How practitioners say they answer the questions of patients about ultraviolet protection

Patients should be able to rely on optometrists and optical dispensers to provide evidence-based answers to their questions on eye protection, including against ultraviolet radiation. Surveys indicate that there is public concern about the need for protection against ultraviolet radiation, particularly in sunlight. This investigation aimed to evaluate the quality of information provided by practitioners in response to typical questions to which they might reasonably be expected to have ready answers. A cross-sectional study was conducted of on-site responses from attendees of a 3 day optical fair, in Sydney, Australia, in 2017. Subjects were not forewarned about the study. The portion of the questionnaire reported here comprised open answers to four questions intended to represent typical enquiries of patients. The questions were about recommendations for ultraviolet protection in the context of 1) computer use, 2) outdoor use, 3) driving and 4) under office lighting. Eighty-three participants returned completed questionnaires out of 140 issued (61% response). The open-answer question responses were grouped into appropriate, borderline (mostly appropriate but mixed with non-UVR related recommendations) and others (mostly non-UVR related recommendations) and by job title. The proportion of appropriate answers to the four questions were 20%, 30%, 12% and 15%, respectively, which did not differ by job title. A significantly higher proportion of optical dispensers than optometrists selected ‘Don’t know/no answer’ for all questions except office use. Eyecare professionals need to be educated on eye protection against UV radiation to improve the quality of information to be given to the public

Impact of Gamification of Vision Tests on the User Experience

Objective: Gamification has been incorporated into vision tests and vision therapies in the expectation that it may increase the user experience and engagement with the task. The current study aimed to understand how gamification affects the user experience, specifically during the undertaking of psychophysical tasks designed to estimate vision thresholds (chromatic and achromatic contrast sensitivity). Methods: Three tablet computer-based games were developed with three levels of gaming elements. Game 1 was designed to be a simple clinical test (no gaming elements), game 2 was similar to game 1 but with added gaming elements (i.e., feedback, scores, and sounds), and game 3 was a complete game. Participants (N = 144, age: 9.9-42 years) played three games in random order. The user experience for each game was assessed using a Short Feedback Questionnaire. Results: The median (interquartile range) fun level for the three games was 2.5 (1.6), 3.9 (1.7), and 2.5 (2.8), respectively. Overall, participants reported greater fun level and higher preparedness to play the game again for game 2 than games 1 and 3 (P < 0.05). There were significant positive correlations observed between fun level and preparedness to play the game again for all the games (p < 0.05). Engagement (assessed as completion rates) did not differ between the games. Conclusion: Gamified version (game 2) was preferred to the other two versions. Over the short term, the careful application of gaming elements to vision tests was found to increase the fun level of users, without affecting engagement with the vision test

Normative values for a tablet computer-based application to assess chromatic contrast sensitivity

Tablet computer displays are amenable for the development of vision tests in a portable form. Assessing color vision using an easily accessible and portable test may help in the self-monitoring of vision-related changes in ocular/systemic conditions and assist in the early detection of disease processes. Tablet computer-based games were developed with different levels of gamification as a more portable option to assess chromatic contrast sensitivity. Game 1 was designed as a clinical version with no gaming elements. Game 2 was a gamified version of game 1 (added fun elements: feedback, scores, and sounds) and game 3 was a complete game with vision task nested within. The current study aimed to determine the normative values and evaluate repeatability of the tablet computer-based games in comparison with an established test, the Cambridge Colour Test (CCT) Trivector test. Normally sighted individuals [N = 100, median (range) age 19.0 years (18–56 years)] had their chromatic contrast sensitivity evaluated binocularly using the three games and the CCT. Games 1 and 2 and the CCT showed similar absolute thresholds and tolerance intervals, and game 3 had significantly lower values than games 1, 2, and the CCT, due to visual task differences. With the exception of game 3 for blue-yellow, the CCT and tablet computer-based games showed similar repeatability with comparable 95% limits of agreement. The custom-designed games are portable, rapid, and may find application in routine clinical practice, especially for testing younger populations

Luminance contrast preferences of people with a vision impairment for elements in the built environment

BACKGROUND: Standards for building elements recommend a minimum luminance contrast of 30%. The basis of this value and the metric originally used is not known. OBJECTIVE: To begin to provide an evidence base for the specification of minimum contrast in building elements. METHODS: Subjects with and without a vision impairment were characterized by visual acuity, contrast sensitivity, visual fields and color vision. On an iPad they rated the visibility, as a function of contrast, of simulated door frames, door handles, light switches and stair nosings as 'not visible at all', 'poorly visible', 'easily visible' and 'extremely easily visible'. RESULTS: The contrasts for each level of visibility were highly correlated with visual acuity and contrast sensitivity. A principal component analysis also verified the importance of visual acuity, contrast sensitivity and visual fields in rating visibility of simulations of building elements. The required contrast for door handles, light switches and stair nosings to attain the same ratings of visibility were very similar but less contrast was required for door frames. CONCLUSIONS: 30% Michelson contrast for building elements renders building elements only poorly visible for those with severe vision impairments. 65% luminance contrast is necessary for all elements to be 'easily visible'. Some increase (not a decrease) on the present 30% requirement and encouragement to exceed this requirement would seem appropriate. The use of simulated objects facilitates a systematic examination of the effect of contrast, but the applicability of the results to real-life remains to be demonstrated

Issues in specifying contrast in building elements for people with a visual disability

Standards writers, national and international, have used different contrast calculations to set requirements in building elements for people with visual impairments. On the other hand, they have typically set a single requirement (30%) for specifying the minimum contrast. The systems are not linearly related and 30% means something rather different in each system. OBJECTIVE: To provide a comparison of the various scales in order to illustrate the differences caused by multiple scales with a single compliance value, recommend a single scale for universal adoption and, if a new measure is problematic for implementation, to recommend the most perceptually uniform of the present methods. METHODS: We use the contrast between combinations of 205 paint colours to illustrate the relationships between the measures. We use an internationally accepted scale, with equal perceptual steps, as a 'gold standard' to identify the most perceptually uniform measurement scale in the existing methods. RESULTS: We show that Michelson contrast is the most perceptually uniform of the existing measurement scales. We show the contrasts in the proposed method that equate to the various current requirements. CONCLUSIONS: We propose that CIE Metric Lightness could be used as the contrast measure. Alternatively, Michelson contrast is the most perceptually linear of the current measurement scales

Footprint of increased anthropogenic disturbance elevates termite pest status

Tese de doutoramento em Ciências Farmacêuticas, na especialidade de Farmacognosia e Fitoquímica, apresentada à Faculdade de Farmácia da Universidade de CoimbraCymbopogon citratus (DC). Stapf (Poaceae), commonly known as lemongrass, is a tropical perennial shrub originated from the Southeast Asia. This plant is reported to possess antifungal, insecticidal, anti-diabetic, anti-septic, anti-mutagenic, anti-carcinogenic activities as well as anti-inflammatory. In fact, aqueous extracts of dried leaves are used all over the year in folk medicine for the treatment of peptic ulcers and inflammatory conditions. Recently, some phenolic compounds, such as luteolin and apigenin glycosides and condensed tannins, were identified and related to both antioxidant and anti-inflammatory properties. The purposes of this work were to i) validate an analytical method for quantification of phenolic compounds of C. citratus; ii) study the influence of harvest time and plant quality on the phenolic composition and antioxidant activity; iii) characterize the tannins; iv) validate the traditional uses of lemongrass infusion as anti-inflammatory in vivo; v) obtain a topical formulation to evaluate the phenolic compounds permeation and their anti-inflammatory activity; vi) trace the pharmacokinetic profile of the main phenolic compounds in rats. Three different extracts: infusion (CcI), 50% aqueous ethanol (CcM50%) and ethanol (CcM100%) extracts were prepared and a simple and efficient RP-HPLC-PDA method was successfully validated for simultaneous identification and quantification of phenolic acids and flavonoids. Infusions were also obtained from different harvest dates (April, June, July, August and September) and quality grades (High, Medium and Low). It was verified that the content on polyphenols and the antioxidant capacity of CcI is strongly related with the quality of the plant. The total phenols assay showed a substantial loss from August to September. It was possible to find out the best month to harvest the plant to get the most of each phenolic group: April and June for hydroxycinnamic acids; June and September for flavonoids; June, July and August for tannins. Regardless the group of phenolic compound addressed, its content was always inversely proportional to the degree of leaves ageing. For all tested oxidant species, the high-quality samples exhibited the best antioxidant results. CcI was fractionated by column chromatography and polyphenol-rich fractions, namely phenolic acids (CcPA), flavonoids (CcF) and tannins (CcT) were obtained. CcT was characterized by HPLC-PDA-ESI/MSn, revealing the presence of proanthocyanidin hetero-dimers, along with some common procyanidin dimers. These hetero-dimeric flavan structures have been described for the first time in lemongrass and consist of apigeniflavan or luteoliflavan units linked to a flavanone, either naringenin or eriodictyol, and may occur as aglycone or glycosylated forms. For the in vivo assays, CcI, CcF and CcT were tested. CcI administered before and after ethanol stimulus, significantly reduced the incidence and severity of gastric lesions and, consequently, the ulcer index, corroborating the traditional medicinal use of this plant to ameliorate gastritis and/or peptic ulcers symptoms. On the other hand, CcI, CcF and CcT were orally administered to rats, in order to evaluate the anti-inflammatory effect at the carrageenan-induced paw edema assay. The observed effect by CcI (68.24 mg/kg), 82.30% of edema inhibition, was very similar to that obtained by the reference NSAID used (diclofenac, 10 mg/kg), 84.00%. On the other hand, flavonoid (7.42 mg/kg) and the tannin-rich (5.96 mg/kg) fractions significantly contributed for the anti-inflammatory activity on the edema volume (59 and 61%, respectively). The topical anti-inflammatory activity of CcI was also addressed. The results suggest that flavonoids, mainly, luteolin 7-O-neohesperidoside, cassiaoccidentalin B, carlinoside and cynaroside, may contribute to the topical anti-inflammatory effect. CcF (0.6%), CcT (0.3%) and CcF+CcT (0.66%+0.34%) topical formulations were also tested, and the results obtained suggest that tannins and flavonoids also possess a significant activity and that a synergistic mechanism of action may occur. In fact, edema inhibitions of 43%, 47% and 59% were respectively verified, being CcF+CcT effect very close to that of 1% diclofenac (65.9%). Pharmacokinetic analysis was performed in plasma, liver and kidney and showed that the compounds present in CcI are not detected in vivo after a single-dose oral administration. In contrary, the metabolites, luteolin 7-O-glucuronide and luteolin 3’-O-sulfate, present at the highest bioavailability, are probably the main responsible for the anti-inflammatory activity previously reported. In conclusion, this work has developed a method to quantify the phenolic compounds contained in C. citratus; pointed the importance of harvesting and storing the plant material, in order to take the maximum advantages from the phenolic compounds use; and demonstrated, in safe doses, its anti-inflammatory activity, using an in vivo approach, which supports the traditional use of lemongrass infusion. Furthermore, C. citratus leaves flavonoids and tannins were highlighted as bioactive compounds, encouraging the development of new anti-inflammatory drugs or nutraceuticals

Fractal Dimension Analysis of Transient Visual Evoked Potentials: Optimisation and Applications

Purpose The visual evoked potential (VEP) provides a time series signal response to an external visual stimulus at the location of the visual cortex. The major VEP signal components, peak latency and amplitude, may be affected by disease processes. Additionally, the VEP contains fine detailed and non-periodic structure, of presently unclear relevance to normal function, which may be quantified using the fractal dimension. The purpose of this study is to provide a systematic investigation of the key parameters in the measurement of the fractal dimension of VEPs, to develop an optimal analysis protocol for application. Methods VEP time series were mathematically transformed using delay time, τ, and embedding dimension, m, parameters. The fractal dimension of the transformed data was obtained from a scaling analysis based on straight line fits to the numbers of pairs of points with separation less than r versus log(r) in the transformed space. Optimal τ, m, and scaling analysis were obtained by comparing the consistency of results using different sampling frequencies. The optimised method was then piloted on samples of normal and abnormal VEPs. Results Consistent fractal dimension estimates were obtained using τ = 4 ms, designating the fractal dimension = D2 of the time series based on embedding dimension m = 7 (for 3606 Hz and 5000 Hz), m = 6 (for 1803 Hz) and m = 5 (for 1000Hz), and estimating D2 for each embedding dimension as the steepest slope of the linear scaling region in the plot of log(C(r)) vs log(r) provided the scaling region occurred within the middle third of the plot. Piloting revealed that fractal dimensions were higher from the sampled abnormal than normal achromatic VEPs in adults (p = 0.02). Variances of fractal dimension were higher from the abnormal than normal chromatic VEPs in children (p = 0.01). Conclusions A useful analysis protocol to assess the fractal dimension of transformed VEPs has been developed

Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand

Access to culturally safe health services is a basic human right, however through the lasting effects of colonisation, oppression, and systemic racism, the individual and community health of Indigenous peoples in Australia and Aotearoa New Zealand have been severely impacted. The Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy of the Australian Health Practitioners Regulation Agency, and the Standards of Cultural Competence and Cultural Safety of the Optometrists and Dispensing Opticians Board of New Zealand, recognise the importance of access to safe health care for Aboriginal, Torres Strait Islander and Māori patients, which encompasses both clinical competency and cultural safety. Universities have an ongoing responsibility to ensure their learning and teaching activities result in graduates being able to provide culturally safe practice. This article highlights the emergence of culturally safe practices in the Australian and Aotearoa New Zealand optometry curricula over the last five years incorporating Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities. Whilst there is still much work to do to achieve the goal of graduating culturally safe optometrists, this paper focuses on features that enable or impede progress in the development of culturally safe practices within the optometry programmes to improve eye health equity for Indigenous recognise the diversity of Indigenous cultures across Australia and NZ

Next-generation muscle-directed gene therapy by in silico vector design

There is an urgent need to develop the next-generation vectors for gene therapy of muscle disorders, given the relatively modest advances in clinical trials. These vectors should express substantially higher levels of the therapeutic transgene, enabling the use of lower and safer vector doses. In the current study, we identify potent muscle-specific transcriptional cisregulatory modules (CRMs), containing clusters of transcription factor binding sites, using a genome-wide data-mining strategy. These novel muscle-specific CRMs result in a substantial increase in muscle-specific gene transcription (up to 400-fold) when delivered using adeno-associated viral vectors in mice. Significantly higher and sustained human micro-dystrophin and follistatin expression levels are attained than when conventional promoters are used. This results in robust phenotypic correction in dystrophic mice, without triggering apoptosis or evoking an immune response. This multidisciplinary approach has potentially broad implications for augmenting the efficacy and safety of muscle-directed gene therapy