An evaluation of the Amblyopia and Strabismus Questionnaire using Rasch analysis

noPURPOSE. To evaluate whether the Amblyopia and Strabismus Questionnaire (A&SQ) is a suitable instrument for the assessment of vision-related quality-of life (VR-QoL) in individuals with strabismus and/or amblyopia. METHODS. The A&SQ was completed by 102 individuals, all of whom had amblyopia, strabismus, or both. Rasch analysis was used to evaluate the usefulness of individual questionnaire items (i.e., questions); the response-scale performance; how well the items targeted VR-QoL; whether individual items showed response bias, depending on factors such as whether strabismus was present; and dimensionality. RESULTS. Items relating to concerns about the appearance of the eyes were applicable only to those with strabismus, and many items showed large ceiling effects. The response scale showed disordered responses and underused response options, which improved after the number of response options was reduced from five to three. This change improved the discriminative ability of the questionnaire (person separation index increased from 1.98 to 2.11). Significant bias was found between strabismic and nonstrabismic respondents. Separate Rasch analyses conducted for subjects with and without strabismus indicated that all A&SQ items seemed appropriate for individuals with strabismus (Rasch infit values between 0.60 and 1.40), but several items fitted the model poorly in amblyopes without strabismus. The AS&Q was not found to be unidimensional. CONCLUSIONS. The findings highlight the limitations of the A&SQ instrument in the assessment of VR-QoL in subjects with strabismus and especially in those with amblyopia alone. The results suggest that separate instruments are needed to quantify VR-QoL in amblyopes with and without strabismus

Hiding in plain sight, Ficus desertorum (Moraceae), a new species of rock fig for Central Australia

A new species of lithophytic fig, Ficus desertorum B.C.Wilde & R.L.Barrett, endemic to arid Central Australia, is described and illustrated. It is distinguished from other species in Ficus section Malvanthera Corner by having stiff lanceolate, dark green, discolorous leaves; many parallel, often obscure lateral veins; petioles that are continuous with the midrib; with minute, usually white hairs and non- or slightly sunken intercostal regions on the lower surface. Previously included under broad concepts of either Ficus platypoda (Miq.) Miq. or Ficus brachypoda (Miq.) Miq., this species has a scattered distribution throughout Central Australia on rocky outcrops, jump-ups (mesas) and around waterholes. This culturally significant plant, colloquially referred to as the desert fig, grows on elevated landscapes in central Australia, including Uluru (Ayers Rock), Kata Tjuta (The Olgas) and Karlu Karlu (Devils Marbles), three of Central Australia’s best-known natural landmarks. Evidence is provided to show these plants are geographically and morphologically distinct from Ficus brachypoda, justifying the recognition of F. desertorum as a new species. Taxonomic issues with F. brachypoda and F. atricha D.J.Dixon are also discussed. Lectotypes are selected for Urostigma platypodum forma glabrior Miq. and Ficus platypoda var. minor Benth

(Lack of) Pension Knowledge

Governments are increasingly concerned about the capacity of pensions systems to meet demands in the coming years. According to the OECD, one part of the policy response in many countries will be greater private provision on the part of individuals through occupational and other pension arrangements. If such a strategy is to work, it requires that individuals are well-informed about pensions. However, there are many reasons to believe that individuals may not be well-informed due to the complexity of pensions systems and degrees of myopia. In this paper, we assess levels of knowledge of pensions using a representative sample of older Irish people. Looking at people who are enrolled in pension schemes, we find that two thirds of these people do not know what amount will be paid out on retirement and/or whether the payments will be in the form of lump-sums, monthly payments or both. Women are more likely not to know, as are people with lower levels of education. While one policy conclusion might be to direct pensions-related information at certain groups, another approach might be to extend the mandatory elements in pension systems such as contribution rates

Treating reading difficulties with colour [Editorial]

yesAround 3-6% of children in the United Kingdom have substantial difficulties learning to read, a condition often referred to as dyslexia. They are at high risk of educational underachievement. In a 1996 editorial in The BMJ, Margaret Snowling argued that dyslexia is a verbal (not a visual) disorder.1 An accumulation of evidence supports this position and shows that reading difficulties are best dealt with by interventions that target underlying weaknesses in phonological language skills and letter knowledge.2 The 2009 Rose report, which provides guidance for professionals in schools on identifying and teaching young people with dyslexia and reading difficulties, stresses the importance of early, phonological interventions.3 Despite this evidence, dyslexia is often associated with subjective experiences of visual distortions that lead to discomfort during reading (sometimes termed visual stress). It has been argued that these symptoms can be alleviated by using coloured overlays and lenses.4 Symptoms of visual stress are not unique to dyslexia, and proponents do not claim that the use of colour directly addresses the underlying cause of the reading difficulty. However, they argue that the reduction in visual distortion brought about by a change in colour can improve reading accuracy and fluency.

Treating reading difficulties with colour: Authors’ reply to Evans and Allen

yesWe thank Professors Evans and Allen for their interest in our article.1 2 The charity websites we reviewed refer to colour as though it offers a scientific, evidence based treatment; none referred to feedback from the membership. For example, one charity website makes the claim that “Research in the UK and in Australia shows that people who need coloured filters, who are said to have visual stress, need to have exactly the right colour.” This is incorrect. The research overwhelmingly shows little advantage, or at best conflicting results.3 4

Cohort profile: Canadian study of prediction of death, dialysis and interim cardiovascular events (CanPREDDICT)

Background: The Canadian Study of Prediction of Death, Dialysis and Interim Cardiovascular Events (CanPREDDICT) is a large, prospective, pan-Canadian, cohort study designed to improve our understanding of determinants of renal and cardiovascular (CV) disease progression in patients with chronic kidney disease (CKD). The primary objective is to clarify the associations between traditional and newer biomarkers in the prediction of specific renal and CV events, and of death in patients with CKD managed by nephrologists. This information could then be used to better understand biological variation in outcomes, to develop clinical prediction models and to inform enrolment into interventional studies which may lead to novel treatments. Methods/Designs: Commenced in 2008, 2546 patients have been enrolled with eGFR between 15 and 45 ml/min 1.73m2 from a representative sample in 25 rural, urban, academic and non academic centres across Canada. Patients are to be followed for an initial 3 years at 6 monthly intervals, and subsequently annually. Traditional biomarkers include eGFR, urine albumin creatinine ratio (uACR), hemoglobin (Hgb), phosphate and albumin. Newer biomarkers of interest were selected on the basis of biological relevance to important processes, commercial availability and assay reproducibility. They include asymmetric dimethylarginine (ADMA), N-terminal pro-brain natriuretic peptide (NT-pro-BNP), troponin I, cystatin C, high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL6) and transforming growth factor beta 1 (TGFβ1). Blood and urine samples are collected at baseline, and every 6 monthly, and stored at −80°C. Outcomes of interest include renal replacement therapy, CV events and death, the latter two of which are adjudicated by an independent panel. Discussion: The baseline distribution of newer biomarkers does not appear to track to markers of kidney function and therefore may offer some discriminatory value in predicting future outcomes. The granularity of the data presented at baseline may foster additional questions. The value of the cohort as a unique resource to understand outcomes of patients under the care of nephrologists in a single payer healthcare system cannot be overstated. Systematic collection of demographic, laboratory and event data should lead to new insights. The mean age of the cohort was 68 years, 90% were Caucasian, 62% were male, and 48% had diabetes. Forty percent of the cohort had eGFR between 30–45 mL/min/1.73m2, 22% had eGFR values below 20 mL/min/1.73m2; 61% had uACR < 30. Serum albumin, hemoglobin, calcium and 25-hydroxyvitamin D (25(OH)D) levels were progressively lower in the lower eGFR strata, while parathyroid hormone (PTH) levels increased. Cystatin C, ADMA, NT-proBNP, hsCRP, troponin I and IL-6 were significantly higher in the lower GFR strata, whereas 25(OH)D and TGFβ1 values were lower at lower GFR. These distributions of each of the newer biomarkers by eGFR and uACR categories were variable

Eyewear for rugby union: wearer characteristics and experience with rugby goggles

YesUnlike many other sports, Rugby Union has not permitted players to wear spectacles or eye protection. With an industrial partner, World Rugby developed goggles suitable for use while playing rugby for the purposes of growing participation amongst those that need to wear corrective lenses. This study reports on the profile and experiences of goggle wearers. 387 players received the goggles. Data were obtained from 188 (49 %) using an online, 75-item questionnaire. 87 % “strongly agreed/agreed” that goggles are beneficial and 75 % are happy with goggle performance. Common problems reported by 49.7 and 32.6 % of respondents were issues with fogging-up and getting dirty. 15 (8 %) players stopped wearing the goggles because of fogging-up, limits to peripheral vision and poor comfort/fit. Injuries were reported in 3 % of respondents. In none of these cases did the player stop wearing the goggles. From the positive experience of players in the trial, the goggles were adopted into the Laws of the game on July 1, 2019. As the need to correct vision with spectacles is common, and contact lenses are not worn by 80 % + of spectacle wearers, the new Rugby goggles will widen participation for those that need to wear refractive correction, or have an existing/increased risk of uniocular visual impairment