Retinal Damage in Macaque after White Light Exposures Lasting Ten Minutes to Twelve Hours

Size: px
Start display at page:

Download "Retinal Damage in Macaque after White Light Exposures Lasting Ten Minutes to Twelve Hours"

Transcription

1 PT" Investigative Ophthalmlgy & Visual Science, Vl. 30, N. 6, June 989 Cpyright Assciatin fr Research in Visin and Ophthalmlgy Retinal Damage in Macaque after White Light Expsures Lasting Ten Minutes t Twelve Hurs Jan J. M. Kremers and Dirk van Nrren We induced phtchemical damage in small parts f the retinas f anesthetized macaques after light expsures f varying intensity, lasting between 0 min and 2 hr. Damage was assessed bth with funduscpy and densitmetry at several perids after expsure. Damage was mst extensive 2 days pstexpsure, with similar threshlds fr bth methds. Reciprcity between expsure time and irradiance was fund fr all expsures at a threshld irradiant dse f 230 J/cm 2. This is in gd agreement with part f the literature data n mnkeys, yet cntradicts anther reprt (Sykes et al) in which a much lwer threshld dse was fund. The latter data prbably cncern a different class f damage. It remains unclear what critical factrs distinguish the tw classes. Observatins mre than 70 days pstexpsure shw a divergence between funduscpic and densitmetric threshlds. Althugh the appearance f funduscpic lesins had changed, the threshld dse remained 230 J/cm 2. Densitmetry shwed full recvery f the amunt f visual pigment fr dses belw 600 J/cm 2. Invest Ophthalml Vis Sci 30:032040,989 When the primate retina is expsed t intense light fr perids varying between several secnds and 4 hr, extensive damage t the pigment epithelium and t the neural retina may be fund. " 4 In patients such damage is als reprted after cular surgery in which use was made f bright light surces. 5 " 8 Fr perids between 0 and 000 sec, Ham et al 290 verified that reciprcity hlds, that is, irradiance is exchangeable fr expsure time. The threshld dse fr white light in Ham's experiments varied between 200 t 400 J/cm 2. With expsures shrter than 0 t 00 sec, depending n the size f the retinal image, reciprcity fails because the rise in retinal temperature is such that the dmain f thermal damage is entered. It is unclear hw far reciprcity hlds fr expsures beynd 000 sec. One reprt is available in which macaque mnkeys were expsed t 2 hr f cntinuus flurescent light.'' We calculated that the threshld dse in the latter experiment was abut 6 J/cm 2, an rder f magnitude lwer than Ham et al's J/cm 2. The directin f the deviatin frm reciprcity is unexpected. Naively, it is expected that with increasing expsure time (and decreasing irradiances) repair prcesses gradually vertake damage inductin. As a result the ttal dse t reach thresh Frm the TNO Institute fr Perceptin, Sesterberg, The Netherlands. Supprted by the Netherlands Organizatin fr Scientific Research, thrugh the Fundatin fr Biphysics. Submitted fr publicatin: May 23, 988; accepted December 5, 988. Reprint requests: D. van Nrren, PhD, TNO Institute fr Perceptin, P.O. Bx 23, 3769 ZG Sesterberg, The Netherlands. ld damage shuld increase, rather than decrease. Griess and Blankenstein 2 fund the time cnstant f the repair prcesses t be almst exactly 4 days. Frm this study alne reciprcity is expected t hld up t abut 2 days. But, as Griess and Blankenstein determined the time cnstant in an indirect way, this is nly true when n ther, unexpected, prcesses interfere at lng expsures. Sykes'" experiments actually suggest such an interference. The aim f the present study was t investigate whether r nt there is a deviatin frm reciprcity after lng expsures, as described abve. Therefre, we explred the expsure range frm a few hundred secnds t 2 hr. The cnditins were, apart frm irradiance and time, similar t thse used by Ham et al, 9 that is, anesthetized macaque mnkeys and expsures restricted t small patches f retina. In additin t funduscpy, we intrduced retinal densitmetry as a new technique fr assessing damage. This technique has the advantage f being bth quantitative and nninvasive. Als, direct infrmatin is btained n the kinetics f visual pigments after phtchemical damage. Finally, damage was als assessed between 2 and 7 mnths after expsure, t study the effect f repair mechanisms. Materials and Methds Animal Preparatin Mnkeys were sedated with 2540 mg ketamine hydrchlride (Ketalar, ParkDavis, Barcelna, Spain) and anesthetized with an initial intravenus 032

2 N. 6 RETINAL DAMAGE AFTER WHITE LIGHT EXPOSURES / Kremers and van Nrren 030 dse f 20 mg/kg f pentbarbital (Nembutal, CEVA, Paris, France), fllwed by a cntinuus infusin f 23 mg/kg/hr. After intubatin, artificial respiratin was started with a mixture f 70% nitrus xide and 30% xygen. T prevent eye mvements an intravenus infusin f a muscle relaxant pancurnium brmide (Pavuln, Organn, Oss, The Netherlands) was given. The initial dse was 30 Mg/kg fllwed by a cntinuus infusin f 30 jtg/kg/hr. Pupils were dilated with a drp f Phenylephrin (BurnnvillePharma, Almere, The Netherlands), cmbined with a drp f Cyclgyl (Schieffelin and C., New Yrk, NY). The head was fixed in place with ear bars and a jaw rest. A hard cntact lens was,used t prevent drying f the crnea. All preparatin was dne in yellw light t minimize the pssibility f retinal damage befre expsure. This investigatin adhered t the ARVO Reslutin n the Use f Animals in Research. Irradiatin Whenever we use the term irradiatin, we refer t expsures f white light t establish damage threshlds. We used a dual beam phthalmscpic stimulatr fr irradiatin under Maxwellian view cnditins. The light surce was a 450 W xenn arc with light stabilized pwer supply. Infrared radiatin was eliminated by a Schtt KG 3 filter. UV radiatin was reduced by the glass lenses. Details f this apparatus can be fund in Valetn and van Nrren. 3 Fur patches f retina were defined using a diaphragm with fur hles imaged n the retina. The hles measured 4 diameter and were arranged in a tw by tw array, abut separated. The center f the array was psitined abut 8 abve the fvea. T vary the irradiance level f individual patches, neutral density filters were placed n the hles. The irradiances f the fur patches were regularly calibrated with a Laser Precisin RK500 Pyrelectric Radimeter. The spectral utput f the white light at the crneal level was measured with a scanning spectrradimeter (Pht Research Spectrascan S.N. 286). The results f the latter measurement are presented in Figure. The average clr temperature was 5400 K. Retinal irradiance (E ret ) was calculated frm the measured irradiance (E air ) with 4 : Jret ''air ^ ' in which d is the distance between fcus and the irradiated plane f the measuring device f the radimeter, f the fcal length f the mnkey eye (abut.35 cm), n the refractive index (abut.33), and t the cular transmissin (abut 0.9). The maximal available retinal irradiance was 400 mw/cm 2. Fig.. Spectral distributin f the damageinducing light at the crneal level. Funduscpy The irradiated patch (seen thrugh the phthalmic stimulatr) was marked n a fundus phtgraph. Tw days after expsure, changes were visible as whiteyellwish spts. Funduscpic bservatins were perfrmed with an indirect phthalmscpe (28 dipter lens), because the large field f view made lesins easier t recgnize due t the cmparisn with the undamaged surrundings. We classified the bservatins int three categries: () n change, indicating subthreshld damage r absence f damage; (2) a just visible change (a patch smewhat smaller than the irradiated spt, and with fuzzy edges), as an indicatin fr threshld damage; and (3) a distinct funduscpic change (a patch with a size cmparable t the irradiated spt r smewhat larger, and with sharp edges), indicating suprathreshld damage. Funduscpic bservatins were made at fur different time intervals after expsure: () 0.52 hr; (2) 42 hr; (3) abut 2 days; and (4) minimally 70 days. The mst cmplete bservatins were made 2 days pstexpsure because at that time funduscpic changes were mst clearly present (in accrdance with bservatins f, eg, Ham et al u0 ). Densitmetry In retinal densitmetry a beam f light is shne int the eye, reflected at the fundus and cllected by a lightsensitive device, usually a phtmultiplier (PM). Essential in the technique is: first, that measuring light bleaches nly a small fractin f the phtpigment. Secnd, measurements are dne in tw cnditins, ne with high adapting illuminance which virtually bleaches all visual pigment, resulting in a relatively high number f reflected phtns, and

3 034 INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE / June 989 Vl. 30 ne with lwer adapting illuminances in which the visual pigment is partially regenerated, resulting in a lwer number f reflected phtns. Cmparisn f the tw cnditins yields a quantity bearing a relatin t the density f the visual pigment. In ur experiments, the density f the rd visual pigment was assessed with a labratrybuilt device in which several features f the Utrecht densitmeter 4 were incrprated, but which had the advantage f measuring at seven wavelengths in rapid successin. It was the prttype f a densitmeter described by van Nrren and van de Kraats. 5 Briefly, in a 00 msec cycle the eye is repetitively expsed t seven perids f light with different wavelengths, a dark perid, and fur perids f high adapting illuminance, each perid lasting 5 msec. The mean retinal level f bleaching light in the mnkey eye was equivalent t 3.2 X 0 5 td (2.2 X 0 5 sct td) fr humans; the retinal illuminance due t the sequential expsure t the varius wavelengths f the measuring light amunted an average f 3000 equivalent td (0 4 sct td). The measuring beam illuminated a field f 4.3 ; the bleaching beam was 0. The phtmultiplier in phtn cunting mde cllected light frm a 2.6 area cncentric with the illuminated field. The bleaching light was yellw (cut ff at 530 nm) in rder t avid interference between bleaching and damaging light. A micrprcessr srted the cunts f the phtmultiplier fr the prper wavelengths int seven channels, and these were all subsequently crrected fr the cunts cllected in the dark perid. The running average (with a time cnstant f fur sec) f the cunts at a chsen wavelength culd be displayed as a functin f time n a mnitr, and all results culd be stred n disk. Density was defined as the lgarithm f the rati f the number f cunts at 5 nm and at that at 730 nm, 4 the latter being a wavelength nt appreciably absrbed by the visual pigment. Densitmetric damage was defined by the damage index (D): D = (A B)/A (2) where A and B are the density differences between high and lw light level cnditins, befre and after expsure, respectively. Prcedure At the beginning f an experimental sessin the anesthetized animal was placed behind the irradiating device and the blck f fur patches f retina was selected and marked n a fundus phtgraph. Next, the animal was placed behind the densitmeter and the density f rhdpsin was measured at minimally tw f the fur selected patches f retina. When these densities were similar, the ther tw patches were nt measured. Then, the animal was placed back behind the irradiating device and irradiatin was started. At predetermined times subsequent hles f the diaphragm were cvered t allw fr different expsure times. T assess shrtterm damage, density was measured at a number f patches between 0.5 hr and 2 hr after irradiatin was cmpleted. On ther ccasins the bservatins and measurements were dne between 4 and 2 hr pstexpsure. Therefre, they were gruped int a separate categry. Density was nearly always measured 2 days after irradiatin. Depending n the length f the irradiatin this was between 3340 hr after cmpletin f irradiatin. Additinal density measurements were btained between 7020 days after irradiatin. Whenever density was measured, ntes were made n the appearance f the fundus. Sme eyes were used mre than nce. Eye mvements during expsure excluded sme patches frm evaluatin. Results Funduscpy Tw days pstexpsure, the retinal patches that underwent a funduscpical change shwed a brighter appearance than undamaged retina. The size f the damaged patches varied slightly, depending n the irradiant dse. Figure 2A thrugh 2D summarizes the results f funduscpic bservatins fr different irradiances and expsure times. The data are based n bservatins n 4 irradiated patches in ten eyes f seven animals. Up t 2 hr pstexpsure nt much damage was bserved; nly in a limited number f cases were threshld funduscpic lesins visible (halfpen circles in Fig. 2A, B). In Figure 2C the results f the mst extensive bservatins, made 2 days pstexpsure, are given. In any single experiment, we nted that the transitin between n damage and evident damage always was within a factr f tw f irradiant dse. The spread in threshld dse between individuals was nt large either: it was easy t draw a line by eye with slpe (cnstant dse) which separated sub frm suprathreshld data. This line represents a well defined and remarkably cnstant threshld dse f 230 J/cm 2 ver tw decades f expsure times. T enable cmparisns, the threshld dse line was drawn in all plts f Figure 2. It shws that it represents a cnservative estimate f a threshld curse fr the pstexpsure bservatins at ther times. With the lngest expsure time used, 2 hr, threshld damage is fund at abut 5 mw/cm 2. Fr a human eye, this wuld crrespnd t abut 3 X 0 6 td white light.

4 N. 6 RETINAL DAMAGE AFTER WHITE LIGHT EXPOSURES / Kremers nd vn Nrren 035 Fig. 2. Data n funduscpic bservatins 0.52 hr (A),42hr(B), 2 days (C), and mre than 70 days (D) pstexpsure. Filled circles represent a clear funduscpic lesin (suprathreshld damage), halffilled circles a just visible lesin (threshld damage), and pen circles n visible lesin (subthreshld damage). The dashed line represents an irradiant dse f 230 J/cm 2, which is the bestfitby eye fr threshld damage 2 days pstexpsure. 0 3 a.0' < ^ «0 A 0 3 * V^»«O _ A:0.52hrs C: 2dys * s ""* * N.* O 3 ^.» ' B:42hrs en D:>70 days j ""* * i i 0' 0 u retinal irradiance (mw.cnrr 2 ) After 70 r mre days, damaged patches which tw days pstexpsure were brighter than undamaged retina, nw appeared darker and had a granular texture. They were surrunded by an annulus f abut half a degree, with a smewhat brighter appearance than the rest f the retina. Recvery, in the sense that patches returned t nrmal, was minimal, as can be seen frm Figure 2D. Densitmetry An example f densitmetric measurements at 5 nm is given in the left part f Figure 3. In the upper panel a measurement befre expsure is given. The recrd starts with the bleaching light n; after 2 min the light was switched ff and pigment regeneratin was fllwed fr 5 min in the dark. Thereafter, the bleaching light was switched n again and the trace is seen t return t its riginal fully bleached level. The density difference between bleached and regenerated was 0.09, fairly typical fr the recrds btained in these experiments. The accuracy with which the density differences culd be assessed was between 0 and 20%. In the right part f Figure 3, density difference is given as functin f wavelength. The difference is maximal at 5 nm, indicative fr rd invlvement. The middle panel f Figure 3 presents the results f measurements taken 2 days after 4800sec expsure with an irradiance f 220 mw/cm 2, which was 4.6 times the funduscpic threshld dse. N changes in density are bserved fllwing an identical bleaching and regeneratin sequence, which is indicative fr a serius disturbance in the regeneratin cycle f rhdpsin. In the lwer panel f Figure 3, a measurement in the same patch 85 days after expsure is presented. Partial recvery f the density f rhdpsin was fund. In Figure 4A densitmetric damage indices btained fr 2 days pstexpsure are given as a functin f irradiant dse. The threshld dse btained frm funduscpy, the vertical line, prvides a satisfactry separatin between high and lw damage. In Figure 4B the same mde f presentatin is chsen fr densitmetric changes after prlnged recvery. The threshld dse fr lngterm densitmetric damage, thugh less accurately determined, lies at abut 600 J/cm 2, which is a factr f 2.6 higher than the dse fr funduscpic and densitmetric threshld damage 2 days pstexpsure. S, again, the fundu

5 006 INVESTIGATIVE OPHTHALMOLOGY & VI5UAL SCIENCE / June 989 Vl. 30 pre ij) c kmim I.**"* 2 days pst 85 days pst U 6 time (min) ^ VMUMMJ a> Jl 0 Ui 0 CD " days pst 85 days pst wavelength (nm) Fig. 3. Example f densitmetry befre expsure (tp panels), 2 days after a 4800sec expsure t 220 mw/cm 2 (middle panels), and 85 days after the same expsure (bttm panels). The left panels shw the density traces fr the measuring light f 5 nm wavelength. A trace starts with the pigment bleached. After 2 min the bleaching light is turned ff, and the visual pigment is allwed t regenerate fr 5 min. Then, the bleaching light is turned n again, and the density trace is seen t return t its previus level. The right panels shw the difference spectrum, which resembles the rhdpsin density spectrum. Nte the absence f visual pigment 2 days pstexpsure and the partial recvery f visual pigment after 85 days. scpic criterin 2 days pstexpsure prves t be the mst cnservative damage criterin. In Figure 5, funduscpic and densitmetric results are cmpared fr 2 days, and mre than 70 days pstexpsure, respectively. Crrespndence is high fr bservatins 2 days pstexpsure, but much prer after prlnged recvery. In distinct funduscpic lesins partial r even cmplete densitmetric recvery was measured in many instances. The data btained between 0.5 and 2 hr pstexpsure are nt presented in a figure, because nne f the ten measurements shwed a densitmetric change, despite the fact that the irradiant ttal dse was abut 550 J/cm 2, and despite the fact that in ne f the measured patches a vague funduscpic change was bserved (after a 2 hr expsure t.5 mw/cm 2 ). Only tw measurements were dne between 4 and 2 hr pstexpsure. The irradiant dses in the tw patches were 35 and 200 J/cm 2, respectively, and bth displayed a vague funduscpic change. Only the high dse expsure resulted in a densitmetric damage (D = ). Discussin Relatin between Irradiance and Expsure Time at Threshld The funduscpic threshld damages, btained 2 days pstexpsure, (Fig. 2C) ccurred at a cnstant 230 J/cm 2 irradiant dse fr expsure cnditins f up t 2 hr. This result is interesting in tw ways. In the first place it extends the dmain f timeirradiance reciprcity. Frm Ham et al's 9 data, reciprcity was clear up t at least 000 sec. By cmbining data in the literature fr varius animal mdels, we culd already tentatively extend that perid t abut 4 hr. 6 This study nw prvides experimental evidence fr reciprcity up t 2 hr in ne animal mdel, the macaque. In the secnd place the value f the threshld dse f 230 J/cm 2 merits attentin. It is nly slightly lwer than the 40 J/cm 2 value derived frm the data f Ham et al. 9 This difference may have a technical explanatin. Ham et al 9 used the integrated value frm nm, whereas urs ranged frm nm. Since all evidence suggests that wavelengths ver 700 nm d nt cntribute t phtchemical damage (prvided they d nt increase retinal temperature), ur threshld data are cmparable t Ham's data. Hwever, ur results are clearly at variance with thse f Sykes et al," wh fund threshld damage already at 6 J/cm 2 in an animal mdel clsely related t urs. The cntradictin with Ham's data was nt bvius as Sykes' expsure was utside the irradiance/time dmain cvered by Ham. The cntrversy has nw becme much mre manifest by ur extensin f the reciprcity dmain t 2 hr. Despite similarities in expsure time and animal mdel, there are differences between ur and Sykes' experiments, which might explain the different threshld irradiant dses. These differences are the use f anesthetics, the size f the expsed retinal area,

6 N. 6 RETINAL DAMAGE AFTER WHITE LIGHT EXPOSURES / Kremers and van Nrren 037 the technique f damage assessment and the light surce.. Anesthetics: We expsed the mnkey's eye under Nembutal anesthesia, whereas the animals in Sykes' experiments were unanesthetized. There is evidence indeed that Nembutal prvides prtectin. 7 On the ther hand, rugh estimatins f the damage dse in (unanesthetized) human sungazers are certainly nt lwer than ur 230 J/cm 2 value, because nly minr damages were reprted even after hr f sungazing 8 (retinal irradiance estimated t be abut 0 4 mw/cm 2, n crrectins fr eye mvements). 2. Size f expsed retinal area: Sykes et al used largefield expsure, whereas we used 4 field sizes A: 2 days x 0.4 I l_ * Q) r n= n=2 2 days >70days. n= B:>70days I irradiant dse (J.cnr 2 ) Fig. 4. Densitmetric damage index as a functin f the irradiant dse, fr measurements 2 days (A) and mre than 70 days (B) pstexpsure. The dashed lines represent the best fitting dses fr threshld densitmetric damage: 230 J/cm 2 after 2 days, and 600 J/cm 2 after mre than 70 days. n just clear funduscpic damage Fig. 5. Relatin between funduscpic and densitmetric damage indices tw days and mre than 70 days after expsure. The mean densitmetric damage and standard deviatin are presented at three funduscpic damage indices, tgether with the number f bservatins. Crrespndence between bth indices is mst clearly present 2 days after expsure. As a matter f fact, Ham et al 9 have suggested, but never substantiated, such an explanatin. 3. Technique f damage assessment: Sykes used histlgic criteria, whereas ur data were based n funduscpic and densitmetric bservatins. Bth this study and ur earlier literature survey have shwn, hwever, that different techniques d nt markedly differ in results. Fuller et al 20 fund that the irradiant dse fr a funduscpic threshld was nly

7 038 INVESTIGATIVE OPHTHALMOLOGY & VI5UAL 5CIENCE / June 989 Vl B CD e O Q. a 0 3 a a a A a A A class I O i90580 V. 0' 0" 3 0,2 0 A 0 V ^ irradiance (mw.crrr 2 ) class n week* day* 2hrs* hr* Fig. 6. Funduscpic data frm the present experiments (circles), brught tgether with literature data. Open symbls dente subthreshld damage, halffilled symbls threshld damage, and clsed symbls represent suprathreshld damage. The drawn curve is a theretical threshld curve fr Class II damage. 26 The fllwing Class I data were used: V: rats 2 (dented with , indicating the wavelength cntents f the irradiant light); D: rats 23 ; A: pigens 24 ; >: mnkeys". The literature data n Class II damage shwn here (0) riginate frm Ham et al. 9 Except fr the experiments f Nell et al 2 all expsures invlved white light surces. One f ur bservatins (2 hr expsure t 0.7 mw/cm 2 ) was nt shwn in Figure 2, as it did nt prvide additinal infrmatin n threshld data, but it has been included in this figure t emphasize the cntrversy with the data f Sykes etal." abut a factr f tw higher than the dse fr a histlgic threshld. 4. Light surce: We used a xenn arc lamp, whereas flurescent bulbs were used in Sykes' experiments. Hwever, taking accunt fr the actin spectra f phtchemical damage, it is very unlikely that the difference in spectral distributin f the radiatin might cause such large differences in threshld dses. Anther difference might be the flicker in the flurescent lights due t the AC pwer supply. We d nt find any mechanistic justificatin fr this pssibility. Therefre, it seems very imprbable that the differences in threshld dses wuld have been caused by the use f different light surces. The imprtance f these pssible differences may becme clear when things are put in a different perspective by nting that the results f the Sykes experiments d nt frm just an dd pint in a further cnsistent picture f threshld dses (Fig. 6). They seem t fit int a series f threshld data mainly fund in rats (eg, 223) but als in pigens 24 and in ther mnkey experiments These are the scalled Class I damages as defined by Mainster 27 and Kremers and van Nrren. 6 Class I damage is fund in experiments that have the fllwing characteristics in cmmn: unanesthetized animals, mainly rats, are expsed t largefield, lngterm (2 hr r lnger) irradiatin, with retinal irradiance seldm exceeding mw/cm 2 (data n white light surces 6 ). On histlgical examinatin f the retina, damage is mainly restricted t the phtreceptr level (fr a review see Lanum 28 ). The actin spectrum, fund in rats, is similar t the absrptin spectrum f visual pigment Harwerth and Sperling's 25 experiments, in which phtreceptr systems culd be selectively damaged by clred light, suggest an actin spectrum resembling visual pigment absrptin spectrum als exists in mnkeys. The damages prduced in ur experiments are typically f the Class II type. Cnditins in which phtchemical damage f Class II is fund can be characterized as fllws. Small patches f retina in usually anesthetized animals were expsed, fr limited perids f time, t irradiances typically exceeding 0 mw/cm 2 using white light surces. Damage is assessed at least 24 hr after expsure; in general the first signs f damage appear in the pigment epithelium. 9 The actin spectrum, in macaque mnkeys, shwed

8 N. 6 RETINAL DAMAGE AFTER WHITE LIGHT EXPOSURES / Kremers and vn Nrren 039 maximum sensitivity in the UV. Animal mdels in these experiments invlved primates and rabbits. 29 " 32 Human subjects, abut t underg eye enucleatin, were als studied. 833 The amunt f unbleached visual pigment has been suggested as crucial factr fr class determinatin, resulting in lwer threshld dses than expected fr Class II damage fr expsures f 2 hr r lnger. 6 Althugh this hypthesis seemed attractive fr explaining literature data, ur experiments d nt supprt it. Pssibly, a cmbinatin f sme f the afrementined factrs is required fr class determinatin. The unreslved cntrversy between Sykes' and ur results shuld, therefre, nt be viewed as just differences between tw experiments, but shuld be placed in the mre interesting, unreslved distinctin between Class I and Class II damage. Recvery Tw days pstexpsure, damage seems t be mst distinct. Thereafter, the appearance f the funduscpic lesins changes and the regeneratin cycle f the visual pigments may recver. Tw days after expsure, the damaged part f the retina appeared lighter than the rest and ccasinally it seemed edematus. This is in line with reprted depigmentatin and mild edema. ' 34 ' 35 After mre than 70 days, the lesin was less bvius (als bserved by Ham et al ), darker than the rest f the retina, and it had a granular appearance. The granularity after prlnged recvery culd be attributed t the irregular pigmentatin f the RPE cells as described by Ts. 35 We fund substantial recvery frm damage with densitmetry. Thus, the disturbance f the visual cycle may vanish cmpletely with the funduscpic lesin still present. The extent f recvery was fund t depend n the irradiant dse: when the dse was higher than abut 600 J/cm 2, recvery was never cmplete. These results are in qualitative agreement with the effects reprted by Mn et al. 36 After expsing the macula f a rhesus mnkey t 44 nm light, inducing a funduscpic threshld lesin, they fund visual perfrmance (visual acuity measured with Landlt rings) t be temprarily impaired, and returning t nrmal in abut 0 days. After a suprathreshld expsure (.5 times threshld dse) visual perfrmance nly shwed partial recvery. We fund incmplete recvery nly after an irradiant dse f 2.6 times threshld. This might indicate a lingering damage t the neural retina despite full recvery f the visual pigment regeneratin cycle. Key wrds: retina, phtchemical damage, white light, irradiant dse, densitmetry Acknwledgments The authrs thank Drs. J. J. Vs and B. de Graaf fr useful discussins, Dr. G. Szant fr crrecting the manuscript's grammar, and Mr. F. Fiirrer and Mrs. N. Blkland fr assistance during the experiments. References. Ham WT Jr, Ruffl JJ Jr, Mueller HA, Clarke AM, and Mn ME: Histlgic analysis f phtchemical lesins prduced in rhesus retina by shrtwavelength light. Invest Ophthalml Vis Sci 7:029, Ham WT Jr, Mueller HA, RufFl JJ Jr, Guerry D III, and Guerry RK: Actin spectrum fr retinal injury frm nearultravilet radiatin in the aphakic mnkey. Am J Ophthalml 93:299, Lawwill T, Crckett S, and Currier G: Retinal damage secndary t chrnic light expsure: Threshlds and mechanisms. Dc Ophthalml 44:379, Calkins JL, Hchheimer BF, and D'anna SA: Ptential hazards frm specific phthalmic devices. Visin Res 20:039, de Laey JL, de Wachter A, van Oye R, and Verbraeken H: Retinal phttrauma during intracular lensimplantatin. Int Ophthalml 7:09, Headn M, Jacbs N, and Rsen ES: Slar hazard: Eclipse viewing in Manchester. In Hazards f Light; Myths and Realities; Eye and Skin, CrnlyDilln J, Rsen ES, and Marshall J, editrs. Oxfrd, Pergamn Press, 986, pp PigeaudKJessens M and van der Heijde G: Operating micrscpe induced maculpathy: A case histry. In Hazards f Light; Myths and Realities; Eye and Skin, CrnlyDilln J, Rsen ES, and Marshall J, editrs. Oxfrd, Pergamn Press, 986, pp Khwarg SG, Linstne FA, Daniels SA, Isenberg SJ, Hanscm TA, Geghegan M, and Straatsma BR: Incidence, risk factrs, and mrphlgy in perating micrscpe light retinpathy. Am J Ophthalml 03:255, Ham WT Jr, Mueller HA, Ruffl JJ Jr, and Guerry D III: Slar retinpathy as a functin f wavelength: Its significance fr prtective eyewear. In The Effects f Cnstant Light n Visual Prcesses, Williams TP and Baker BN, editrs. New Yrk, Plenum Press, 980, pp Ham WT Jr, Mueller HA, and Sliney DH: Retinal sensitivity t damage frm shrt wavelength light. Nature 260:53, Sykes SM, Rbisn WG Jr, Waxier M, and Kuwabara T: Damage t the mnkey retina by bradspectrum flurescent light. Invest Ophthalml Vis Sci 20:425, Griess GA and Blankenstein MF: Additivity and repair f actinic retinal lesins. Invest Ophthalml Vis Sci 20:803, Valetn JM and van Nrren D: Fractinal recrding and cmpnent analysis f primate LERG: Separatin f phtreceptr and ther retinal ptentials. Visin Res 22:38, van Nrren D and van de Kraats J: A cntinuusly recrding retinal densitmeter. Visin Res 2:897, van Nrren D and van de Kraats J: A densitmeter with the size f a funduscamera. Visin Res 29:369, Kremers JJM and van Nrren D: Tw classes f phtchemical damage f the retina. Lasers and Light in Ophthalmlgy 2:45, Sperling HG: Spectral sensitivity, intense spectral light studies, and the clr receptr msaic f primates. Visin Res 26:557, Ts MOM and LaPiana FG: The human fvea after sungazing. Trans Am Acad Ophthalml Otlaryngl 79:788, 975.

9 040 INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE / June 989 Vl Ham WT, Allen RG, FeeneyBurns L, Marmr MF, Parver LM, Prctr PH, Sliney DH, and Wlbarsht ML: The invlvement f the retinal pigment epithelium. In Optical Radiatin and Visual Health, Waxier M and Hitchins VM, editrs. Bca Ratn, CRC Press, 986, pp Fuller D, Machemer R, and Knightn RW: Retinal damage prduced by intracular fiber ptics light. Visin Res 20:055, Nell WK, Walker VS, Kang BS, and Berman S: Retinal damage by light in rats. Invest Ophthalml 5:450, Williams TP and Hwell WL: Actin spectrum f retinal lightdamage in albinrats. Invest Ophthalml Vis Sci 24:285, Rapp LM and Williams TP: A parametric study f retinal light damage in albin and pigmented rats. In The Effects f Cnstant Light n Visual Prcesses, Williams TP and Baker BN, editrs. New Yrk, Plenum Press, 980, pp Marshall J, Melleri J, and Palmer DA: Damage t pigen retinae by mderate illuminatin frm flurescent lamps. Exp Eye Res 4:64, Harwerth RS and Sperling HG: Effects f intense visible radiatin n the incrementthreshld spectral sensitivity f the rhesus mnkey eye. Visin Res 5:93, Zwick H and Beatrice ES: Lngterm changes in spectral sensitivity after lwlevel (54 nm) expsure. Md Prbl Ophthalml 9:39, Mainster MA: Light and macular degeneratin: A biphysical and clinical perspective. Eye :304, Lanum J: The damaging effects f light n the retina: Empirical findings, theretical and practical implicatins. Surv Ophthalml 22:22, Lawwill T: Effects f prlnged expsure f rabbit retina t lwintensity light. Invest Ophthalml 2:45, McKechnie NM and Jhnsn NF: Light damage t the retina. Graefes Arch Klin Exp Ophthalml 203:283, Skg KO and Jarkman S: Phtic damage t the eye: Selective extinctin f the cwave f the electrretingram. Dc Ophthalml 6:49, Rinkff J, Machemer R, Hida T, and Chandler D: Temperaturedependent light damage t the retina. Am J Ophthalml 02:452, Rbertsn DM and Feldman RB: Phtic retinpathy frm the perating rm micrscpe. Am J Ophthalml 0:56, Ts MOM, Fine BS, and Zimmerman LE: Phtic maculpathy prduced by the indirect phthalmscpe:. Clinical and histpathlgic study. Am J Ophthalml 73:686, Ts MOM: Phtic maculpathy in rhesus mnkey: A light and electrn micrscpic study. Invest Ophthalml 2:7, Mn ME, Clarke AM, Ruffl JJ Jr, Mueller HA, and Ham WT Jr: Visual perfrmance in the rhesus mnkey after expsure t blue light. Visin Res 8:573, 978.

DIRECTED FORGETIING: SHORT-TERM MEMORY OR CONDITIONED RESPONSE? WENDY S. MILLER and HARVARD L. ARMUS The University of Toledo

DIRECTED FORGETIING: SHORT-TERM MEMORY OR CONDITIONED RESPONSE? WENDY S. MILLER and HARVARD L. ARMUS The University of Toledo The Psychlgical Recrd, 1999, 49, 211-220 DIRECTED FORGETIING: SHORT-TERM MEMORY OR CONDITIONED RESPONSE? WENDY S. MILLER and HARVARD L. ARMUS The University f Tled Previus researchers have interpreted

More information

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,

More information

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by ESTIMATION PROCEDURES USED TO PRODUCE WEEKLY FLU STATISTICS FROM THE HEALTH INTERVIEW SURVEY James T. Massey, Gail S. Pe, Walt R. Simmns Natinal Center fr Health Statistics. INTRODUCTION In April 97, the

More information

detailed in Ward and Lockhead (1970), is only summarized here.

detailed in Ward and Lockhead (1970), is only summarized here. Respnse system prcesses in abslute judgment* LAWRENCE M. WARDt and G. R. LOCKHEAD Duke University, Durham, Nrth Carlina 2778 Cnsistent relatinships are fund between Ss' abslute judgments f the value f

More information

TOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH

TOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH Tpic Circulatin list In case f query please cntact Executive Summary TOP TIPS Lung Cancer Update Dr Andrew Wight Cnsultant respiratry Physician - WUTH All Wirral GP s JaneFletcher2@nhs.net Dear Clleagues,

More information

DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 2016 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS

DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 2016 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 216 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS This briefing has been specifically prepared fr the Ministry f Health t prvide infrmatin frm this

More information

AP Biology Lab 12: Introduction to the Scientific Method and Animal Behavior

AP Biology Lab 12: Introduction to the Scientific Method and Animal Behavior Name: AP Bilgy Lab 12: Intrductin t the Scientific Methd and Animal Behavir Overview In this lab yu will: -Observe an rganism and design an experiment t investigate their respnses t envirnmental variables.

More information

Benefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria

Benefits for Anesthesia Services for the CSHCN Services Program to Change Effective for dates of service on or after July 1, 2008, benefit criteria Benefits fr Anesthesia Services fr the CSHCN Services Prgram t Change Effective fr dates f service n r after July 1, 2008, benefit criteria fr anesthesia will change fr the Children with Special Health

More information

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018) Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages

More information

Rate Lock Policy. Contents

Rate Lock Policy. Contents Rate Lck Plicy Cntents Rate Lcks... 2 Rate Lck Cnfirmatin... 2 Lck Term... 2 Pre-Lck... 2 Maximum Qualified Rate... 3 Extensins... 3 Cst t Extend... 3 Relcks... 4 Re-Negtiatin r Flat Dwn Plicy... 4 Prgram

More information

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder? updated 2012 Relaxatin training Q 5: Is relaxatin training better (mre effective than/as safe as) than treatment as usual in adults with depressive episde/disrder? Backgrund The number f general health

More information

Completing the NPA online Patient Safety Incident Report form: 2016

Completing the NPA online Patient Safety Incident Report form: 2016 Cmpleting the NPA nline Patient Safety Incident Reprt frm: 2016 The infrmatin cntained within this dcument is in line with the current Data Prtectin Act (DPA) requirements. This infrmatin may be subject

More information

SCALES NW HEARING PROTECTION PROGRAM

SCALES NW HEARING PROTECTION PROGRAM PURPOSE Expsure t excessive nise in the wrkplace can cause permanent hearing lss. The Hearing Prtectin Prgram has been established t help ensure that emplyees f Scales NW, Inc. d nt suffer health effects

More information

Glaucoma Interviews: Due Tuesday, May 22 nd

Glaucoma Interviews: Due Tuesday, May 22 nd Glaucma Interviews: Due Tuesday, May 22 nd 1) Read the glaucma article well! It will explain what it is, plus tell yu sme symptms and risk factrs. Yu may want t use a highlighter r pen t mark imprtant

More information

A Unified Approach to Conflict Mineral Compliance for the Tungsten Industry. The Westin, Sydney, 23 September 2013

A Unified Approach to Conflict Mineral Compliance for the Tungsten Industry. The Westin, Sydney, 23 September 2013 A Unified Apprach t Cnflict Mineral Cmpliance fr the Tungsten Industry The Westin, Sydney, 23 September 2013 Backgrund Cmpliance f public US dwnstream tungsten users with the reprting requirements f the

More information

Cardiac Rehabilitation Services

Cardiac Rehabilitation Services Dcumentatin Guidance N. DG1011 Cardiac Rehabilitatin Services Revisin Letter A 1.0 Purpse The Centers fr Medicare and Medicaid Services (CMS) has detailed specific dcumentatin requirements fr Cardiac Rehabilitatin

More information

TABLE OF CONTENTS Glossary of terms Code Pad Diagram 3. Understanding the Code Pad lights.4.

TABLE OF CONTENTS Glossary of terms Code Pad Diagram 3. Understanding the Code Pad lights.4. TABLE OF CONTENTS... Glssary f terms 2... Cde Pad Diagram 3 Understanding the Cde Pad lights.4 Cde Pad tnes 5 Fully arming the system - ON MODE 6 Fully arming the system - Quick Arm MODE 6 Partially arming

More information

HEALTH SURVEILLANCE INDICATORS: CERVICAL CANCER SCREENING. Public Health Relevance. Highlights.

HEALTH SURVEILLANCE INDICATORS: CERVICAL CANCER SCREENING. Public Health Relevance. Highlights. HEALTH SURVEILLANCE INDICATORS: CERVICAL CANCER SCREENING Public Health Relevance Cervical cancer is 90% preventable by having regular Papaniclau (Pap) tests. The Pap test, als knwn as a cervical smear,

More information

Neurological outcome from conservative or surgical treatment of cervical spinal cord injured patients

Neurological outcome from conservative or surgical treatment of cervical spinal cord injured patients 1993 nternatinal Medical Sciety f Paraplegia eurlgical utcme frm cnservative r surgical treatment f cervical spinal crd injured patients J E Kiwerski Spinal Department f Metrplitan Rehabilitatin Centre,

More information

Introduction Teaching Interpretation

Introduction Teaching Interpretation Intrductin Teaching Interpretatin AUTHOR: Kyle Vanderwall Grandville High Schl, Grandville, MI Intrductin The AP U.S. Histry Curriculum Framewrk defines interpretatin in the fllwing way: Interpretatin

More information

The effect of orientation in binocular contour rivalry of real images and afterimages*

The effect of orientation in binocular contour rivalry of real images and afterimages* Perceptin & Psychphysics 1974, Vl. 15, N.2, 227-232 The effect f rientatin in bincular cntur rivalry f real images and afterimages* N.J. WADE University fdundee, Dundee DDI 4HN, Sctland Bincular rivalry

More information

FDA Dietary Supplement cgmp

FDA Dietary Supplement cgmp FDA Dietary Supplement cgmp FEBRUARY 2009 OVERVIEW Summary The Fd and Drug Administratin (FDA) has issued a final rule regarding current gd manufacturing practices (cgmp) fr dietary supplements that establishes

More information

EXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS

EXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS 1 SECTION 1 INTRODUCTION: EXPLORING THE PROCESS OF ASSESSMENT AND OTHER RELATED CONCEPTS The Nature Of Assessment The Definitin Of Assessment The Difference Between Testing, Measurement And Evaluatin Characteristics

More information

Podcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10

Podcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10 Pdcast Transcript Title: Cmmn Miscding f LARC Services Impacting Revenue Speaker Name: Ann Finn Duratin: 00:16:10 NCTCFP: Welcme t this pdcast spnsred by the Natinal Clinical Training Center fr Family

More information

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT WOMEN AND NEWBORN HEALTH SERVICE CLINICAL GUIDELINES SECTION A: GUIDELINES RELEVANT TO OBSTETRICS AND GYNAECOLOGY 1 STANDARD PROTOCOLS 1.11 INSULIN INFUSION PUMP MANAGEMENT - INPATIENT Authrised by: OGCCU

More information

LTCH QUALITY REPORTING PROGRAM

LTCH QUALITY REPORTING PROGRAM 4 LTCH QUALITY REPORTING PROGRAM GENERAL INFORMATION...3 LTCH FACILITY-LEVEL QUALITY MEASURE REPORT...5 LTCH PATIENT-LEVEL QUALITY MEASURE REPORT...18 LTCH REVIEW AND CORRECT REPORT...23 09/2018 v1.04

More information

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams Assessment Field Activity Cllabrative Assessment, Planning, and Supprt: Safety and Risk in Teams OBSERVATION Identify a case fr which a team meeting t discuss safety and/r safety planning is needed r scheduled.

More information

Psychological Review

Psychological Review Psychlgical Review VOLUME 88 NUMBER 2 MARCH 1981 Jeren G. W. Raaijmakers University f Nijmegcn Nijmegen, The Netherlands Search f Assciative Memry Richard M. Shiffrin Indiana University A general thery

More information

Tick fever is a cattle disease caused by any one of the following blood parasites:

Tick fever is a cattle disease caused by any one of the following blood parasites: Tick fever Tick fever is a cattle disease caused by any ne f the fllwing bld parasites: Babesia bvis Babesia bigemina Anaplasma marginale These parasites are all transmitted by the cattle tick (Bphilus

More information

Cancer Association of South Africa (CANSA)

Cancer Association of South Africa (CANSA) Cancer Assciatin f Suth Africa (CANSA) Fact Sheet and Psitin Statement n Cannabis in Suth Africa Intrductin Cannabis is a drug that cmes frm Indian hemp plants such as Cannabis sativa and Cannabis indica.

More information

WHAT IS HEAD AND NECK CANCER FACT SHEET

WHAT IS HEAD AND NECK CANCER FACT SHEET WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice

More information

Refining Blood Collection Techniques to Improve Animal Welfare and Sample Quality

Refining Blood Collection Techniques to Improve Animal Welfare and Sample Quality Refining Bld Cllectin Techniques t Imprve Animal Welfare and Sample Quality Amy Allaire RLATG 1, Jennifer Jhnsn 2, Kimberly Maratea DVM PhD 2, Steven Bulé CMAR RLATG 1, Sara Savage DVM DACLAM 1 1 Dispsitin,

More information

Field Epidemiology Training Program

Field Epidemiology Training Program Field Epidemilgy Training Prgram Cancer Curriculum: Principles f Cancer Registries Case Study: Hspital-Based Cancer Registries FACILITATOR GUIDE FETP Cancer Curriculum: Principles f Cancer Registries Case

More information

Public consultation on the NHMRC s draft revised Australian alcohol guidelines for low-risk drinking

Public consultation on the NHMRC s draft revised Australian alcohol guidelines for low-risk drinking Public cnsultatin n the NHMRC s draft revised Australian alchl guidelines fr lw-risk drinking Recmmendatins frm The Cancer Cuncil Australia The Cancer Cuncil Australia is Australia s peak nn-gvernment

More information

PET FORM Planning and Evaluation Tracking ( Assessment Period)

PET FORM Planning and Evaluation Tracking ( Assessment Period) Divisin f: Behaviral Studies PET FORM Planning and Evaluatin Tracking (2010 2011 Assessment Perid) Persn Respnsible fr this Divisin: Jerry Mller Department f: Behaviral Sciences Persn Respnsible fr this

More information

Indications and Limitations of Coverage and/or Medical back to top

Indications and Limitations of Coverage and/or Medical back to top Fr services perfrmed n r after 09/15/2009 Original Determinatin Ending Date Revisin Effective Date Revisin Ending Date Indicatins and Limitatins f Cverage and/r Medical Necessity Indicatins Medicare cverage

More information

CSHCN Services Program Benefits to Change for Outpatient Behavioral Health Services Information posted November 10, 2009

CSHCN Services Program Benefits to Change for Outpatient Behavioral Health Services Information posted November 10, 2009 CSHCN Services Prgram Benefits t Change fr Outpatient Behaviral Health Services Infrmatin psted Nvember 10, 2009 Effective fr dates f service n r after January 1, 2010, benefit criteria fr utpatient behaviral

More information

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH Aurra Health Care s Research Subject Prtectin Prgram (RSPP) This guidance dcument will utline the prper prcedures fr btaining and dcumenting

More information

Dental Benefits. Under the TeamstersCare Plan, you and your eligible dependents have three basic options when you need dental care.

Dental Benefits. Under the TeamstersCare Plan, you and your eligible dependents have three basic options when you need dental care. Dental Benefits Under the TeamstersCare Plan, yu and yur eligible dependents have three basic ptins when yu need dental care. Optin #1: TeamstersCare Dentists. Yu can use ur in-huse Charlestwn, Chelmsfrd,

More information

Social Learning Theories

Social Learning Theories Scial Learning Theries - Careful scientific prcedures and methdlgy that characterize the behaviurist apprach Albert Bandura - Brn in small twn Alberta - Plish decent - Only sn with 5 sisters - Interested

More information

Module 6: Goal Setting

Module 6: Goal Setting Mdule 6: Gal Setting Objectives T understand the cncept f gal setting in Brief CBT T acquire skills t set feasible and apprpriate gals in Brief CBT What is gal setting, and why is it imprtant t set gals

More information

Attentional Limits on the Perception and Memory of Visual Information

Attentional Limits on the Perception and Memory of Visual Information Jurnal f xperimental Psychlgy: Cpyright 1990 by the American Psychlgical Assciatin, Inc. Human Perceptin and Perfrmance 0096-1523/90/$00.75 1990, Vl. 16, N. 2, 332-350 Attentinal Limits n the Perceptin

More information

Getting Started. Learning Guide. with Continuous Glucose Monitoring for the MiniMed 530G with Enlite. CGM Foundations

Getting Started. Learning Guide. with Continuous Glucose Monitoring for the MiniMed 530G with Enlite. CGM Foundations Getting Started with Cntinuus Glucse Mnitring fr the MiniMed 530G with Enlite Learning Guide CGM Fundatins Cntinuus Glucse Mnitring Learning Guide MiniMed 530G with Enlite - Cntinuus Glucse Mnitring Settings

More information

Forensic Science: Fundamentals & Investigations, 2e Chapter 2. All rights Reserved Cengage/NGL/South-Western 2016

Forensic Science: Fundamentals & Investigations, 2e Chapter 2. All rights Reserved Cengage/NGL/South-Western 2016 1 Frensic Science: Fundamentals & Investigatins, 2e Cengage/NGL/Suth-Western 2016 Crime-Scene Investigatin and Evidence Cllectin By the end f this chapter yu will be able t: 2.1 Summarize Lcard s Principle

More information

Reliability and Validity Plan 2017

Reliability and Validity Plan 2017 Reliability and Validity Plan 2017 Frm CAEP The principles fr measures used in the CAEP accreditatin prcess include: (a) validity and reliability, (b) relevance, (c) verifiability, (d) representativeness,

More information

Treatment Guidelines June 2013, D0028 Rev. F

Treatment Guidelines June 2013, D0028 Rev. F Treatment Guidelines June 2013, D0028 Rev. F Cutera Inc. Wrld Headquarters 3240 Bayshre Bulevard, Brisbane, CA 94005 USA Tel: +1 415 657 5500 Fax: +1 415 330 2444 www.cutera.cm June 2010, D0028 Rev. F

More information

Initial Postoperative Knee Care Patella or Quadriceps Tendon Repairs: - Videos are available on Dr. Witty s website: drjeffreywitty.

Initial Postoperative Knee Care Patella or Quadriceps Tendon Repairs: - Videos are available on Dr. Witty s website: drjeffreywitty. Initial Pstperative Knee Care Patella r Quadriceps Tendn Repairs: - Vides are available n Dr. Witty s website: drjeffreywitty.cm Imprtant Phne Numbers: - Please see the cntact infrmatin abve fr imprtant

More information

How to become an AME Online

How to become an AME Online Hw t becme an AME Online 1. Check that yu meet the minimum technical requirements in rder t use the AME Online system: Operating System: Windws Vista (Service Pack 2) Windws 7 Windws 8, 8.1 Windws 10 Please

More information

Cnsideratin fr Optimizatin: Optimizatin is a prgram transfrmatin technique, which tries t imprve the cde by making it cnsume fewer resurces (i.e. CPU, Memry) and deliver high speed. In ptimizatin, high-level

More information

Reference: Patient A. Brenda WXXXXX Date of Birth: 4/15/57

Reference: Patient A. Brenda WXXXXX Date of Birth: 4/15/57 Reference: Patient A Brenda WXXXXX Date f Birth: 4/15/57 49 year ld white female patient presented n July 20, 2006 with chief cmplaint f stage 4 cancer, initially diagnsed in Octber, 2003 with Cervical

More information

2018 Medical Association Poster Symposium Guidelines

2018 Medical Association Poster Symposium Guidelines 2018 Medical Assciatin Pster Sympsium Guidelines Overview The 3 rd Annual student-run Medical Assciatin f the State f Alabama Research Sympsium will take place n Friday and Saturday, April 13-14 at the

More information

Irradiation Treatment of Animal Foods

Irradiation Treatment of Animal Foods Irradiatin Treatment f Animal Fds Marsida Klem PhD, Engineering Sciences Department, Alexandër Misiu University, Durres, Albania Email: marsi_82h@yah.cm Azem Hysa MSc, Engineering Sciences Department,

More information

The principles of evidence-based medicine

The principles of evidence-based medicine The principles f evidence-based medicine By the end f this mdule yu shuld be able t: Describe what evidence based medicine is Knw where t find quality evidenced based medicine n the internet Be able t

More information

PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS

PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS INTRODUCTION This ntice prvides an verview f the parental special educatin rights, smetimes called prcedural safeguards

More information

Programme of Learning. Physical Education. Key Stage 4 Year 10 BTEC Sport

Programme of Learning. Physical Education. Key Stage 4 Year 10 BTEC Sport Prgramme f Learning Physical Educatin Key Stage 4 Year 10 BTEC Sprt BTEC Sprt Level 2 Unit 1Fitness fr Sprt and Exercise... 2 Learning aim A: Knw abut the cmpnents f fitness and the principles f training...

More information

23/11/2015. Introduction & Aims. Methods. Methods. Survey response. Patient Survey (baseline)

23/11/2015. Introduction & Aims. Methods. Methods. Survey response. Patient Survey (baseline) Intrductin & Aims Drug and Alchl Cnsultatin Liaisn (AOD CL) services aim t imprve identificatin and treatment f patients with AOD mrbidity. The csts and cnsequences f targeting AOD patients presenting

More information

GSB of EDA Meeting Minutes

GSB of EDA Meeting Minutes Hell Everyne! We held a General Service Bard meeting n 04/10/2013. Attendees: Alita, British Clumbia, CAN Annette H, Phenix, AZ Fran, IL Rachel F, Tempe, AZ Rger, MA Vanessa S, Lngwd, FL Ntes: Rger asked

More information

Data Fusion for Predicting Breast Cancer Survival

Data Fusion for Predicting Breast Cancer Survival Data Fusin fr Predicting Breast Cancer Linbailu Jiang, Yufei Zhang, Siyi Peng Mentr: Irene Kaplw December 11, 2015 1 Intrductin 1.1 Backgrund Cancer is mre f a severe health issue than ever in ur current

More information

Introduction. Lesson developed by: Heather Medema-Johnson, M.S, ATC, CSCS

Introduction. Lesson developed by: Heather Medema-Johnson, M.S, ATC, CSCS Updated DATE BSL PRO Lessn H35: Range f Mtin/Sit and Reach Lessn develped by: Heather Medema-Jhnsn, M.S, ATC, CSCS Intrductin A well-runded physical activity prgram is an integral part f a strng, verall

More information

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) Percutaneus Nephrlithtmy (PCNL) What is a percutaneus nephrlithtmy? is the mst effective f the cmmnly perfrmed prcedures fr kidney stnes. It is the best prcedure fr large and cmplex stnes. T perfrm this

More information

Meeting Minutes. III. New Business (Slide Presentation is embedded for reference) [slides 3-47] May 2011 DMRAB Presentation PUBLIC C

Meeting Minutes. III. New Business (Slide Presentation is embedded for reference) [slides 3-47] May 2011 DMRAB Presentation PUBLIC C Cmmnwealth f Kentucky Cabinet fr Health and Family Services Department fr Medicaid Services Drug Management Review Advisry Bard Meeting May 12, 2011 Meeting Minutes Vting Members in attendance: Kim Crley,

More information

Frequently Asked Questions: IS RT-Q-PCR Testing

Frequently Asked Questions: IS RT-Q-PCR Testing Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld

More information

ALLERGY. The effect of alternate-day prednisone on the white blood count in children with chronic asthma

ALLERGY. The effect of alternate-day prednisone on the white blood count in children with chronic asthma The Jurnal f ALLERGY and CLINICAL IMMUNOLOGY VOLUME 51 NUMBER 2 The effect f alternate-day prednisne n the white bld cunt in children with chrnic asthma H. Cha, M.D., and A. Gilbert, M.T. Denver, Cl. Children

More information

Annual Principal Investigator Worksheet About Local Context

Annual Principal Investigator Worksheet About Local Context Cmpleting the NCI CIRB Annual Principal Investigatr Wrksheet Abut Lcal Cntext and the Study-Specific Wrksheet Abut Lcal Cntext at the University f Iwa All investigatrs cnducting research with the Natinal

More information

Imaging tests allow the cancer care team to check for cancer and other problems inside the body.

Imaging tests allow the cancer care team to check for cancer and other problems inside the body. IMAGING TESTS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu

More information

The Interface Between Theory of Mind and Language Impairment

The Interface Between Theory of Mind and Language Impairment The Interface Between Thery f Mind and Language Impairment By Lauren Lwry Hanen Certified SLP and Clinical Staff Writer When mst f us hear the term thery f mind we usually think abut children with autism

More information

Human papillomavirus (HPV) refers to a group of more than 150 related viruses.

Human papillomavirus (HPV) refers to a group of more than 150 related viruses. HUMAN PAPILLOMAVIRUS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between

More information

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study Synpsis fr Public Disclsure This clinical study synpsis is prvided in line with Behringer Ingelheim s Plicy n Transparency and Publicatin f Clinical Study Data. The synpsis which is

More information

Instruction Manual IC ACCESS CONTROL

Instruction Manual IC ACCESS CONTROL Instructin Manual IC ACCESS CONTROL Mde: DH16A-12CT Metal surface and keypads Un-netwrked Mde: DH16A-12CTQ Metal surface and keypads Netwrked Mde: DH16A-50CT/CTN Metal surface and keypads Un-netwrked Mde:

More information

Widening of funding restrictions for rituximab and eltrombopag

Widening of funding restrictions for rituximab and eltrombopag 20 February 2014 Widening f funding restrictins fr rituximab and eltrmbpag PHARMAC is pleased t annunce the apprval f prpsals t widen the restrictin n rituximab use in DHB hspitals and expand the funding

More information

PERCEPTUAL DEVELOPMENT CHAPTER 16

PERCEPTUAL DEVELOPMENT CHAPTER 16 PERCEPTUAL DEVELOPMENT CHAPTER 16 Overview f Questins What can newbrns perceive? When can an infant perceive clr? Can a newbrn recgnize his r her mther? INFANT BRAIN DEVELOPMENT At birth babies brain has

More information

QP Energy Services LLC Hearing Conservation Program HSE Manual Section 7 Effective Date: 5/30/15 Revision #:

QP Energy Services LLC Hearing Conservation Program HSE Manual Section 7 Effective Date: 5/30/15 Revision #: QP Energy Services LLC Hearing Cnservatin Prgram HSE Manual Sectin 7 Effective Date: 5/30/15 Revisin #: Prepared by: James Aregd Date: 5/30/15 Apprved by: James Aregd Date: 5/30/15 Page 1 f 8 Cntents Sectin

More information

Measure Specific Guidelines for Comprehensive Diabetes Care (CDC)

Measure Specific Guidelines for Comprehensive Diabetes Care (CDC) Measure Specific Guidelines fr Cmprehensive Diabetes Care (CDC) Descriptin: Members age 18-75 years f age with diabetes (Type 1 and Type 2)* that had all f the fllwing: *Members in hspice are excluded

More information

A pre-conference should include the following: an introduction, a discussion based on the review of lesson materials, and a summary of next steps.

A pre-conference should include the following: an introduction, a discussion based on the review of lesson materials, and a summary of next steps. NAU Mdel Observatin Prtcl The mdel prtcl was develped with supprt and expertise frm the Natinal Institute fr Excellence in Teaching (NIET) and is based in great part n NIET s extensive experience cnducting

More information

Meaningful Use Roadmap Stage Edition Eligible Hospitals

Meaningful Use Roadmap Stage Edition Eligible Hospitals Meaningful Use Radmap Stage 1-2011 Editin Eligible Hspitals CPSI is dedicated t making yur transitin t Meaningful Use as seamless as pssible. Therefre, we have cme up with a radmap t assist yu in implementing

More information

Influence of Endosperm Type On the Nutritive Value Of Grain Sorghum and Corn

Influence of Endosperm Type On the Nutritive Value Of Grain Sorghum and Corn Influence f Endsperm Type On the Nutritive Value Of Grain Srghum and Crn c. A. Hibberd, R. Schemm and D. G. Wagner Stry in Brief The nutritive value f several varieties f grain srghum and crn was studied

More information

TREATMENT OF POLYCYTHEMIA VERA

TREATMENT OF POLYCYTHEMIA VERA RUSSELL L. HADEN, M.D. Plycythemia vera is characterized by an increase in the number f red bld cells. This disease is insidius in rigin, chrnic, and withut pathgnmnic symptms r physical findings. Early

More information

Chapter 6: Impact Indicators

Chapter 6: Impact Indicators Overview Chapter 6: Impact Indicatrs The best measure f the lng-term impact f all HIV preventin activities is the HIV incidence rate, namely the number f new cases f HIV infectin per year divided by the

More information

P02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017

P02-03 CALA Program Description Proficiency Testing Policy for Accreditation Revision 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin Revisin 1.9 July 26, 2017 P02-03 CALA Prgram Descriptin Prficiency Testing Plicy fr Accreditatin TABLE OF CONTENTS TABLE OF CONTENTS...

More information

FOUNDATIONS OF DECISION-MAKING...

FOUNDATIONS OF DECISION-MAKING... Table f Cntents FOUNDATIONS OF DECISION-MAKING... Errr! Bkmark nt Describe the decisin-making prcess pp.62-66... Errr! Bkmark nt Explain the three appraches managers can use t make decisins pp.67-70 Errr!

More information

Methadone Maintenance Treatment for Opioid Dependence

Methadone Maintenance Treatment for Opioid Dependence POLICY STATEMENT Methadne Maintenance Treatment fr Opiid Dependence APPROVED BY COUNCIL: May 2010 PUBLICATION DATE: Dialgue, Issue 2, 2010 Disclaimer: As f May 19, 2018 physicians n lnger require an exemptin

More information

Herbal Medicines: Traditional Herbal Registration

Herbal Medicines: Traditional Herbal Registration Herbal Medicines: Traditinal Herbal Registratin In the UK, cmpanies can nly sell herbal medicines with the apprpriate prduct licence, as fllws: A full marketing authrisatin based n the safety, quality

More information

STUDIES WITH HUMAN INFLUENZA VIRUS CULTIVATED IN ARTIFICIAL MEDIUM

STUDIES WITH HUMAN INFLUENZA VIRUS CULTIVATED IN ARTIFICIAL MEDIUM Published Online: 1 June, 1936 Supp Inf: http://di.rg/1.184/jem.63.6.83 Dwnladed frm jem.rupress.rg n August 13, 218 STUDIES WITH HUMAN INFLUENZA VIRUS CULTIVATED IN ARTIFICIAL MEDIUM BY T. P. MAGILL,

More information

(From the Laboratories of the International Health Division of The Rockefeller Foundation, New York)

(From the Laboratories of the International Health Division of The Rockefeller Foundation, New York) THE QUANTITATIVE DETERMINATION OF INFLUENZA VIRUS AND ANTIBODIES BY MEANS OF RED CELL AGGLUTINATION BY GEORGE K. HLRST, M.D. (Frm the Labratries f the Internatinal Health Divisin f The Rckefeller Fundatin,

More information

INFERTILITY DIAGNOSIS

INFERTILITY DIAGNOSIS INFERTILITY Infertility is the inability t cnceive after 12 mnths f unprtected intercurse. There are multiple causes f infertility and a systematic way t evaluate the cnditin. Let s lk at sme f the causes.

More information

The data refer to persons aged between 15 and 54.

The data refer to persons aged between 15 and 54. Drug-related hspital stays in Australia 1993-2005 Prepared by Amanda Rxburgh and Luisa Degenhardt, Natinal Drug and Alchl Research Centre Funded by the Australian Gvernment Department f Health and Ageing

More information

Coding. Training Guide

Coding. Training Guide Cding (Specialty Hspital) Visin 4.3 (January 2013) Training Guide SurceMedical VisinSH Cding Learning Center f Excellence Last change made: January 2013 2013 Surce Medical Slutins, Inc. All Rights Reserved.

More information

Analysis of Normal Flicker Sensitivity and Its Variability in the Visuogram Test

Analysis of Normal Flicker Sensitivity and Its Variability in the Visuogram Test Investigative Ophthalmlgy & Visual Science. Vl. 32, N. 9, August 1991 Cpyright Assciatin fr Research in Visin and Ophthalmlgy Analysis f Nrmal Flicker Sensitivity and Its Variability in the Visugram Test

More information

Accounting Assessment Report

Accounting Assessment Report Accunting 2014-2015 Assessment Reprt 1. Please give a brief verview f the assessment data yu cllected this year. This can be in any frm yu feel is apprpriate, such as a table, a shrt narrative f results,

More information

Appendix C. Master of Public Health. Practicum Guidelines

Appendix C. Master of Public Health. Practicum Guidelines Appendix C Master f Public Health Practicum Guidelines 0 Gergia State University, Schl f Public Health Master f Public Health Practicum Guidelines Fr mre infrmatin, cntact Jessica Hwell Pratt, MPH Practicum

More information

Swindon Joint Strategic Needs Assessment Bulletin

Swindon Joint Strategic Needs Assessment Bulletin Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical

More information

EMC believes the information in this publication is accurate as of its publication date. The information is subject to change without notice.

EMC believes the information in this publication is accurate as of its publication date. The information is subject to change without notice. EMC DATA PROTECTION ADVISOR (DPA) MIGRATION TECH NOTE With SQL as external database fr t 5.5.1 and later DPA versin 5.x releases t 6.0 SP1 and later ABSTRACT This Tech Nte prvides the steps t migrate frm

More information

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están

More information

NYS Common Core ELA & Literacy Curriculum Grade 12 Module 4 Unit 1 Lesson 14

NYS Common Core ELA & Literacy Curriculum Grade 12 Module 4 Unit 1 Lesson 14 12.4.1 Lessn 14 Intrductin In this final lessn f the unit, the 12.4.1 End-f-Unit Assessment, students craft a frmal, multi-paragraph respnse t ne f tw prmpts f their chice. Each f the tw ptins requires

More information

NHAIS SIS Communication

NHAIS SIS Communication T: All NHAIS Key Users/Screening Managers Frm: Catherine Rberts SIS Request: T/14528 HSCIC Change Number: 15846 Date: 24/03/2015 Page 1 f 5 Impacted Applicatins: SD screen, Lab Links, MM screen, AJ-CD

More information

Lesson Unit content* Activities Resource checklist Links to other units

Lesson Unit content* Activities Resource checklist Links to other units BTEC First Sprt Unit 1: Fitness fr Sprt and Exercise Scheme f wrk Guided learning hurs (GLH): 30 Number f lessns: 20 Duratin f lessns: 1-2 hurs (as shwn) This scheme f wrk is prvided t help yu make the

More information

Materials Dissecting pan, dissecting kit, safety glasses, lab apron, pig heart, & gloves

Materials Dissecting pan, dissecting kit, safety glasses, lab apron, pig heart, & gloves Heart Dissectin Intrductin Mammals have fur-chambered hearts and duble circulatin. The heart f a bird r mammal has tw atria and tw cmpletely separated ventricles. The dublelp circulatin is similar t amphibians

More information

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher:

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher: Year 10 Fd Technlgy Assessment Task 1: Fds fr Special Needs Name: Teacher: Due Date: Term 2, Week 1 Type f Task: Design Task Planning Fd Requirements Cllectin f Assessment: Submit in Class Assessment Plicy:

More information

2017 Optum, Inc. All rights reserved BH1124_112017

2017 Optum, Inc. All rights reserved BH1124_112017 1) What are the benefits t clients f encuraging the use f MAT? Withut MAT, 90% f individuals with Opiid Use Disrder (OUD) will relapse within ne year. With MAT, the relapse rate fr thse with OUD decreases

More information

2017 PEPFAR Data and Systems Applied Learning Summit Day 2: MER Analytics/Available Visualizations, Clinical Cascade Breakout Session TB/HIV EXERCISE

2017 PEPFAR Data and Systems Applied Learning Summit Day 2: MER Analytics/Available Visualizations, Clinical Cascade Breakout Session TB/HIV EXERCISE 2017 PEPFAR Data and Systems Applied Learning Summit Day 2: MER Analytics/Available Visualizatins, Clinical Cascade Breakut Sessin TB/HIV EXERCISE Created by the ICPI TB/HIV Wrkstream Abut this Handut

More information