Mark H.H.,Yale New Haven Hospital
Survey of Ophthalmology | Year: 2010
In antiquity the aqueous humor was seen as essential to moisten and nourish the lens- the actual organ of vision-and therefore any loss was believed to lead to blindness. The recuperation of the eye after some aqueous loss during cataract couching and experimental loss in animals slowly undermined this idea in the 16th and 17th centuries. In the 18th century production of aqueous from the ciliary region and its outflow from the anterior chamber, and thus its circulation, was generally accepted. Early in the 19th century the aqueous was thought to be encapsulated, but by the end of the century the general dynamic principles of aqueous flow as we know them today were experimentally and clinically confirmed. The controversy concerning its mode of production and circulation that took place early in the 20th century was resolved with the discovery of the aqueous veins and advances in molecular biology. © 2010 Elsevier Inc. All rights reserved.
Bouley G.,Yale New Haven Hospital
Dimensions of Critical Care Nursing | Year: 2011
Rapid response teams have been in existence in hospitals over the past decade. This team call may offer life-saving interventions that save lives but, in some cases, may prolong the dying process. There are times in which the rapid response team nurse and the intensive care nurses need to have an understanding of the families' perception of what is occurring and manage this situation through communication, empathy, and information sharing. The nurse must be involved during discussions surrounding end-of-life decisions. The nurse also has a role in supporting the family through this difficult time of making a decision to withhold life-supporting measures. Copyright © 2011 Lippincott Williams & Wilkins.
Noonan B.C.,Yale New Haven Hospital
Journal of Strength and Conditioning Research | Year: 2010
This study evaluated the on ice blood-lactate values during a division 1 ice hockey game in an attempt to demonstrate the highly variable nature of the game. Our hypothesis was that intragame blood-lactate (BLa) values would be highly variable and related to shift length. Six men (age = 20.4 + 1.8 years, body mass 81.3 +8.7 kg) agreed to have fingerstick BLa samples taken at the completion of selected shifts (n = 35 samples) during the first and third periods of a division 1 ice hockey game. Shift length including work and rest intervals were also recorded for each of these shifts. Blood-lactate values ranged from 4.4 to 13.7 mmol·L-1 with a mean value of 8.15 (+2.72) mmol·L-1. Shift length ranged from 55 to 145 seconds with individual work intervals within the shifts ranging from 29 to 102 seconds in length. Most shifts had either 1 or no play stoppages and rest to work intervals ranged from 0-1.66 (+0.53). These results further support the intense and variable nature of ice hockey and should help coaches develop more specific training and testing regimens to prepare for these demands. They also highlight the need for a validated and reliable test of repeated sprint ability for ice hockey players. © 2010 National Strength and Conditioning Association.
Weigert J.,Mandell and Blau MDs PC |
Steenbergen S.,Yale New Haven Hospital
Breast Journal | Year: 2015
To determine if the addition of screening breast ultrasound in women with mammographically normal but dense breasts improves breast cancer detection. The study utilized a retrospective chart review. Data collected included: (a) total number of screening mammograms; (b) total number of dense breast screening ultrasounds; (c) screening ultrasound Breast Imaging Reporting Data System (BI-RADS) code results; (d) biopsy results; and (e) demographic data on women with malignant biopsies. Data were obtained from sites throughout Connecticut from November 1, 2010 to October 31, 2011. Data from 5 Connecticut radiology practices covering 10 sites were collected. Sites conducted a total of 57,417 screening mammograms and 10,282 dense breast screening ultrasounds. Of the screening ultrasounds, 87% (8,972/10,282) were BI-RADS 1 or 2, 9% (875/10,282) were BI-RADS 3, 4% (435/10,282) were BI-RADS 4 or 5, and 39 were found to have a cancer or high-risk lesion on biopsy. This correlates to 3.8 cancers or high-risk lesions per 1,000 women screened. If high-risk lesions are excluded, there are 24 cases of biopsy proven malignancy corresponding to 2.3 cancers per 1,000 women screened. In this study, screening breast ultrasound in women with mammographically normal but dense breasts demonstrated a positive predictive value of 9% (39/435) and specificity of 96% (8,972/9,368). Based on the data collected from sites throughout Connecticut, screening breast ultrasound in women with dense breast parenchyma detects mammographically occult malignancy and high-risk lesions. The results are especially significant given recent studies suggesting that breast density is an independent risk factor for breast cancer and that mammography is less effective in detecting cancer in dense breasts. The improved specificity and sensitivity between the 1st and 2nd years' suggests there is a learning curve that may continue to improve the results. © 2015 Wiley Periodicals, Inc.
Lau K.H.V.,Yale New Haven Hospital
Medical Education | Year: 2014
Context: The computer-based teaching module (CBTM), which has recently gained prominence in medical education, is a teaching format in which a multimedia program serves as a single source for knowledge acquisition rather than playing an adjunctive role as it does in computer-assisted learning (CAL). Despite empirical validation in the past decade, there is limited research into the optimisation of CBTM design. This review aims to summarise research in classic and modern multimedia-specific learning theories applied to computer learning, and to collapse the findings into a set of design principles to guide the development of CBTMs. Methods: Scopus was searched for: (i) studies of classic cognitivism, constructivism and behaviourism theories (search terms: 'cognitive theory' OR 'constructivism theory' OR 'behaviourism theory' AND 'e-learning' OR 'web-based learning') and their sub-theories applied to computer learning, and (ii) recent studies of modern learning theories applied to computer learning (search terms: 'learning theory' AND 'e-learning' OR 'web-based learning') for articles published between 1990 and 2012. The first search identified 29 studies, dominated in topic by the cognitive load, elaboration and scaffolding theories. The second search identified 139 studies, with diverse topics in connectivism, discovery and technical scaffolding. Based on their relative representation in the literature, the applications of these theories were collapsed into a list of CBTM design principles. Results: Ten principles were identified and categorised into three levels of design: the global level (managing objectives, framing, minimising technical load); the rhetoric level (optimising modality, making modality explicit, scaffolding, elaboration, spaced repeating), and the detail level (managing text, managing devices). Conclusions: This review examined the literature in the application of learning theories to CAL to develop a set of principles that guide CBTM design. Further research will enable educators to take advantage of this unique teaching format as it gains increasing importance in medical education. © 2014 John Wiley & Sons Ltd.