Longitudinal Impact of Vision Impairment on Concern About Falling in People With Age-Related Macular Degeneration

Purpose: To explore the longitudinal impact of central vision loss on concern about falling (CF), over a 12-month period, in people with age-related macular degeneration (AMD). Methods: Participants included 60 community-dwelling older people (age, 79.7 ± 6.4 years) with central vision impairment due to AMD. Binocular high-contrast visual acuity, contrast sensitivity, and visual fields were assessed at baseline and at 12 months. CF was assessed at both time points using the Falls Efficacy Scale–International (FES-I). Senso-rimotor function (sit to stand, knee extension, postural sway, and walking speed) and neuropsychological function (reaction time, symptoms of anxiety and depression) were also assessed at both time points using validated instruments. Falls data were collected using monthly diaries during the 12 months. Results: CF increased by a small but significant amount over the 12-month follow-up (2.1 units; P = 0.01), with increasing prevalence of high levels of CF (FES-I score ≥ 23), from 48% at baseline to 65% at 12 months. Linear mixed models showed that reduced contrast sensitivity was significantly associated with increased concern about falling (P = 0.004), whereas declines in both visual acuity and contrast sensitivity during the follow-up period were associated with increases in CF over the 12-month follow-up (P = 0.041 and P = 0.054, respectively), independent of age, gender, falls history, or number of comorbidities. Conclusions: Higher levels of CF are common in older people with AMD, and levels increase over time; this increase is associated with declines in both visual acuity and contrast sensitivity. These findings highlight the need for regular assessment of both visual acuity and contrast sensitivity to identify those at greatest risk of developing higher CF. Translational Relevance: Routine assessment of visual acuity and contrast sensitivity in older people with AMD will assist in identifying those at risk of developing high CF

To what extent does school leadership facilitate Community Cohesion for students in an English secondary school?

This thesis is a study of the implementation of the policy of Community Cohesion in one maintained secondary school in England. It explores the policy cycle through the stages of influence, production and practice and notes how discourses at national and local levels influenced the policy. The literature review considers the discourses of multiculturalism, interculturalism, citizenship, identity and security that influenced the policy at its inception at national level. The case study examines documentary evidence including the racist incidents log and elicits the views of staff and students through interviews and focus groups addressing the process of implementation. The study uses the standards set by the ministry to describe and evaluate Community Cohesion in the study school. The analysis seeks to explain the outcomes of the Community Cohesion policy and the relative influence of national and school level discourses on the practice of Community Cohesion. The top down dominant discourse identified as influencing the policy is neo-liberalism, expressed in the national drive for standards and effectiveness and prioritising results. The system leadership model, adopted by the school’s leaders, accommodates to 4 the national agenda but also includes a moral purpose that influences the local response both to standards and to Community Cohesion. During the study, inspectors recognised the school as effectively developing Community Cohesion. The research identifies the extent to which the successful outcomes can be attributed to the influence of the system leadership that enables individual school leaders to exercise initiative based on moral purpose, personal conviction and positive relationships. Examples include a focus on the achievement of all students, a link to the local Jewish school and a twinning link with Kenya. The sense of moral purpose was disseminated through the leadership team’s interactions with the school community, school activities and the school’s newsletter

Experiences following cataract surgery - patient perspectives

PURPOSE: Most patients report being highly satisfied with the outcome of cataract surgery but there are variable reports regarding the impact of cataract surgery on some real-world activities, such as fall rates. We hypothesised that adaptations to changed refractive correction and visual function may cause difficulties in undertaking everyday activities for some patients and used a series of focus groups to explore this issue. METHOD: Qualitative methods were used to explore patients' experiences of their vision following cataract surgery, including adaptation to vision changes and their post-surgical spectacle prescription. Twenty-six participants took part in five focus groups (Mean age = 68.2 ± 11.4 years), and the data were analysed using thematic analysis. RESULTS: We identified three themes. 'Changes to Vision' explores participants' adaptation following cataract surgery. While several had problems with tasks relying on binocular vision, few found them bothersome and they resolved following second eye surgery. Participants described a trial and error approach to solving these problems rather than applying solutions suggested by their eyecare professionals. 'Prescription Restrictions' describes the long-term vision problems that pre-surgery myopic patients experienced as a consequence of becoming emmetropic following surgery and thus needing spectacles for reading and other close work activities, which they did not need before surgery. Very few reported that they had the information or time to make a decision regarding their post-operative correction. 'Information Needs' describes participant's responses to the post-surgical information they were given, and the unmet information need regarding when they can drive following surgery. CONCLUSION: The findings highlight the need for clinicians to provide information on adaptation effects, assist patients to select the refractive outcome that best suits their lifestyle, and provide clear advice about when patients can start driving again. Patients need to be provided with better guidance from clinicians and prescribing guidelines for clinicians would be beneficial, particularly for the period between first- and second-eye surgery

International Laboratory Comparison of Influenza Microneutralization Assays for A(H1N1) pdm09, A(H3N2), and A(H5N1) Influenza Viruses by CONSISE

The microneutralization assay is commonly used to detect antibodies to influenza virus, and multiple protocols are used worldwide. These protocols differ in the incubation time of the assay as well as in the order of specific steps, and even within protocols there are often further adjustments in individual laboratories. The impact these protocol variations have on influenza serology data is unclear. Thus, a laboratory comparison of the 2-day enzyme-linked immunosorbent assay (ELISA) and 3-day hemagglutination (HA) microneutralization (MN) protocols, using A(H1N1)pdm09, A(H3N2), and A(H5N1) viruses, was performed by the CONSISE Laboratory Working Group. Individual laboratories performed both assay protocols, on multiple occasions, using different serum panels. Thirteen laboratories from around the world participated. Within each laboratory, serum sample titers for the different assay protocols were compared between assays to determine the sensitivity of each assay and were compared between replicates to assess the reproducibility of each protocol for each laboratory. There was good correlation of the results obtained using the two assay protocols in most laboratories, indicating that these assays may be interchangeable for detecting antibodies to the influenza A viruses included in this study. Importantly, participating laboratories have aligned their methodologies to the CONSISE consensus 2-day ELISA and 3-day HA MN assay protocols to enable better correlation of these assays in the future

Distribution of macroinvertebrate communities across surface and groundwater habitats in response to hydrological variability

Macroinvertebrate communities are strongly influenced by hydrological variability in surface waters. However, the response of these communities in corresponding groundwater-dependent habitats is not well understood. This study characterised the macroinvertebrate fauna and physicochemical characteristics of a chalk aquifer and its rivers in southern England. Over one year, samples were collected from five paired benthic-hyporheic sites located in perennial or temporary rivers, and a further seven phreatic sites in the surrounding aquifer. The study was preceded by a period of below average rainfall, providing an opportunity to assess the response of macro-invertebrate communities to unseasonal declines in river discharge and groundwater levels. Benthic, hyporheic and phreatic habitats each supported a distinct macroinvertebrate community, with the hyporheic habitat support- ing both epigean taxa and stygofauna. As discharge declined, the composition of these communities changed. In particular, the abundance of the epigean amphipod Gammarus pulex was higher in hyporheic than benthic habitats during periods of low river discharge, suggesting potential refuge-seeking behaviour. Similarly, fluctuations in the abundance and distribution of two stygofauna, Crangonyx subterraneus and Niphargus fontanus, coincided with marked changes in groundwater levels, suggesting that the contraction of available habitat and changes in connectivity also influenced the phreatic community. The variable distribution of macroinvertebrates between these habitats, especially in response to hydrological variability, suggests a dynamic connection between the river and its aquifer. This connection is an important consideration for the assessment and conservation management of both surface and groundwater communities and may help underpin integrated, catchment-based management, especially in river systems with temporary reaches

Visual Predictors of Postural Sway in Older Adults

Purpose: Accurate perception of body position relative to the environment through visual cues provides sensory input to the control of postural stability. This study explored which vision measures are most important for control of postural sway in older adults with a range of visual characteristics. Methods: Participants included 421 older adults (mean age = 72.6 ± 6.1), 220 with vision impairment associated with a range of eye diseases and 201 with normal vision. Participants completed a series of vision, cognitive, and physical function tests. Postural sway was measured using an electronic forceplate (HUR Labs) on a foam surface with eyes open. Linear regression analysis identified the strongest visual predictors of postu-ral sway, controlling for potential confounding factors, including cognitive and physical function. Results: In univariate regression models, unadjusted and adjusted for age, all of the vision tests were significantly associated with postural sway (P < 0.05), with the strongest predictor being visual motion sensitivity (standardized regression coefficient, β = 0.340; age-adjusted β = 0.253). In multiple regression models, motion sensitivity (β = 0.187), integrated binocular visual fields (β =−0.109), and age (β = 0.234) were the only significant visual predictors of sway, adjusted for confounding factors, explain-ing 23% of the variance in postural sway. Conclusions: Of the vision tests, visual motion perception and binocular visual fields were most strongly associated with postural stability in older adults with and without vision impairment. Translational Relevance: Findings provide insight into the visual contributions to postural stability in older adults and have implications for falls risk assessment

Laser-wakefield accelerators as hard x-ray sources for 3D medical imaging of human bone

A bright μm-sized source of hard synchrotron x-rays (critical energy Ecrit > 30 keV) based on the betatron oscillations of laser wakefield accelerated electrons has been developed. The potential of this source for medical imaging was demonstrated by performing micro-computed tomography of a human femoral trabecular bone sample, allowing full 3D reconstruction to a resolution below 50 μm. The use of a 1 cm long wakefield accelerator means that the length of the beamline (excluding the laser) is dominated by the x-ray imaging distances rather than the electron acceleration distances. The source possesses high peak brightness, which allows each image to be recorded with a single exposure and reduces the time required for a full tomographic scan. These properties make this an interesting laboratory source for many tomographic imaging applications

The use of driver screening tools to predict self-reported crashes and incidents in older drivers

There is a clear need to identify older drivers at increased crash risk, without additional burden on the individual or licensing system. Brief off-road screening tools have been used to identify unsafe drivers and drivers at risk of losing their license. The aim of the current study was to evaluate and compare driver screening tools in predicting prospective self-reported crashes and incidents over 24 months in drivers aged 60 years and older. 525 drivers aged 63–96 years participated in the prospective Driving Aging Safety and Health (DASH) study, completing an on-road driving assessment and seven off-road screening tools (Multi-D battery, Useful Field of View, 14-Item Road Law, Drive Safe, Drive Safe Intersection, Maze Test, Hazard Perception Test (HPT)), along with monthly self-report diaries on crashes and incidents over a 24-month period. Over the 24 months, 22% of older drivers reported at least one crash, while 42% reported at least one significant incident (e.g., near miss). As expected, passing the on-road driving assessment was associated with a 55% [IRR 0.45, 95% CI 0.29–0.71] reduction in self-reported crashes adjusting for exposure (crash rate), but was not associated with reduced rate of a significant incident. For the off-road screening tools, poorer performance on the Multi-D test battery was associated with a 22% [IRR 1.22, 95% CI 1.08–1.37] increase in crash rate over 24 months. Meanwhile, all other off-road screening tools were not predictive of rates of crashes or incidents reported prospectively. The finding that only the Multi-D battery was predictive of increased crash rate, highlights the importance of accounting for age-related changes in vision, sensorimotor skills and cognition, as well as driving exposure, in older drivers when using off-road screening tools to assess future crash risk

Ultrasonic Wave Dispersion and Attenuation in Fluid Filled Porous Media

The study of ultrasonic wave propagation in granular materials can lead to a better understanding of wave interaction with such materials as uncured cement and concrete. The measured parameters can then be used to investigate the curing process in particular the time required for a given mixture to consolidate. The cohesionless granular materials having loose contact between the constituent grains form a matrix that has negligible shear modulus. Sediment, sandy ground and concrete before solidification can be considered as examples of cohesionless granular materials. The shear and rigidity moduli of these materials can differ greatly from the values obtained by effective medium theories. In particular these differences could affect the ultrasonic wave propagation in such a material. In the case of cohesionless granular material the complete description of mechanical properties requires the consideration of discrete nature of the solid frame and the contact areas between the grains. Therefore wave interaction with such a material should also include the above mentioned effects. The goal of this work is to investigate the ultrasonic wave dispersion and attenuation in cohesionless granular materials the results can be to applied to the monitoring of cement and concrete during the curing process