Interventions to limit the progression of myopia

Myopia is invariably a lifelong condition characterised by high prevalence, significant risk in terms of associated ocular pathology, due to its increased axial length, and a substantial economic and social burden. While myopia can be corrected with spectacles and standard contact lenses, neither protect the eye from continued growth nor increased progression. At birth, the eye’s refractive error can be significant. As the eye grows the magnitudeof refractive error commonly reduces in a process termed ‘emmetropisation’. Substantial evidence exists to suggest that emmetropisation is an active process which relies on a normal visual experience, the absence of which in early life typically results in a refractive error. Research from animal models has shown the peripheral retina also plays a role in the emmetropisation process. Modification of the peripheral focus has been found to influence myopia progression. This thesis is stimulated by the findings of Anstice and Phillips (2011) who, using a Dual-Focus contact lens, which provided clear central vision and simultaneous peripheral myopic retinal defocus, showed a reduction in axial myopic progression in children. This thesis aims to describe the efficacy of a parallel-group, double blind and randomised controlled trial of a dual focus contact lens to slow myopia progression in children. Biometric data were compared for 27 myopic child participants aged 8 to 12 years at baseline. Children who wore the test lens had 41% less progression of myopia as measured by cycloplegic refraction and 44.5% less axial elongation after 12 months of lens wear. Additionally, the effect of lag of accommodation, peripheral refractive error, pupil size and time spent outdoors were explored. This thesis demonstrates that peripheral retinal defocus plays a role in slowing the progression of myopia in children and that interventions to limit the progression of myopia may need to be tailored to individual characteristics

Object orientated automated image analysis: quantitative and qualitative estimation of inflammation in mouse lung

Historically, histopathology evaluation is performed by a pathologist generating a qualitative assessment on thin tissue sections on glass slides. In the past decade, there has been a growing interest for tools able to reduce human subjectivity and improve workload. Whole slide scanning technology combined with object orientated image analysis can offer the capacity of generating fast and reliable results. In the present study, we combined the use of these emerging technologies to characterise a mouse model for chronic asthma. We monitored the inflammatory changes over five weeks by measuring the number of neutrophils and eosinophils present in the tissue, as well as, the bronchiolar associated lymphoid tissue (BALT) area on whole lungs sections. We showed that inflammation assessment could be automated efficiently and reliably. In comparison to human evaluation performed on the same set of sections, computer generated data was more descriptive and fully quantitative. Moreover optimisation of our detection parameters allowed us to be to more sensitive and to generate data in a larger dynamic range to traditional experimental evaluation, such as bronchiolar lavage (BAL) inflammatory cell counts obtained by flow cytometry. We also took advantage of the fact that we could increase the number of samples to be analysed within a day. Such optimisation allowed us to determine the best study design and experimental conditions in order to increase statistical significance between groups. In conclusion, we showed that combination of whole slide digital scanning and image analysis could be fully automated and deliver more descriptive and biologically relevant data over traditional methods evaluating histopathological pulmonary changes observed in this mouse model of chronic asthma

Left Atrial scar assessment using imaging with isotropic spatial resolution and compressed sensing

Summary. We assess left atrial scar using late gadolinium enhancement (LGE) with isotropic spatial resolution of $1.4^3 mm^3$ by using highly accelerated LOST [1] reconstruction. Background. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia [2]. Pulmonary vein isolation (PVI) using radiofrequency (RF)-ablation is the leading treatment for AF. Recently, LGE imaging of the LA has been used to identify atrial wall scar due to RF-ablation [3]. However, current LGE methods have limited spatial resolution that substantially impact assessment of scar in the complex geometry of PVs and LA. In this study, we sought to utilize prospective random k-space sampling and LOST [1] for accelerated LGE imaging, where reduction in imaging time was traded-off for improved isotropic spatial-resolution. Methods. 23 patients with history of AF (6 females, $58.1 \pm 9.6$ years, 9 pre-PVI, 2 with history of PVI; 8 post-PVI; 3 with both pre and post-PVI) were recruited for this study. LGE images were acquired 10-to-20 minutes after bolus infusion of 0.2 mmol/kg Gd-DTPA. Free-breathing ECG-triggered navigator-gated inversion-recovery GRE sequences were used for all acquisitions ($TR/TE/ \alpha = 5.2/2.6ms/25°, FOV=320×320×100mm$). The PV inflow artifact reduction technique in [4] was also utilized. For each patient, a standard non-isotropic 3D LGE scan ($1.4×1.4×4.0mm^3$) and a 3-fold-accelerated highresolution 3D LGE scan ($1.4^3 mm^3$) were performed, with randomized acquisition order. For random undersampling, central k-space (45×35 in ky-kz) was fullysampled, edges randomly discarded, and phase reordering performed as in [5]. Acquisition times were ~4 mins assuming 100% scan-efficiency at 70bpm for both scans. All undersampled data were reconstructed offline using LOST [1]. LOST-reconstructed high-resolution, and standard LGE images were scored by two blinded readers for diagnostic value, presence of LGE(yes/no); and image quality in axial(Ax), coronal(Co) and sagittal (Sa) views (1=poor,4=excellent). Results. Three cases were declared non-diagnostic due to contrast-washout and imperfect inversion-time. LGE was visually present in 14 of the remaining 20 patients based on standard-LGE images, and 12 based on LOST-reconstructed ones (disagreement on one pre- and one postPVI patient). Figure 1 and 2 show comparisons of isotropic vs. non-isotropic LGE images in two patients. Image scores for LOST-LGE: $Ax=2.90 \pm 0.70, Sa=3.33 \pm 0.66, Co=3.00 \pm 0.63$; and standard LGE: $Ax=3.76 \pm 0.54, Sa=2.48 \pm 0.60, Co=2.24 \pm 0.44$, where differences were significant in all views. Conclusions. LOST allows isotropic spatial-resolution in LGE for assessment of LA and PV scar. Isotropic resolution allows reformatting LGE images in any orientation and facilitates assessment of scar. Further clinical study is needed to assess if the improved spatial resolution will impact the diagnostic interpretation of data

Measuring spiritual belief: development and standardization of a beliefs and values scale

Background. Higher levels of religious involvement are modestly associated with better health, after taking account of other influences, such as age, sex and social support. However, little account is taken of spiritual beliefs that are not tied to personal or public religious practice. Our objective was to develop a standardized measure of spirituality for use in clinical research. Method. We characterized the core components of spirituality using narrative data from a purposive sample of people, some of whom were near the end of their lives. These data were developed into statements in a scale to measure strength of spiritual beliefs and its reliability, validity and factor structure were evaluated in order to reach a final version. Results. Thirty-nine people took part in the qualitative study to define the nature of spirituality in their lives. These data were used to construct a 47-item instrument that was evaluated in 372 people recruited in medical and non-medical settings. Analysis of these statements led to a 24-item version that was evaluated in a further sample of 284 people recruited in similar settings. The final 20-item questionnaire performed with high test–retest and internal reliability and measures spirituality across a broad religious and non-religious perspective. Conclusions. A measure of spiritual belief that is not limited to religious thought, may contribute to research in psychiatry and medicine

The Trail, 1964-11-05

https://soundideas.pugetsound.edu/thetrail_all/1896/thumbnail.jp

Exploring the neurocognitive correlates of challenging behaviours in young people with autism spectrum disorder

Many young people with autism spectrum disorder display ‘challenging behaviours’, characterised by externalising behaviour and self-injurious behaviours. These behaviours can have a negative impact on a young person’s well-being, family environment and educational achievement. However, the development of effective interventions requires greater knowledge of autism spectrum disorder–specific models of challenging behaviours. Autism spectrum disorder populations are found to demonstrate impairments in different cognitive domains, namely social domains, such as theory of mind and emotion recognition, but also non-social domains such as executive functioning and sensory or perceptual processing. Parent-rated self-injurious behaviour and externalising behaviours, and neurocognitive performance were assessed in a population-derived sample of 100 adolescents with autism spectrum disorder. Structural equation modelling was used to estimate associations between cognitive domains (theory of mind, emotion recognition, executive functioning and perceptual processing) and self-injurious behaviour and externalising behaviours. Poorer theory of mind was associated with increased self-injurious behaviour, whereas poorer perceptual processing was associated with increased externalising behaviours. These associations remained when controlling for language ability. This is the first analysis to examine how a wide range of neurocognitive domains relate to challenging behaviours and suggests specific domains that may be important targets in the development of interventions in adolescents with autism spectrum disorder

NACCHO Exchange: Health Equity

Essential Elements of Health Equity Practice: Partnering to Support Power-Building; Revitalizing Communities: Partnerships to Create Active, Safe Places in Merced County, California; Advancing Health Equity through Regional Collaboration; and Governing for Racial Equity: A Local Health Department's Journe

Infant regulatory function acts as a protective factor for later traits of autism spectrum disorder and attention deficit/hyperactivity disorder but not callous unemotional traits

Abstract: Background: Reduced executive functions (EF) are commonly associated with developmental conditions (e.g., autism spectrum disorder, ASD; attention deficit/hyperactivity disorder, ADHD), although EF seems to be typical in children with callous unemotional (CU) traits. Regulatory function (RF) is a proposed infant precursor that maps on onto factors driving later EF. Here, we first test whether RF is specifically and negatively associated with ASD and ADHD traits, but not CU traits. Second, we test whether RF can act as a protective factor, by moderating the association between infant markers and subsequent ASD and ADHD traits. Methods: Participants were 79 infants at high (N = 42) and low (N = 37) familial risk for ASD. Data come from the 14-month infant visit (Autism Observational Scale for Infants; AOSI; activity level and RF from the Infant Behavior Questionnaire; IBQ) and the 7-year visit (ASD traits: Social Responsiveness Scale, SRS; ADHD traits: Conners 3, CU traits: Inventory of Callous Unemotional Traits). Results: Infant RF was negatively associated with later traits of ASD (B = − 0.5, p = 0.01) and ADHD inattention (B = − 0.24, p = 0.02) but not hyperactivity (B = − 0.25, p = 0.10) or CU traits (B = 0.02, p = 0.86). RF moderated the association between infant AOSI score and ASD traits, with a significant effect in those with low RF (B = 0.10, p = 0.006), not high RF (B = 0.01, p = 0.78). Similarly, for ADHD, infant activity level was associated with later ADHD inattention in those with low (B = 0.17, p = 0.04) but not high RF (B = 0.07, p = 0.48). For ADHD hyperactivity symptoms, activity level was predictive at both high and low levels of RF. Conclusions: Strong RF may allow children to compensate for other atypicalities, thus attenuating the association between infant markers and later disorder traits. Whilst infant RF was associated with both ASD and ADHD inattention traits, there was no association with ADHD hyperactivity or CU traits. This suggests that any protective effect may not be universal and emphasises the need for a better understanding of the underlying moderating mechanisms

Regression, developmental trajectory and associated problems in disorders in the autism spectrum: the SNAP study

We report rates of regression and associated findings in a population derived group of 255 children aged 9-14 years, participating in a prevalence study of autism spectrum disorders (ASD); 53 with narrowly defined autism, 105 with broader ASD and 97 with non-ASD neurodevelopmental problems, drawn from those with special educational needs within a population of 56,946 children. Language regression was reported in 30% with narrowly defined autism, 8% with broader ASD and less than 3% with developmental problems without ASD. A smaller group of children were identified who underwent a less clear setback. Regression was associated with higher rates of autistic symptoms and a deviation in developmental trajectory. Regression was not associated with epilepsy or gastrointestinal problems