Low vision and diabetes in older people living in residential care homes

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Doctor of PhilosophyBackground: Worldwide one in twelve people are living with diabetes and one in two people do not know they have diabetes. Currently large numbers of the older people live in residential care homes in the UK, and up to one in four older people living in residential care homes present with diabetes. Low vision is one of the complications associated with diabetes in older people. In those aged 75 and over, one in five, and in those aged over 90, one in two people are affected by low vision and they are at an increased risk of developing other eye diseases. Within 20 years of diagnosis nearly all people with Type 1 and almost two thirds of people with Type 2 diabetes (60%) have some degree of diabetic retinopathy. Aims and Objectives: This study aimed to investigate the issues and problems faced by older people living in residential care homes with low vision and diabetes; to evaluate health professionals’ knowledge and understanding of the impact of low vision associated with diabetes in older people living in residential care homes; and to develop an educational toolkit which aimed to educate health care assistants about low vision and diabetes. Methods: This study is an exploratory investigation of older people living in residential care homes with low vision and diabetes. Adopting an open-ended qualitative approach using focus groups, interviews and a health professional’s survey, 116 participants were involved. These included GPs, ophthalmologists, nurses, optometrists, health care assistants and older people with low vision and diabetes. The data was analysed thematically. The educational toolkit was developed in the second part of this study, and 20 healthcare assistants were trained using this toolkit. Their knowledge was tested before the training, immediately after the training and one month after the initial training. Following Kirkpatrick’s model, the skills and practical use of the educational toolkit was assessed using an open-ended qualitative approach. Results: The results found that many older people and the health care assistants had the perception that low vision was a normal ageing process and could not be rectified. The study found that there was evidence to suggest that eye health was not considered to be a priority; instead, it was considered to be a natural part of the ageing process. The results found that 82% of the HCAs had not had any training in the area, and more than half of the nurses and GPs did not have sufficient knowledge of low vision and diabetes. After training, however, their knowledge was increased. This suggested that low vision and diabetes toolkit training could be used to educate healthcare assistants on a regular basis. The study also found that knowledge does decline over time, and therefore regular training for HCAs is required in order to maintain eye health and diabetes in older people, as well as improving their quality of life. Conclusion: In the research findings it was found that 50% to 70% of low vision was preventable or treatable if detected in its early stages and could be avoided by simply wearing appropriate spectacles, or possible surgery. However, in order to identify these 50% to 70% with low vision, everyone concerned should be able to recognise the signs and symptoms of preventable low vision, particularly health care assistants, as according to this study, health care assistants spent large amount of time in the residential care homes compared to the other health professionals

Evaluation of physical and chemical properties and total phenolic content in baker’s yeast obtained from grape juice

Baker`s yeast is mainly produced from molasses in various parts of the world, and other sources, including grape juice. In this study, the grape juice was chosen. This study aimed to produce a biomass from dry baker`s yeast. Its physical and chemical properties was evaluated. The biomass from baker’s yeast S. cerevisiae was equal to 41.50±0.01 g/L. The following fermentation conditions, i.e. temperature (30.1oC), pH (4.75), sugar concentration (158.36 g/L), ratio of carbon to nitrogen (11.9), and initial concentration of yeasts (2.5 g/L) were used. The fermentation was carried out for a period 12 h. Grape juice was subjected to four different heat treatments as follows: pasteurized grape juice at (65, 70, and 75oC) for 10 min, and sterilized grape juice in the autoclave at 121oC for 20 min. The effect of each treatment was determined on inhibition of the enzyme polyphenol oxidase present in grape juice. The total phenolic content was determined in the yeast. Heat treatments gave the best phenolic content in the resulting yeast. The heat treatments of the juice succeeded in reducing the activity of the enzyme polyphenol oxidase and autoclave heat treatment gave the best phenolic content in the yeast

Prospective Monte Carlo Simulation for Choosing High Efficient Detectors for Small-Field Dosimetry

In this chapter, a detailed study on physics and methodology of small field dosimetry are reported. It introduces talking about how small radiation fields came into existence and the importance of accurate small-field dosimetry. In addition, it discusses small and long cavity theories for evaluating accurate dose response. It sheds the spot on pencil beam algorithms for evaluating dose response and uses Monte Carlo (MC) simulation in categorizing primary and scattering components of the radiotherapeutic photon beam. Moreover, it summarizes all commercial dosimeters used in small-field dosimetry. It gives good knowledge about detectors and equipment like ionization chambers for reference dosimetry in small and non-reference fields and different types of solid-state detector. The importance and applications of Monte Carlo techniques in small-field dosimetry and radiotherapeutic treatment methods based on small field are reported. For this purpose, different commonly used Monte Carlo codes are handled like Electron Gamma Shower (EGSnrc), Geant4, PENELOPE, and Monte Carlo N-Particle (MCNP). A review on the recent studies of using Monte Carlo simulation particularly on the small-field dosimetric studies is also reported. This chapter also discusses the recommendations of the code of practices (COPs) for dosimetry of small radiation fields. It mentions all recommendations provided by TRS-483 for accurate beam data collection and accurate dosimetric measurements. It gives good knowledge to the user for selecting a suitable dosimeter in small-field dosimetry through investigation of different practical methods and Monte Carlo simulations

Impact of trp2 allele mutation of α2 chain in collagen IX on the structural integrity of human annulus fibrosus

Conference Theme: Spinal Motion Segment: From Basic Science to Clinical Applicationpublished_or_final_versio

Epidemic cholera in KwaZulu-Natal : the role of the natural and social environment

Cholera made an unforeseen appearance on the eastern coast of South Africa in the province of KwaZulu-Natal (KZN) in August 2000. Having started from the more urban centres of the coastal region of the province, cholera proceeded unabated to the interior of the province where no community was spared from the scourge. Despite prompt medical intervention, health education and media awareness campaigns, cholera continued to spread throughout KZN. By March 2004, the official statistics of cholera cases in KZN as per the Cholera Database records, stood at 158 895 cases (Dept-KZN Health, 2000). The death toll as reported in the Cholera Database was 575 persons that translated to a percentage case fatality rate of 0.36%; the lowest when compared to the previous epidemics recorded in South African (Kustner et al., 1981; Küstner and du Plessis, G. 1991). An interesting feature of the epidemic was that 99% of the cases recorded by the central and provincial Departments of Health during the height of the epidemic were all from KZN. The question then was, what factors played a role in the cholera epidemic of KZN? This study sought to understand the outbreak and the factors that possibly contributed to the spread of the 2000-2004 cholera epidemic in KZN. The drivers of disease associated with the communities affected by cholera were also explored by analysing the complex and dynamic interaction of their biological, socio economic, and environmental nature over time and space. The nature of the study was such that it called for a multi faceted design to involve not just understanding the societal aspect of the disease but its demographic, ecological and spatial characteristics as well. Thus GIS was used as a research tool to facilitate the comparison of the disease trends and risk factors on a spatial level in order to determine the possible role(s) played by the different environmental and socio-economic drivers. The objective of the study was to investigate the possible role of the natural environment i.e. temperature, rainfall and humidity as the primary factors that influence cholera outbreaks in KZN; on the basis of its uniqueness in climatic conditions as compared to other areas of the Republic of South Africa (RSA). The other socio-economical and demographic factors were considered as factors that enhance the spread of the disease. As such, the exploration of the Cholera Database by use of spreadsheet, statistical correlations and spatial mapping using GIS technology mutually investigated the relationships between the different variables that came up as important factors in the spread of cholera. Results indicated that 52% of the total cholera cases in KZN were reported from DC28 (Uthungulu), making it the focal point of the epidemic. In general, all the age groups were represented in the cholera database though the age groups 15-19 years and 0-4 years featured more prominently in the overall epidemic picture. On average the male to female case ratio was 1:1.5 respectively. The major cholera peak was experienced in 2001 and a minor peak in 2002. Both the peaks appeared during the summer months, which are also characterised by heavy rains. The issues that were statistically proven to be associated with the spread of the disease were related to issues highlighting the inefficiencies in the provision of water and sanitation, which go hand in hand with poverty. Thus poverty was indirectly reflected in the data as an issue that compounded the cholera epidemic. There was no statistical correlation between the incidence of cholera and the climatic variables of rainfall, humidity and temperature. Notwithstanding, there was an overall seasonality revealed by the data, as seen with the cases peaking and waning between the summers and the winters respectively. Furthermore, GIS mapping revealed a concurrence between the incidence of cholera and the climatic variables of rainfall, humidity and maximum temperature. At the spatial level, the characteristics of the epidemic as revealed by the GIS maps and spatial modelling highlighted possible relationships between the incidence of cholera and the various socio-economic and climatic variables (Chapter 6: 6.2.3; 6.2.3). The spatial disease picture displayed a link between climatic seasons and the incidence of cholera. Spatial modelling offered more insight that the statistically supported climatic and socio-economic aspects were indeed important factors in guiding cholera outbreak predictions in the future. The cholera model illustrated this as it selected for areas considered to be at high risk for cholera (Map 34). The results give an altogether holistic portrayal of the cholera epidemic from all perspectives and also supported to the hypothesis that cholera is a function of social and environmental factors. The results from this study further confirm the negative health effects of inadequacies in basic services delivery. The study made use of data resources to understand the relationships between the incidence of cholera and the different demographic, socio-economic and climatic variables implicated in the spread of cholera epidemics (Chapter 3: 3.3.3). It also emphasizes the importance of using reliable data as a management tool to model various scenarios in order to obtain information that could be used in the prediction and management of diseases like cholera at the community level in the future.Thesis (PhD (Water Resource Management))--University of Pretoria, 2006.Microbiology and Plant Pathologyunrestricte

LiDAR Based Object Detection and Tracking in Stationary Applications

This thesis investigates dense Light Detection and Ranging (LiDAR) sensors as a method for object detection and tracking in stationary infrastructure-like applications. A literature review of existing works is conducted, with discussion and comparisons for other sensing technologies. Additional discussions are made for geometric feature-based methods and end-to-end learning methods for object detection from pointcloud data. Subsequently, theoretical pointcloud spacing models for multi-beam 360 deg LiDAR sensors are developed, with analysis on placement strategies and LiDAR configurations. The thesis continues with an implementation of a geometric feature based object detection method, primarily for vehicles. Several algorithm designs are presented for pointcloud background removal, clustering, orientation detection, tracking, and filtering. Detection and tracking metrics are then established to observe the system's performance on both experimental and simulation datasets. Two datasets collected with a Velodnye VLP-16 sensor on both a highway and urban road segment are utilized for experimentation, while scenarios of light traffic and stop-and-go traffic on a highway are developed in the CARLA simulator to further validate tracking performance