This document describes the procedures and measures that will be used to assess study participants. It outlines the primary and secondary outcome measures, which include the Convergence Insufficiency Symptom Survey (CISS), near point of convergence (NPC), and positive fusional vergence (PFV) at near. It also describes other clinical tests for corrected visual acuity, cycloplegic refraction, versions, stereopsis, and accommodative function. Detailed testing protocols are provided for each measure. The order of testing and equipment needed are specified to ensure standardized assessment across all study sites.
Dr. Serkan Toy (Children's Mercy Hospital Kansas City) summarizes current literature on assessment, evaluations, rubrics, and Global Assessment Scales from the perspective of Psychometrics.
Ever wonder how a cutscore is set on a certification/licensure test? This is a very brief intro to the topic of standard setting, that is, how cutscores (passing points) are set on credentialing exams using scientifically-backed research and rigorous psychometrics. Some approaches include the modified-Angoff, Bookmark, and Contrasting Groups. Visit www.assess.com to learn more.
Dr. Serkan Toy (Children's Mercy Hospital Kansas City) summarizes current literature on assessment, evaluations, rubrics, and Global Assessment Scales from the perspective of Psychometrics.
Ever wonder how a cutscore is set on a certification/licensure test? This is a very brief intro to the topic of standard setting, that is, how cutscores (passing points) are set on credentialing exams using scientifically-backed research and rigorous psychometrics. Some approaches include the modified-Angoff, Bookmark, and Contrasting Groups. Visit www.assess.com to learn more.
For the assignments in this course, you will be developing a Disas.docxmecklenburgstrelitzh
For the assignments in this course, you will be developing a Disaster Recovery and Business Continuity (DR/BC) Plan that defines the objectives, planning process, team creation, risk analysis, business issues, implementation, testing, and maintenance required for safeguarding the organization. Your first task in this process will be to consider situation of an imaginary company of your choice and create the framework for a DR/BC Plan.
Project Concept and Executive Sponsorship:
- Provide a brief description a company of your choice and your assignment to create the DR/BC Plan.
- Provide comments regarding the instructions that you might receive from corporate executives.
- Provide support through research regarding the need for executive sponsorship.
DR/BC Introduction and Risk Assessment:
- Provide an introduction to the new DR/BC Plan that the organization plans to implement.
- Prepare a risk assessment that explains the various types of threats that could disrupt the business of your chosen company.
- This should include consideration of both manmade and natural threats, as well as any threats that may be more likely given the geographic location of company facilities.
- Support your positions with references obtained from the university library, Web, text, or other reputable sources.
1
Rutgers University – Newark
College of Arts & Sciences
Department of Biological Sciences
General Biology II (21:120:102)
Lab Learning Objectives & Lab Learning Activities
CONTENT
General Information .................................................................................................... 3 1
Laboratory Safety Rules ............................................................................................... 4 2
Laboratory Syllabus ..................................................................................................... 5 3
Microscope Use ........................................................................................................... 7 4
4.1 The Compound Microscope ................................................................................. 7
4.2 The Dissecting Microscope ................................................................................... 9
Lab Report Format ..................................................................................................... 11 5
Lab 1 – Viewing and Measuring Cells ........................................................................ 12 6
6.1 Exercise 1 - Features of the compound microscope .......................................... 12
6.2 Exercise 2 – Procedure for viewing specimens .................................................. 14
6.3 Exercise 3 – The image under a compound microscope.................................... 15
6.4 Exercise 4 – Mirror images ................................................................................. .
Effects of Viewing Angle and Contrast Ratio on Visual Performance using TFT-LCDIJERA Editor
This study intends to investigate the effects of viewing angle for horizontal and vertical axis, and contrast ratio on visual performance during TFT-LCD visual work. Two dependent measures are collected: visual acuity and search performance. The measure of minimal separable visual angel of Landolt-C is used to evaluate the visual acuity. Search performance measured by correct percentage of searching task on pseudo-text. Results showed that viewing angle for horizontal and vertical axis, and contrast ratio significantly affect visual performance. Subjects at 0° and 15° on horizontal and vertical axis had better visual performance than at 30° and 45°. Visual performance increased as contrast ratio increased up to 11:1 and then slightly decreased once the contrast ratio was greater than 11:1.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
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- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Mop chapter04
1. Chapter 4 Assessment of Study Measures
11/30/2005 Page 4 - 1
Chapter 4: Assessment of Study Measures..................................................................................2
4.1 Overview................................................................................................................................2
4.1.1 Overview of Eligibility and Masked Examination Procedures........................................2
4.1.2 Equipment Needed for Masked Examination Procedures ...............................................3
4.2 Primary and Secondary Outcome Measures..........................................................................3
4.2.1 Convergence Insufficiency Symptom Survey (CISS) .....................................................3
4.2.2 Near Point of Convergence (NPC) ..................................................................................3
4.2.3 Positive Fusional Vergence (PFV) at Near......................................................................4
4.3 Other Clinical Testing (not Outcome Measures)...................................................................5
4.3.1 Corrected Visual Acuity (Distance and Near) .................................................................5
4.3.2 Cycloplegic Refraction ....................................................................................................6
4.3.3 Versions ...........................................................................................................................6
4.3.4 Stereopsis (Randot Stereotest).........................................................................................7
4.3.5 Cover Testing: Unilateral (UCT) and Alternate Cover Test (ACT)................................7
4.3.6 Monocular Amplitude of Accommodation (Right Eye Only).........................................8
4.3.7 Monocular Accommodative Facility (Right Eye Only)...................................................8
4.3.8 Negative Fusional Vergence (NFV) at Near....................................................................9
4.4 Rule out Systemic/Neurological Basis for CI......................................................................10
2. Chapter 4 Assessment of Study Measures
6/30/2005 Page 4 - 2
Chapter 4: Assessment of Study Measures
4.1 Overview
4.1.1 Overview of Eligibility and Masked Examination Procedures
The following measurements will be taken at all eligibility examinations and at all masked
examinations. The order of testing for these examinations will be:
1. CISS
2. Cover testing (distance and near)
3. NFV at near
4. PFV at near
5. NPC
6. Accommodative amplitude (RE only)
7. Accommodative facility (RE only)
8. CISS
The subject must wear his/her optical correction for each of the above tests. If the subject does
not bring his/her optical correction to the visit, a trial frame should be prepared which contains
the subject’s correction.
The neurological checklist, academic performance questionnaire, eligibility medication form,
personal history form, contact information form, and eligibility checklist must also be completed
at the eligibility examination. Completion of the consent for use of information and persona form
is not required for participation, but must be completed before a patient’s image can be included
on any CITT bulletin board, etc.
Other test results that must be collected at eligibility examinations include corrected visual acuity
(distance and near), versions, stereopsis, pupil testing, cycloplegic refraction, and eye health
(anterior and posterior segment examination). All tests except the posterior segment examination
must be performed either at or within 2 months prior to the initial eligibility examination. A
posterior segment examination must be performed either at or within 12 months prior to the
initial eligibility examination.
Corrected visual acuity must be tested prior to performing the masked examination at the 12
week, 6 month, and 12 month masked examinations. If corrected visual acuity is 20/30 or worse
in either eye with the current correction, a subjective refraction should be performed (to achieve
20/25 or better vision) and testing should be performed with the best correction in a trial frame.
The medication form must be re-administered at all masked examinations. The academic
performance questionnaire must be repeated at the 12 week, 6 month, and 12 month masked
examinations. The same parent/guardian who completed the academic performance
questionnaire initially must again complete the form at subsequent visits. (If a different person
brings the child to these examinations, the academic performance questionnaire can be sent home
and then the completed form can be returned via mail or the results can be obtained over the
phone.)
3. Chapter 4 Assessment of Study Measures
6/30/2005 Page 4 - 3
4.1.2 Equipment Needed for Masked Examination Procedures
1. B-16 prism bar (1, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 25, 30, 35, 40, and 45 prism diopter
prisms)
2. Astron International (ACR/21) Accommodative Rule (Gulden 15150 Near Point Rule)
3. Gulden Fixation Stick #15302 with 40 cm. CITT string attached to fixation stick
4. Printed Gulden Fixation target (with single column of 20/30 letters) for the
Accommodative Rule
5. ±2.00 D flipper lenses
6. Stopwatch
4.2 Primary and Secondary Outcome Measures
4.2.1 Convergence Insufficiency Symptom Survey (CISS)
This is the first test that is administered. After all primary and secondary outcome measures,
and monocular accommodative testing measures are taken (i.e., Eligibility Form-Part 2 or
Masked Examiner Form is completed), the CISS is repeated.
Testing Protocol
1. The Convergence Insufficiency Symptom Survey should be administered first before any
other testing is administered. It is then repeated after all other testing is completed.
2. Before administering the CISS, the subject is given a card to hold which contains a list of
the five response options (i.e., Never, Infrequently (not very often), Sometimes, Fairly
Often, and Always).
3. Before reading the questions the investigator should say the following to the subject:
“Please answer the following questions about how your eyes feel when reading or doing
close work. First think about whether or not you have the symptom. If you do, please tell
me whether the problem occurs: Infrequently (not very often), Sometimes, Fairly Often,
or Always.”
4. Each question should be read verbatim, slowly, and clearly.
5. If subject responds with “yes” – the investigator should ask the subject to qualify the
frequency by choosing one of the following five options: “Never, Infrequently (not very
often), Sometimes, Fairly Often, or Always”.
6. The investigator should never give examples regarding any of the questions or response
options. However, he/she may repeat the question and ask the subject to answer as best
as he/she can.
7. The investigator will record the response to each question on the CI Symptom Survey
form.
4.2.2 Near Point of Convergence (NPC)
Testing Protocol
1. Make sure ambient and overhead lighting provide good illumination.
2. Begin testing with subject wearing his/her optical Rx.
3. Use the Astron International (ACR/21) Accommodative Rule with the printed Gulden
fixation target consisting of a single column of 20/30 letters at 40 cm.
4. Chapter 4 Assessment of Study Measures
11/30/2005 Page 4 - 4
4. Hold the edge of rule on the center of the subject’s forehead just above the level of
his/her brow (so the patient is looking down slightly at the target). Begin with the target
placed at the 40 cm mark on the rule.
5. Instruct subject “to look at letters and report when they become double or break into two
but try to keep the target one/single as long as possible.”
6. Slowly (1-2cm/sec) move target toward subject. When diplopia is reported stop moving
the target and ask the subject “Does it stay two or does it come back into one?”
• If it comes back into one within 1-2 seconds, continue slowly moving the target
towards the patient until the patient is unable to regain fusion. Do not hold the
target in place for longer than 2 seconds.
• If it stays double, this endpoint is the NPC break.
• If the examiner observes a loss of fusion (without a report of double), the point at
which the examiner observed a loss of fusion is considered the NPC break.
• If the patient continues to converge until the target is against the nose/brow (i.e.
break does not occur), measure how closely the subject converged and consider
this the NPC break.
7. Measure the NPC break to the nearest half centimeter (using the center of the subject’s
forehead just above the level of the brow as the zero measure point from which the NPC
is taken.)
8. If the subject did not break, have the patient close or cover one eye for 3-5 seconds to
break fusion so that recovery can be measured.
9. Ask the subject to tell you “when it comes back together into one” and slowly move the
target away from the subject until the subject reports single vision or the examiner
observes a recovery of fusion. This is the NPC recovery.
10. Measure the NPC recovery to the nearest half centimeter.
11. Record the NPC break and recovery values on the appropriate data form.
12. Measure the break and recovery as described above three times, waiting 10 seconds
between paired break/recovery measurements.
4.2.3 Positive Fusional Vergence (PFV) at Near
PFV should be performed after the negative fusional vergence (NFV) assessment (described
below 4.3.8). The examiner should wait 30 seconds after the NFV measure before performing
the PFV measures.
Testing Protocol
1. Make sure ambient and overhead lighting provide good illumination.
2. Ensure that prisms are clean and that there are no scratches that may interfere with the
patient’s ability to see the target.
3. Begin testing with subject wearing his/her optical Rx.
4. Place target (Gulden Fixation Stick with single column of 20/30 letters) in primary gaze
40 cm from subject’s eyes. (Check testing distance with CITT string attached to fixation
stick.)
5. Place Gulden B-16 horizontal prism bar with the flat side of the prism bar towards the
subject in a base-out orientation with subject viewing through 1∆ BO.
5. Chapter 4 Assessment of Study Measures
11/30/2005 Page 4 - 5
6. Ask subject to “tell me when the letters become blurred or become double (split into 2),
but try to keep the target single as long as possible” as BO prism is introduced.
7. Increase magnitude of BO prism at approx 2∆/sec, pausing at each prism to confirm that
the target is “single and clear.”
8. If the subject reports blur, pause and note BO prism amount then continue to increase
BO prism pausing at each prism to confirm that the target is “single.” When the subject
reports double or break, ask subject “Does it stay two or does it come back into one?”
Continue to introduce BO prism if subject recovers single vision. When subject can no
longer maintain single vision and has diplopia, note the BO prism amount and record this
value as the “BO break.”
9. After the subject reports diplopia, increase the BO prism by 5∆, and then at a rate of
about 2∆/second, reduce the BO prism until the subject reports single vision. Consider
this the “recovery” finding. If recovery finding is higher than the break, the examiner
should repeat the entire measurement (blur, break and recovery).
10. Accurately record blur, break and recovery findings in the appropriate places on the CITT
data collection form.
11. If blur is not reported, record “X” on the data sheet (do not leave it blank).
12. Repeat blur/break/recovery sequence 2 more times waiting 30 seconds between
measures.
NOTE: If diplopia is not reported but examiner notes loss of fusion, the prism through which
fusion is lost will be recorded as the “break” finding. Likewise, an examiner observation or
recovery of fusion will be recorded as “recovery.”
NOTE: If the patient is able to fuse the largest (45∆) prism, record 50∆ for the break value
and have the patient close or cover one eye to break fusion so that recovery can be measured.
Record the amount of prism through which the patient was able to regain fusion (maximum
value would be 45∆).
4.3 Other Clinical Testing (not Outcome Measures)
4.3.1 Corrected Visual Acuity (Distance and Near)
Note: For determination of corrected distance and near visual acuity, investigators can use the
standard acuity chart that they typically use in clinical practice provided that it is age appropriate
and uses letter optotypes (e.g., Snellen, ETDRS, Bailey Lovie).
Testing Protocol
1. Make sure patient is wearing his/her optical correction. (A trial frame should be prepared
if the subject did not bring his/her optical correction.)
2. With the left eye covered, the examiner will ask the subject to read the first letter on each
line until he/she makes an error.
3. When the subject makes an error, the examiner will move two lines higher and ask the
subject to call out all of the letters in that row.
6. Chapter 4 Assessment of Study Measures
11/30/2005 Page 4 - 6
a. If the subject misses more than half of the letters at this acuity level, ask the
subject to read progressively larger acuity levels until the subject is able to
correctly identify at least half of the letters on a line.
b. If the subject correctly identifies at least half of the letters correctly at this acuity
level, proceed to progressively smaller acuity levels.
4. Stop testing when the subject misses more than 50% of the letters on a line (e.g., 3 out of
5 on a line).
5. The final acuity will be the smallest acuity level at which the subject can identify 50% or
more of the letters..
6. Repeat steps 2-5 with the right eye covered.
7. If corrected visual acuity is 20/30 or worse in either eye, a subjective refraction should be
performed and visual acuity testing should be repeated with the best correction in a trial
frame.
Note: Every few letters throughout the testing encourage the subject and give reminders for
the subject to look carefully when reading the chart.
4.3.2 Cycloplegic Refraction
Testing Protocol
1. Administer two drops of cyclopentolate. (Prior administration of topical anesthetic is up
to investigator discretion).
2. Perform static retinoscopy 20-30 minutes after instillation of the last drop of
cyclopentolate.
3. Perform a subjective refraction.
4. Determine the final cycloplegic Rx using the subjective finding.
4.3.3 Versions
Testing Protocol
1. The subject, with spectacle frames removed, is seated at arm’s length from the examiner.
2. The examiner holds a penlight, transilluminator, or other small target in one hand, leaving
the other hand free to elevate the lids.
3. The target is held about 30 cm from the eyes.
4. Beginning in primary gaze, the target is moved smoothly to the examiner’s right until the
eyes are no longer able to follow.
5. The target is then moved upward until the eyes cannot follow, and then downward. On
down gaze, the examiner must gently place the thumb of the free hand near the lash line
of one lid and the forefinger near the other and lift the lids to allow observation of the iris
margins. This is also done on the lower lids for observation of down right and down left.
6. Return the target to the extreme horizontal position and move it smoothly across the
midline to the opposite horizontal extreme.
7. Repeat up and down to that side.
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4.3.4 Stereopsis (Randot Stereotest)
Testing Protocol
1. Use normal room illumination with auxiliary lighting that does not produce glare on the
test booklet, place the polarizing filters on the subject (over best correction with
spectacles or contact lenses, if worn), and use a testing distance of approximately 40 cm.
2. Show the subject the symbols on the cover of the book and ask him/her to name them
aloud.
3. Direct the subject’s attention to the top 4 panels on the right-hand side of the open test
book. Ask for each of the 3 panels which contain a shape or figure, “which of the shapes
or figures that you just saw on the front of the book do you see here?”
4. Record whether or not the subject achieved 500” of random dot stereo. The subject must
identify all 3 of the shapes correctly to have 500” of stereopsis.
4.3.5 Cover Testing: Unilateral (UCT) and Alternate Cover Test (ACT)
Testing Protocol
1. Select an isolated letter 20/30 at 6m.
2. Perform testing through subject's optical correction.
3. Use either the Gulden B-16 prism bar or a comparable loose prism set (i.e., at a minimum
the prism set must contain all prisms contained on the B-16 prism bar). Ensure that
prisms are clean and that there are no scratches that may interfere with the patient’s
ability to see the target.
4. Instruct the subject to fixate the letter and to “keep it clear” throughout testing.
5. Cover the subject's right eye (OD) and watch left eye (OS) as OD is covered.
6. Cover the subject's OS and watch OD as OS is covered.
7. Perform the UCT a sufficient number of times to determine if strabismus is present.
8. Allow the subject adequate time to regain fixation.
9. Record the presence or absence of strabismus.
a. If a strabismus is present, record whether it is intermittent or constant.
10. Neutralize the ACT according to the following procedure:
a. Introduce prism with the base in the appropriate direction.
b. Cover one eye with the occluder, interposing the prism behind the occluder.
c. Switch the occluder and observe the eye movement behind the prism. (Only
observe eye behind prism during ACT.)
d. Interpose different magnitudes of prism until neutrality is obtained.
e. Continue adding prism until the first reversal (subject was initially exo and now
becomes eso through the prism). The amount of prism that resulted in neutrality
before this reversal of movement is recorded as the high neutral value.
11. Record the amount and base of prism for the high neutral.
12. Repeat the procedure at 40 cm using a single 20/30 letter. (Check testing distance with
CITT string attached to fixation stick.)
13. During the cover test procedure the examiner should also observe whether a vertical
deviation is present.
a. If a vertical deviation is present, the examiner should measure the magnitude of
the deviation and record.
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4.3.6 Monocular Amplitude of Accommodation (Right Eye Only)
Testing Protocol
1. Make sure ambient and overhead lighting provide good illumination.
2. Begin testing with the subject wearing his/her optical Rx.
3. Occlude the subject’s left eye.
4. Hold the Astron Accommodative Rule (with the printed Gulden fixation target consisting
of a column of 20/30 letters at 40 cm) gently with edge of rule above subject’s right eye
just above the level of his/her brow. Begin with the target placed at the 40 cm mark on
the rule.
5. Instruct the subject to, “Tell me when the letters first start to blur, but try to keep the
letters clear as long as possible.”
6. Slowly move the target toward the subject at approximately 1 to 2 cm/sec until subject
reports first blur. Ask if the letters stay blurry or become clear. If target becomes clear,
continue moving target closer until blurred. Stop at “first sustained blur.”
7. End the test when “first sustained blur” is reported.
8. Measure to the nearest one-half centimeter (using forehead just above the level of the
subject’s brow as the zero measure point).
9. Record accommodative amplitude in the appropriate spaces on the data collection form.
4.3.7 Monocular Accommodative Facility (Right Eye Only)
Testing Protocol
1. Make sure ambient and overhead lighting provided good illumination.
2. Ensure that the ±2.00 lens flippers are clean and that there are no scratches that may
interfere with the patient’s ability to see the target.
3. Perform testing with subject wearing his/her optical Rx.
4. Occlude the subject’s left eye.
5. Have subject view the single column of 20/30 letters on Gulden Fixation Stick at 40 cm
distance. (Check testing distance with CITT string attached to fixation stick.)
6. Place plus side of +/- 2.00 lens flipper before subject’s right eye. Ask subject to try to
make letters clear as quickly as possible.
7. Instruct subject to report clarity (say “clear”) as soon as the letters are clear.
8. When letters are reported to be clear, quickly flip the flipper to the minus side, again
instructing subject to read letters & report when clear.
9. Prepare to begin timing for one minute using a stopwatch.
10. Start timing as you place the plus side of the flipper lens in front of the subject’s eye.
Continue to alternate sides of flipper lenses for 1 minute, while counting the number of
“flips” of the lens that the subject was able to clear.
11. Record number of lens flips on data collection form.
NOTE: Even if the subject has difficulty (i.e., is slow or takes awhile) clearing a lens, testing
should be continued for a full minute. However, if the subject cannot clear one side of the
flipper lens in one minute, then 0 flips will be recorded.
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NOTE: The lenses should be “flipped” from one side to another, not slid/moved up and down in
front of the subject’s eye.
4.3.8 Negative Fusional Vergence (NFV) at Near
Testing Protocol
1. Make sure ambient and overhead lighting provide good illumination.
2. Ensure that prisms are clean and that there are no scratches that may interfere with the
patient’s ability to see the target.
3. Begin testing with subject wearing his/her optical Rx.
4. Place target (Gulden Fixation Stick with single column of 20/30 letters) in primary gaze
40 cm from subject’s eyes. (Check testing distance with CITT string attached to fixation
stick.)
5. Place Gulden B-16 horizontal prism bar with the flat side of the prism bar towards the
subject in a base-in orientation with subject viewing through 1∆ BI.
6. Ask the subject to “tell me when the letters become blurred or become double (split into
2), but try to keep the target single as long as possible” as BI prism is introduced.
7. Increase magnitude of BI prism at approx 2∆/sec, pausing at each prism to confirm that
the target is “single and clear.”
8. If the subject reports blur, pause and note BI prism amount then continue to increase BI
prism pausing at each prism to confirm that the target is “single.” When the subject
reports double or break, ask subject ”Does it stay two or does it come back into one?”
Continue to introduce BI prism if subject recovers single vision. When subject can no
longer maintain single vision and has diplopia, note the BI prism amount and record this
value at the “BI break.”
9. After the subject reports diplopia, increase the BI prism by 5∆, and then at a rate of about
2∆ /second, reduce the BI prism until the subject reports single vision. Consider this the
“recovery” finding. If recovery finding is higher than the break, the examiner should
repeat the entire measurement (blur, break and recovery).
10. Accurately record blur, break and recovery findings in the appropriate places on the CITT
data collection form.
11. If blur is not reported, record “X” on the data sheet (do not leave it blank).
NOTE: If diplopia is not reported but examiner notes loss of fusion, the prism through which
fusion is lost will be recorded as the “break” finding. Likewise, an examiner observation or
recovery of fusion will be recorded as “recovery.”
NOTE: If the patient is able to fuse the largest (45∆) prism, record 50∆ for the break value
and have the patient close or cover one eye to break fusion so that recovery can be measured.
Record the amount of prism through which the patient was able to regain fusion (maximum
value would be 45∆).
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4.4 Rule out Systemic/ Neurological Basis for CI
It is important for CITT investigators to carefully examine all potential CITT subjects to rule out
a systemic or neurological etiology for the CI. Particular attention should be paid to the case
history (onset and duration of symptoms, medical history and medication, accompanying
signs/symptoms), pupil evaluation, versions, and evaluation of the retina and optic nerve head.
The CITT Neurological Checklist form serves to ensure uniform collection of historical
information across all clinical sites. A positive response on the checklist will render the subject
ineligible for the CITT study. The subject must then be referred to an appropriate physician for
further evaluation.