Meeting the needs of older peoplewith visual impairment: social care orsocial exclusion?

This paper is based on the research study ?Housing and supportneeds of older people with visual impairment ? experiences andchallenges? (Hanson et al, 2002).1The full findings of this study are reported in another occasionalpaper produced by Thomas Pocklington Trust.2 It is, however, usefulto state that this study found evidence that sight loss in later life hassignificant emotional consequences, often unacknowledged byprofessionals. It also showed how older people with visionimpairment often have their own coping strategies, but are less ablethan sighted peers to carry out certain daily tasks.The study suggested that professionals should offer sensitive andtimely support, in a more collaborative manner, and that serviceshave to be monitored and evaluated to avoid wide-ranging needsremaining unmet. In respect of the home environment, researchindicated that adequate and accessible domestic space in which todo housework safely, low vision equipment and the provision ofovernight accommodation for guests and carers was required.Most participants in the study wished to stay in their homes andneighbourhoods. When asked about possible alternative options,participants emphasised the importance of location and sufficientspace. If they were considering supported housing, they requiredfull information about how it addressed their particular needs.This paper focuses on whether older people with visual impairmentare vulnerable to social exclusion if their social care needs are unmet. In particular, this paper argues that:? Greater professional collaboration is required to improve eyeclinic and community support services.? Relevant staff should aim to provide timely and holisticassessments of need.? Older people with vision impairment have significant needs asregards home care support, access to information, psychologicalstress and social isolation.? Initiatives such as peer support groups and resource centres offeropportunities to tackle social exclusion arising from unmetneeds. This paper is based on the research study ?Housing and supportneeds of older people with visual impairment ? experiences andchallenges? (Hanson et al, 2002).1The full findings of this study are reported in another occasionalpaper produced by Thomas Pocklington Trust.2 It is, however, usefulto state that this study found evidence that sight loss in later life hassignificant emotional consequences, often unacknowledged byprofessionals. It also showed how older people with visionimpairment often have their own coping strategies, but are less ablethan sighted peers to carry out certain daily tasks.The study suggested that professionals should offer sensitive andtimely support, in a more collaborative manner, and that serviceshave to be monitored and evaluated to avoid wide-ranging needsremaining unmet. In respect of the home environment, researchindicated that adequate and accessible domestic space in which todo housework safely, low vision equipment and the provision ofovernight accommodation for guests and carers was required.Most participants in the study wished to stay in their homes andneighbourhoods. When asked about possible alternative options,participants emphasised the importance of location and sufficientspace. If they were considering supported housing, they requiredfull information about how it addressed their particular needs.This paper focuses on whether older people with visual impairmentare vulnerable to social exclusion if their social care needs are unmet. In particular, this paper argues that:? Greater professional collaboration is required to improve eyeclinic and community support services.? Relevant staff should aim to provide timely and holisticassessments of need.? Older people with vision impairment have significant needs asregards home care support, access to information, psychologicalstress and social isolation.? Initiatives such as peer support groups and resource centres offeropportunities to tackle social exclusion arising from unmetneeds

The Housing and Support Needs of Older People with Visual Impairment

Visual impairment is one of the most prevalent anddisabling conditions among older people, and yet verylittle research has been conducted that could inform thedevelopment of appropriate public services. In order toaddress this deficiency, Thomas Pocklington Trust fundedresearch to examine the housing and support needs of 400visually impaired people aged over 55.The study found that:? There is little professional recognition, or offers of help andadvice for the anxiety, depression, and sense of profoundloss that people experience with late onset of visualimpairment.? Both blind and partially sighted people need timely andholistic assessment, rehabilitation, affordable equipment andregular review.? People with sight loss do not wish to leave their homes.Home is the epicentre of a mental map that assistsorientation and continuity following sight loss.? Social isolation and lack of human contact are majorproblems for people with sight loss.? People with sight loss have poor knowledge of supportgroups, community services and/or specialist housingoptions for older people with visual impairment. Visual impairment is one of the most prevalent anddisabling conditions among older people, and yet verylittle research has been conducted that could inform thedevelopment of appropriate public services. In order toaddress this deficiency, Thomas Pocklington Trust fundedresearch to examine the housing and support needs of 400visually impaired people aged over 55.The study found that:? There is little professional recognition, or offers of help andadvice for the anxiety, depression, and sense of profoundloss that people experience with late onset of visualimpairment.? Both blind and partially sighted people need timely andholistic assessment, rehabilitation, affordable equipment andregular review.? People with sight loss do not wish to leave their homes.Home is the epicentre of a mental map that assistsorientation and continuity following sight loss.? Social isolation and lack of human contact are majorproblems for people with sight loss.? People with sight loss have poor knowledge of supportgroups, community services and/or specialist housingoptions for older people with visual impairment

Three-Dimensional Percolation Modeling of Self-Healing Composites

We study the self-healing process of materials with embedded "glue"-carrying cells, in the regime of the onset of the initial fatigue. Three-dimensional numerical simulations within the percolation-model approach are reported. The main numerical challenge taken up in the present work, has been to extend the calculation of the conductance to three-dimensional lattices. Our results confirm the general features of the process: The onset of the material fatigue is delayed, by developing a plateau-like time-dependence of the material quality. We demonstrate that in this low-damage regime, the changes in the conductance and thus, in similar transport/response properties of the material can be used as measures of the material quality degradation. A new feature found for three dimensions, where it is much more profound than in earlier-studied two-dimensional systems, is the competition between the healing cells. Even for low initial densities of the healing cells, they interfere with each other and reduce each other's effective healing efficiency.Comment: 15 pages in PDF, with 6 figure

Adalimumab in Active and Inactive, Non-Infectious Uveitis: Global Results from the VISUAL I and VISUAL II Trials

PURPOSE: Report global adalimumab safety and efficacy outcomes in patients with non-infectious uveitis. METHODS: Adults with non-infectious intermediate, posterior, or panuveitis were randomized 1:1 to receive placebo or adalimumab in the VISUAL I (active uveitis) or VISUAL II (inactive uveitis) trials. Integrated global and Japan substudy results are reported. The primary endpoint was time to treatment failure (TF). RESULTS: In the integrated studies, TF risk was significantly reduced (hazard ratio [95% CI]) with adalimumab versus placebo (VISUAL I: HR = 0.56 [0.40-0.76], p < 0.001; VISUAL II: HR = 0.52 [0.37-0.74], p < 0.001). In Japan substudies, no consistent trends were observed between groups (VISUAL I: HR = 1.20 [0.41-3.54]; VISUAL II: HR = 0.45 [0.20-1.03]). Adverse event rates were similar between treatment groups in both studies (854 to 1063 events/100 participant-years). CONCLUSIONS: Adalimumab lowered time to TF versus placebo in the integrated population; no consistent trends were observed in Japan substudies. Safety results were consistent between studies

Combinatorial Roles of Heparan Sulfate Proteoglycans and Heparan Sulfates in Caenorhabditis elegans Neural Development

Heparan sulfate proteoglycans (HSPGs) play critical roles in the development and adult physiology of all metazoan organisms. Most of the known molecular interactions of HSPGs are attributed to the structurally highly complex heparan sulfate (HS) glycans. However, whether a specific HSPG (such as syndecan) contains HS modifications that differ from another HSPG (such as glypican) has remained largely unresolved. Here, a neural model in C. elegans is used to demonstrate for the first time the relationship between specific HSPGs and HS modifications in a defined biological process in vivo. HSPGs are critical for the migration of hermaphrodite specific neurons (HSNs) as genetic elimination of multiple HSPGs leads to 80% defect of HSN migration. The effects of genetic elimination of HSPGs are additive, suggesting that multiple HSPGs, present in the migrating neuron and in the matrix, act in parallel to support neuron migration. Genetic analyses suggest that syndecan/sdn-1 and HS 6-O-sulfotransferase, hst-6, function in a linear signaling pathway and glypican/lon-2 and HS 2-O-sulfotransferase, hst-2, function together in a pathway that is parallel to sdn-1 and hst-6. These results suggest core protein specific HS modifications that are critical for HSN migration. In C. elegans, the core protein specificity of distinct HS modifications may be in part regulated at the level of tissue specific expression of genes encoding for HSPGs and HS modifying enzymes. Genetic analysis reveals that there is a delicate balance of HS modifications and eliminating one HS modifying enzyme in a compromised genetic background leads to significant changes in the overall phenotype. These findings are of importance with the view of HS as a critical regulator of cell signaling in normal development and disease

Disulfide Bridges Remain Intact while Native Insulin Converts into Amyloid Fibrils

Amyloid fibrils are β-sheet-rich protein aggregates commonly found in the organs and tissues of patients with various amyloid-associated diseases. Understanding the structural organization of amyloid fibrils can be beneficial for the search of drugs to successfully treat diseases associated with protein misfolding. The structure of insulin fibrils was characterized by deep ultraviolet resonance Raman (DUVRR) and Nuclear Magnetic Resonance (NMR) spectroscopy combined with hydrogen-deuterium exchange. The compositions of the fibril core and unordered parts were determined at single amino acid residue resolution. All three disulfide bonds of native insulin remained intact during the aggregation process, withstanding scrambling. Three out of four tyrosine residues were packed into the fibril core, and another aromatic amino acid, phenylalanine, was located in the unordered parts of insulin fibrils. In addition, using all-atom MD simulations, the disulfide bonds were confirmed to remain intact in the insulin dimer, which mimics the fibrillar form of insulin

Altered versican cleavage in ADAMTS5 deficient mice : a novel etiology of myxomatous valve disease

AbstractIn fetal valve maturation the mechanisms by which the relatively homogeneous proteoglycan-rich extracellular matrix (ECM) of endocardial cushions is replaced by a specialized and stratified ECM found in mature valves are not understood. Therefore, we reasoned that uncovering proteases critical for ‘remodeling’ the proteoglycan rich (extracellular matrix) ECM may elucidate novel mechanisms of valve development. We have determined that mice deficient in ADAMTS5, (A Disintegrin-like And Metalloprotease domain with ThromboSpondin-type 1 motifs) which we demonstrated is expressed predominantly by valvular endocardium during cardiac valve maturation, exhibited enlarged valves. ADAMTS5 deficient valves displayed a reduction in cleavage of its substrate versican, a critical cardiac proteoglycan. In vivo reduction of versican, in Adamts5−/− mice, achieved through Vcan heterozygosity, substantially rescued the valve anomalies. An increase in BMP2 immunolocalization, Sox9 expression and mesenchymal cell proliferation were observed in Adamts5−/− valve mesenchyme and correlated with expansion of the spongiosa (proteoglycan-rich) region in Adamts5−/− valve cusps. Furthermore, these data suggest that ECM remodeling via ADAMTS5 is required for endocardial to mesenchymal signaling in late fetal valve development. Although adult Adamts5−/− mice are viable they do not recover from developmental valve anomalies and have myxomatous cardiac valves with 100% penetrance. Since the accumulation of proteoglycans is a hallmark of myxomatous valve disease, based on these data we hypothesize that a lack of versican cleavage during fetal valve development may be a potential etiology of adult myxomatous valve disease