Breaking the barriers: Methodology of implementation of a non-mydriatic ocular fundus camera in an emergency department.

Despite evidence that non-mydriatic fundus cameras are beneficial in non-ophthalmic settings, they are only available in a minority of hospitals in the US. The lag from research-based evidence to change in clinical practice highlights the complexities of implementation of new technology and practice. We describe the steps used to implement successfully a non-mydriatic ocular fundus camera combined with optical coherence tomography (OCT) in a general emergency department (ED) using Kotter's 8-Step Change Model. We prospectively collected the number of trained personnel in the ED, the number of imaging studies obtained each week during the first year following implementation, and we documented major achievements each month, as well as outcome measures, barriers to implementation and possible solutions. Between 12 and 42 patients were imaged per week, resulting in a total of 1274 patients imaged demonstrating sustained usage of non-mydriatic fundus camera/OCT in the ED one year after implementation. The implementation process was contingent upon multidisciplinary collaboration, extensive communication, coordinated training of staff, and continuous motivation. The future will likely include the use of artificial intelligence deep learning systems for automated interpretation of ocular imaging as an immediate diagnostic aid for ED or other non-eye care providers.

Synergistic application of digital outcrop characterization techniques and deep learning algorithms in geological exploration.

In order to meet the needs of geologists for the analysis of data characterizing field outcrops (rock sections or formations exposed on the ground surface), this study developed a field digital outcrop visualization platform based on Cesium (a 3D geospatial visualization technology) digital outcrop characterization technology. The platform was developed based on WebGL (a protocol for rendering interactions on web pages), which overcame the shortcomings of traditional software in terms of visualization, cross-device, cross-platform, and ease of use. Firstly, UAV inclined photography is used for data collection, which transforms a large amount of geological data into an intuitive 3D geological model, while the visualization platform provides rich measurement and mapping tools for the identified features, which more intuitively displays the outcrop information, helps geological explorers to understand the geological conditions in the field more quickly and comprehensively, and improves the analysis efficiency and ease-of-use of outcrop characterization data. Combined with the improved VGG19 (a deep convolutional neural network architecture) algorithm model, it has excellent performance in dealing with the fine texture and complex structure of rocks, which significantly improves the accuracy of lithology identification. The synergistic application of this technology provides geologists with a faster and more comprehensive means to understand the geological conditions in the field. The reliability of combining the Cesium digital outcrop characterization technology with the VGG19 lithology identification algorithm in geological exploration is verified through case studies. The synergistic application of this technology will greatly enhance the efficiency and ease of analysis of outcrop characterization in the field, and provide new perspectives for future research in geosciences.

Outdated and re-configured: Challenging linear conceptualizations of ageing through the case of revived obsolete technologies.

Taking as a starting point the conventional view of ageing as a linear process beginning in a youthful and productive stage but gradually deteriorating, this paper shifts the usual anthropocentric focal point towards technological artifacts which do not conform to this typical view. More specifically, three examples of technologies previously considered obsolete, but which have seen a revival in the last decade, are presented: the so-called dumbphones, analogue cameras, and vinyl players. Although very different at first glance, the three cases of these revived technologies show a similar evolution trajectory which breaks from the typical view of ageing in technological artifacts. Instead, they indicate how their revival does not simply entail a reconsideration of their initial value (such as it is often the case with antiques or heirlooms), but a transformation, hybridisation, and re-envisioned purpose. To this effect, the agential realism theory is applied to show how the revival of technological artifacts and practices once considered outdated attempts to dissolve binaries such as old/new, young/old, or slow/fast. Furthermore, such artifacts reveal trajectories of ageing that are unlike their human counterparts, but which can make way for new manners of articulating issues pertaining to ageing as a process in humans as well. The contribution of the paper lies in illustrating how adopting a non-linear view of ageing and fundamentally questioning its inherent binaries has the capacity to produce a much-needed nuanced view of ageing in humans, non-humans, and their sociomaterial entanglements.

ETDRS grading with CLARUS ultra-widefield images shows agreement with 7-fields colour fundus photography.

BACKGROUND: To analyse and compare the grading of diabetic retinopathy (DR) severity level using standard 35° ETDRS 7-fields photography and CLARUS™ 500 ultra-widefield imaging system. METHODS: A cross-sectional analysis of retinal images of patients with type 2 diabetes (n = 160 eyes) was performed for this study. All patients underwent 7-fields colour fundus photography (CFP) at 35° on a standard Topcon TRC-50DX® camera, and ultra-widefield (UWF) imaging at 200° on a CLARUS™ 500 (ZEISS, Dublin, CA, USA) by an automatic montage of two 133° images (nasal and temporal). 35° 7-fields photographs were graded by two graders, according to the Early Treatment Diabetic Retinopathy Study (ETDRS). For CLARUS UWF images, a prototype 7-fields grid was applied using the CLARUS review software, and the same ETDRS grading procedures were performed inside that area only. Grading of DR severity level was compared between these two methods to evaluate the agreement between both imaging techniques. RESULTS: Images of 160 eyes from 83 diabetic patients were considered for analysis. According to the 35° ETDRS 7-fields images, 22 eyes were evaluated as DR severity level 10-20, 64 eyes were evaluated as DR level 35, 41 eyes level 43, 21 eyes level 47, 7 eyes level 53, and 5 eyes level 61. The same DR severity level was achieved with CLARUS 500 UWF images in 92 eyes (57%), showing a perfect agreement (k > 0.80) with the 7-fields 35° technique. Fifty-seven eyes (36%) showed a higher DR level with CLARUS UWF images, mostly due to a better visualization of haemorrhages and a higher detection rate of intraretinal microvascular abnormalities (IRMA). Only 11 eyes (7%) showed a lower severity level with the CLARUS UWF system, due to the presence of artifacts or media opacities that precluded the correct evaluation of DR lesions. CONCLUSIONS: UWF CLARUS 500 device showed nearly perfect agreement with standard 35° 7-fields images in all ETDRS severity levels. Moreover, CLARUS images showed an increased ability to detect haemorrhages and IRMA helping with finer evaluation of lesions, thus demonstrating that a UWF photograph can be used to grade ETDRS severity level with a better visualization than the standard 7-fields images. TRIAL REGISTRATION: Approved by the AIBILI - Association for Innovation and Biomedical Research on Light and Image Ethics Committee for Health with number CEC/009/17- EYEMARKER.

Identification of Decedents by Restoring Mummified Fingerprints: Forensic Dermatology in the Investigation of Mummy Dermatoglyphics.

Fingerprints are created by elevations and depressions on the fingertip pads. Each person has their own unique fingerprints which can be used in the identification of that individual when alive, during the immediate postmortem period, or even after the digits have become mummified. Mummification can occur naturally; it can be partial (such as localized to only the hands and feet, extensive, or complete. Obtaining fingerprints after the skin has become mummified can be attempted while the digits remaining intact with the hand; however, the digits may need to be removed from the hand and the finger pads may also need to be separated from the underlying bone to secure an adequate fingerprint. Frequently, the mummified tissue needs to be rehydrated; numerous solutions have been used that increase the turgor of the digits, provide softening and pliability of the tissue, and enhance the details of the finger pad ridges. An aqueous solution of sodium carbonate (either combined with acetic acid or combined with 95 percent ethanol and distilled water) was found to be most effective for rehydration. Thereafter, various techniques can be attempted to obtain the fingerprint. These include the traditional method of inking and rolling of the finger or photographing the finger. Powders (such as aluminum powder, black fingerprint powder, white cornstarch-based powder, or fluorescent powder) can be used to enhance the ridge features; adhesive tape can be pressed against the powdered digit and the print pattern preserved by applying the adhesive tape to a clear transparency sheet. In addition, molds (using modeling clay or silicone rubber) and casts (using plaster of Paris, dental casting materials, or putty) can be made of the digits; either the molds or the casts or both can be photographed with or without prior application of fingerprint powder. Transillumination, using a fiber optic light source to illuminate the epidermis and underlying remaining dermis of a scraped and defleshed finger pad can be used to demonstrate the finger ridge pattern when the photographing the tip of the digit. In summary, forensic dermatology can have an integral role in obtaining fingerprints from mummified digits, which can be successfully used for the identification of the decedent.

An accessible digital imaging workflow for multiplexed quantitative analysis of adult eye phenotypes in Drosophila melanogaster.

The compound eye of Drosophila melanogaster has long been a model for studying genetics, development, neurodegeneration, and heterochromatin. Imaging and morphometry of adult Drosophila and other insects is hampered by the low throughput, narrow focal plane, and small image sensors typical of stereomicroscope cameras. When data collection is distributed among many individuals or extended time periods, these limitations are compounded by inter-operator variability in lighting, sample positioning, focus, and post-acquisition processing. To address these limitations we developed a method for multiplexed quantitative analysis of adult Drosophila melanogaster phenotypes. Efficient data collection and analysis of up to 60 adult flies in a single image with standardized conditions eliminates inter-operator variability and enables precise quantitative comparison of morphology. Semi-automated data analysis using ImageJ and R reduces image manipulations, facilitates reproducibility, and supports emerging automated segmentation methods, as well as a wide range of graphical and statistical tools. These methods also serve as a low-cost hands-on introduction to imaging, data visualization, and statistical analysis for students and trainees.

Remote Diagnosis of Retinal Detachment in an Emergency Department Using Nonmydriatic Hybrid Ocular Imaging.

Background: Ocular emergencies are commonly evaluated in general emergency departments (ED) where ophthalmologists are rarely available. Nonmydriatic ocular imaging combining color fundus photographs and optical coherence tomography (NMFP-OCT) can help with rapid remote triage by ophthalmologists. We evaluated the rate at which retinal detachments (RDs) can be diagnosed with NMFP-OCT in the ED. Methods: Quality improvement project with prospective collection of data on RD patients who had NMFP-OCT obtained by ED staff over 1 year. Photographs were interpreted remotely by ophthalmologists and all patients underwent an in-person ophthalmologic examination in the ED to confirm the presence of a RD. Results: A total of 63 eyes (58 patients) had a RD, among which 53 (84.1%) had strong suggestion of RD on ocular imaging (34 [54%] were seen on both color and OCT nerve/macula; 11 [17.5%] were seen on color but missed on OCT; 8 [12.7%] were missed on color but seen on OCT). Ten RDs (15.9%) were missed on both color and OCT because of peripheral location of the RD (4, 40%), vitreous hemorrhage (4, 40%), or poor image quality (2, 20%). A total of 40 out of 58 patients were not seen by an eye care provider prior to reaching our ED and 10 had an inappropriate stroke workup for acute vision loss of presumed vascular origin. Conclusion: NMFP-OCT of the posterior pole obtained by ED staff revealed the RD in 84.1% of eyes, allowing for rapid remote triage of patients with visual symptoms and avoiding unnecessary testing when the diagnosis of RD is confirmed.

Development of a Standardized Photo Guideline for Online Hair Transplantation Consultation.

BACKGROUND: Telemedicine has rapidly advanced in plastic and aesthetic surgery, but obtaining high-quality images during online hair transplantation consultations remains challenging, impeding doctors' visual evaluation. OBJECTIVE: To investigate patients' attitude and satisfaction with online hair transplantation consultations, and to develop a standardized photo guideline to help patients capture high-quality images. METHODS: We surveyed patients' attitudes and satisfaction with online hair transplantation consultations from November 23, 2023 to May 3, 2024. Meanwhile, five surgeons developed a standardized photo guideline and assessed its effectiveness by comparing image quality between two patient groups: those using the photo guideline and those not using it. RESULTS: We collected 570 responses to the attitude questionnaire, with 76.66% of participants expressing a willingness to undergo online hair transplantation consultations. The patient satisfaction survey yielded an overall satisfaction score of 4.44 ± 0.72 out of 5 for online hair transplantation consultations. Furthermore, all five surgeons rated photographs taken by patients following the photo guideline as higher quality compared to those taken by patients who did not use it. CONCLUSION: Patients show high satisfaction with online hair transplantation consultations. The standardized photo guideline proves effective in helping patients take high-quality photographs for online consultations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of AI-enhanced non-mydriatic fundus photography for diabetic retinopathy screening.

OBJECTIVE: To assess the feasibility of using non-mydriatic fundus photography in conjunction with an artificial intelligence (AI) reading platform for large-scale screening of diabetic retinopathy (DR). METHODS: In this study, we selected 120 patients with diabetes hospitalized in our institution from December 2019 to April 2021. Retinal imaging of 240 eyes was obtained using non-mydriatic fundus photography. The fundus images of these patients were divided into two groups based on different interpretation methods. In Experiment Group 1, the images were analyzed and graded for DR diagnosis using an AI reading platform. In Experiment Group 2, the images were analyzed and graded for DR diagnosis by an associate chief physician in ophthalmology, specializing in fundus diseases. Concurrently, all patients underwent the gold standard for DR diagnosis and grading-fundus fluorescein angiography (FFA)-with the outcomes serving as the Control Group. The diagnostic value of the two methods was assessed by comparing the results of Experiment Groups 1 and 2 with those of the Control Group. RESULTS: Keeping the control group (FFA results) as the gold standard, no significant differences were observed between the two experimental groups regarding diagnostic sensitivity, specificity, false positive rate, false negative rate, positive predictive value, negative predictive value, Youden's index, Kappa value, and diagnostic accuracy (X2 = 0.371, P > 0.05). CONCLUSION: Compared with the manual reading group, the AI reading group revealed no significant differences across all diagnostic indicators, exhibiting high sensitivity and specificity, as well as a relatively high positive predictive value. Additionally, it demonstrated a high level of diagnostic consistency with the gold standard. This technology holds potential for suitability in large-scale screening of DR.

The Infinite Corridor.

Description This photograph was chosen as a visual representation of the poem "Theory of a Well Mind" to capture the essence of the poem's exploration of the human psyche and the journey toward mental wellness. The corridor, with its repeating arches and vanishing point, symbolizes the cyclical nature of thoughts, emotions, and actions that the poem delves into. Just as the corridor seems to stretch into infinity, the poem reflects on the seemingly endless and challenging process of personal growth and self-discovery. The contrast between light and shadow within the image mirrors the poem's themes of introspection, uncertainty, and the pursuit of clarity amidst the complexities of the mind. The light that filters through the arches and windows represents moments of insight and hope, while the shadowed areas evoke the difficulties and unknowns that one encounters on the path to wellness.

Learning, internalisation and integration of the COVID-19 pandemic in healthcare workers: A qualitative document analysis.

The COVID-19 pandemic triggered an unprecedented health crisis that impacted healthcare systems worldwide. This study explores how Spanish healthcare workers learned, internalised and integrated values and work behaviours during the COVID-19 pandemic and their impact on the personal sphere. This documentary research, using images, narratives and audiovisual content, was framed within the interpretative hermeneutic paradigm. Categories and subcategories emerged after a final theoretical sampling that focused on the analysis. Data triangulation between researchers favoured theoretical saturation. A total of 117 images and 27 texts were selected. The analysis identified three stages: bewilderment, seeking functionality in the chaos and integrating chaos into care. The data reflects how the need for security and knowledge, and the exhaustion and frustration caused by the initial working conditions, prompted adaptive responses. These responses involved focusing on problem-solving and strengthening group sentiments and solidarity. Subsequently, the data indicates the acceptance of new structural, organisational and communication aspects. The findings of the analysis will contribute towards finding a framework that can help understand community health crisis events.

Photovoice and Health Perception in a Group of Early-Career Nurses.

Background. Nurses' perceptions of health are essential to decision making and communicating with clients. However, little is known about their own perceptions of this phenomenon. This study focuses on health-related beliefs among young nurses enrolled in a master's-level nursing program using a modified photovoice methodology. Methods. The study population was 87 nurses undergoing a master's degree in nursing at Jagiellonian University Medical College in Krakow, Poland, participating in an obligatory health psychology course. For the modified photovoice activity, the participants took three photos related to their perceptions of (1) health, (2) health protective factors, and (3) health risk factors. The data interpretation involved a thematic analysis of these photos and captions; a narrative analysis to distinguish between documentary and symbolic photos; and a descriptive analysis of the photo production. Results. Eighty-seven students completed the photography assignment. The mean age was 22.1 years (SD = 1.1). Most photos (91%) documented real-life health behaviours. Some photos (9%) used everyday objects such as sunflowers to create symbols related to health. A photo series showed a model of the human brain in different environments and activities. Conclusions. Student participation in the photovoice activity appeared to strengthen observation and interpretation skills, which are essential to client care. Students used this opportunity to reflect on their own lives and environments and show their perceptions of health, health protective factors, and health risks. The activity planted seeds for changes in students' health perceptions and critical thinking. Future research could explore whether participation in a modified photovoice activity as experiential learning in a required health psychology course contributes to changes in master's-level nursing students' personal health behaviours and client care.

Case report: Characterizing of free-floating pigmented vitreous cyst using swept-source optical coherence tomography.

Aim: A free-floating vitreous cyst is a rare eye disease. This study aimed to find diagnostic imaging methods and imaging features for vitreous cysts. Methods: This article presents a case report along with a literature review of published cases of vitreous cysts. The case report describes a highly myopic 60-year-old woman with a pigmented, free-floating vitreous cyst in her right eye. A search of the PubMed database using the keywords "vitreous cyst" was performed to identify other cases reported in the literature and to summarize the imaging methods used to diagnose and visualize vitreous cysts and the imaging features of vitreous cysts. Results: A thorough ophthalmic examination was performed in the present case, including slit-lamp photography, B-scan ultrasound, broad line fundus imaging, spectral-domain optical coherence tomography (SD-OCT), and ultra-wide field SS-OCT. The literature review revealed the imaging methods used in previously reported cases of vitreous cysts in which ultra-wide field SS-OCT has the advantages of wide scanning depth and high imaging clarity. Conclusion: SS-OCT has an advantage over SD-OCT in providing intuitive morphological characteristic images for the diagnosis of posterior vitreous cysts. The comprehensive assessment of multimodal imaging examinations, including SS-OCT, is of significant value for the diagnosis and differential diagnosis of vitreous cysts.

Perception and acceptance of medical photography among Arab dermatology patients: a cross-sectional analysis.

Medical photography has been utilized in clinical, academic, and research settings. In conservative countries, such as Saudi Arabia, limited data reflect patients' viewpoints on medical photography. The aim of this paper was to assess patients' opinions on medical photography and the factors influencing its acceptability. A cross-sectional study utilizing a self-distributed paper-based questionnaire was performed in the dermatology clinics at King Abdulaziz Medical City (Riyadh, Saudi Arabia) between February 2020 and January 2021. The response rate is 100% as only willing participants were handed a hard-copy survey and then retrieved once completed. A total of 414 Saudi adults were enrolled. Medical photography was highly acceptable, fairly acceptable, and poorly acceptable in 36.7%, 11.6%, and 14.3% of the patients, respectively. Females were more accepting of medical photography than males (p=0.041). Physicians were the most preferred choice as photographers (83%). Stating all intended use of the photographs was favored by most patients. Using a department-owned camera was essential to 84%. Patients who never had their photographs taken previously were more unaccepting of medical photography than those with prior experience (p=0.037). The main limitation of the study was that it was conducted at a single center; therefore, it may not represent the entire population. Medical photography is acceptable to the majority of patients. Meeting popular preferences, including physicians as photographers, using department-owned cameras, and stating all possible uses of the photographs may enhance patients' experience. The findings offer insight for developing a standardized framework that is suitable for both patients and physicians.

Enhancing diabetic retinopathy screening: Non-mydriatic fundus photography-assisted telemedicine for improved clinical management.

The utilization of non-mydriatic fundus photography-assisted telemedicine to screen patients with diabetes mellitus for diabetic retinopathy provides an accurate, efficient, and cost-effective method to improve early detection of disease. It has also been shown to correlate with increased participation of patients in other aspects of diabetes care. In particular, patients who undergo teleretinal imaging are more likely to meet Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set metrics, which are linked to preservation of quality-adjusted life years and additional downstream healthcare savings.