society reminded the mathematics community that, under the Axiom of Choice, it is possible to have a universal predictor: if we input, into this predictor, the values of a function for all moments t \u3c to for some to, then, for almost all to, this predictor correctly predicts the next values of this function on some interval [to, to + ε). This predictor cannot be used for actual predictions: it is based on the Axiom of Choice and is, therefore, not constructive. A natural question is: maybe it is possible to have another universal predictor, which is constructive? In this paper we show that, unfortunately, it is not possible to have a constructive universal predictor. In other words, the above universal predictor result cannot be used for actual predictions
Exploring Principals\u27 Equity Mindset As It Applies To Their Practice Within A Mexican-U.S. Border Community
No full textThe study\u27s aimed to explore principals\u27 equity mindset to respond to the research question: How do principals\u27 lived experiences, identity, beliefs, attitudes, and values construct their understanding of equity, and how does it impact their practice within the school communities they serve? The study employed narrative inquiry as a methodology to gain knowledge and understanding of principals\u27 conceptualization of equity and how equity emerges in their practice. These principals\u27 rich descriptive narratives showed that their understanding and embodiment of equity are reflected within their practice. Their inherent values, beliefs, attitudes, and overall sense of self and upbringing are at the core of their equity mindset and perception of themselves within their practice. Their equity embodiment emerged during their practice through a seemingly inherent personal equity compass of the constructs of who they are and their lived experiences. Overall, for principals, equity was not a new concept but rather something relatable back in the early stages of their lives. Throughout their narratives, there were numerous examples of their equity-based efforts to address the needs of vulnerable learners. By embodying equity within their practice, they lead the school communities they serve, becoming the agents of change that, as educators, they are required to be within a transformative leadership lens. Hence, school districts and policymakers, among other stakeholders, playing a crucial role in supporting principals\u27 equity efforts, as they can provide the necessary resources and policy frameworks to address systemic inequalities that leverage their decision-making within their practice. Therefore, it is poignant to learn about the unique constructs of principals\u27 mindsets regarding equity, as these findings inform about the complexities of equity in education and the role of principals in achieving student success