Oct units which one is right for me

The high dependency on interpolation often leads to loss of important details in these maps, like in the case of fine pathology where the lesion falls between the six intersecting raster lines and is thus missed, leading to inaccurate macular thickness calculation. Denser scan patterns, which require much less interpolation of points, are possible with the high speed of the spectral-domain OCTs, and thus it is now possible to obtain much more accurate depiction of retinal thickness.

The SLD light source used is centered at nm with a bandwidth of 50 nm. The unique feature of this device lies in its integration of a true color non-mydriatic fundus camera, in addition to the spectral-domain OCT.

Besides being a cost and space saving option, this setup makes the correlation of specific lesions observed on the color fundus photo to the corresponding OCT image possible. Various overlays, such as the topographic retinal thickness map and projection image, may be placed over the fundus photo simultaneously with different fundus grids, such as the EDTRS-like map, rectangular map 5 mm x 5 mm map with six boxes horizontally and vertically and volume map.

The superposition of the retinal thickness map with the EDTRS-like map helps to detect eccentric fixation See Figure 3 , which can then be corrected manually. In addition, the 3D OCT software interfaces smoothly with IMAGEnet and integrates with other types of images like fluorescein and indocyanine green angiography, red-free and autofluorescence and thus it is possible to register fluorescein and other image types and register them to OCT scans.

Bioptigen 3D SDOCT is a device clinically suitable for the scanning of patients, in addition to its usefulness in clinical and animal biomedical research. The device is unique in that it has two light sources, one centered at 1, nm and another at nm. The dual light source makes it especially suitable for multiple research settings. The 1, nm engine may be clinically helpful for anterior segment imaging and in basic scientific research for tissue, small animal, external and ex-vivo imaging.

The nm engine may be clinically helpful for human retinal imaging and in basic science research for retinal imaging in small i. A nm bandwidth light source upgrade is also available for high-resolution imaging. Additionally, the Bioptigen 3D SDOCT contains a variety of scanners and probes for various applications such as a Doppler processing system for retinal blood flow analysis, small animal probe for basic scientific research, pediatric probes for infants and corneal probe for anterior segment examination.

It utilizes a SLD light source at nm. The design of the Cirrus is different from the other commercial OCT devices since it is not designed around a slit lamp and joystick, but instead employs a mouse.

Additionally, the Cirrus has a dedicated iris CCD charge-coupled device camera that allows for live monitoring of the pupil during scans and a separate near infrared fundus SLD camera nm for live fundus visualization. For repeat scans, Cirrus HD-OCT has a "repeat function," whereby with a click of a mouse, the device returns to the previous setup for that particular patient head and chin rest positions and camera focus and it activates visit-to-visit registration using retinal vessel tracing.

The use of vessel registration is an improvement from older generation devices, as it does not rely merely on the proper patient fixation, thus improving inter-scan reproducibility. The use of registration is also useful for tracking the progression of various ocular diseases. This function allows for visualization of pathologies such as epiretinal membranes or macular holes. With the Cirrus HD-OCT the operator can also create customized scan patterns by varying the raster length or scan density and changing the angle of the raster lines.

Copernicus HR. The system uses SLD light source centered at nm. The rapid scanning speed decreases scan time and further reduces instances of fixation drift and motion artifacts, while expanding retinal coverage.

That soon rolled into a two-bedroom, then a three-bedroom, and finally landed me in my room penthouse on Fifth Avenue in New York City. Buying that tiny studio was the most important decision I made because it got me in the game. Your best bet is investing in residential properties that produce rental income year-round. Just make sure you understand all of the associated legal fees and are prepared for unexpected costs. Follow her on Instagram.

But let me be clear: That doesn't mean that all real estate is a good idea. I only buy certain types of properties, generally multifamily ones in upscale locations that provide consistent cash flow and great potential for future appreciation. I stay away from low-income areas and single-family homes. But even those assets are probably a better place to store your money than letting cash depreciate while sitting in the bank! Follow him on Facebook , Instagram and YouTube. Real estate consistently increases in value over time and outperforms other investments.

Plus, it isn't as vulnerable to short-term fluctuations as the stock market. You get a tangible, usable asset, whether you're renting out an apartment or commercial building for income or buying a home. And there can also be tax benefits for investment properties.

It's always a good time to buy real estate. In fact, the real wealth is made by buying when everyone else is selling and vice versa. While many are talking about a recession, the market is strong, with increasing prices and transactions. And the rate is fixed for 30 years — the best kind of rent control.

When the feature is enabled, you can have your thermostat set itself to its Away mode when you leave and Home mode when you return. It can also tell compatible smart-home devices, such as lights, plugs, and cameras, to adjust. When we walked in the door, our Philips Hue lights turned on, our Arlo cameras turned off, and the thermostat switched to Home almost instantly. Another feature we really like is that the Nest can automatically shut down your HVAC system when a connected Nest Protect smoke alarm detects smoke or fire.

The Nest Learning Thermostat is very expensive. In our experience, problems can crop up because the system gets confused about which temperature you want. To fix the issue, we deleted the Schedule the Nest had set and told it to relearn, which it did much more effectively the second time. If you run into similar issues, we recommend resetting your automatic Schedule at the start of a new season to let the thermostat learn your new pattern.

We also think Google should include one sensor with the Nest thermostat, as Ecobee does for its model. If you want a thermostat you can put on a wall and forget, Nest is best. But if you want deep control over every change your thermostat makes, Ecobee is the better choice. The Ecobee SmartThermostat with Voice Control is a complex piece of equipment that can do nearly everything you might want a smart thermostat to do; it also works with every major smart-home system including Apple HomeKit , and it even doubles as an Alexa smart speaker.

However, it has a more difficult learning curve, needs a C wire for power, and requires you to do a bit of tinkering to get the most out of its powerful capabilities. The Ecobee SmartThermostat is a well-designed device that looks good on a wall.

It has small touchpoints, however, which are tricky for those with larger fingers to navigate precisely a 6-foot-4 member of our household has a tough time with it. These small, square devices have sleek rounded corners and a variety of mounting options so you can easily place them around your house to monitor temperature and occupancy. By keeping tabs on two or more areas this way, you can choose to have your system prioritize one sensor over the others or average the temperatures between them.

This arrangement solves the age-old heating and cooling problem where one room is toasty and warm while another feels like a refrigerator or vice versa in the summer. The thermostat comes with one sensor, and you can add up to The Ecobee thermostat is compatible with the same number of HVAC systems as the Nest, including those systems with humidifiers, dehumidifiers, and ventilators you can check its compatibility with your system.

It is also Energy Star rated, potentially qualifying you for a rebate. Installation is similar to that of the Nest and straightforward, although if you have a complicated HVAC system you may want to enlist the help of an expert. Including pairing four sensors, connecting to Wi-Fi, and setting up three smart-home system integrations, installation took us about an hour. If you have to wire in the power extender kit, factor in an extra two hours or hiring an electrician.

This is the only thermostat to feature a built-in smart speaker, and the audio quality and microphone responsiveness are on a par with those of the third-gen Amazon Echo Dot in quality. All the standard Echo speaker features are here, including Alexa Calling, Messaging, and Drop In, so you can use your thermostat as you would an old-school intercom system.

When we were away, however, it took too long to automatically adjust to Away Mode, and then to recognize when we returned home, even with geofencing options turned on. For example, when we arrived home while the Schedule was set to Away, it took over 30 minutes to switch, by which time we had walked over to the thermostat and changed it.

To get the greatest energy savings, you need to either manually change the mode to Home or Away status on the touchscreen or in the app or set up other smart-home integrations to do that for you more on those later. But a word of warning here: If you deviate from the Schedule or presence-sensing setup, the system goes into an indefinite hold and can cause problems such as your system running overnight when you thought it would revert to your Sleep setting this happened in our testing.

If you want to use your Ecobee thermostat with a smart-home system, this problem gets trickier: If you use Alexa, HomeKit, or another external system to change the temperature, the thermostat will hold at that setpoint until you manually change it.

A big selling point of the Ecobee thermostat is that it's compatible with all those different smart-home systems. Because Alexa is built into the device, you can use your voice to adjust the temperature, ask Alexa which equipment is running, and hear what the temperature is in different rooms. HomeKit integration is a nice feature for Apple users. But the alerts it sent indicating that humidity was high seemed to be a useful addition. But if yours does, we advise talking with your utility company first to understand exactly how the program might impact you before enabling anything through the thermostat.

The T5 is good-looking, if somewhat chunky, consisting of a sleek black box with white fonts on a black screen, like a digital alarm clock. Installation is straightforward, and the device walks you through enabling geofencing and setting the temperature you want for Wake, Home, Away, and Sleep Modes.

You use the Honeywell Home companion app to pair the thermostat with HomeKit if you want to and to connect the device to Wi-Fi to set up Schedules or enable geofencing.

In our initial testing, we encountered issues with the device disconnecting from Wi-Fi, but after a reset we had no further problems. The screen displays the time and current temperature until you touch it, which in our testing required a surprisingly forceful press and sometimes more than one.

It then displays the time, the target temperature, the current temperature, and a huge array of on-screen buttons, including for plus and minus temperature; Home, Away, and Sleep Modes; the current Mode; and Off, Cool, Heat, Emergency Heat, and Fan. Resideo, the manufacturer, crammed in quick access to all the buttons to relieve you from having to manually scroll through and select the functions, which is clunky and unintuitive.

Based on your location and time of day, it then switches to your Home, Away, or Sleep preset. This function worked well in the downstairs zone of our two-story test home, but we preferred the scheduling option for the upstairs zone.

The Mysa Smart Thermostat is a line-voltage smart thermostat, so unlike all the other models we tested, it works with or volt electric heating sources, such as electric baseboard heating. Baseboard heaters are typically controlled by individual thermostats at each unit—adding smart thermostats brings a huge benefit because it allows you to control all your units at once rather than by hand in every single room. You can also put multiple units into zones—upstairs, downstairs, bedrooms, and so on—to adjust them simultaneously in the app as one unit.

Aside from offering a huge boost in convenience, the Mysa has the potential to dramatically improve efficiency by intelligently adapting to your energy usage. The big caveat is that in installing the Mysa system, you need to replace every thermostat, which gets expensive quickly—though that up-front cost could be offset by energy bill savings, since electric baseboard heating is so much less energy-efficient than other systems.

The only setting you can adjust directly on the Mysa is temperature, so to tweak other settings you have to use the app. The display shows the ambient temperature by default, and when you press the up or down arrow, it changes the heat settings accordingly and shows the adjusted temperature.

The Mysa thermostat manages your heating in a few different ways. You can use a preset, Energy Star—recommended work-week Schedule or create a customized Schedule by using a wizard. The wizard asks a few simple questions concerning what time you wake up and go to bed, how often you leave the house, and what Sleep, Home, and Away setpoints you prefer. Early Start is an optional setting that learns how long it takes to heat up a given room and then adjusts the Schedule to make everything toasty right on time.

The optional Intelligent Eco Mode which you can turn off imperceptibly modulates the temperature by a half-degree to boost your savings over time as it learns how your system works. One feature we were able to fully test—and found very reliable—is geolocation. On the Mysa thermostat, it works in tandem with the scheduling so it works more like the feature on the Ecobee than on the Honeywell , giving you the option to have your regular Schedule resume or pause when you arrive or leave, or to hold a set temperature.

That lets you see exactly how much electricity you're using—as well as exactly how much that energy is costing you, an impressive motivator to put on an extra sweater. You can drill down into the month, week, and day, as well as by the whole system, zone, or individual unit. The biggest flaw of the Mysa thermostat is its price, since electrical baseboard heating generally requires a thermostat in every room. So if you want to tweak a daily start time, for example, you have to either manually copy it to every day or delete the whole Schedule and start from scratch.

Some thermostats, including Nest models, can work in the absence of a C wire by stealing power from other wires. Similarly, health insurers that are slow to embrace and support the value agenda—by failing, for example, to favor high-value providers—will lose subscribers to those that do.

The strategic agenda for moving to a high-value health care delivery system has six components. They are interdependent and mutually reinforcing; as we will see, progress will be easiest and fastest if they are advanced together. They are interdependent and mutually reinforcing. Progress will be greatest if multiple components are advanced together. For the most part, the solutions have focused on the levers that particular stakeholders can push and have been designed to preserve existing roles.

None of them tackle the underlying strategic and structural problems that work against value for patients. Disappointment with their limited impact has created skepticism that value improvement in health care is possible and has led many to conclude that the only solution to our financial challenges in health care is to ration services and shift costs to patients or taxpayers.

A realistic assessment of these piecemeal reforms reveals that none of them—or even all of them taken together—address the root causes of low value. While many of the steps are useful, there is no substitute for the strategic transformation the value agenda requires. Fraud and self-dealing occur, but enforcement here does not address the root causes of low-value health care. Regulations intended to reduce self-dealing can actually impede progress toward improving value, by inhibiting integrated care across specialties.

Also, consumer shopping can have only limited impact in a fragmented system where information about outcomes and price is lacking. Research-based practice guidelines are of course desirable, but compliance with them does not necessarily lead to improved outcomes or efficiency.

Guidelines cover only a small slice of the overall care cycle and fail to reflect many individual patient circumstances.

Rapid advances in medical knowledge constantly improve the state of the art, which means that providers are measured on compliance with guidelines that are often outdated. New models of delivering routine primary care in lower-cost settings such as retail clinics have a role, but they will do little to address the bulk of health care costs, most of which are generated by care for more-complex diseases.

Also, retail clinics and other adjuncts to primary care practices are not equipped to provide holistic and continuous care for healthy patients or acute and preventive care for patients with complex, chronic, or acute conditions.

Capitation—a payment model in which providers receive a flat fee for taking care of an individual enrolled in a health care plan, covering any and all needed services—provides a strong incentive to reduce spending but not necessarily to improve value. This payment model also exposes providers to risks over which they have little control. Capitation motivates providers to offer every service line in an attempt to keep spending internal, instead of providing only services where they can offer excellent value.

Reducing errors is essential, but errors are just one of the outcomes that matter to patients. Reducing errors does not itself lead to a redesign of overall care that improves value. Information technology is a powerful tool for enabling value-based care. But introducing EMR without restructuring care delivery, measurement, and payment yields limited benefits. And siloed IT systems make cost and outcomes measurement virtually impossible, greatly impeding value improvement efforts.

The components of the strategic agenda are not theoretical or radical. All are already being implemented to varying degrees in organizations ranging from leading academic medical centers to community safety-net hospitals. No organization, however, has yet put in place the full value agenda across its entire practice.

Every organization has room for improvement in value for patients—and always will. At the core of the value transformation is changing the way clinicians are organized to deliver care. The first principle in structuring any organization or business is to organize around the customer and the need. We call such a structure an integrated practice unit. IPUs treat not only a disease but also the related conditions, complications, and circumstances that commonly occur along with it—such as kidney and eye disorders for patients with diabetes, or palliative care for those with metastatic cancer.

IPUs not only provide treatment but also assume responsibility for engaging patients and their families in care—for instance, by providing education and counseling, encouraging adherence to treatment and prevention protocols, and supporting needed behavioral changes such as smoking cessation or weight loss.

They are expert in the condition, know and trust one another, and coordinate easily to minimize wasted time and resources. They meet frequently, formally and informally, and review data on their own performance. Armed with those data, they work to improve care—by establishing new protocols and devising better or more efficient ways to engage patients, including group visits and virtual interactions.

Take, for example, care for patients with low back pain—one of the most common and expensive causes of disability. One patient might begin care with a primary care physician, while others might start with an orthopedist, a neurologist, or a rheumatologist.

What happens next is unpredictable. Patients might be referred to yet another physician or to a physical therapist. They might undergo radiology testing this could happen at any point—even before seeing a physician. Each encounter is separate from the others, and no one coordinates the care. Duplication of effort, delays, and inefficiency is almost inevitable. Since no one measures patient outcomes, how long the process takes, or how much the care costs, the value of care never improves.

The impact on value of IPUs is striking. Patients with low back pain call one central phone number SPINE , and most can be seen the same day. Those with serious causes of back pain such as a malignancy or an infection are quickly identified and enter a process designed to address the specific diagnosis. Other patients will require surgery and will enter a process for that.

For most patients, however, physical therapy is the most effective next intervention, and their treatment often begins the same day. Rather, it eliminated the chaos by creating a new system in which caregivers work together in an integrated way. The impact on value has been striking. Better care has actually lowered costs, a point we will return to later. Virginia Mason has also increased revenue through increased productivity, rather than depending on more fee-for-service visits to drive revenue from unneeded or duplicative tests and care.

The clinic sees about 2, new patients per year compared with 1, under the old system, and it does so in the same space and with the same number of staff members. Wherever IPUs exist, we find similar results—faster treatment, better outcomes, lower costs, and, usually, improving market share in the condition.

But those results can be achieved only through a restructuring of work. Simply co-locating staff in the same building, or putting up a sign announcing a Center of Excellence or an Institute, will have little impact. IPUs emerged initially in the care for particular medical conditions, such as breast cancer and joint replacement. Today, condition-based IPUs are proliferating rapidly across many areas of acute and chronic care, from organ transplantation to shoulder care to mental health conditions such as eating disorders.

Porter, Erika A. Pabo, and Thomas H. By its very nature, primary care is holistic, concerned with all the health circumstances and needs of a patient. The complexity of meeting their heterogeneous needs has made value improvement very difficult in primary care—for example, heterogeneous needs make outcomes measurement next to impossible. In primary care, IPUs are multidisciplinary teams organized to serve groups of patients with similar primary and preventive care needs—for example, patients with complex chronic conditions such as diabetes, or disabled elderly patients.

Different patient groups require different teams, different types of services, and even different locations of care. Within each patient group, the appropriate clinical team, preventive services, and education can be put in place to improve value, and results become measureable. This approach is already starting to be applied to high-risk, high-cost patients through so-called Patient-Centered Medical Homes. But the opportunity to substantially enhance value in primary care is far broader.

At Geisinger Health System, in Pennsylvania, for example, the care for patients with chronic conditions such as diabetes and heart disease involves not only physicians and other clinicians but also pharmacists, who have major responsibility for following and adjusting medications. The inclusion of pharmacists on teams has resulted in fewer strokes, amputations, emergency department visits, and hospitalizations, and in better performance on other outcomes that matter to patients.

Rapid improvement in any field requires measuring results—a familiar principle in management. Teams improve and excel by tracking progress over time and comparing their performance to that of peers inside and outside their organization.

Indeed, rigorous measurement of value outcomes and costs is perhaps the single most important step in improving health care. Wherever we see systematic measurement of results in health care—no matter what the country—we see those results improve. Yet the reality is that the great majority of health care providers and insurers fail to track either outcomes or costs by medical condition for individual patients. That surprising truth goes a long way toward explaining why decades of health care reform have not changed the trajectory of value in the system.

When outcomes measurement is done, it rarely goes beyond tracking a few areas, such as mortality and safety. HEDIS the Healthcare Effectiveness Data and Information Set scores consist entirely of process measures as well as easy-to-measure clinical indicators that fall well short of actual outcomes. For diabetes, for example, providers measure the reliability of their LDL cholesterol checks and hemoglobin A1c levels, even though what really matters to patients is whether they are likely to lose their vision, need dialysis, have a heart attack or stroke, or undergo an amputation.

Few health care organizations yet measure how their diabetic patients fare on all the outcomes that matter. The only true measures of quality are the outcomes that matter to patients.

And when those outcomes are collected and reported publicly, providers face tremendous pressure—and strong incentives—to improve and to adopt best practices, with resulting improvements in outcomes.

Take, for example, the Fertility Clinic Success Rate and Certification Act of , which mandated that all clinics performing assisted reproductive technology procedures, notably in vitro fertilization, provide their live birth rates and other metrics to the Centers for Disease Control.

After the CDC began publicly reporting those data, in , improvements in the field were rapidly adopted, and success rates for all clinics, large and small, have steadily improved.