Federal and state health investigators have connected a listeria outbreak in Florida at least in part to a Sarasota ice cream business.

On Saturday evening, the Centers for Disease Control said that Big Olaf Creamery was voluntarily contacting retail locations that use its ice cream to “recommend against selling their ice cream products.”

“Consumers who have Big Olaf Creamery brand ice cream at home should throw away any remaining product,” the CDC said on its website.

The CDC said that the Florida Department of Health, CDC, public health and regulatory officials in several other states and the U.S. Food and Drug Administration (FDA) are collecting different types of data to investigate a multistate outbreak of listeria monocytogenes infections.

Restaurant inspections:9 Sarasota and Manatee restaurants ace inspections, 7 get high-priority violations

More:Even with cut flight schedules and high gas prices, busy Fourth of July weekend expected

Listeria can cause severe illness (known as invasive listeriosis) when the bacteria spread beyond the gut to other parts of the body, the CDC said.

Symptoms of severe illness usually start within two weeks after eating food contaminated with listeria, but may start as early as the same day or as late as 70 days after.

Listeria can also cause common food poisoning symptoms, like diarrhea and fever. People who experience these symptoms usually recover without treatment.

Public health officials continue to interview people about the foods they ate in the month before they got sick, the CDC reported. Of the 17 people interviewed, 14 (82%) reported eating ice cream. Among 13 people who remembered details about the type of ice cream they ate, six reported eating Big Olaf Creamery brand ice cream or eating ice cream at locations that might have been supplied by Big Olaf Creamery, the CDC said.

“Products identified in this alert are part of an ongoing investigation,” the CDC said.

The CDC said Big Olaf Creamery began its recall on Friday. 

Dr. Washington Hill, a maternal-fetal medicine specialist at Sarasota Memorial Hospital, recommended those that are showing symptoms to reach out to their doctor. 

“Who cares? We care because in pregnant and older people and those that are immunocompromised it can cause serious disease,” Hill said of listeria. 

Most pregnant women show no symptoms of listeria, but Hill said that the concern lies with the fetus. He said listeria in pregnant women can cause miscarriage still birth, pre-term labor and death of the fetus. 

Rosie Peachey, a representative of Big Olaf Creamery who responded by email with a statement to questions, contended that, in contrast to the CDC warnings, nothing has been proven, and that the company is cooperating with the FDA. 

“For now it is only speculation as it is an ongoing investigation,” Peachey said. “Our brand has not been confirmed to be linked to these cases. I am not sure why only Big Olaf is being mentioned and targeted.” 

Big Olaf Creamery’s website calls its ice cream “A Florida Tradition Since 1982,” saying it “has been family owned and operated for 25 Years.” 

“All of our ice cream is handmade in batch freezers just like the good old days!” the website says. “Creamery direct delivery to most of Florida. Our primary focus is to serve ice cream parlors, senior homes, restaurants, fairs, and supermarkets with a full range of premium frozen products.

“The ice cream is made at a local creamery near Sarasota’s Amish village of Pinecraft. Every tub of Big Olaf Ice Cream is hand mixed with the finest ingredients and is then churned in batch freezers by local Amish Craftsmen. The smooth, creamery consistency comes from two sources: attention to detail, and fresh, high butter fat (14%) milk.” 

The site calls it “Your wholesale source for premium, handmade ice cream.” 

A Big Olaf franchise on Tamiami Trail in Sarasota remained open Sunday, despite warnings from the CDC.  

A customer, Paula Russell, who lives in Sarasota, said she didn’t know about the outbreak and didn’t care. 

“We come here three times a week,” Russell said. “We went to the one on Beneva, but it was too far so we started going to this one.”

But Big Olaf Siesta Key sent a statement Sunday evening stating that the business had “voluntarily and temporarily closed, as we have chose to take aproactive stance regarding the potential issue with one of our distributors.”

Signed “Management of Big Olaf Siesta Key, the statement went on to say: “We are conducting a thorough disinfecting process throughout the store, have discarded all product from the distributor in question and will have a new vendor upon our opening in a few days.

“We greatly appreciate your understanding and as always we strive to maintain as the number one priority the safety of our customers and employees.”

On its website, the CDC provided the following advice about the outbreak:

What everyone should do

Consumers who have Big Olaf Creamery brand ice cream at home should throw away any remaining product. Big Olaf Creamery brand ice cream is only sold in Florida.

Clean any areas, containers, and serving utensils that may have touched Big Olaf ice cream products.

What businesses should do

Do not serve or sell any Big Olaf ice cream products.

Clean and disinfect any areas and equipment that may have touched Big Olaf ice cream products, including ice cream scoops and other serving utensils.

What people at higher risk should do

Listeria is most likely to sicken pregnant people and their newborns, adults aged 65 or older, and people with weakened immune systems. Other people can be infected with listeria, but they rarely become seriously ill.

Call your health care provider right away if you have any of these listeria symptoms: Pregnant people typically experience only fever, fatigue, and muscle aches. However, listeria infections during pregnancy can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn.

People who are not pregnant may experience headache, stiff neck, confusion, loss of balance, and convulsions, in addition to fever and muscle aches.

About the illness

On Thursday, the Associated Press reported that one death and nearly two dozen hospitalizations were tied to a new listeria outbreak that was then of unknown origin.

CDC officials said at the time nearly all the 23 people known to have been infected in the outbreak either live in Florida or traveled to the state about a month before they got sick.

Listeria is one of the most dangerous forms of food poisoning, and 22 of the infected people were hospitalized. One person from Illinois died and one pregnant woman lost her fetus, the CDC said.

Listeria symptoms usually start one to four weeks after eating contaminated food, but can start as soon as the same day.

The first cases occurred in January of this year, but have continued through June, when two of the people got sick, CDC officials said.

This report includes material from the Associated Press.

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Originally Appeared Here

Introduction

Glaucoma is one of the leading causes of irreversible blindness across the globe occurring due to retinal ganglion cell (RGC) loss leading to visual field (VF) defects. With the growing number and proportion of elderlies in the population, it is projected that 111.8 million people will have glaucoma in 2040.1 Testing of the VFs is the only method to quantify the extent of functional loss in glaucoma patients.2

Humphrey Field Analyzer (HFA), Medmont Automated Perimeter (MAP) and Octopus are commonly used perimeters for standard automated perimetry (SAP). SAP using the HFA Swedish Interactive Threshold Algorithm (SITA) Standard and SITA Fast program is widely accepted as the “clinical standard”.3 Automated perimeters have several inherent disadvantages such as their bulky nature, exclusive space for installation, need for a dark room for examination and limited portability in addition to being costly and requiring trained personnel to run it.4 Many patients have difficulty concentrating throughout the test and find the test tiring.5 Fixation Losses are consistently elevated after the third decade of life, and False Negatives elevated after the seventh decade.6 Therefore, portable, tablet (iPad) based tests and virtual reality (VR) headset based perimetry are gaining popularity as an alternative form of VF testing. Tablet perimetry has the potential to be used as a low-cost method for glaucoma screening. Tablet based perimetry has become possible as the newer tablets have a high spatial resolution, large dynamic luminance range and 8-bit luminance control, that makes them suited for this purpose.7,8

Additionally, the ongoing coronavirus pandemic has highlighted the need for sanitisation of all ophthalmic equipment, in the interest of patient safety. The guidelines given by the American Academy of Ophthalmology highlight the importance of following manufacturer’s instructions for disinfection between patients. The makers of HFA warn against the risk of damage to the Ganzfield bowl because of the rubbing motion against the surface. It is recommended to use an atomizing sprayer followed by allowing a full 10 to 15 minutes to let it dry.9 Haag-Streit, makers of Octopus, suggest that frequent use of even an atomizer spray can cause damage to the bowl surface.10 Disinfection procedures for an iPad/tablet is simple as the surface can be wiped without causing damage to the screen.

The current review focuses on evaluating glaucoma detection sensitivities, diagnostic abilities and correlation of each parameter and examination time of the iPad based perimetry applications with those of HFA.

Visual Field Easy

The first, free iPad (Apple, Cupertino, CA) suprathreshold perimetric screening application was the Visual Field Easy (VFE) application [https://itunes.apple.com/us/app/visualfields-easy/id495389227]. It is a “free of cost” application, requiring purchase of only an iPad. The VFE program tests 96 visual field locations within the central 30 degrees, using a background luminance of 31.5 apostilbs (10 cd/m2), a size V target (when placed at a 33 cm test distance) and a 16 dB suprathreshold static perimetry target for screening purposes.

Studies using VFE have shown that it could detect only moderate and advanced visual field loss. Johnson and co-workers conducted a study in rural/suburban Nepal to evaluate the efficacy of VFE and compared it with the HFA 24–2 SITA standard test procedure. On the VFE application the missed locations correlated with the mean deviation (MD) (r = 0.79), pattern standard deviation (PSD) (r = 0.60), locations worse than the 95% confidence limits for total deviation (r = 0.51) and pattern deviation (r = 0.68) using SITA standard. iPad suprathreshold perimetry had greater difficulty in detecting early VF deficits (MD < –6 dB) but could detect most VF deficits with moderate (MD: −6 to −12 dB) and advanced (MD > −12 dB) loss, due to high false positivity.11

In another prospective study conducted by Ichhpujani et al, 210 eyes (60 normal and 150 glaucomatous) were tested using the VFE and the results were compared with HFA 24–2 SITA standard program.12 On correlating the missed points, for mild glaucoma, missed points were 37.5, sensitivity and specificity were 77.8% and 52.6%, respectively. For moderate glaucoma, missed points were 33.5, sensitivity was 90% and specificity was 48% while for severe glaucoma, missed points were 23, both sensitivity and specificity improved to 97% and 70%, respectively. VFE was found to be not suitable as a rapid screening tool for community/mass screening of glaucoma as it cannot detect early and moderate glaucoma. Other limitations of this application cited by the authors included the smudging of the screen due to repeated display touch by the subjects leading to an altered contrast of the target but this can now be overcome by the use of a Bluetooth linked keyboard with the iPad.

The VFE incorporates a large number of test positions (96), and it remains to be shown whether all of these locations are needed for the optimal performance of the application. Additionally, it needs a parser code to get the missed point data, thus making the data analysis slightly impractical for day-to-day use.

Kitayama et al compared VFE with Humphrey Frequency Doubling Technology (FDT) N-30-5 for detecting abnormal visual fields in a health fair setting for community screening of high-risk Latino adults.13 VFE testing took on average 141 seconds longer per eye than FDT and FDT resulted in 7.50% more missed points than VFE (p = 0.002). For VFE, they reported a sensitivity and specificity of 67% and 77%, respectively, with an area under the receiver operator curve (ARUC) of 0.71. Agreement between FDT and VFE was greater for patients with mild-to-moderate visual field loss.

Melbourne Rapid Field

Melbourne Rapid Field (MRF) (GLANCE Optical Ltd, Melbourne, Australia) is an iPad-based application approved by the FDA as a class 1 device. It has been validated as a tangent perimeter. MRF, is an improved thresholding version of the VFE, developed by the same research group as VFE.

In the current version of the app, the iPad luminance output is calibrated automatically by the MRF software before starting the test. The MRF assessment can be done in two modes, a full threshold test and a screening test. Full-threshold module has been evaluated in several studies.

The screening module was derived from the full-threshold MRF test using minimum required suprathreshold intensity at each test location. The full threshold version of MRF uses a modified 24–2 grid or a full test centred at fixation, which tests 66 points in the 30° × 20° of the VF, equivalent to the HFA 24–2 program. Initially, the central field is tested (36 points tested with fixation in the center of the screen) followed by the peripheral field (30 test points). As the screen size is small, subtending around 15° × 12°, the patient must fixate on all the four corners of the iPad screen at different times to cover the entire 30°. Fixation changes during testing for 9.7 inch, 10.5 inch and 11 inch iPads.14 Patients wear their near correction while taking the test. Targets are presented for 300 milliseconds. The thresholding strategy is started with a 17 dB stimulus and uses a three-presentation binary Bayesian protocol to yield eight steps (0, 3, 6, 12, 17, 22, 26, and 30 dB) across the 30 dB range (Zippy Estimation by Sequential Testing, ZEST). More intermediate points adjacent to a detected area of scotoma are also tested.15,16 This contrasts with the SITA algorithms, which use a post hoc Bayes prediction returned from 4 dB step (as in SITA-fast) or 4–2 dB (as in SITA-standard). In the test printout, color-coded indicators appear; “Green” refers to within normal limits (95% of normals), “Amber” refers to borderline (<5% of normals), and “Red” indicates outside normal limits (<1% of normals). Additionally, the test spot size increases into the periphery (from Size III to Size IV) and this is expected to reduce variability of outcome.

Although head-to-head comparison between MRF and HFA should be interpreted carefully as both use entirely different test paradigms, still since the output is similar in terms of global indices and regional threshold values, researchers have compared the two tests.

Schultz et al examined the validity of MRF testing with HFA 24–2 SITA standard. They recruited 60 glaucoma patients; where 17 had pre-perimetric glaucoma and 43 had manifest VF defects. All patients found the MRF test easy to use with mean test duration of 4 minutes 16 seconds ±1 minute 8 seconds vis-a-vis HFA test duration of 5 minutes 44 seconds ± 1 minute 1 second MRF performed well in terms of VF abnormality detection in comparison to HVF. For the MRF, MD, PSD, and Visual Field Index (VFI) it showed good overall performance for sensitivity and specificity with ARUC values of 0.84 for MD, 0.81 for PSD and 0.85 for VFI. AUC values for MD (0.85) and VFI (0.88) were significantly comparable to those obtained with HFA, whilst the difference between the devices was noted for PSD (0.81 for MRF and 0.93 for HFA).15 The authors noted that although some early cases were not picked by MRF, it provided additional information in some cases, as there are several additional test points in the central field (similar to a 10–2 strategy). This fact needs to be explored in larger studies with early glaucoma.

The point to point reproducibility of threshold values with MRF was less in cases with manifest glaucoma vis-à-vis HFA. This can be explained by the fact that during the MRF test the patient has to change fixation points four times to four corners of the iPad screen, unlike the solitary, conventional central fixation for the HFA.14 These multiple fixation shifts are likely to contribute to increased variability in threshold. For improving reliability of outcome, a headrest was be used by the authors. But screen malalignment and tilting can cause issues with variation of luminance.16

Vingrys et al validated that at numerous test locations the MRF application accomplished fast thresholding within 30 degrees of fixation. MRF perimetry has adequate potential to find early defects which have MD values smaller than 3.3 dB.8 In another study, Kong et al studied correlation between the perimetric outcomes from MRF application and those from the HFA in 90 subjects. They found that the test durations were longer on HFA than MRF (6.3 ± 0.1 minutes versus 5.7 ± 0.1 minutes, p < 0.001). Intraclass coefficient (ICC) was 0.93 for MD and 0.86 for PSD, HFA giving more negative MD (1.4 dB bias) than MRF. MRF Test 1 and Test 2 results were correlated with test-retest reliability of HFA SITA-standard, with MRF having an ICC of 0.93 for MD and 0.89 for PSD and HFA showing an ICC of 0.95 for MD and 0.90 for PSD.16 There was a high level of concordance in outcomes and the test-retest reliability of MRF was also found to be comparable to HFA.17

Prea et al enrolled 60 patients (stable ocular hypertensives as well as glaucoma patients on treatment and glaucoma suspects) from two clinical sites to establish MRF applications medium-term repeatability compared to HFA 24–2 SITA-standard and SITA-fast programs. MRF was found to have a better coefficient of repeatability (8.1%) than both SITA-fast (17.9%, p = 0.001) or SITA-standard (12.2%, p = 0.02). Results showed MRF was faster than SITA-standard (mean test duration of MRF being 4.6 ± 0.1 minutes versus mean test duration on SITA-fast 4.3 ± 0.2 minutes versus SITA-standard mean test duration being 6.2 ± 0.1 minutes, p < 0.001) and was similar to SITA-fast in terms of speed.18 The authors also found that although the global MD of the MRF compared well to the MD of both SITA-standard and SITA-fast tests, the tests did not have concordance on a point-wise or regional basis.

Kumar et al compared VF using MRF and HFA in 28 eyes of glaucoma patients. Mean test times were 342.07 ± 56.70 seconds for MRF and 375.11 ± 88.95 seconds for HFA 24–2 SITA standard (p: −0.046).19 Mean MD was significantly lower for MRF (Δ-3.09, p < 0.001), and mean PSD was significantly higher for MRF (Δ-1.40, P-0.005) compared with HFA. The mean foveal threshold for the MRF was significantly lower than the mean HFA foveal threshold (Δ-9.25, p < 0.001). The number of points depressed at p < 5% on the PSD probability plot was significantly less for MRF (p < 0.001). Other perimetric outcomes showed no significant differences between both. They concluded that MRF is a cost-effective, time-saving as well as user-friendly tool for monitoring visual fields in settings where access to traditional perimetry is limited. However, the lack of internet connectivity/strength in rural areas and questionable detection of early damage are potential cons.

In a recent study conducted at Tema (low-resource setting) in Ghana by Prince et al, the performance of the MRF was evaluated. For glaucoma patients, MD and PSD from the HFA and MRF correlated strongly (r = 0.84; p < 0.001) and moderately (r = 0.61; p < 0.001), respectively. On agreement analysis, MRF generated significantly higher PSD values (bias, 1.9 ± 2.8 dB; p = 0.03) and MD (bias, 3.3 ± 4.1 dB; p = 0.03), with wide limits of agreement. Significant agreement biases suggested a weak agreement between the MRF and HFA.

For detecting moderate to advanced glaucoma, the sensitivity and specificity was 60.9% and 86.5% for the MRF while for HFA sensitivity was 78.3% and specificity was 83.8%.20

Prea et al studied the short-term uptake, compliance, and performance of a tablet device (using MRF) for home monitoring of visual field by glaucoma patients. The uptake of home monitoring was good to the tune of 88% and high correlation was noted for the MD between in-clinic (HFA) and at-home (MRF) outcomes (R = 0.85). They found that information technology logistical reasons, lack of motivation, and/or competing life demands were the chief barriers to uptake and compliance of app-based home testing.21

Prea, Kong and Vingrys reported a 12 month home-monitoring trial using MRF for glaucoma patients and showed MRF to be similar to HFA Guided Progression Analysis (GPA) for detecting progression in glaucoma cases. The benefit of the home monitoring process was that the volume of testing (weekly) allowed detection of change in those patients who progressed in under 3 months compared with GPA which took 30 months for the same outcome.22

One of the disadvantages with MRF for home monitoring is nonavailability of Size V stimulus which results in some patient discomfort due to the need for appropriate positioning.

Peristat Online Perimetry

Peristat online perimetry (POP) was first developed in 2002 by two resident doctors of Doheny Eye Institute (University of Southern California), Dr Ianchulev and Dr Peter Pham.

POP is delivered via the KYS telemedicine platform (https://kysvision.com/peristat-test/).

POP allows perimetry testing of up to 24° of VF from fixation horizontally and 20° vertically using four levels of standardized threshold stimuli. POP testing is performed with dimmed ambient light and no direct light sources over the screen. The Red Green Blue range for the target is between 64 and 225 with a differential light intensity between 30 and 300 lux. Target is presented for 0.2 seconds, and an additional grace period of 1.8 seconds is given to the patient to respond. The appropriate working distance is determined by adjusting positioning until the flashing light temporal to the fixation point disappears in the blind spot. Gaze fixation assurance and false-positive/false-negative registration is also present. Patient responses can then be composed into a grayscale visual field image. Earlier, POP was available for use by any patient across the globe, but now it is available only for registered practices in the United States.

In a prospective study conducted by Ianchulev et al, 58 eyes of 33 patients underwent POP and HVF and their scores were compared. All the patients were able to complete the test with no difficulty within 2 to 5 minutes (longer test time in patients with severe defects). There was a high degree of correlation between the Peristat and the HFA. The sensitivity of Peristat for mild to severe HVF defects exceeded 80% with a specificity around 94%. They observed that more than 70% of the disparity was due to the Peristat false negatives, signifying that Peristat is unable to register very early defects in the far periphery of the test range. When the mild defects were excluded from the study, both the sensitivity and specificity increased.23

Lowry et al, compared the two modalities among 77 glaucoma patients in a clinic-based setting. POP and HFA abnormal points highly correlated with Spearman rank correlations ranging from 0.55 to 0.77 (all p < 0.001). They also plotted the curve to test the ability of Peristat to identify the severity of glaucoma. There was no significant difference between the AUC of the three receiver operating characteristics curves (ie, −16.7, −21.7, or −26.7 dB) for distinguishing mild or worse glaucoma versus controls (p = 0.36) or moderate or worse glaucoma from the combined controls and mild glaucoma patients (p = 0.75, χ2 test). They concluded that the number of abnormal points correlated significantly among both the tests and Peristat exhibited a significant correlation with the 24° HFA.24

Visual Field Fast

The “Visual Field Fast” (VFF) application draws its inspiration from noise field campimetry or snowfield perimetry, wherein the entire VF is simultaneously tested by confronting patients with a screen of randomly flickering, black and white stimulus.

“Visual Field Fast” (VFF) (Leonard Yip, Apple App Store), is available for free on the Apple App Store and operates on any iPad running iOS 10.0 or higher. VFF covers the same VF area as the HFA 24–2 assessment. For performing perimetry using the VFF app an iPad with a 9.7 inch screen is used in a dark room with all light sources switched off (<0.1 Lux). The screen brightness of the app is recommended to be set to auto-brightness mode (5 cd/m2). The test is performed at 33 cm using near correction. Patients can perceive scotomas as zones of abnormal flickering in terms of colour and frequency and delineate the scotomas using the touch screen for automated quantification of the VF loss.25

Eyecatcher

Eyecatcher is an open-source eye-movement perimeter. The Goldmann Size III stimuli are displayed on a Windows tablet computer (not on iPad) and the eye movements are recorded using a Tobii EyeX eye-tracker (Tobii Technology, Stockholm, Sweden). This is a low cost, near infrared, remote eye tracker which allows a precision of >0.6 degrees. There is no response button or central fixation target. A target comparable to Goldman Size III is presented on a 24–2 grid, against a 10 cd/m2 white background. Patient’s receive a visual feedback (a confirmation flashing dot) confirming the true stimulus location after each button press. The output from Eyecatcher is a retinotopic map, giving the probability of seeing the target at 22 paracentral locations. A summary measure of performance is computed by mean-averaging the probability-of-seeing values across all 22 test locations. The resultant metric is “mean hit rate”, which is a scalar value between 0 and 1 (reflects the amount of “greenness” in the VF plot). Mean hit rate is potentially comparable to MD of HFA.26

The complete source code for Eyecatcher is available online at https://github.com/petejonze/Eyecatcher. The codebase in principle supports iOS, but the latest version of Eyecatcher will work on an Android system.

Jones et al conducted a study to compare the results of eyecatcher with SAP using HFA in subjects with glaucoma and healthy age matched controls. They observed that the application was clearly able to distinguish between the glaucomatous and healthy eyes and also between eyes with mild and severe impairment. The results were consistent with SAP. The eyecatcher scores strongly correlated with MD (r2 = 0.64, p < 0.0001), and there was good concordance between corresponding VF locations (~84%). In a single eye analysis the test was also able to localise scotomas with a reasonable spatial precision. The test was found to be more user friendly than SAP using HFA.26

A disadvantage noted by the authors was the inability to track eye movements in eyes with very high refractive error through thick lenses. Thick lenses restrict spatial range as majority of the stimuli are presented within ± 15 degrees horizontally and ± 9 degrees vertically.

Jones et al conducted another study to assess the accuracy and adherence of VF home monitoring in 20 glaucoma patients using the Eyecatcher application over a period of six months. They found a good concordance between VFs measured at home and in the clinic (r = 0.94, p < 0.001). Data from 6 home-monitoring tests correlated well with the in-office SAP. In 21 of 236 tests (9%) MD deviated by more than ±3 dB from the median. These anomalous tests could be identified by applying machine learning techniques to recordings from the tablets’ front-facing camera.27

Eyecatcher can be used as a “rapid triage” tool to screen glaucoma in the community and waiting areas in hospitals to screen glaucomatous eyes from healthy ones and false positive referrals having no VF or optic nerve damage. Further studies are required to ascertain the boundaries for this test and to ascertain its role as a home-monitoring tool. Currently, due to the absence of a photometrically calibrated display, the test is not available as a downloadable “app” for all.28 Basic parameters of available applications (Apps) for tablet perimetry are elucidated in Table 1.

Table 1 Basic Parameters of Available Applications (Apps) for Tablet Perimetry

iPad (tablet) based perimetry can allow for more datapoints for monitoring of glaucoma as patients can test their visual function in home settings, avoiding travel and waiting time in busy clinics.29 Additionally, since the tests are less time consuming, it reduces the element of fatigue in elderly and debilitated patients as many of them have arthritic problems which makes repeatedly pressing a button difficult.

To conclude, tablet perimetry is a promising tool for tele-glaucoma care, but the sensitivity and specificity of the currently available applications for glaucoma detection is insufficient for stand-alone screening. When combined with other risk factors such as optic nerve appearance using portable non-mydriatic fundus photography, as well as clinical and demographic risk factors such as age, IOP, and family history of glaucoma when available, the sensitivity, specificity, and positive predictive value of app-based perimetry tests can be improved.29

Disclosure

The authors report no conflicts of interest in this work.

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21. Prea SM, Kong GYX, Guymer RH, Vingrys AJ. Uptake, persistence, and performance of weekly home monitoring of visual field in a large cohort of patients with glaucoma. Am J Ophthalmol. 2021;223:286–295. doi:10.1016/j.ajo.2020.10.023

22. Prea SM, Kong G, Vingrys AJ. Visual field home-monitoring with a tablet perimeter by glaucoma patients.Invest. Ophthalmol. Vis. Sci. 2022;63(7):4381–A0424.

23. Ianchulev T, Pham P, Makarov V, Francis B, Minckler D. Peristat: a computer-based perimetry self-test for cost-effective population screening of glaucoma. Curr Eye Res. 2005;30(1):1–6. doi:10.1080/02713680490522399

24. Lowry EA, Hou J, Hennein L, et al. Comparison of peristat online perimetry with the Humphrey perimetry in a clinic-based setting. Trans Vis Sci Tech. 2016;5(4):4. doi:10.1167/tvst.5.4.4

25. Ding J, Tecson IC, Ang BCH, Chiew W, Chua C, Yip LWL. The performance of iPad-based noise-field perimeter versus Humphrey field analyser in detecting glaucomatous visual field loss. Eye. 2021;20:1–12.

26. Jones PR, Smith ND, Bi W, Crabb DP. Portable perimetry using eye-tracking on a tablet computer-A feasibility assessment. Transl Vis Sci Technol. 2019;8(1):17. doi:10.1167/tvst.8.1.17

27. Jones PR. An open-source static threshold perimetry test using remote eye-tracking (Eyecatcher): description, validation, and preliminary normative data. Transl Vis Sci Technol. 2020;9(8):18. doi:10.1167/tvst.9.8.18

28. Jones PR, Lindfield D, Crabb DP. Using an open-source tablet perimeter (Eyecatcher) as a rapid triage measure for glaucoma clinic waiting areas. Brit J Ophthalmol. 2021;105:681–686. doi:10.1136/bjophthalmol-2020-316018

29. Krishnadas R. Commentary: evolving role of portable visual field testing in communities. Indian J Ophthalmol. 2021;69(1):92–93. doi:10.4103/ijo.IJO_731_20

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The logistics industry, which transports goods from the mainland to Macau, has seen a 72% reduction in transported items amid the surge of cases in the city.

This is because of the increased control of Zhuhai-Macau logistics as part of pandemic prevention measures, which has led to many goods that cannot be transited to Macau and are instead stranded in Zhuhai. 

Also, the delivery time will increase by three to five days with additional surcharges for transit through Macau courier collection stores.

The delay occurred throughout China’s 618 Shopping Festival, which is the second-largest and most important shopping festival in China, as the country e-commerce landscape is filled with large-scale promotional activities and discounts on a wide series of products. 

Figures provided by the E-commerce Logistics Development Promotion Association of Macao shows that the average daily quantity of goods for online shopping was about 70,000 to 80,000 pieces prior to the current outbreak.

However, it has been reduced to some 20,000 to 30,000 items, showing a plunge of some 72%.

As for the surcharges, the association’s chairman, Cheang Hang Tai told local media outlet Exmoo, “So far, the employees of Zhuhai storehouse must be in self-isolation at home in order to cooperate with Zhuhai’s pandemic prevention policy, which reduces the manpower of the storehouse.”

“Moreover, the reported disinfection fee and other fees [have] greatly increased as well as the operating costs of the logistics industry.  This is why they have added an additional fee,” he added.

Cheang also noted that the inspection of goods in the neighboring region has increased, making wait times longer for the foods to arrive in the city. 

Furthermore, due to the impact of the pandemic, some goods that were set to be delivered to Macau from high-risk areas in mainland China are concerning Macau shoppers who fear the packages may be contaminated with the virus. 

Meanwhile, a staff member from the courier pick up store gave assurances that, according to guidelines set forth by pick up stores like theirs, “all the goods must be disinfected before being transfered to Macau.”

“In addition, when the collection store receives the goods, they are recommended disinfect [the goods] again to ensure safety,” the staff member told the Times.

The representatives of the logistics industry have expressed their hope that the authorities will pay more attention to the issue of e-commerce logistics and transportation, so as to provide protection for people and maintain the operation of the logistics industry. Staff Reporter

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Originally Appeared Here

—

Summer is a common season for power outages, especially when extreme weather such as thunderstorms and heat arise, so that means there could be times when your food will be at risk of becoming inconsumable.

DON’T MISS: What to pack for your kid’s day at camp according to the forecast

But when your house goes dark for more than a few minutes, it doesn’t necessarily mean food in your refrigerator will spoil. There are things you can do to prepare before, during and after an outage that can save your food.

“It is extremely important to keep perishable food cold, so that your food never reaches the ‘temperature danger zone,'” said Health Canada in a written statement provided to The Weather Network through email.

The public health agency noted the danger zone is where bacteria can grow quickly and cause food-borne illness. The hazardous temperature range is between 4°C and 60°C.

(Ello/Unsplash)

WHAT TO DO BEFORE

If you’re expecting foul weather and want to be prepared, there are several things to look at to ensure your fridge and freezer will be outage-ready.

• Check the temperatures of your fridge and freezer. Are they cold enough?

• Set refrigerators at/or below 4°C. Use a refrigerator thermometer to check the temperature.

• Keep freezers at/or below -18°C. Use a freezer thermometer to check the temperature.

• If there is a power outage, refrigerator and freezer thermometers will indicate the internal temperature of the appliances to help you determine if the stored food is safe.

Brett Jordan/Unsplash

• Have a cooler with ice ready ahead of time to keep refrigerated food cold, if you know the power will be out for more than four hours.

• Have items on hand that do not require refrigeration, such as shelf-stable foods, including canned goods and water. Remember to replace these emergency storage food items periodically.

• Make sure to have ready-to-use baby formula and pet food, if needed.

• Ensure you have a handheld can opener to use during an emergency.

DURING AND AFTER AN OUTAGE

The first thing you can do to keep the integrity of the food intact is to avoid opening the refrigerator or freezer door unless it’s necessary, so the cold temperature can be maintained. An unopened refrigerator will keep food cold for about four hours, Health Canada said.

(Canva)

While you can add ice to the fridge to keep the food cold, especially if the power will be out for a prolonged period of time, keeping it in the freezer will give the products a longer shelf life.

So, how long will food remain safe in the freezer when there is no electricity?

According to Health Canada, a full freezer will keep food frozen for about 48 hours. A half-full freezer will keep food frozen for about 24 hours.

Throw out any thawed food that has been at room temperature for two or more hours, and anything that has an obvious unusual colour or odour. Just remember that food contaminated with bacteria does not necessarily have a bad odour or appear spoiled.

Food that still contains ice crystals or feels refrigerator-cold can be refrozen.

(Pixabay/Pixels)

If raw food has leaked during thawing, clean and disinfect the areas the food has touched. Do not reuse the cloths you have used for cleanup until they have been disinfected by washing in hot water.

BE PREPARED FOR AT LEAST THREE DAYS

In case of any emergency situation, households should be prepared to be self-sufficient for at least 72 hours.

The Canadian government recommends people create an emergency plan, have emergency kits to use at home and in their vehicle.

“Remember that in case of a major event you must prepare to be self-sufficient for at least 72 hours while emergency workers focus on people in urgent need,” added Health Canada.

Thumbnail courtesy of Ello/Unsplash.

Follow Nathan Howes on Twitter.

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We’re all aware that the air quality on busy city streets is not the best for our health. But few of us pay as much attention to the air we breathe inside our homes, despite one study finding that indoor air pollution can be over three times worse than outdoors. This can be created by fresh paint, cleaning products and even that beloved scented candle, while airborne allergens such as dust and pet fur can cause severe problems for some people.

Regular cleaning won’t do the trick either: while thorough dusting is always advisable, it won’t eliminate microscopic particles or prevent the continual release of gases, including VOCs (volatile organic compounds) from some paints, varnishes or furniture made from MDF and plywood. Alongside daily ventilation, air purifiers help clean the air and remove impurities, but they sadly won’t eliminate particles that have already settled on surfaces (so you can’t throw away your duster just yet).

Instead, they trap airborne pollutants in a filter, which needs to be cleaned or replaced regularly. The CADR (clean air delivery rate) indicates how quickly the purifier will remove contaminants from the air. But be aware that some manufacturers, most notably Dyson, believe this rating can be misleading, and testing for it does not represent real living conditions.

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NewsDesk @bactiman63

In a follow-up on the multistate outbreak of Listeria in people who live in or traveled to Florida, an investigation by The Florida Department of Health, CDC, public health and regulatory officials in several other states, and the U.S. Food and Drug Administration (FDA) have linked the outbreak to ice cream.

As a result of this investigation, Big Olaf Creamery in Sarasota, FL, is voluntarily contacting retail locations to recommend against selling their ice cream products. Consumers who have Big Olaf Creamery brand ice cream at home should throw away any remaining product. Big Olaf Creamery brand ice cream is only sold in Florida.

Public health officials continue to interview people about the foods they ate in the month before they got sick. Of the 17 people interviewed, 14 (82%) reported eating ice cream. Among 13 people who remembered details about the type of ice cream they ate, six reported eating Big Olaf Creamery brand ice cream or eating ice cream at locations that might have been supplied by Big Olaf Creamery.

23 people infected with the outbreak strain have been reported from 10 states.

22 people have been hospitalized and one death has been reported from Illinois.

Five people got sick during their pregnancy, and one illness resulted in a fetal loss.

Big Olaf Creamery today responded:

For now it is only speculation as it is an ongoing investigation, our brand has not been confirmed to be linked to these cases, I am not sure why only Big Olaf is being mentioned and targeted. The original report we got from the Florida Department of Health on Friday July 1st, was that there are 23 cases reported, the first one reported was January 2022. 6 out of the 23 patients mentioned having consumed Big Olaf ice cream, but nothing has been proven. We have been cooperating with the Florida Department of Health, FDACS and the FDA as soon as we were informed about the situation. We have been transparent and have answered all their questions and provided them with all the information requested from us, as the health and well being of the public is our first priority.

The CDC recommends businesses clean and disinfect any areas and equipment that may have touched Big Olaf ice cream products, including ice cream scoops and other serving utensils.

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Listeria can cause severe illness (known as invasive listeriosis) when the bacteria spread beyond the gut to other parts of the body.

Pregnant women, adults 65 years or older, and people with weakened immune systems are at higher risk for severe illness.

Symptoms of severe illness usually start within 2 weeks after eating food contaminated with Listeria, but may start as early as the same day or as late as 70 days after.

Listeria can also cause common food poisoning symptoms, like diarrhea and fever. People who experience these symptoms usually recover without treatment.

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Originally Appeared Here

We usually use it more in cooking and drinks, but as it turns out, the properties of the beloved sour lemon are not limited to that at all. Lemon is a unique fruit, and it would be a real miss to ignore it and its useful properties! Some people love it so much that they even grow it at home as a cute lemon tree! So, why not get the most that this tropical fruit has to offer? No one will be surprised by the fact that lemon is the first remedy for all kinds of colds and sore throats. But did you know that there are more unique and cool ways to make use of the lemons in your home? Let us show you the best lemon tips and tricks below:

Let’s see all the different and unique ways you can use lemons in your household

#For calmness

It’s no coincidence that Sicilian restaurants worried about their “image” plant lemon trees in their yards. The aroma of the ripe fruit gives a feeling of security and comfort. People feel good, welcome, relaxed and in the end, they come again! So, how can you replicate this feeling of calmness in your apartment or house? Just cut a lemon in half, squeeze the juice into a cool saucer and place it in the room. The light, zesty aroma is enough to make you feel calm and relaxed. Another idea is to just grow your own lemon tree and wait for it to grow patiently. This lush lemon plant will turn your home into a little piece of Italian paradise.

A lemon tree in your home will bring the feelings of calmness and relaxation

#For fresh produce

Not many people know that lemon juice has disinfectant and antibacterial properties. Thanks to lemon, you can wash vegetables and fruits well, and the delicate lemon aroma will be a nice bonus. For this method, it is useful for you to have a spray bottle: pour freshly squeezed lemon juice into a container and spray on your vegetables and fruits!

Wash and disinfect your fresh produce with some lemon water

#For crispy greens

One of the great mysteries of cooking is leafy greens. How do you keep them fresh longer? We have the answer! Take your lettuce or another leafy vegetable and place them in a bowl of cold water. Then squeeze the juice from half a lemon. Put the container in the fridge, and after an hour take them out and dry them. You will have the crispiest lettuce, perfect for a delicious salad.

Keep your leafy greens super crispy and fresh with lemon juice

#For purifying air

Do the same when you want to clean and purify the air. Let’s say there is someone snotty in the house. Put lemon not only in their tea but also spread some lemon slices around the apartment. Lemon “alcohol” will significantly reduce the percentage of insidious germs, which means that the chance of getting sick will decrease. If you want to make your home a place of the freshest air, make sure to add some air-purifying plants, as well.

Lemon slices around your house will purify and disinfect the indoor air

#For your cutting board

Does your favorite cutting board smell bad? That is not surprising, especially if you like to cook fish, onions, garlic, or other delicious foods that happen to smell a lot. Half a lemon will help get rid of unpleasant smells and extend the life of this beloved kitchen item. Just wipe the board thoroughly with half a lemon and all the smells will disappear, and your cutting board will be good as new!

Keep your cutting board fresh and clean with the help of lemons

#For concentration

The Japanese generally believe that if the scent of lemon is inhaled every day, one becomes more alert and efficient, memory improves, and the brain works better overall. They noticed this feature when they started putting lemons in offices. Employees are less likely to make mistakes and are more efficient in their work. So, place a diffuser with lemon essential oil in your working space, or just put some lemon slices in a bowl next to you!

Lemons can help boost your concentration, memory, and quality of work

#For stains

Getting rid of stains on clothes is a hard task. But, with the help of a glass of lemon juice, you will be more than fine. Just pour it into the washing machine during washing. Your clothing items will acquire a pleasant zesty aroma and there will be no trace of stains. For large stains, mix some baking soda with lemon juice in a 50/50 ratio and apply the solution to the stain before washing. Voilà!

TIP: Want to remove yellow stains from your clothes? Check our easy methods for getting rid of yellow stains on clothes!

Some lemon juice in your washing machine can do miracles for stains

#Against high blood pressure

Some believe that lemon has a miraculous effect on hypertensive patients. The aroma of lemon can lower blood pressure and relax you! So, surround yourself with this fresh scent and let it do its magic! However, this does not mean that you should give up prescribed medications.

Lemons are believed to help hypertensive people

#Against bad breath

Have you ever tried to freshen your breath with lemon juice? Freshly squeezed lemon juice is perfect for this. Please note that the juice should not be kept in your mouth for a long time to avoid damaging your tooth enamel. So, drink some lemon juice (which will help prolong the freshness of your breath) or swish it around your mouth and spit it out after a couple of seconds.

Munch on a piece of lemon for the freshest breath

#Against insects

Many insects are known to be sensitive to pungent odors, especially citrus ones. By spraying lemon juice in corners, crevices, and along window sills in your home, you can be sure that spiders, ants, fleas, and even cockroaches will not bother you. For even more security, you can add the juice of this fruit to the water you intend to wash your floors with. On a hot summer night, when hordes of bloodthirsty mosquitoes surround you on all sides, take half a lemon, squeeze some juice and place it beside you. For an increased effect, you can add cloves.

TIP: Are you struggling with indoor and outdoor pests? This organic pest-control guide has many all-natural recipes to help you!

Lemons can protect you against annoying insects 

#Make lemon water

This is a method that is practiced all over the world by people living a healthy lifestyle. And, that is starting your mornings with a glass of warm water with freshly squeezed lemon. If you drink lemon water often, you will feel like a rocket taking off to start a new day! Learn more about the benefits of lemon water and how it can help you!

A glass of lemon water a day has many health benefits

#For a sparkling kitchen

Not happy with the gray aluminum objects and items in your kitchen? You can add a sparkle to the interior with the help of half a lemon. Just make some homemade eco-cleaning solution of vinegar, lemon juice, and warm water. Your kitchen will sparkle! Find more eco recipes in our guide!

Lemon can make your aluminum items sparkle

#For a clean bath

A lemon will be an excellent helper in cleaning your bathtub. By mixing lemon juice with water and vinegar, you create an excellent cleaning solution to combat water and lime deposits, rust stains, and soap residue. What’s more, your bathroom will be smelling super fresh by the time you are done cleaning! See more amazing hacks in this guide for keeping your home smelling fresh!

For a sparkling bathtub and a fresh aroma, use a lemon while cleaning your bath

Sources

Eat This ©

Housewife How To’s ©

Po Pantofi ©

The Happier Homemaker ©

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Originally Appeared Here

Andrew Suggitt* says the latest outbreak of avian flu is a now global problem as it has jumped from chickens to wild birds and is spreading fast.

 

After a series of localised outbreaks in the past few years, avian flu has re-emerged as a major driver of bird deaths across the United Kingdom.

Until the past few weeks, the latest outbreak of the disease — also known as bird flu or, to scientists, highly pathogenic avian influenza — was treated primarily as a problem for chickens and other domestic birds.

This triggered localised responses such as culls, and farmers were ordered to keep their animals indoors for six months over the winter.

However, reports of large numbers of wild seabirds found dead in Scotland, and increasingly in England and Wales, suggest that avian flu is now prevalent in wild birds across most of northern Britain.

I encountered a number of these birds on the Northumberland coast.

This latest outbreak is a global problem, with cases of the virulent H5N1 subtype detected in West Africa, Asia, and nearly every country of Europe and North America.

It is primarily a disease of domesticated birds, where it is thought to have originated, and has led to the culling of hundreds of millions of birds, including 38 million in the United States this year alone.

In the UK, the disease was first detected in October 2021. As elsewhere, the outbreak was at first largely confined to poultry, and farmers were forced to cull 500,000 chickens and other birds.

In response, the UK established an Avian Influenza Prevention Zone, including buffer zones of 10 kilometres around detected cases, with restrictions on bird movement and enhanced biosecurity.

Over the northern winter there were reports of a number of wild bird populations being affected by avian flu, including great skua, pink-footed geese and barnacle geese.

These included the mass death of 4,000 birds on the Solway Firth, representing one-third of the Svalbard barnacle goose population that spend winters in the area.

As spring has turned to summer, there is now no doubt that avian flu is spreading into a wider diversity of wild birds in the UK.

For some species this probably reflects their return to summer breeding colonies, and the increased mixing that involves (avian flu is spread by contact with saliva or droppings).

As this breeding season reaches its peak, a wide array of seabirds have been affected, including great skua, eider ducks, fulmar, terns, gannets and guillemots.

The UK holds more than half the world’s population of gannet and great skua, both of which have been officially recognised as birds of moderate conservation concern.

Avian flu adds to the litany of problems these birds face, from climate change to entanglement in abandoned fishing gear, and increases the concerns of organisations who already consider this outbreak to be the worst the UK has ever faced.

Conservation organisations have asked for more resources to help with monitoring and tackling the problem.

Many bird wardens and reserve managers already work on the nature reserves most affected by avian flu, and so will be an important part of the solution.

We could also reduce the level of human disturbance at particularly sensitive sites, for example by introducing buffer zones or seasonal restrictions.

More broadly, we need more surveillance of avian flu so that we can get a better idea of the problem.

This will mean giving the relevant Government Agencies the resources they need to monitor and test more wild birds.

In summer, avian flu retains infectivity in the environment for up to 18 days.

The large number of dead birds on the coast with possible infections presents a continuing pathway for transmission to birds of prey and carrion feeders, particularly gulls, which are known to be susceptible to avian flu.

Increasing the number of carcasses being collected would have the added benefit of removing the potential for carrion feeders to become infected, and so further infect other birds.

Given some of these seabirds can range over huge distances in search of food — up to 400 kilometres for gannets, for instance — we will need coordination across the four nations of the UK.

Because the virus has been repeatedly transmitted between the domestic stocks and wild bird populations, we should also look again at biosecurity measures in the poultry industry.

Although avian flu is a zoonotic disease like COVID-19, the risk to human health is very low, and cases in humans have almost exclusively arisen from close contact between bird keepers and their stock.

The advice for the public is not to touch any dead birds and to report them.

Those who feed wild birds should remember to wash and disinfect feeders every week and clean bird baths every day.

Dog walkers should keep a closer eye on their animals if they are on the beach or by water.

There is no doubt that the increased visibility of the deaths will bring home the scale of the problem to the general public.

Bird flu has now ‘arrived’ in our minds, and will take on more prominence as the summer continues and holidays begin.

It serves as another reminder of how connected we are to nature, and how our interactions with the natural world have huge consequences for what we regard as ‘human’ systems.

 

*Andrew Suggitt is a Vice Chancellor’s Senior Research Fellow in the Department of Geography and Environmental Sciences at Northumbria University. His research examines the effects of environmental change on the natural world.

This article first appeared on The Conversation UK website.

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Originally Appeared Here

Pool noodles are a lot more versatile than you think, and can be used for storage, DIYs and gardening.

Keen fishers will find them useful for storing their rods.

Just cut a section to fit the side of a metal shelf and make slits along the noodle for each rod you need to store. Click here for the instructions.

If you’re more of a DIYer, pool noodles have been used to make bedheads and even velvet stools. You just need a staple gun, a lot of fabric and some patience.

READ MORE: DIY fan makes $40 dupe of $600 tufted velvet bench using an unlikely item

As for gardeners, pool noodles help save on soil and improve drainage in pots.

Simply cut up a pool noodle into smaller pieces, pop in the bottom third of a large plant pot and then fill with soil.

With the pool noodles at the base of the pot, you’ll need less soil, which will save you money.

Plus there’ll be plenty of space to allow water to flow out of the pot more easily, preventing the plant from getting root rot.

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A kayaker cools off by practicing eskimo rolls in the Potomac River with his freestyle kayak.

Journal file photo

Canoeing, kayaking, and tubing are all popular summer pastimes. But it is important to keep safety first when going out to enjoy time at the river. Keep the following tips in mind when heading out with paddle in hand to enjoy some fun in the sun.

Be sure that someone not going on the trip is aware of what rivers and trails will be traversed while out. Cellphones can call for help in case of an emergency. But often cellphone service is inconsistent when outside of city limits. It is best that someone knows where a trip is going and when they can expect travelers back home.

Keeping a physical map rather than relying on Google Maps to get around the river is also recommended by river safety advocacy group Friends of the River. Maneuvering a paddle or board while holding an electronic device can be difficult, and a cell phone can be destroyed if submerged in water. Also be sure to purchase a case that can protect cellphones if they come into contact with water, as they likely are while traveling in the kayak or raft.

Matthew Knott is the CEO of River Riders, a guide service that has shown groups the path through white water rafting expeditions for 40 years. Knott has been with River Riders since 1994, and knows important rules for water travel that are often forgotten about.

“Weather is often overlooked by kayakers or rafters,” Knott says. “Looking at what a day is going to look like a week before the trip is not being careful. Check the weather for where you’re going multiple times before the trip.”

Also remember to never traverse waters alone. Water currents can be unpredictable and having another person to keep an eye on the state of the water is safer for all who are traveling on the water. A first aid kit is also important to keep on person while kayaking, canoeing, or tubing. Infection can come from a cut being exposed, so it is important to disinfect and bandage wounds as soon as they are seen.

Know where park ranger stations or patrol areas are if traveling down a body of water that goes through a National Park. Check for major checkpoints that are near the body or water such as buildings or large natural features by the water. Keep a lookout for what can help keep bearings while going downstream, and use that to make an experience just as safe as it is fun and memorable.

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Originally Appeared Here