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To report outcomes using Lean concepts (FlowOne Lean Consulting, LLC) and implemented changes in a single academic pediatric ophthalmology practice. Lean principles such as patient flow, wasted movement, and non-value added visit time were taught to clinic staff. Spaghetti maps to document patient and staff movement during examinations, patient simulation, and clinic flow exercises were performed prior to implementing clinic changes. Clinic changes included maximizing easily reachable equipment and standardizing equipment in each examination room, physician-controlled doorbells to notify staff for help, and implementing a visual real-time electronic board of patients throughout the entirety of their examination. Patient surveys before and after Lean and staff feedback were obtained. Four years of data were collected of patient examination visits after Lean principles were introduced. Prior to Lean implementation, mean pediatric ophthalmology clinic visit times were 120 minutes. Within 3 months of Lean clinic changes, mean visit times reduced to 75 minutes. Four years later, this was sustained at 69 minutes. Clinic templates were modified and increased by 17%. Patient satisfaction surveys before and after demonstrated improved scores from 6.5 to 9.0. Patient survey comments included satisfaction with shorter patient examination visits, less shuffling between examination rooms, less non-value added time, and perception of happier clinic staff. Staff survey comments included receiving fewer parent complaints, feeling less disorganized, being able to troubleshoot in real time, and leaving at an earlier time at the end of the clinic day. Lean improved clinic efficiency, reduced patient visit times, and improved patient and staff satisfaction. These improvements were sustained 4 years after Lean principles were implemented. [J Pediatr Ophthalmol Strabismus. 2024;61(1):14-19.].

In-home 'smart' consumer devices such as voice assistants, doorbells, thermostats, and lightbulbs have been advocated by organisations in the UK such as the RNIB, Alzheimer Scotland, and the NHS. Yet the use of these devices, which are not purposely designed as care devices and therefore are not subject to evaluation and regulation, has been neglected in the academic literature. This paper reports on a study which examined 135 Amazon reviews of 5 'top-selling' smart devices, concluding that such devices are being used to supplement informal caring, albeit in different ways. The implications of this phenomena are necessary to consider, specifically the consequences for 'caring webs' and expectations about the future role of digital devices within the landscape of informal caring.

Rhesus macaques (Macaca mulatta) housed indoors experience many routine husbandry activities on a daily basis. The anticipation of these events can lead to stress, regardless of whether the events themselves are positive or aversive in nature. The specific goal of this study was to identify whether increasing the predictability of husbandry events could decrease stress and anxiety in captive rhesus macaques. This study was conducted on 39 single-housed subjects in four indoor rooms at the Oregon National Primate Research Center. Temporal and signaled predictability were added to four daily husbandry events: morning and afternoon feeding, enrichment distribution, and room cleaning. Temporally predictable husbandry events occurred reliably at the same time daily, while signaled predictable husbandry events were preceded by a distinct event-specific signal in the form of a doorbell. Informal tests prior to study onset found the doorbells not to be aversive to the subjects. Subjects received each of four treatments: unpredictable events, temporally predictable events, signaled predictable events, and temporally and signaled predictable events. Change in stress was evaluated by monitoring changes in motor stereotypies and displacement behaviors. Our results showed that subjects displayed less stress and anticipatory behaviors related to feeding and enrichment events when the events were temporally predictable (P < 0 .0001). When husbandry events were preceded by a reliable signal, subjects vocalized less prior to the event and were less responsive to activity outside of the room (P < 0 .01). However this may have come at a cost as the animals were extremely reactive to the doorbell signals and showed a heightened stress response during the actual husbandry events (P < 0 .01). Similar to temporal predictability alone, when temporal predictability was combined with signaled predictability subjects displayed less stress and anticipatory behaviors related to feeding and enrichment events (P < 0 .0001). In addition, when both forms of predictability were combined subjects showed less stress behaviors while waiting for daily room cleaning (P < 0 .01). When signaled predictability was paired with temporal predictability subjects no longer had the negative response to the doorbell signal, as they were able to predict and anticipate when the events would occur. Because these results are not necessarily applicable to animals that are given control over their environment or housed in a group setting, the management recommendation that can be made from this study is that temporal predictability of feeding reduces stress and anxiety and is thus beneficial to captive indoor single-housed rhesus macaques.

Aesthetic experience seems both regular and idiosyncratic. On one hand, there are powerful regularities in what we tend to find attractive versus unattractive (e.g., beaches versus mud puddles).1-4 On the other hand, our tastes also vary dramatically from person to person:5-8 what one of us finds beautiful, another might find distasteful. What is the nature of such differences? They may in part be arbitrary-e.g., reflecting specific past judgments (such as liking red towels over blue ones because they were once cheaper). However, they may also in part be systematic-reflecting deeper differences in perception and/or cognition. We assessed the systematicity of aesthetic taste by exploring its typicality for the first time across seeing and hearing. Observers rated the aesthetic appeal of ordinary scenes and objects (e.g., beaches, buildings, and books) and environmental sounds (e.g., doorbells, dripping, and dialtones). We then measured "taste typicality" (separately for each modality) in terms of the similarity between each individual's aesthetic preferences and the population's average. The data revealed two primary patterns. First, taste typicality was not arbitrary but rather was correlated to a moderate degree across seeing and hearing: people who have typical taste for images also tend to have typical taste for sounds. Second, taste typicality captured most of the explainable variance in people's impressions, showing that it is the primary dimension along which aesthetic tastes systematically vary.

The availability of auditory rehabilitation has significantly improved with the current legislation. Rehabilitation options have developed with advanced hearing aid technology. With the aging population, the number of persons using a hearing aid is increasing. A physician will need basic abilities to communicate with an elderly for whom the use of a hearing aid may be problematic. Besides a hearing aid, a hearing-impaired person may need other appliances, such as a better audible doorbell or an amplified telephone. In severe cases, alarm systems comprising of a fire alarm and indicator of doorbell and telephone ringing may be necessary.

To better characterize psychotic symptoms and their treatment in Hispanic populations. Chart review. Chelsea MGH Health Center and Chelsea Counseling Center (both affiliates of the Massachusetts General Hospital). Forty-four Hispanic patients presenting with psychotic symptoms in the context of mood and anxiety disorders. Chart review focussed on diagnosis, description, and cataloguing of psychotic symptoms and review of treatment efficacy. All but two patients described some atypical psychotic symptoms (e.g., doorbells or telephones ringing, voices of children, and visual hallucinations of animals or relatives). Treatment varied; 34 percent received monotherapy (either neuroleptic, antidepressant, or anxiolytic); 61 percent received polypharmacy; of these, 48 percent received a combination of antidepressant and anxiolytic; 19 percent received antidepressant with neuroleptic; 14 percent received antidepressant with neuroleptic and anxiolytic. No regimen was significantly better than any other. Psychotic symptoms in Hispanic patients have been noted anecdotally to present differently from those described in other populations. Our review appears to support this observation. Clinicians who work with Hispanic patients should ask about these atypical psychotic symptoms. We provide speculation on the nature of these symptoms, review approaches to treatment, and make recommendations for further investigation.

The aim of our study is to present the results of 11 children where auditory brainstem implantation (ABI) was successfully performed to restore hearing. Case presentation. This study was conducted at the departments of Otolaryngology and Neurosurgery at Hacettepe University Ankara, Turkey. Between July 2006 and April 2008, 11 prelingual (30-56 mo) deaf children with several cochlear malformations had ABI. All patients were programmed and were enrolled in auditory verbal therapy sessions and family counseling programs at Hacettepe Auditory Verbal Center. The evaluation was performed at preimplant and again 1, 3, 6, 9, and 12 months post-switch on. The main test components composing this test battery were Ling 6 Sound Detection-Identification Test, Word Identification Test in Turkish, Meaningful Auditory Integration Scale, and Meaningful Use of Speech Scale. Successful brainstem implantations were performed in all patients with retrosigmoid approach. Six children gained basic audiologic functions and were able to recognize and discriminate sounds, and many could identify environmental sounds such as a doorbell and telephone ring by the third month of ABI. Improvement in mean performance on Meaningful Auditory Integration Scale is apparent for all ABI children. Improvement in Meaningful Use of Speech Scale scores in 2 patients, demonstrating that the child using its own voice for speech performance, was observed between the baseline and 12th month. First, 5 children were able to identify Ling's 6 sound by the end of 2 to 6 months, and 2 of them also started to identify words due to their pattern differences and multisyllabic word identification by 6 to 9 months. Two children with Attention Deficit Hyperactivity Disorder have made slower progress than the other children with ABIs. Our preliminary results show that there is adequate contribution of brainstem implants in the development of auditory-verbal skills. Additional handicaps slow the progress of the prelingually deaf children.

These two studies were aimed at evaluating standard technology resources for supporting activity and travel among patients with moderate Alzheimer's disease. Specifically, Study I assessed a pictorial instruction program relying on the use of a portable computer and a commercially available and inexpensive video editing software for supporting the performance of daily activities with three patients. Study II assessed the indoor travel performance of four patients (i.e., the three involved in Study I and a fourth patient with no previous research exposure) using a commercially available, basic doorbell system with sound and light cues. The percentages of correct activity steps obtained with the instruction program used in Study I were relatively high and largely similar to the percentages reported in previous studies using more sophisticated technology. During Study II, the percentages of correct travels of two patients matched the data of the most successful patients involved in previous studies with more sophisticated technology. The percentages of the other two patients tended to be lower than those obtained previously, but were still practically relevant. The implications of the results of the two studies and a number of issues for new research are discussed.

Reserpine and prochlorperazine were administered in separate experiments to adult CAW:CF1 mice and to adult LVG:LAK hamsters that had recovered from audiosensitization induced by 30 sec of doorbell sound during a critical period of infantile development. In contrast to controls that showed tranquilization in response to these drugs, the previously audiosensitized animals o both species responded with a high incidence of convulsive seizures. The proconvulsant effect of reserpine and prochlorperazine in previously audiosensitized mice was present one hour after drug administration, but had subsided 20 hr post-administration. The proconvulsant effect of reserpine in previously audiosensitized mice was shown to be dose-dependent. The proconvulsant effect of reserpine in previously sensitized hamsters was present 100 days after reserpine and prochlorperazine are poorly understood, possible mechanisms are discussed. Environmental noise during early inantile development appears to have significant residual effects persisting into adult life. This study has shown that idiosyncratic responses to antipsychotic drugs in adult laboratory animals can result from infantile auditory exposure, and it is speculated that human idiosyncrasies to psychoactive drugs may be similarly based.

Behavioural and neuroscientific research has provided evidence for a strong functional link between the neural motor system and lexical-semantic processing of action-related language. It remains unclear, however, whether the impact of motor actions is restricted to online language comprehension or whether sensorimotor codes are also important in the formation and consolidation of persisting memory representations of the word's referents. The current study now demonstrates that recognition performance for action words is modulated by motor actions performed during the retention interval. Specifically, participants were required to learn words denoting objects that were associated with either a pressing or a twisting action (e.g., piano, screwdriver) and words that were not associated to actions. During a 6-8-minute retention phase, participants performed an intervening task that required the execution of pressing or twisting responses. A subsequent recognition task revealed a better memory for words that denoted objects for which the functional use was congruent with the action performed during the retention interval (e.g., pepper mill-twisting action, doorbell-pressing action) than for words that denoted objects for which the functional use was incongruent. In further experiments, we were able to generalize this effect of selective memory enhancement of words by performing congruent motor actions to an implicit perceptual (Experiment 2) and implicit semantic memory test (Experiment 3). Our findings suggest that a reactivation of motor codes affects the process of memory consolidation and emphasizes therefore the important role of sensorimotor codes in establishing enduring semantic representations.

To enrich the discussion on mobility in stroke rehabilitation by translating theoretical repertoires of mobility from the context of geography to rehabilitation. Qualitative research methodology was applied, and included in-depth interviews with stroke survivors. This study revealed: (a) social and material differences in clinical, private and public places; (b) ambivalences and shifting tensions in bodily, family and community life; (c) differences in access to resources to be used for mobility. Moving around safely was not a matter of being physically able to walk independently, it also involved dealing with different human actors - such as children, partners and shoppers, and non-human actors - such as doorbells and traffic rules. Stroke survivors had to balance exercise and training, family and working life, and leisure and pleasure, and to renegotiate their mobility in each context. Our study showed that mobility has many aspects that interact with each other in multiple ways for stroke survivors when they return home and thereafter. The current focus on adherence to mobility and exercise training at home needs to be critically reviewed as it does not capture the multiplicities embodied in real-life settings. Implications for rehabilitation Rehabilitation medicine needs to consider mobility as a way to connect places that are meaningful to individuals rather than as movements from A to B. Clinical outcome measurement tools, such as the 10-meter walk test, are inadequate for evaluating participation in the mobility domain at home or in the community. Mobility issues at the participation domain need to be considered in "how they hang together" rather than distinguished in different disciplinary domains. Rehabilitation practitioners should teach stroke survivors concrete strategies on how to creatively deal with the ambivalences and tensions around mobility in home and community life.