Oral History Interview: Anna L. Copley

This interview is one of a series conducted concerning rural life in West Virginia. At the time of the interview, Mrs. Anna L. Copely was ninety-five years old and a resident of Wayne County, West Virginia. Among the subjects discussed are: family background, early education, teaching experiences, entertainment, and the two World Wars.https://mds.marshall.edu/oral_history/1199/thumbnail.jp

Is there overutilisation of cataract surgery in England?

<b>Objectives:</b> Following a 3.7-fold increase in the rate of cataract surgery in the UK between 1989 and 2004, concern has been raised as to whether this has been accompanied by an excessive decline in the threshold such that some operations are inappropriate. The objective was to measure the impact of surgery on a representative sample of patients so as to determine whether or not overutilisation of surgery is occurring. <b>Design:</b> Prospective cohort assessed before and 3 months after surgery. <b>Setting:</b> Ten providers (four NHS hospitals, three NHS treatment centres, three independent sector treatment centres) from across England. <b>Participants:</b> 861 patients undergoing first eye (569) or second eye (292) cataract surgery provided preoperative data of whom 745 (87%) completed postoperative questionnaires. <b>Main outcome measures:</b> Patient-reported visual function (VF-14); general health status and quality of life (EQ5D); postoperative complications; overall view of the operation and its impact. <b>Results:</b> Overall, visual function improved (mean VF-14 score increased from 83.2 (SD 17.3) to 93.7 (SD 13.2)). Self-reported general health status deteriorated (20.3% fair or poor before surgery compared with 25% afterwards) which was reflected in the mean EQ5D score (0.82 vs 0.79; p = 0.003). At least one complication was reported by 66 (8.9%) patients, though this probably overestimated the true incidence. If the appropriateness of surgery is based on an increase in VF-14 score of 5.5 (that corresponds to patients’ reporting being "a little better"), 30% of operations would be deemed inappropriate. If an increase of 12.2 (patients’ reports of being "much better") is adopted, the proportion inappropriate is 49%. Using a different approach to determining a minimally important difference, the proportion inappropriate would be closer to 20%. Although visual function (VF-14) scores were unchanged or deteriorated in 25% of patients, 93.1% rated the results of the operation as "good," "very good" or "excellent," and 93.5% felt their eye problem was "better." This partly reflects inadequacies in the validity of the VF-14. <b>Conclusions:</b> Improvement in the provision of cataract surgery has been accompanied by a reduction in the visual function threshold. However, methodological difficulties in measuring the impact of cataract surgery on visual function and quality of life mean it is impossible to determine whether or not overutilisation of cataract surgery is occurring. N Black1, J Browne1, J van der Meulen1, L Jamieson2, L Copley2 and J Lewsey

Findings of the International Subarachnoid Aneurysm Trial and the National Study of Subarachnoid Haemorrhage in context.

Concern has been expressed about the applicability of the findings of the International Subarachnoid Aneurysm Trial (ISAT) with respect to the relative effects on outcome of coiling and clipping. It has been suggested that the findings of the National Study of Subarachnoid Haemorrhage may have greater relevance for neurosurgical practice. The objective of this paper was to interpret the findings of these two studies in the context of differences in their study populations, design, execution and analysis. Because of differences in design and analysis, the findings of the two studies are not directly comparable. The ISAT analysed all randomized patients by intention-to-treat, including some who did not undergo a repair, and obtained the primary outcome for 99% of participants. The National Study only analysed participants who underwent clipping or coiling, according to the method of repair, and obtained the primary outcome for 91% of participants. Time to repair was also considered differently in the two studies. The comparison between coiling and clipping was susceptible to confounding in the National Study, but not in the ISAT. The two study populations differed to some extent, but inspection of these differences does not support the view that coiling was applied inappropriately in the National Study. Therefore, there are many reasons why the two studies estimated different sizes of effect. The possibility that there were real, systematic differences in practice between the ISAT and the National Study cannot be ruled out, but such explanations must be seen in the context of other explanations relating to chance, differences in design or analysis, or confounding

Cross-sectional analysis of lithium ion electrodes using spatial autocorrelation techniques.

Join counting, a standard technique in spatial autocorrelation analysis, has been used to quantify the clustering of carbon, fluorine and sodium in cross-sectioned anode and cathode samples. The sample preparation and EDS mapping steps are sufficiently fast for every coating from two Design of Experiment (DoE) test matrices to be characterised. The results show two types of heterogeneity in material distribution; gradients across the coating from the current collector to the surface, and clustering. In the cathode samples, the carbon is more clustered than the fluorine, implying that the conductive carbon component is less well distributed than the binder. The results are correlated with input parameters systematically varied in the DoE coating blade gap, coating speed, and other output parameters coat weight, and electrochemical resistance

Roman diet and trade: evidence from organic residues on pottery sherds recovered at the Roman town of Calleva Atrebatum (Silchester Hants.)

The analysis of organic residues from pottery sherds using Gas-Chromatography with mass-spectroscopy (GC-MS) has revealed information about the variety of foods eaten and domestic routine at Silchester between the second and fourth–sixth centuries A.D. Two results are discussed in detail: those of a second-century Gauloise-type amphora and a fourth-century SE Dorset black-burnished ware (BB1) cooking pot, which reveal the use of pine pitch on the inner surface of the amphora and the use of animal fats (ruminant adipose fats) and leafy vegetables in cooking at the Roman town of Silchester, Hants

Observations and dynamical implications of active normal faulting in South Peru

SUMMARY Orogenic plateaus can exist in a delicate balance in which the buoyancy forces due to gravity acting on the high topography and thick crust of the plateau interior are balanced by the compressional forces acting across their forelands. Any shortening or extension within a plateau can indicate a perturbation to this force balance. In this study, we present new observations of the kinematics, morphology and slip rates of active normal faults in the South Peruvian Altiplano obtained from field studies, high-resolution DEMs, Quaternary dating and remote sensing. We then investigate the implications of this faulting for the forces acting on the Andes. We find that the mountains are extending ∼NNE–SSW to ∼NE–SW along a normal fault system that cuts obliquely across the Altiplano plateau, which in many places reactivates Miocene-age reverse faults. Radiocarbon dating of offset late Quaternary moraines and alluvial fan surfaces indicates horizontal extension rates across the fault system of between 1 and 4 mm yr–1—equivalent to an extensional strain rate in the range of 0.5–2 × 10−8 1 yr–1 averaged across the plateau. We suggest the rate and pattern of extension implies there has been a change in the forces exerted between the foreland and the Andes mountains. A reduction in the average shear stresses on the sub-Andean foreland detachment of ≲4 MPa (20–25 per cent of the total force) can account for the rate of extension. These results show that, within a mountain belt, the pattern of faulting is sensitive to small spatial and temporal variations in the strength of faults along their margins.Denman Baynes Senior Studentship, Clare College Cambridge Arup Santander Mobility Grant (University of Cambridge