Hiring PA’s and NP’s? Consider These Tips LETTERS TO THE EDITOR
SUMMER
2015
Smart Phone Apps To ImproveYour TPractice H E M AG A Z I N E
The 10 Greatest Medical Inventions of the Last 50 Years
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CONTENTS
Drs.Reference T H E M AG A Z I N E
4 Top 10 Medical Innovations of the Last 50 Years
13 Bringing PA’s and NP’s on Board
20 Interview with Dr. Moazzaz on advances in robotic spine surgery
31 Does looking at a Computer damage your eyes?
26 Top Ten Best Luxury Hotels
36 Top 10 Luxury Cars for 2015
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MEDICAL INNOVATION
The 10 Greatest Medical Inventions of the Last 50 Years W
e can’t deny that digital technologies have completely changed our world, and the influence of these modern innovations on our personal and professional lives has made a significant mark on the medical industry.
Saving millions of lives around the world, preventing the spread of disease, allowing for more accurate diagnosis, and enabling better patient care are just some of the great benefits medical inventions and technologies have made on our world. But with new medical devices being introduced to the healthcare industry on a regular basis, it’s hard to keep track of all of the great innovations that have made the most significant impact on the lives of people all around the globe. Here on Health Exec News, we are committed to bringing you the best news, updates, and studies related to the healthcare industry, and have conducted extensive research to compile this list of the 10 Greatest Medical Inventions of the Last 50 Years. Considering how quickly medical technology evolves, it was not easy to come up with only 10 medical innovations that have made the most impact throughout the past 5 decades. However, the top 10 medical inventions that made our list range from life-saving drugs, like
Highly Active Anti-retroviral Therapy (HAART) - which combines 3 different medications into 1 for a powerful prescription that can help extend the lives of patients with HIV/AIDS - to the artificial heart developed by Dr. Robert Jarvik, which replaces one of the most vital organs in the human body and has been saving lives since the early 1980’s. Even the “classic” medical testing devices have their place on our list; in fact, our top pick for MRI and CT technologies reflects what an incredible impact these two technologies have made on the medical industry since their inception in the late 1970’s. We can’t deny that digital technologies have completely changed our lives, and the influence of these modern innovations on our personal and professional lives has made a significant mark on the medical industry. Many physicians and caregivers are now dedicated to using mobile medical technology, like tablets, smart phones, and other telecommunications devices to improve patient care in less time and without having to worry about geographical boundaries. Other digital applications, like in the newly-created Active Bionic Prosthesis (number 10 on our list), use modern technologies like microprocessors and Bluetooth to replicate natural functions in muscles and tendons. Patients using this medical invention
can make adjustments to their “wearable robotics” right through their smart phones. Now that’s modern innovation! Each of the 10 medical inventions acknowledged in our list is responsible for saving or improving the lives of patients around the world and have made their mark in medical history. Here is an in-depth guide to the Health Exec News list of the Top 10 Best Medical Inventions of the Last 50 Years: 10 Active Bionic Prosthesis (Wearable Robotic Devices). Prosthetic limbs are no longer non-functioning items. Technology now allows us to replicate the action of a person’s
continued...
Above: Highly active anti-retrovival therapy (HAART). 4
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tendons and muscles to mimic natural body motion. Battery-powered motors, microprocessors, and Bluetooth technology allow a person to adjust settings easily with a smart phone to ensure natural and consistent motion. 9 Health IT (especially mobile/ wireless devices). Physicians no longer have to dig through piles of
books and case studies to find the information they need to help a patient. Now they can look up information, access patient records, and view digital medical information in seconds, no mater where they are located. In fact, nearly 82% of physicians are projected to use smartphones in 2012. 8 Molecular Breast Imaging (MBI) This technology is making an impact in the fight against breast cancer. While mammography has been one of the leading methods of detection
for breast cancer for years, it has not been effective in detecting tumors in dense tissue. MBI is a safe and more powerful scan which serves as an encouraging alternative to mammography. 7 Modern Telehealth Telehealth is helping to significantly reduce the number of ER visits and hospitalizations around the world. By combining powerful telecommunications technology and healthcare advancements, patients and doctors can connect like never before without
Prosthetic limbs are no longer non-functioning items. 6
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consideration for geographical boundaries. Telehealth supports more efficient diagnosis, treatment, and care management for patients by enabling doctors to share and access diagnostic images, video, and patient data.
6 Highly active anti-retrovival therapy (HAART). This medication has been in development stages for years but has proven to be a powerful symptom reliever for patients suffering from HIV/AIDS. By using three medications to create one powerful combination, HAART has been clearly shown to delay progression to AIDS and prolong the life of infected patients anywhere from 4 to 12 years.
5 Functional Magnetic Resonance Imaging (fMRI). By non-invasively recording brain signals without the risks of radiation, this new technique tracks blood flow in the brain to monitor areas of activity. It can be used to monitor the growth of brain tumors, determine how well the brain is functioning after a stroke or diagnosis of Alzheimer's disease,
and find out where in the brain seizures are originating. 4 Minimally invasive robotic surgeries. Surgeries aided by robots were first introduced in the late 1980’s with laproscopic procedures and have been advancing ever since. Today’s “da Vinci” robot has treated more than 775,000 patients, and
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plification by Stimulated Emission of Radiation (LASER) allows for accurate focus on very small areas of the body. 2 The Artifical Heart. Robert Jarvik, MD is widely known as the inventor of the first successful permanent artificial heart, the Jarvik 7, first
implanted in 1982. Since that time, this medical invention has helped save thousands of lives all over the world, as heart disease is the number one cause of death in the United States and many other countries, leading cardiologists to continually search for ways to improve heart health. Currently, temporary and
Instead of leaving patients with extensive scarring, these minimally-invasive surgeries leave only a few small marks on the body and allow for greater accuracy during surgery and less post-operation recovery time. 3 Laser Surgeries were first used to correct vision, but today their use spans across many medical and cosmetic procedures. Whether used for corrective eye surgeries, cosmetic dermatology, or the removal of precancerous lesions, Light Am-
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and CT scans were developed by Sir Godfrey Hounsfield and Dr. Alan Cormack, for which they were awarded the Nobel Prize in 1979. By combining a series of images, or “slices”, taken from many different
angles, doctors can examine detailed parts of the body individually or produce a 3-D image of that area, allowing them to quickly and accurately identify internal trauma or irregularities.
permanent artificial hearts are being used to help patients stay healthy while awaiting a heart transplant or to nurse their current hearts back to health. 1 Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). These two medical technologies seem like standard procedures today, hinting at their significant impact on healthcare. The first whole-body MRI scanner was constructed 1977 by Dr. Damadian, which he dubbed the "Indomitable”
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STAFF HIRING
Bringing PA’s and NP’s on board: What to do if you're hiring M
ore practices are talking about employing these kinds of health practitioners. Here are some things to consider.
By VICTORIA STAGG ELLIOTT, amednews staff. Posted Jan. 10, 2011.
If you are considering employing a nurse practitioner or a physician assistant, the success of the hire likely rests on one simple question: What do you want the person to do? That may be harder to answer than it seems. "Simply adding somebody and saying they are going to improve your care or improve your productivity is almost always doomed to failure," said family physician Daniel Mingle, MD, chief physician executive and an owner of Maine MSO in Portland. "You need to be clear on how to incorporate that person in the practice and really understand how you want them to perform." Experts say the first step is to determine whether a nurse practitioner or physician assistant would suit the practice's needs. State regulations, which differ across the country, will help with that decision. "First and foremost, be familiar with the state laws," said Marsha Siegel, a nurse practitioner in Cheyenne, Wyo., and president of the board of the American College of Nurse Practitioners.
[Illustration by Andrew DeGraff / www.andrewdegraff.com]
For example, nurse practitioners can prescribe in all 50 states but can prescribe controlled substances in only 47. Physician assistants are generally supervised by a doctor. Nurse practitioners are more likely to work in collaboration with a physician and can practice independently in 16 states. Some states require a physician to audit a percentage of the charts. Others require a written supervision or collaboration plan either on file with a state agency or held at the practice. Nurse practitioners are usually regulated by the state board of nursing and physician assistants by the state's medical board. Several medical societies have advo-
cated against the expansion of the scope of practice of physician assistants and nurse practitioners. The American Medical Association, along with the American Osteopathic Assn., the American Academy of Family Physicians and the American Academy of Pediatrics published a letter in the Dec. 15, 2010, issue of The New England Journal of Medicine advocating a physician-led approach to care, "with each member of the team playing the role he or she has been educated and trained to play." Nurse practitioners can prescribe in all 50 states and can prescribe controlled substances in 47.
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State penalties for wrongly setting up a physician assistant or nurse practitioner at a practice vary widely but can include fines and criminal charges. "You have to understand what the scope of practice is and what supervision and collaboration means," said Ron L. Nelson, a physician assistant and CEO and president of Health Services Associates, a practice management consulting firm in Fremont, Mich. "And it's important to have systems in your practice to make sure that adequate collaboration and supervision occur. A physician is ultimately responsible for the quality of care provided by these individuals." Practices also need to think about the tasks required. Physician assistants tend to carry out more procedures. Nurse practitioners are more likely to provide services related to evaluation and management. "If practices want the person to do lots of technical procedures like
bone marrow aspirations, they often hire physician assistants," said Carolyn Buppert, ANP, a nurse practitioner and an attorney in Bethesda, Md. "If the job entails more visits for evaluation and management, then it is more likely to be a nurse practitioner." Defining the parameters of the job can lead to the biggest mistakes. Those who work for organizations representing these health care providers say nurse practitioners and physician assistants quickly will leave practices that do not use their full set of skills, or expect them to go well beyond them. "The main reasons physician assistants leave is not because of money," said Ellen Rathfon, senior director of professional advocacy at the American Academy of Physician Assistants. "It's because of the type of relationship with the supervising physician and the relationship with the practice, or a lack of opportunities to grow."
Nurse practitioners can practice independently in 16 states. For example, Taynin Kopanos, director of health policy/state government affairs at the American Academy of Nurse Practitioners, recently spoke to nurse practitioners thinking about leaving medical practices that had recently hired them. One was a nurse practitioner who was being asked to manage children's health care needs, which was outside her base of knowledge. The other was being used by the physician primarily to take notes and then educate patients on various health matters. "That was really a mismatch between her skills and the role that the practice has created," Kopanos said. "In that case, the practice doesn't need an advanced practitioner." Personal preference also can play a significant role. For example, Cynthia CotĂŠ, MD, a family physician who also performs noninvasive cosmetic procedures at her practice in Maple Valley, Wash., recently hired a physician assistant. She chose this type of health practitioner over an nurse practitioner because she had more experience with PAs. When the type of medical practitioner is identified, a job description should be formalized. Will there be overtime? Will the nurse practitioner or physician assistant be on call? Does a practice want NPs or PAs to have their own panel of patients, or will they be shared with the physician? Will they handle only urgent care, chronic disease management or both? Will they provide services that are separately billable or those that allow physicians to see more patients and increase collections? What level of supervision or collaboration does a physician feel
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comfortable with, and what is required by law? Does a physician want to review more charts, at least initially, than the number mandated by regulation?
the Medical Group Management Assn. Health Care Consulting Group. "You need to have a clear appreciation for what they can and cannot do."
"You have to ask how independent of a practice are you going to develop for our nurse practitioners and physician assistants," said Ken Lester, a network executive with Halley Consulting in Westerville, Ohio.
Medical practices also need to determine a salary and a compensation structure.
Reimbursement and salary The next step is to talk to insurers about how this health care practitioner needs to be credentialed and how services will be paid. This can take months. Some insurers will reimburse directly for services provided by a nurse practitioner or physician assistant. Others will require that they be linked directly to a credentialed physician. "You need to understand how to handle the billing and the coding." said Kenneth Hertz, a principal in
Most nurse practitioners and physician assistants are on a straight salary, although compensation is increasingly linked to productivity and quality much like a growing number of physicians. Some are paid on a percentage of receipts or charges or a per-visit fee. Professional organizations and medical societies can be a source of information on salary ranges and typical benefits for a practice's location and specialty and the job's duties. Recruiters say, however, that medical practices, even small ones, competing with large hospital systems may not necessarily have to match
or beat salary and benefits, which tend to be higher at larger institutions. The medical practice setting may have other advantages, such as set hours or no night work. Some nurse practitioners and physician assistants may be looking for a small practice. "Most don't care about a few thousand dollars," said Carlos O. Hernandez, MD, an internist and president of WellMed Medical Group in San Antonio. "What they are going to look for is fit." After taking these steps, it's time to get the word out that a job is available. Experts suggest contacting a local training program to get the position listed on virtual as well as cork-andwood bulletin boards. Societies representing these health care practitioners also have job listings, which may be free. License, background checks Background checks are important for promising applicants, including a license check with the appropriate state board. Applicants should be asked during interviews whether they are under investigation, being audited by Medicare or part of pending liability litigation. Ask about any convictions. Answering "yes" to any of these questions does not automatically mean the person should not be hired, but the issue should be further explored. For example, the applicant may be part of a long list of physicians, nurse practitioners and physician assistants who provided care at some point to a patient who has filed a lawsuit. An audit does not necessarily mean anything is wrong. In addition, an applicant may have
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learned something from the experience that could be valuable to the practice. "You want to know the specifics," Buppert said. "There's nothing negative about being audited, but you want to know how it worked out." Experts say the most important issue is whether the personality and style of a physician assistant or nurse practitioner fits with the practice and the physician. "You can have the best-educated physician assistant or nurse practitioner, but if they don't fit into the group, it is not going to work," Dr. Hernandez said. "They have to have an ability to fit into our specific culture." Number of NPs, PAs up sharply These figures show how the number of RNs educated as nurse practitioners and physician assistants in clinical practice has grown over the years.
nonphysician providers and allied health providers in usual parlance and medical society policies. The descriptors make these health care practitioners bristle. Using them when trying to recruit, rather than specifying "nurse practitioner" or "physician assistant," may turn prospective hires off rather than persuade the best and brightest to send in their resumes. "I believe we should be called by the professional credentials we have and not boxed into some 'midlevel' label," said Ron L. Nelson, CEO and president of Health Services Associates, a practice management consulting firm in Fremont, Mich. Other preferred terms include independently licensed providers, primary care providers, health care professionals and clinicians.
conflict over terminology also hints at the long-simmering battles about scope of practice and the role the professionals fill at a practice. People who hire NPs and PAs say nonphysicians who feel their work is equivalent to that of a physician can sometimes cause discord. "Some have real issues with having physician supervision, and that sometimes can be a stumbling block," said Carlos O. Hernandez, MD, an internist and president of WellMed Medical Group in San Antonio. Experts advise having clear boundaries around what a PA or NP does, and what duties and decisions belong to the physician. This should be discussed during the interview process to help avoid problems.
People who work on this issue say the frowned-upon terms confuse patients and make it seem as if the care provided is of lower quality than that delivered by physicians. But the
Sources: American Academy of Physician Assistants, Health Resources and Services Administration
Improper titles may offend professionals, confuse patients Nurse practitioners and physician assistants are frequently called physician extenders, midlevel practitioners, limited license providers,
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PROFILE SECTION
Interview with Dr Moazzaz on advances in robotic spine surgery BY APRIL CASHIN-GARBUTT, BA HONS (CANTAB)
1.
Please could you give a brief outline of robotic spine surgery and its recent history?
Robotic spine surgery is very new, less than 10 years old. There are only 10 hospitals in the US offering it and we are the second hospital in California to offer this technology. We are one of the sites helping Mazor to develop the technology for further uses. 2. How was the robotic technology developed? The technology was developed in Israel. It is based on a CT scan. They developed a computer software program that takes the patient’s pre-emptive CT scan and helps register that with two X-rays taken in the operating room. The computer program can go back and forth between the images. It uses this to allow the robot to navigate up and down the spine with extreme accuracy. 3. What are the benefits of Mazor’s Renaissance guidance system The Mazor Renaissance guidance system works by taking an oblique X-ray in the operating room. This is a miniscule amount of radiation in comparison to what we used to do in the past. Previously, we would take six or seven X-rays for each screw to make sure that it was not too close to a
blood vessel, the spinal cord or to the nerve root. Now we take two X-rays at the beginning of the surgery and then can place multiple screws during the operation without the need to take any more X-rays.
4. So the technology reduces the amount of radiation experienced by the patient? Yes, but the technology is also of benefit to the whole team providing the healthcare. This is because the entire team in the operating room experiences less radiation. The operating team in robotic spine surgery typically consists of two surgeons; the scrub nurse, who hands us instruments; the circulating nurse, who gets things that are not in the room; the anesthesiologist and a
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fourth doctor who monitors all the nerves during the surgery. Prior to the surgery, the doctor responsible for monitoring the nerves places monitors on the patient’s body and throughout the surgery makes sure the nerves are stable and makes sure the screws are not placed in a position which will affect the nerves. 5. It was recently announced that you are using an enhancement to the Mazor Renaissance guidance system, could you tell us a little bit about this? In the enhanced system we use the same technology to enable us to get an intraoperative 3D reconstruction of the spine. This is the equivalent of getting a post-operative CT scan. Now we can get this without the radiation of a CT scan, which is high. The beauty of the technology is that at the end of the surgery, the Xray machine can be brought back in and the 3D reconstruction created without having to take the patient to the CT scanning room. The reconstruction can be done within the operating room. Then we can continue with the surgery if we need to. 6. So what is the typical procedure of robotic spine surgery? Typically once we have done the instrumentation portion of the sur-
gery, we bring the X-ray machine in and do the 3D reconstruction. Then the X-ray machine leaves the room. We then usually need to do a decompression then do the fusion part of the surgery. 7. What kind of patients do you use the technology on? The majority of my patients are elderly. My areas of expertise are minimally invasive spine surgery and spinal deformity. The technology is really useful for treating the elderly or those with osteoporotic bones. This is because when you are doing surgery on patients with osteoporosis, if you are a little bit off with the placement of the screw and you need to reorientate it two or three times, you quickly find that you have nothing left to put the screw in to. Thus, with osteoporotic patients you really need to get the screw positioning right on your first attempt. The Mazor technology allows you to do so and get it perfect. This means that you don’t have to make multiple passes thought the bone which ends up weakening the bone and the construct. This essentially leads to failure due to lack of fusion. The technology is also perfect for revision surgery and surgery on those with spinal deformity. This is because the surgeon can still place the screws in position even though he doesn’t have the normal landmarks to rely on. Instead the surgeon can rely on the pre-emptive CT scan.
The technology means that the patients heal faster and can leave the hospital sooner. They also tend to need less post-operative narcotics. They are up walking the same day of the surgery, and it is generally a much more pleasant experience for them. The smaller incision that we are able to make means that there is less blood loss, less chance of infection and less anesthesia complications.
This is because we don’t need to keep the patients anesthetised for long periods of time anymore. 9. Overall how revolutionary do you think this technology is? I think the technology is a gamechanger. Previously screws would be put in the wrong place and cause injury to the nerves. This was not recognised until after the surgery when the patient would wake up in pain.
8. Are there any other benefits to the technology? The technology also allows the surgeon to make much smaller incisions and do minimally invasive surgery, as we don’t have to rely on our eyes. We can rely on the technology to put the screws in the right spot. Visit DrsReference.com J U LY 2 0 1 5
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Now we can get the screw positioning right during the surgery. I ask for the technology on every one of my cases now, as I can go to sleep at night knowing the screws are in the perfect place and that the patient is going to wake up and do very well. 10. How do you think the future of robotic spine surgery will progress? There is certainly a learning curve with this technology, although I wouldn’t say it is a very steep learning curve. We are still new to this technology and we are getting faster and faster with every case we do. Right now the technology is being used to put screws in thoracic and lumbar spine and we have started to put screws in the pelvis: so far we have done one case here. As the technology evolves I see that they’ll be putting screws in the cervical spine with the same tech-
nology as well. Also, in addition to placing screws, I think we will be able to place cages or interbody devices in the spine with this technology. One day all types of implants will be able to be put in using the Mazor technology. About Dr. Payam Moazzaz
Dr. Moazzaz specializes in minimally invasive spine surgery and complex spinal deformity of the cervical, thoracic, and lumbar spine. Dr. Moazzaz is passionate about offering his patients surgery through the least invasive approach possible to achieve excellent patient outcomes and quicker recovery times. From nerve decompression and sophisticated fusion procedures to ad-
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vanced motion-sparing and minimally invasive techniques, Dr. Moazzaz is an expert in the newest advances in spinal surgery. Dr. Moazzaz completed his surgical internship and orthopaedic surgery residency at the prestigious University of California, Los Angeles Medical Center, consistently ranked as the #1 hospital in the western United States. He then returned to his hometown of San Diego and completed a fellowship in spine surgery with an emphasis on minimally invasive surgery and complex deformity surgery. Dr. Moazzaz is committed to research and education and advancing the field of spinal surgery. Dr. Moazzaz has published several book chapters and peer-reviewed publications on orthopaedic and spinal surgery and has received numerous research awards and grants. He has presented his research at over twenty national and international
meetings and is a key investigator in many ongoing clinical studies. Dr. Moazzaz is a native of the San Diego North County and strongly feels that service and giving back to the less-fortunate are important aspects of his medical practice. He has volunteered at local San Diego hospitals and traveled to Mexico to perform medical mission trips. When not in the operating room or taking care of his patients in the clinic, Dr. Moazzaz enjoys spending time with his wife Amanda, working out, playing the piano, and traveling.
About Orthopaedic Specialists of North County Orthopaedic Specialists of North County (OSNC), was founded in Oceanside in 1965 and incorporated in 1973. Over the years, they have treated multi- generations of families, including parents, grandparents and great-grand-parents for their orthopaedic injuries and ailments. Their 13 board-certified physicians care for accident, sports - or work-related injuries, replacing total joints, or relieving chronic or acute pain. They give patients more lifestyle choices by offering the latest procedures, to help them stay active. For the convenience of their patients OSNC also offers services such as imaging, urgent care, and physical therapy to help patients recover; regain body strength quicker with less locations to visit. For more information on their doctors and services please visit: www.orthonorthcounty.com
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TRAVEL / LEISURE
Top Ten Best Luxury Hotels T
he word conjures up images of pure pleasure, indulgence in the finest of everything. When you apply the word to hotels, you immediately envision impressive décor, impeccable service, and a myriad of accoutrements and amenities to make your stay beyond memorable. Those attributes, and many more, are what make these hotels the ten finest luxury hotels in the world.
The Steigenberger Frankfurter Hof hotel in Frankfurt is ranked among the top 100 hotels in the world. The
Avenida Palace – Lisbon, Portugal At this luxury hotel, you stay in the city’s only palace. Built in 1892, this magnificence hotel features elegant rooms with marble bathrooms, a Jacuzzi and spectacular view of St. Jorge Castle and Marques de Pombal Square are the epitome of luxury. Located in Restauradores
Steigenberger Frankfurter Hof is located in the city centre, moments away from Frankfurt’s shopping areas and cultural treasures. The hotel is considered to be a living monument to the five-star hotel industry and is luxuriously furnished and fitted with modern communication and entertainment facilities. Fujairah Rotana Resort and Spa – Fujairah, United Arab Emirates The setting is spectacular: vibrant gardens surrounded by dazzling waterfalls and pools, and white sand beaches that seem to go on for days. Each room has a private terrace
Square, you’re but a few moments away from the heart of the city’s cultural district. The Avenida Palace is truly a place fit for royalty.
overlooking either the Indian Ocean or the mesmerizing lakes and hills. The discreet service is five-star, the cuisine is incomparable, and you can pamper yourself silly with an array of Zen-inspired spa treatments to de-stress and detox. Definitely a place to luxuriate. Marco Polo Parkside Beijing – Beijing, China This grand jewel of the East shines with it all: two club lounges, a four thousand square meter spa, a gym, a sauna, an indoor pool, five restau-
rants, two ballrooms, and all on fivestar property that is as close as you can get to the Summer Palace. Each room has an East-West stylistic fusion that is a haven in this busy city, and the luxury suites are unforgettable. The Marco Polo is also a perfect choice if you’re headed to the Olympics in 2008; the hotel is just a short walk from the Olympic Main Stadium.
Steigenberger Frankfurter Hof – Frankfurt, Germany
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stay at the Grace, and you may never want to go home!
Grace Hotel Sydney – Sydney, Australia You have heard the rumors that the Grace Hotel has the most comfortable beds in Sydney, and after you spend a night on the feather pillows under the feather comforter, you’ll know why. An art deco luxury hotel built in 1930; this hotel was restored with original features, so you’ll walk down wide hallways over marble floors under pressed-metal ceilings alongside masterful ironwork. It’s an easy walk to the Darling Harbour and King St. Wharf, not to mention the fabulous shopping at the Queen Victoria Building. Say, “yes” to a
Warwick New York Hotel – New York City, United States When you arrive at this historic landmark built in 1927 by William Randolph Hearst for his lover, you will be greeted with chilled champagne and chocolates. The spacious rooms offer marble bathrooms and twenty-four hour room service, and
Radio City Music Hall, Times Square or Rockefeller Center, you don’t have far to walk. That Cary Grant lived here for twelve years says it all. Al Manshar Rotana Hotel – Kuwait, Kuwait Designed to be in keeping with traditional architecture, this modern nineteen-floor, five-star luxury hotel has a pool on the roof that allows you to swim amid a scintillating view of the Kuwait Harbor and radiant Gulf. Or you can relax in the outdoor Jacuzzi, the sauna or steam room, or while you’re getting an in-
the restaurant features more than fifty stunning murals. Whether you want to go to Central Park, Fifth and Madison Avenue for shopping,
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credible massage. World class shopping is right outside the door, and each of the two hundred luxurious rooms is fully equipped with a kitchenette. There is also a poolside snack bar and an elegant in-house restaurant that provides incomparable cuisine all through the day and night. No matter what you want, this place has it.
Roman stone, or lapping up the luxury in another room that has a sofa covered with fuchsia velvet and a bed covered with a high couture patchwork quilt. The best location in town, this luxury hotel is one street away from the Grand Palace and a heartbeat away from the Sablon Antique Square. It’s not called a palace for nothing.
Royal Windsor Grand Palace – Brussels, Belgium Because this hotel offers a selection of rooms individually designed by famous fashion designers, your
Silken Puerta America – Madrid, Spain Eighteen world famous architects and designers combined efforts to create this dream luxury hotel. Each of the twelve floors is truly unique, and exquisite attention has been paid to the smallest detail in every room. Gracefully situated on a quiet, residential street, it is only a five minute-walk to the world fa-
choices are incredible. Imagine sleeping in one room with frescoes painted by an Italian artist on the walls and floors of ceruse wood and
mous Avenida de America and its access to all the city’s best sites. The hotel also sits just a short walk away from the exclusive shops of Serrano Street. Grand Rotana Resort and Spa – Sharm El Sheikh, Egypt `While staying in this luxury hotel by the sea, you can snorkel, windsurf, ride horses or camels, take a desert
safari or visit the ancient sites; you even have your own private beach. The hotel boasts seven restaurants and bars including Ramses for local cuisine. Swim on the private beach, or the lagoon-style pool that is the size of three Olympic pools; there’s even a kids private club and pool. It’s little mystery why we think this the best luxury hotel in the world.
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EQUIPMENT ISSUES
Does looking at a computer damage your eyes? BY APRIL CASHIN-GARBUTT, BA HONS (CANTAB)
T
he old saying goes that watching too much TV will make your eyes go square. Nowadays, we seem to spend most of our time looking at screens: be it a computer screen at work, a mobile phone screen to make a call or a TV screen to relax. But how bad is looking at screens for our eyes? Is there really any truth behind the old saying? According to Dr Blakeney, an optometric adviser to the College of Optometrists, computers will not permanently damage the eyes; however, they can cause strain or exacerbate existing eye conditions. (1) What problems do looking at computer screens cause? People who look at computers frequently, (in particular those that look at a computer for more than three hours a day), (2) may experience symptoms such as: Eye discomfort Headaches Itchy eyes Dry or watering eyes Burning sensations Changes in color perception Blurred vision Difficulty focussing (1, 2, 3) Eyestrain Eyestrain is a type of repetitive strain injury (RSI) that is caused by insufficient rest periods, incorrect working conditions and so forth. (2, 4)
There are many causes of eye-
strain. One of these is glare. There are two types of glare, direct and indirect. Direct glare is where light shines directly in your eyes; whereas indirect glare is caused by light reflecting off surfaces into your eyes. (3) Glare often results from computer screens being too dark or too bright. (2, 5) Glare leads to eye muscle fatigue, for the eyes have to struggle to make out the images on the screen. (2)
Another major cause of eyestrain is the position of the computer screen. Naturally, the eyes are positioned so that they look straight ahead and slightly down. If the eyes have to look in a different direction, the muscles have to
continually work to hold this position. Thus, if your computer monitor is positioned incorrectly, the eye muscles must constantly work to hold the eyes in the correct position to view the monitor. (2) In order to prevent the eyes becoming strained in this way, the top of your computer screen should be no higher than eye level. (3) Dry eye syndrome According to the NHS, using your computer correctly can also help to prevent dry eye syndrome. Dry eye syndrome is a condition in which the eyes become inflamed due to a lack of tears. This lack of tears is commonly due to a blockage of the oil secreting glands in the eyes.
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Although this condition causes discomfort, it does not usually affect vision. (6) Ways to minimise damage to your eyes caused by computer screens There are several ways you can minimise the potential damage to your eyes caused by looking at computer screens. Firstly, it is important to set up your computer screen so that it is in the correct position in relation to your eyes. As previously mentioned, the top of the screen should be in line with your eye level. In addition, the screen should be placed approximately 18-30 inches from you. The screen should also be tilted slightly back – between 10 to 15 degrees depending on the person’s particular preference. This is so that you do not receive glare from lights in the ceiling. (3, 7) Glare can also be avoided by placing blinds over nearby windows, or using a glare screen. (2, 5) In addition to adjusting the position of your screen, you can also
minimise eye problems by simply blinking more frequently. Many people don’t realise that they actually blink less when they look at a screen. (2) Blinking is important, however, as it washes your eyes in their naturally therapeutic fluids. (5) It is also important to take breaks from looking at your screen. One easy way to remember this is to think of 20-20-20. This reminds you that every 20 minutes you should try to look at something 20 feet away for a minimum of 20 seconds. (5) It is also recommended to take breaks from your screen altogether, in particular every 2 hours. (2) Can looking at screens improve eyesight? Despite the potential eye problems caused by looking at a screen too frequently, research carried out in the US has actually found that some screen viewing can be of benefit to the eyes. Specifically, they found that playing video games can improve vision.
This is because playing video games gives the users chance to improve their contrast sensitivity. (8) Contrast sensitivity refers to how faded an object can be before it is impossible to differentiate it from the same field of view. It is something that is affected by ageing. (8, 9) Contrast sensitivity is particularly important for activities such as driving in poor visibility, like in fog or at night. (8) Overall does looking at computers damage your eyes? Overall it seems that although looking at a computer may not cause permanent eye damage, it can cause some irritating problems, such as eye strain and dry eyes. It is also important to remember, that there are many other potential problems associated with sitting down and staring at a computer for long periods of times, such as deep vein thrombosis (DVT). Sources 1. http://www.nhs.uk/livewell/eyehealth/pages/eye safety.aspx
2. http://www.princeton.edu/uhs/healthy-living/hottopics/ergonomics/
3. http://www.une.edu.au/hrs/handbook/04/4.12.pdf
4. http://staffcentral.brighton.ac.uk/xpedio/groups/ public/documents/workshop_docs_is/doc002851.pdf
5. http://www.wellness.uci.edu/toolkit/march/ screenstrain.pdf
6. http://www.nhs.uk/conditions/dry-eyesyndrome/Pages/Introduction.aspx
7. http://publichealth.lacounty.gov/ivpp/pdf_injury_ factsheets/WorkStationSetUp_Jan2012.pdf
8. http://news.bbc.co.uk/1/hi/health/7967381.stm
9. http://www.ndt-ed.org/EducationResources/ CommunityCollege/PenetrantTest/Introduction/ contrastsensitivity.htm
10. http://news.bbc.co.uk/1/hi/england/bristol/ 4753833.stm
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SPECIAL SECTION
Top 10 Luxury Cars of 2015 T
here are plenty of great luxury sedans of all shapes and sizes, but here are the ones that shine in 2012. Although we aimed for a Top 10 list, we couldn’t decide which one of these beauties to cut, so in the immortal words of the faux band Spinal Tap, “We’ve got 11.” Here’s the list, in alphabetical order:
Audi A6 – Beautifully updated for 2012, the midsize sedan has been overshadowed by its flashier sibling, the A7. Bentley Continental Flying Spur – Splendid British luxury pow-
ered by a VW-sourced W12 engine with 552 horsepower, and priced at $181,000. BMW 5-Series – Still the benchmark midsize luxury sedan for driving enthusiasts, highlighted by its high-performance M5 version.
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Cadillac CTS-V – In either sedan, coupe or wagon form, the super Caddy comes with a 556-horsepower supercharged V8, Magnetic Ride Control and Brembo disc brakes to compete with the world’s best luxury/performance cars.
the new model drives like a thoroughbred, with the performancetuned XFR boasting a 510horsepower supercharged V8. Lexus LS460 – The lush full-size sedan provides the exemplary comfort and smooth-riding charInfiniti M class – These choice sedans come in a range of types, from the base M35 to the highperformance M56 and the clean M35h hybrid.
erates 355 horsepower in the fullsize luxury craft. Maserati Quattroporte – A sexy Italian body and finely crafted interior make the Quattroporte (Italian for four-door) a fitting sedan model for the storied performance brand. Mercedes-Benz E-Class – The German automaker’s most-popular model is better than ever with sharpened styling and a wide
Jaguar XF – Stylish and refined,
acteristics favored by many luxury-car buyers. Also available as a pricey hybrid. Lincoln MKS – The flagship sedan can be boosted with an EcoBoost V6 that efficiently gen-
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choice of variations including the high-performance AMG version and the impressive Bluetec diesel. Rolls-Royce Ghost – Here’s the real deal, the top of the luxury-car heap and the latest craft to wear a Flying Lady on its nose, in either base or extended-wheelbase model, priced from $250,000 to $290,000.
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