The Service will provide initial contact, telephone triage, remote consultations and where necessary face to face assessments and management of recent onset symptomatic or urgent ocular presentations.
Initial telephone contact and access to clinical triage — access to the Service is restricted to telephone booking only, to:. The main priority is to address the need for the rapid commissioning, and implementation of, an accessible urgent eye care service in areas without an existing CCG commissioned primary eye care pathway for the duration of the coronavirus COVID pandemic as outlined in NHS England Publication approval reference: Where appropriate, larger regional groupings may wish to commission at a larger scale.
In health communities where a prime provider is already involved in the delivery of locally commissioned optometric services, commissioners should expect to continue using this mechanism to deliver and manage the CUES service. Commissioners without such relationships should consider their use to deliver the CUES service.
Some CCGs and primary eye care services have already agreed amended service delivery specifications to use the skills of primary eye care practitioners to triage, manage and prioritise patients presenting with an urgent eye condition. This Service specification is not intended to interfere with locally agreed arrangements to manage the COVID pandemic, where they are working well.
Any service requires clinical leadership in enabling and assuring the delivery of high-quality care. The Service will therefore provide effective clinical leadership using the principles of multidisciplinary and organisational collaboration, training, clinical governance and clinical audit.
A locally based clinical lead optometrist will oversee the implementation and performance management of the Service, and will work in partnership with the Trust clinical lead ophthalmologist to agree local pathways; revisions to local ophthalmology triage guidelines, joint care protocols and support responsive service co-developments, as required.
Emergent pandemics are times of high uncertainty, the commissioners and service provider and local ophthalmology department will need to work collaboratively to adapt and develop the service to best meet the immediate and intermediate needs of the local health care system, for the duration of the pandemic. Working in an integrated way with local ophthalmology teams the Service has the potential to provide a basis for offering further support during the recovery of routine hospital eye services:.
People self-presenting with an urgent eye condition requiring consultation Closed door policies apply with telephone booking only. Forms Accessibility Related Articles Is this page helpful? Yes No. Any additional feedback? Skip Submit. Submit and view feedback for This product This page. View all page feedback. Ok, maybe not, but you can still learn some cool stuff on how to lose fat and get bigger gunz! Enough chatter, and strap in for a fun ride. Nothing wrong with wanting to look good at all, but I believe focusing on performance first is the fastest way to get there.
The first thing I do with a new client after discussing their goals , is to translate their aesthetic goals into a performance goal. While you may be expecting me to slap him around a bit for his crazy goal, the reality is it is my job to get him to his goal. Keep in mind that your goals are your goals. One of my main goals is to lift the lb Dinnie Stones.
My goals are my goals and wanting to do something performance or have something aesthetics is perfectly fine. It is your life; do as you wish. My job is to get you to your goal in the safest and fastest way possible.
Back to our friend who currently has string hanging from his shirt sleeves I mean small arms and is seeking to display the gun show when the sun is out er, the black lights at the trendy Friday night club in this case. After measuring his arm circumference his main goal , I would have him do a few strength tests. Trying to detect a small change in arm circumference on even a weekly or monthly basis is quite hard. Hell, even with uber expensive lab equipment it is hard!
Their results were debated by Phillips SM using the very data they found. In short, even with high level researchers using very spendy equipment like MRIs, a small direct change in size is not super easy to detect.
Plus Johnny Small Arms does not want to wait months to find out his new arm routine that he is paying me big money for too is not delivering. But if we measure performance along the way, we can detect changes from one training session to the next instead of waiting 3 months to see if it is working.
Performance is measured by the amount of overload via volume, weight, or density at each and every session. Muscle physiology states that the local stimulation of the muscle tissue is by far and away the biggest stimulus for muscle growth. Without the stress on the muscle, there is ZERO reason for it to get bigger and stronger.
Thus, we apply stress via overload and then monitor his performance — can he do more work volume , in less time density or more weight intensity. Since my bias is a performance based model, my bias for cues is also geared towards performance; hence the use of external cues. Batch process all wav files in any source folder with freely selectable target folder to either overwrite the existing files or create copies of them Autodetect pitch of sample and store information in file and manually edit dwMIDIUnityNote and dwMIDIPitchFraction.
Trim away unused wav data from looped samples in batch mode. What you need If you use the pre-compiled executables for windows then no additional software is required, but the folder layout must be kept so that the icons will be found.
For sound the RtAudio library is used. Plays a sound cue for: Incoming enemy melee attacks Aiming at an enemy Landing a shot on an enemy. Audio cues for traversal and combat can be enabled from the Accessibility menu. Combat Accessibility. Because combat in The Last of Us Part II should be accessible for all players, there are a number of options that can significantly alter the gameplay experience. For instance, the Invisible While Prone feature allows you to experience stealth gameplay that might otherwise be inaccessible.
If you have difficulty aiming, you can give yourself more time by enabling Slow Motion while aiming. These features provide you with all the tools you need to make the combat experience enjoyable and challenging. These settings are designed to make combat accessible for all players. As such, they can significantly alter the gameplay experience.
This setting will not apply during certain combat encounters. This setting is relative to the chosen difficulty. This setting is disabled during certain encounters where stealth is not an option. To address this discrepancy, there are several options to display this information visually instead.
This setting is recommended for players who are deaf or hard of hearing. Available with Patch 1. Hints are activated by pressing L3. Subtitles are an extremely popular accessibility feature, and The Last of Us Part II offers you with a wide array of customization options for them.
You can tweak the size and color, add a dark background for contrast, enable speaker names, and even a directional arrow for offscreen speakers. For the first time in a Naughty Dog game, you can enable subtitles for all systemic enemy dialogue during stealth and combat. Does not display for on-screen speakers.
Game Difficulty. Players can also customize specific aspects of difficulty to your needs or desired experience.A highlight in the score is “Sascha Meet Vlad (Alternate)”, where suspense slowly builds, the tempo grows urgent and knockout bass trombones with tuba doubling in lower octaves suddenly punch through in fortissimo manner. The cues that follow continue the tense activity with “Checkpoint” introducing the Russian-flavor action.