Barriers to childhood cataract services across India. A mixed methods study using the Theoretical Domains Framework (TDF) of behaviour change

Purpose : Early identification and presentation for childhood cataract surgery remains a major challenge in developing countries. The main aim of this study was to identify potential barriers to childhood cataract services from the perspective of parents’ and carers’, as a critical step towards achieving the timely uptake of cataract services. Methods : We used a mixed methods explanatory sequential study and interviewed 572 parents/carers attending tertiary hospitals in 8 states across India for their child's cataract surgery. We collected information on barriers to accessing services using a 12-item questionnaire and for each reported barrier, responses recorded on a 5 point scale ranging from “low to high importance”. Based on the quantitative data, in-depth interview questions were prepared and 35 interviews were conducted with randomly selected parents/ carers. Majority of these interviews were conducted at the hospital and /at home for those who did not undergo the surgery. Quantitative questionnaires were completed by the trained interviewer and responses were recorded in a pre-designed format. In-depth interviews were audio taped and transcribed for analysis. Quantitative data were analysed using SPSS 22 while qualitative data were organised with NVivo 11 and a thematic analysis was conducted utilising TDF, an integrative framework of theories. Results : From the 831 responses the 5 most important barriers were: economic (40%; n=222); child too young for surgery (17%; n=97); the problem was not felt as severe (16%; n=90); distance (14.5%; n=83) and no one to accompany to the hospital (9.5%; n=54). In addition, being advised by a local ophthalmologist to delay the surgery was also reported (n=16). Domains identified by the TDF included “Knowledge”, “Beliefs about consequences”, “Intentions”, “Goals”, “Decision processes”, “Environmental context and resources”, “Social influences and emotion”. This comprehensive TDF approach enabled us to understand the parents perceived barriers to access services for the children. Conclusions : Barriers to accessing childhood cataract services include both practical concerns relating to the family’s socio economic status as well as obstacles from the providers. Mapping out the barriers is necessary to design appropriate intervention for achieving positive behaviour change that can have potential social and economic impact

Electrophysiological and Psychophysical Studies of Meridional Anisotropies in Children With and Without Astigmatism.

Purpose: We investigated the pattern of meridional anisotropies, if any, for pattern onset-offset visual evoked potential (POVEPs) responses and psychophysical grating acuity (GA) in children with normal letter visual acuity (20/20 or better). Methods: A total of 29 children (aged 3-9 years), nine of whom were astigmatic (AS), were recruited. Orientation-specific monocular POVEPs were recorded in response to sinewave grating stimuli oriented along the subjects' principal AS meridians. Horizontal and vertical gratings were designated Meridians 1 and 2, respectively, for nonastigmatic patients (Non-AS). Binocular POVEPs in response to the same stimuli, but oriented at 45°, 90°, 135°, and 180°, were recorded. Psychophysical GAs were assessed monocularly and binocularly along the same meridians using the same stimuli by a 2-alternative-forced-choice staircase technique. The C3 amplitudes and peak latencies of the POVEP and GAs were compared across meridians using linear mixed models (monocular) and ANOVA (binocular). Results: There were significant meridional anisotropies in monocular C3 amplitudes regardless of astigmatism status (P = 0.001): Meridian 2 (mean ± SE Non-AS, 30.13 ± 2.07 μV; AS, 26.53 ± 2.98 μV) was significantly higher than Meridian 1 (Non-AS, 26.14 ± 1.87 μV; AS, 21.68 ± 2.73 μV; P = 0.019), but no meridional anisotropies were found for GA or C3 latency. Binocular C3 amplitude in response to horizontally oriented stimuli (180°, 29.71 ± 3.06 μV) was significantly lower than the oblique (45°, 36.62 ± 3 .05 μV; P = 0.03 and 135°, 35.95 ± 2.92 μV; P = 0.04) and vertical (90°, 37.82 ± 3.65 μV; P = 0.02) meridians, and binocular C3 latency was significantly shorter in response to vertical than oblique gratings (P ≤ 0.001). Conclusions: Meridional anisotropy was observed in children with normal vision. The findings suggest that horizontal gratings result in a small, but significantly lower POVEP amplitude than for vertical and oblique gratings

Formation and Structure of a Current Sheet in Pulsed-Power Driven Magnetic Reconnection Experiments

We describe magnetic reconnection experiments using a new, pulsed-power driven experimental platform in which the inflows are super-sonic but sub-Alfv\'enic.The intrinsically magnetised plasma flows are long lasting, producing a well-defined reconnection layer that persists over many hydrodynamic time scales.The layer is diagnosed using a suite of high resolution laser based diagnostics which provide measurements of the electron density, reconnecting magnetic field, inflow and outflow velocities and the electron and ion temperatures.Using these measurements we observe a balance between the power flow into and out of the layer, and we find that the heating rates for the electrons and ions are significantly in excess of the classical predictions. The formation of plasmoids is observed in laser interferometry and optical self-emission, and the magnetic O-point structure of these plasmoids is confirmed using magnetic probes.Comment: 14 pages, 12 figures. Accepted for publication in Physics of Plasma

An Experimental Platform for Pulsed-Power Driven Magnetic Reconnection

We describe a versatile pulsed-power driven platform for magnetic reconnection experiments, based on exploding wire arrays driven in parallel [Suttle, L. G. et al. PRL, 116, 225001]. This platform produces inherently magnetised plasma flows for the duration of the generator current pulse (250 ns), resulting in a long-lasting reconnection layer. The layer exists for long enough to allow evolution of complex processes such as plasmoid formation and movement to be diagnosed by a suite of high spatial and temporal resolution laser-based diagnostics. We can access a wide range of magnetic reconnection regimes by changing the wire material or moving the electrodes inside the wire arrays. We present results with aluminium and carbon wires, in which the parameters of the inflows and the layer which forms are significantly different. By moving the electrodes inside the wire arrays, we change how strongly the inflows are driven. This enables us to study both symmetric reconnection in a range of different regimes, and asymmetric reconnection.Comment: 14 pages, 9 figures. Version revised to include referee's comments. Submitted to Physics of Plasma

Biodiversity and resilience of ecosystem functions

Accelerating rates of environmental change and the continued loss of global biodiversity threaten functions and services delivered by ecosystems. Much ecosystem monitoring and management is focused on the provision of ecosystem functions and services under current environmental conditions, yet this could lead to inappropriate management guidance and undervaluation of the importance of biodiversity. The maintenance of ecosystem functions and services under substantial predicted future environmental change (i.e., their ‘resilience’) is crucial. Here we identify a range of mechanisms underpinning the resilience of ecosystem functions across three ecological scales. Although potentially less important in the short term, biodiversity, encompassing variation from within species to across landscapes, may be crucial for the longer-term resilience of ecosystem functions and the services that they underpin

Does Gender Influence Colour Choice in the Treatment of Visual Stress?

Purpose Visual Stress (VS) is a condition in which words appear blurred, in motion, or otherwise distorted when reading. Some people diagnosed with VS find that viewing black text on white paper through coloured overlays or precision tinted lenses (PTLs) reduces symptoms attributed to VS. The aim of the present study is to determine whether the choice of colour of overlays or PTLs is influenced by a patient’s gender. Methods Records of all patients attending a VS assessment in two optometry practices between 2009 and 2014 were reviewed retrospectively. Patients who reported a significant and consistent reduction in symptoms with either overlay and or PTL were included in the analysis. Overlays and PTLs were categorized as stereotypical male, female or neutral colours based on gender preferences as described in the literature. Chi-square analysis was carried out to determine whether gender (across all ages or within age groups) was associated with overlay or PTL colour choice. Results 279 patients (133 males and 146 females, mean age 17 years) consistently showed a reduction in symptoms with an overlay and were included. Chi-square analysis revealed no significant association between the colour of overlay chosen and male or female gender (Chi-square 0.788, p = 0.674). 244 patients (120 males and 124 females, mean age 24.5 years) consistently showed a reduction in symptoms with PTLs and were included. Chi-square analysis revealed a significant association between stereotypical male/female/neutral colours of PTLs chosen and male/female gender (Chi-square 6.46, p = 0.040). More males preferred stereotypical male colour PTLs including blue and green while more females preferred stereotypical female colour PTLs including pink and purple. Conclusions For some VS patients, the choice of PTL colour is influenced not only by the alleviation of symptoms but also by other non-visual factors such as gender

A synthesis is emerging between biodiversity–ecosystem function and ecological resilience research: reply to Mori

Letter

Global prevalence of childhood cataract: a systematic review

Childhood cataract is an avoidable cause of visual disability worldwide and is a priority for VISION 2020: The Right to Sight. There is a paucity of information about the burden of cataract in children and the aim of this review is to assess the global prevalence of childhood cataract. The methodology for the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a literature search for studies reporting estimates of prevalence or incidence of cataract among children (aged<18 years) at any global location using the Cochrane Library, Medline and Embase up to January 2015. No restrictions were imposed based on language or year of publication. Study quality was assessed using a critical appraisal tool designed for systematic reviews of prevalence. Twenty prevalence and four incidence studies of childhood cataract from five different geographical regions were included. The overall prevalence of childhood cataract and congenital cataract was in the range from 0.32 to 22.9/10000 children (median=1.03) and 0.63 to 9.74/10000 (median=1.71), respectively. The incidence ranged from 1.8 to 3.6/10000 per year. The prevalence of childhood cataract in low-income economies was found to be 0.42 to 2.05 compared with 0.63 to 13.6/10000 in high-income economies. There was no difference in the prevalence based on laterality or gender. This review highlights substantial gaps in the epidemiological knowledge of childhood cataract worldwide, particularly from low and lower middle-income economies. More studies are needed using standard definitions and case ascertainment methods with large enough sample sizes

Formation and structure of a current sheet in pulsed-power driven magnetic reconnection experiments

We describe magnetic reconnection experiments using a new, pulsed-power driven experimental platform in which the inflows are super-sonic but sub-Alfvénic. The intrinsically magnetised plasma flows are long lasting, producing a well-defined reconnection layer that persists over many hydrodynamic time scales. The layer is diagnosed using a suite of high resolution laser based diagnostics, which provide measurements of the electron density, reconnecting magnetic field, inflow and outflow velocities, and the electron and ion temperatures. Using these measurements, we observe a balance between the power flow into and out of the layer, and we find that the heating rates for the electrons and ions are significantly in excess of the classical predictions. The formation of plasmoids is observed in laser interferometry and optical self-emission, and the magnetic O-point structure of these plasmoids is confirmed using magnetic probes.Engineering and Physical Sciences Research Council (Grant EP/N013379/1)United States. Department of Energy (Awards DE-F03-02NA00057)United States. Department of Energy (Awards DE-SC-0001063)National Science Foundation (U.S.) (Award DE-sc0016215