Detecting Early-Stage Pressure Injury in Patients With Dark Skin Tones Using an Enhanced Physical Assessment Technique and Halogen Lighting.

PURPOSE: The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting. PARTICIPANTS AND SETTING: This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones. APPROACH: The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis. OUTCOMES: Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period. IMPLICATIONS FOR PRACTICE: The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.

Reduction of coastal lighting decreases seabird strandings.

Artificial light at night (ALAN) is negatively impacting numerous species of nocturnally active birds. Nocturnal positive phototaxis, the movement towards ALAN, is exhibited by many marine birds and can result in stranding on land. Seabird species facing major population declines may be most at risk. Leach's Storm-Petrels (Hydrobates leucorhous) are small, threatened seabirds with an extensive breeding range in the North Atlantic and North Pacific Oceans. The Atlantic population, which represents approximately 40-48% of the global population, is declining sharply. Nocturnal positive phototaxis is considered to be a key contributing factor. The Leach's Storm-Petrel is the seabird species most often found stranded around ALAN in the North Atlantic, though there is little experimental evidence that reduction of ALAN decreases the occurrence of stranded storm-petrels. During a two-year study at a large, brightly illuminated seafood processing plant adjacent to the Leach's Storm-Petrel's largest colony, we compared the number of birds that stranded when the lights at the plant were on versus significantly reduced. We recorded survival, counted carcasses of adults and juveniles, and released any rescued individuals. Daily morning surveys revealed that reducing ALAN decreased strandings by 57.11% (95% CI: 39.29% - 83.01%) per night and night surveys revealed that reducing ALAN decreased stranding of adult birds by 11.94% (95% CI: 3.47% - 41.13%) per night. The peak stranding period occurred from 25 September to 28 October, and 94.9% of the birds found during this period were fledglings. These results provide evidence to support the implementation of widespread reduction and modification of coastal artificial light as a conservation strategy, especially during avian fledging and migration periods.

Randomized trial comparing the effects of a 3D head-up system and microscope eyepiece-assisted simulated vitrectomy with intraocular illumination on the ocular surface of an operator.

BACKGROUND: To compare the effects of a 3D head-up system and microscope eyepiece-assisted simulated vitrectomy intraocular illumination on the ocular surface of an operator. METHODS: This was a prospective randomized controlled study. According to the application system, thirty ophthalmic operators (60 eyes) were randomly divided into 3D and eyepiece groups. Under different intensities of intraocular illumination, operators in both groups viewed the fundus model through a 3D display screen or microscopic eyepiece for 2 h. Objective examinations and a subjective symptom questionnaire were used immediately after the test to evaluate the ocular surface of the operators. Objective examinations included nonintrusion tear meniscus height (NIKTMH), nonintrusion break-up time (NIKBUT), and bulbar redness and strip meniscometry tube (SMTube) measurements. Statistical analyses were performed by using SPSS 26.0 software. RESULTS: After the test, the NIKTMH, NIKBUT and SMTube measurements decreased; however, the degree of change varied among the groups of different systems. The differences between the 3D group and the eyepiece group in NIKTMH measurements, SMTube measurements, subjective symptom scores (eye dryness, difficulty focusing, and cervical pain), and light intensity reaching the ocular surface of the operators were statistically significant (P < 0.05). All of the objective and subjective tests showed that the 3D group had fewer effects on the NIKTMH and SMTube measurements, and the subjective comfort of the 3D group was greater. CONCLUSION: For both 3D screens and eyepieces, simulated vitrectomy with intraocular illumination for two hours can lead to discomfort and abnormalities in the operator's ocular surface; however, these abnormalities are less severe in the 3D group. TRIAL REGISTRATION: This trial was registered on December 22, 2022, at the Chinese Clinical Trials Registry with NO. ChiCTR2200066989.

High-speed eye tracking based on a synchronized imaging mechanism by a dual-ring infrared lighting source.

It is a challenge for conventional monocular-camera single-light source eye-tracking methods to achieve high-speed eye tracking. In this work, a dual-ring infrared lighting source was designed to achieve bright and dark pupils in high speed. The eye-tracking method used a dual-ring infrared lighting source and synchronized triggers for the even and odd camera frames to capture bright and dark pupils. A pupillary corneal reflex was calculated by the center coordinates of the Purkinje spot and the pupil. A map function was established to map the relationship between the pupillary corneal reflex and gaze spots. The gaze coordinate was calculated based on the mapping function. The average detection time of each gaze spot was 3.76 ms.

Artificial light at night drives diel activity patterns of synanthropic pipistrelle bats and their prey.

The use of artificial light at night (ALAN) has increased drastically worldwide over the last decades. ALAN can have major effects on nocturnal communities, including insects and bats. Insects are attracted to street lights and few bat species take advantage of this by foraging on the attracted insects. ALAN potentially affects the temporal patterns of insect abundance and thereby bat foraging behaviour. In a natural dark environment, these patterns are usually bimodal, with an activity peak in the early evening and the morning. Little is known about how ALAN affects insect presence throughout the night, and whether the light spectrum plays a role. This is important, as these temporal changes may be a key driver of disturbances in bat-insect interactions. Here, we studied how white and red light affect insects' and bats' nightly activity patterns. The activity of insects and bats (Pipistrellus spp.) was recorded throughout the night at seven experimentally illuminated sites in a forest-edge ecosystem. ALAN disrupted activity patterns, with both insects and bats being more active throughout the night. ALAN facilitated all-night foraging in bats especially near white light, but these effects were attenuated near red light. The ability to forage throughout the night may be a key advantage causing synanthropic bats to dominate in illuminated environments, but this could also prove detrimental in the long term. As red light reduced disturbing effects of ALAN on insects and bats diel activity pattern, it opens the possibility of using spectral composition as a mitigation measure.

Ambient light intensity affecting ultrasound operator detection of liver lesions in cine-clips.

INTRODUCTION: Ambient light (AL) is an important factor to improve ultrasound pathology detection. However, there are no established room AL levels recommended during an ultrasound examination. We aim to examine the diagnostic accuracy using different intensity of AL for the detection of liver lesions in anonymised pre-recorded cine-clips. METHODS: Eight ultrasound operators with 5-14 years' professional experiences were prospectively recruited to evaluate 51 randomised cine-clips directly from one ultrasound machine. These 15-s clips of the right lobe of the liver in longitudinal and transverse planes were meant to simulate the ultrasound examination. Operators reviewed all cine-clips and responded to two questions per cine-clip regarding their detection performance under 3 AL settings; 3, 15 and 25 lux, at one lighting per visit. A repeat visit under each AL was performed to assess for intra-operator variability. Each operator completed six visits in total, with at least a 2-day washout period. The operators' performance was compared against imaging reference standards from contrast CT/MRI for cine-clips with lesion and serial US for those without. RESULTS: AL with highest degree of diagnostic accuracy was found to be at 25 lux. Results from 8 operators revealed sensitivity ranged from 79% to 100%, specificity ranged from 94% to 100%. Positive and negative predictive values were up to 100% with AL at 25 lux. Both intra-and interrater reliability were excellent at 0.85-1.0 (0.79-0.98) and 0.98 (0.97, 0.99) respectively, with AL at 25 lux. CONCLUSION: This study proved that ambient light intensity affects the ultrasound operator detection of liver lesions on cine-clips. IMPLICATIONS FOR PRACTICE: Identifying suitable AL levels will influence future ultrasound room construct.

Influence of lighting on visual performance.

PURPOSE: This review emphasizes the effect of light on visual efficiency, the impact of different lighting focuses, types of lighting, and their influence on vision and productivity. Light sources and standards are intriguing subjects for ophthalmologists. Guidelines regarding the level of lighting influence on visual activities can enhance visual performance.Methods: This article was developed based on literature reviews, with a bibliographic survey conducted in databases such as PubMed, MEDLINE, Web of Science, Embase, LILACS, and SciELO. RESULTS: Provides recommendations for understanding information regarding the influence of lighting on visual performance. CONCLUSION: Proper workplace lighting is crucial for improving visual efficiency, safety, productivity, and worker health. Efficient workplace lighting should avoid light sources directed towards the worker's face, prevent harmful glare, be more intense in the work area, and uniform in the rest of the room. Ophthalmologists should be knowledgeable about and provide guidance on correct lighting to ensure patient comfort and satisfaction with visual correction.

["Wider Den Nächtlichen Unfug"-Bielefeld's Street Lighting from 1853 to the 1880s as a Securatization Infrastructure and Tool for Self-Discipline]. / "Wider den nächtlichen Unfug" ­ Die Bielefelder Straßenbeleuchtung von 1853 bis in die 1880er Jahre als versicherheitlichende Infrastruktur und Mittel der Selbstdisziplinierung.

This article deals with the change in safety requirements and technological possibilities in the course of industrialization by looking at the establishment of street lighting in Bielefeld in the 19th century. As will be shown, the development from oil to gas lanterns coincided with a change in the security needs of the urban middle class. It was the technical possibilities of gas lighting to penetrate the urban space at night that made marginalized groups of people who were perceived as a security risk visible. This, together with the bourgeois internalization of the disciplinary effects of light, made this infrastructure possible in Bielefeld. While the urban populations of the pre-modern and early 19th century were still skeptical or dismissive of lanterns, by the mid-19th century their installation was already part of decidedly urban bourgeois demands for more safety in the areas of personal, economic and traffic safety. The lantern thus changed from an instrument of pre-modern visibility to an instrument of constant visibility in the modern age, which at the same time led to new lines of conflict when the expansion and extension of lighting was not as comprehensive as demanded by the urban bourgeoisie. In addition to the changes and conjunctures of security needs in the course of industrialization, Bielefeld also shows that an internalization of the concept of sovereignty by no means meant the absence of conflict. On the basis of administrative acts and petitions, the history of Bielefeld's street lighting is placed in a larger transformation of security, technology and urban spatial design from the perspective of historical security research, drawing on Foucoult's concept of gouvernmentalité. The results show that the history of technology and infrastructure can significantly deepen and contextualize the findings of historical security research. The use and expectations of technology were an essential part of a new understanding of security, as well as the socially segmented organization of urban space through a sometimes precarious alliance of different groups of actors.

Reducing the fatal attraction of nocturnal insects using tailored and shielded road lights.

The attraction of insects to artificial light is a global environmental problem with far-reaching implications for ecosystems. Since light pollution is rarely integrated into conservation approaches, effective mitigation strategies towards environmentally friendly lighting that drastically reduce insect attraction are urgently needed. Here, we tested novel luminaires in two experiments (i) at a controlled experimental field site and (ii) on streets within three municipalities. The luminaires are individually tailored to only emit light onto the target area and to reduce spill light. In addition, a customized shielding renders the light source nearly invisible beyond the lit area. We show that these novel luminaires significantly reduce the attraction effect on flying insects compared to different conventional luminaires with the same illuminance on the ground. This underlines the huge potential of spatially optimized lighting to help to bend the curve of global insect decline without compromising human safety aspects. A customized light distribution should therefore be part of sustainable future lighting concepts, most relevant in the vicinity of protected areas.

Investigating the impacts of artificial light via blackouts.

Natural experiments provide remarkable opportunities to test the large-scale effects of human activities. Widespread energy blackouts offer such an 'experiment' to test the impacts of artificial light at night (ALAN) on wildlife. We use the situation in South Africa, where regular scheduled blackouts are being implemented, to highlight this opportunity.

Impact of dichromatic lighted incubation on hatching result and post-hatch performance of broiler chickens.

This study was planned to evaluate the impact of dichromatic lights during incubation on the hatching and post-hatch performance of broiler chickens. A total of 500 eggs of broiler breeder (Ross 308; Age 44 weeks) were evenly divided according to a completely randomized design into 4 treatments having 5 replicates and 25 eggs each. Treatments consisted of dichromatic lights Blue + Red (BR), Green + Red (GR) and Green + Blue (GB) provided at an intensity of 250 lx for 12 h a day along with a Dark (D) environment. After hatching 200 chicks (50 from each respective light group) were divided into 4 treatments with 5 replicates each having 10 chicks. Results indicated a higher embryo index (13.12%) in the GR group on the 12th day of incubation; while an ideal hatch window was observed in GR and GB (98.18% and 96.00% hatched chicks) lighting groups. In hatching traits, higher hatchability (86.15) and hatch of fertile (93.85) percentages were observed in GR lighting followed by GB, BR and Dark treatment groups; while dead-in shell embryos were lowest in the GR group. In growth performance, higher feed intake (513.20 g) and body weight (479.20 g) were observed in the GB group followed by GR, BR and dark group; and feed conversion ratio (FCR) was better in the GR group (1.06). In welfare parameters, improved physical asymmetry (0.90 mm) and tonic immobility (54.40 s) were measured in the GR group followed by GB, BR and the dark group. It was concluded that under experimental conditions when broiler breeder eggs are provided with GR lighting during incubation, it can help to improve hatchability, growth performance and welfare traits in chicks.

LED streetlight characteristics alter the functional composition of ground-dwelling invertebrates.

Artificial Light at Night (ALAN) has been identified as a primary driver of environmental change in the 21st century with key impacts on ecosystems. At the same time, developments of LED lighting systems with adjustable parameters-such as color temperature and light intensity-may provide an opportunity to mitigate the negative effects of ALAN. To test the potential effects of LED properties, we conducted a comprehensive field study over two summers at three forest sites in Switzerland. We investigated the impact of three key attributes of LED lights (color temperature, brightness, and luminaire shape) on the abundance and community structure of ground-dwelling invertebrate functional groups (predators, omnivores, and detritivores). We found a significantly increased nocturnal attraction of omnivores (+275%) and predators (+70%), but not detritivores, to ALAN, altering arthropod community composition and trophic interactions in forests. LED color temperature and luminaire shape showed minimal effects on all three functional groups, while reducing light level from 100% to 50% attracted fewer individuals in all groups with a significant effect in omnivores (-57%). In addition, we observed significant interactions of color temperatures and luminaire shapes with light intensity, with a decrease in numbers when dimming the light to 50% intensity combined with a color temperature of 3700 K for predators (-53%), with diffusing luminaire shapes for omnivores (-77%) and with standard luminaire shape for detritivores (-27%). The predator-detritivore ratio showed a significant color temperature - light level interaction, with increased numbers of predators around streetlights with 3700 K and 100% intensity, resulting in an elevated top-down pressure on detritivores. These results suggest the importance of considering combined light characteristics in future outdoor lighting designs.

Diurnal biological effects of correlated colour temperature and its exposure timing on alertness, cognition, and mood in an enclosed environment.

Artificial lighting, which profits from the non-visual effects of light, is a potentially promising solution to support residents' psychophysiological health and performance at specific times of the day in enclosed environments. However, few studies have investigated the non-visual effects of daytime correlated colour temperature (CCT) and its exposure timing on human alertness, cognition, and mood. However, the neural mechanisms underlying these effects are largely unknown. The current study evaluated the effects of daytime CCT and its exposure timing on markers of subjective experience, cognitive performance, and cerebral activity in a simulated enclosed environment. Forty-two participants participated a single-blind laboratory study with a 4 within (CCT: 4000 K vs. 6500 K vs. 8500 K vs. 12,000 K) × 2 between (exposure timing: morning vs. afternoon) mixed design. The results showed time of the day dependent benefits of the daytime CCT on subjective experience, vigilant attention, response inhibition, working memory, emotional perception, and risk decisions. The results of the electroencephalogram (EEG) revealed that lower-frequency EEG bands, including theta, alpha, and alpha-theta, were quite sensitive to daytime CCT intervention, which provides a valuable reference for trying to establish the underlying mechanisms that support the performance-enhancement effects of exposure to CCT in the daytime. However, the results revealed no consistent intervention pattern across these measurements. Therefore, future studies should consider personalised optimisation of daytime CCT for different cognitive demands.

Transparent layer constancy improves with increased naturalness of the scene.

The extent to which hue, saturation, and transmittance of thin light-transmitting layers are perceived as constant when the illumination changes (transparent layer constancy, TLC) has previously been investigated with simple stimuli in asymmetric matching tasks. In this task, a target filter is presented under one illumination and a second filter is matched under a second illumination. Although two different illuminations are applied in the stimulus generation, there is no guarantee that the stimulus will be interpreted appropriately by the visual system. In previous work, we found a higher degree of TLC when both illuminations were presented alternately than when they were presented simultaneously, which could be explained, for example, by an increased plausibility of an illumination change. In this work, we test whether TLC can also be increased in simultaneous presentation when the filter's belonging to a particular illumination context is made more likely by additional cues. To this end, we presented filters in differently lit areas of complex, naturalistically rendered 3D scenes containing different types of cues to the prevailing illumination, such as scene geometry, object shading, and cast shadows. We found higher degrees of TLC in such complex scenes than in colorimetrically similar simple 2D color mosaics, which is consistent with the results of similar studies in the area of color constancy. To test which of the illumination cues available in the scenes are actually used, the different types of cues were successively removed from the naturalistically rendered complex scene. A total of eight levels of scene complexity were examined. As expected, TLC decreased the more cues were removed. Object shading and illumination gradients due to shadow cast were both found to have a positive effect on TLC. A second filter had a small positive effect on TLC when added in strongly reduced scenes, but not in the complex scenes that already provide many cues about the illumination context of the filter.

Optical design of low-location illumination based on asymmetric double freeform surfaces.

The development of optical optics for low-location road lighting is a challenging problem in providing high luminance and uniformity of illumination and meeting many other specific requirements. This study proposes an optical design method of low-location illumination based on an asymmetric double freeform surface lens. The ray emitted from the light source is refracted and reflected through the different surface types to the corresponding area of the receiving surface. In the design example, the road has dual-side mounted luminaires and a width of 6 m, and a height of 0.8 m. Simulation results indicate that, compared with conventional high-pole streetlights, the luminance uniformity had increased from 0.60 to 0.66, the illuminance uniformity had improved from 0.75 to 0.86, and the glare had been reduced.

Color constancy mechanisms in virtual reality environments.

Prior research has demonstrated high levels of color constancy in real-world scenarios featuring single light sources, extensive fields of view, and prolonged adaptation periods. However, exploring the specific cues humans rely on becomes challenging, if not unfeasible, with actual objects and lighting conditions. To circumvent these obstacles, we employed virtual reality technology to craft immersive, realistic settings that can be manipulated in real time. We designed forest and office scenes illuminated by five colors. Participants selected a test object most resembling a previously shown achromatic reference. To study color constancy mechanisms, we modified scenes to neutralize three contributors: local surround (placing a uniform-colored leaf under test objects), maximum flux (keeping the brightest object constant), and spatial mean (maintaining a neutral average light reflectance), employing two methods for the latter: changing object reflectances or introducing new elements. We found that color constancy was high in conditions with all cues present, aligning with past research. However, removing individual cues led to varied impacts on constancy. Local surrounds significantly reduced performance, especially under green illumination, showing strong interaction between greenish light and rose-colored contexts. In contrast, the maximum flux mechanism barely affected performance, challenging assumptions used in white balancing algorithms. The spatial mean experiment showed disparate effects: Adding objects slightly impacted performance, while changing reflectances nearly eliminated constancy, suggesting human color constancy relies more on scene interpretation than pixel-based calculations.

Illumination matters part IV: blackout and whiteout in flexible ureteroscopy - first report on a phenomenon observed by PEARLS.

PURPOSE: To date, no study has evaluated effects of varying brightness settings on image quality from flexible ureteroscopes submerged in saline. The aim was to evaluate blackout and whiteout occurrences in an in-vitro kidney calyx model. MATERIAL AND METHODS: We evaluated a series of contemporary flexible ureteroscopes including the Storz Flex-Xc and Flex-X2s, Olympus V3 and P7, Pusen 7.5F and 9.2F, as well as OTU WiScope using a 3D-printed enclosed pink in-vitro kidney calyx model submerged in saline. Endoscopic images were captured with ureteroscope tip placed at 5 mm,10 mm and 20 mm distances. The complete range of brightness settings and video capture modes were evaluated for each scope. Distribution of brightness on a grayscale histogram of images was analyzed (scale range 0 to 255). Blackout and whiteout were defined as median histogram ranges from 0 to 35 and 220 to 255, respectively (monitor image too dark or too bright for the human eye, respectively). RESULTS: Blackout occurred with the P7, Pusen 7.5F, 9.2F and WiScope at all distances, and V3 at 20 mm - with lowest brightness settings. Whiteout occurred with Flex-X2s, V3 and P7 at 5 mm and 10 mm, as well as with V3 and P7 at 20 mm - mostly with highest brightness settings. The Flex-Xc had neither blackout nor whiteout at all settings and distances. CONCLUSION: Blackout or whiteout of images is an undesirable property that was found for several scopes, possibly impacting diagnostic and therapeutic purposes during ureteroscopy. These observations form a guide to impact a urologist's choice of instruments and settings.

Effects of nocturnal celestial illumination on high-flying migrant insects.

Radar networks hold great promise for monitoring population trends of migrating insects. However, it is important to elucidate the nature of responses to environmental cues. We use data from a mini-network of vertical-looking entomological radars in the southern UK to investigate changes in nightly abundance, flight altitude and behaviour of insect migrants, in relation to meteorological and celestial conditions. Abundance of migrants showed positive relationships with air temperature, indicating that this is the single most important variable influencing the decision to initiate migration. In addition, there was a small but significant effect of moonlight illumination, with more insects migrating on full moon nights. While the effect of nocturnal illumination levels on abundance was relatively minor, there was a stronger effect on the insects' ability to orientate close to downwind: flight headings were more tightly clustered on nights when the moon was bright and when cloud cover was sparse. This indicates that nocturnal illumination is important for the navigational mechanisms used by nocturnal insect migrants. Further, our results clearly show that environmental conditions such as air temperature and light levels must be considered if long-term radar datasets are to be used to assess changing population trends of migrants. This article is part of the theme issue 'Towards a toolkit for global insect biodiversity monitoring'.

Effect of the chromaticity of stimuli on night vision disturbances.

The perception of halos and other night vision disturbances is a common complaint in clinical practice. Such visual disturbances must be assessed in order to fully characterize each patient's visual performance, which is particularly relevant when carrying out a range of daily tasks. Visual problems are usually assessed using achromatic stimuli, yet the stimuli encountered in daily life have very different chromaticities. Hence, it is important to assess the effect of the chromaticity of visual stimuli on night vision disturbances. The aim of this work is to study the influence of the chromaticity of different visual stimuli on night vision disturbances by analyzing straylight and visual discrimination under low-light conditions. For that, we assessed the monocular and binocular visual discrimination of 27 subjects under low illumination using the Halo test. The subjects' visual discrimination was assessed after exposure to different visual stimuli: achromatic, red, green, and blue, both at the monitor's maximum luminance and maintaining the same luminance value for the different visual stimuli. Monocular straylight was also measured for an achromatic, red, green, and blue stimuli. The blue stimulus had the greatest effect on halos in both monocular and binocular conditions. Visual discrimination was similar for the red, green, and achromatic stimuli, but worsened at lower luminance. The greatest influence of straylight was observed for the blue stimulus. In addition, visual discrimination correlated with straylight measurements for achromatic stimuli, wherein greater straylight values correlated with an increased perception of halos and other visual disturbances.