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

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

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

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

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

Quality of life in Type 1 (insulin-dependent) diabetic patients prior to and after pancreas and kidney transplantation in relation to organ function

Improvement of the quality of life in Type 1 (insulin-dependent) diabetic patients with severe late complications is one of the main goals of pancreas and/or kidney grafting. To assess the influences of these treatment modalities on the different aspects of the quality of life a cross-sectional study in 157 patients was conducted. They were categorized into patients pre-transplant without dialysis (n=29; Group A), pre-transplant under dialysis (n=44; Group B), post-transplant with pancreas and kidney functioning (n=31; Group C), post-transplant with functioning kidney, but insulin therapy (n=29; Group D), post-transplant under dialysis and insulin therapy again (n=15; Group E) and patients after single pancreas transplantation and rejection, with good renal function, but insulin therapy (n=9; Group F). All patients answered a mailed, self-administered questionnaire (217 questions) consisting of a broad spectrum of rehabilitation criteria. The results indicate a better quality of life in Groups C and D as compared to the other groups. In general the scores are highest in C, but without any significant difference to D. Impressive significant differences between C or D and the other groups were found especially in their satisfaction with physical capacity, leisure-time activities or the overall quality of life. The satisfaction with the latter is highest in C (mean±SEM: 4.0±0.2 on a 1 to 5-rating scale; significantly different from A: 3.1±0.1, B: 2.7±0.2 and E: 2.6±0.3; p<0.01), followed by D (3.8±0.2; significantly different from B and E; p<0.01). Group F shows a mean of 3.1±0.4, which is not significantly different from C. The percentages of patients in each group, who are not working: A: 38 %, B: 64 %, C: 74 %, D: 66 %, E: 87 % and F: 78 % indicate that there is no marked improvement in the vocational situation after successful grafting

Human Huntington's disease pluripotent stem cell-derived microglia develop normally but are abnormally hyper-reactive and release elevated levels of reactive oxygen species

BACKGROUND: Neuroinflammation may contribute to the pathogenesis of Huntington's disease, given evidence of activated microglia and elevated levels of inflammatory molecules in disease gene carriers, even those many years from symptom onset. We have shown previously that monocytes from Huntington's disease patients are hyper-reactive to stimulation in a manner dependent on their autonomous expression of the disease-causing mutant HTT protein. To date, however, whether human microglia are similarly hyper-responsive in a cell-autonomous manner has not been determined. METHODS: Microglial-like cells were derived from human pluripotent stem cells (PSCs) expressing mutant HTT containing varying polyglutamine lengths. These included lines that are otherwise isogenic, such that any observed differences can be attributed with certainty to the disease mutation itself. Analyses by quantitative PCR and immunofluorescence microscopy respectively of key genes and protein markers were undertaken to determine whether Huntington's disease PSCs differentiated normally to a microglial fate. The resultant cultures and their supernatants were then assessed by various biochemical assays and multiplex ELISAs for viability and responses to stimulation, including the release of pro-inflammatory cytokines and reactive oxygen species. Conditioned media were applied to PSC-derived striatal neurons, and vice versa, to determine the effects that the secretomes of each cell type might have on the other. RESULTS: Human PSCs generated microglia successfully irrespective of the expression of mutant HTT. These cells, however, were hyper-reactive to stimulation in the production of pro-inflammatory cytokines such as IL-6 and TNFα. They also released elevated levels of reactive oxygen species that have neurotoxic potential. Accompanying such phenotypes, human Huntington's disease PSC-derived microglia showed increased levels of apoptosis and were more susceptible to exogenous stress. Such stress appeared to be induced by supernatants from human PSC-derived striatal neurons expressing mutant HTT with a long polyglutamine tract. CONCLUSIONS: These studies show, for the first time, that human Huntington's disease PSC-derived microglia are hyper-reactive due to their autonomous expression of mutant HTT. This provides a cellular basis for the contribution that neuroinflammation might make to Huntington's disease pathogenesis

Developing a visual attention assessment for children at school entry

Whereas young children's visual attention has been explored in a number of previous studies, so far it has not been investigated by an assessment based on Bundesen's Theory of Visual Attention (TVA). TVA is a prominent visual attention model that has been widely used as foundation in studies targeting older children, adolescents or adults. In this paper we explore the utility of adopting TVA to explore the visual attention of 4- to 5- year olds and present the development of a simplified adapted version of a TVA-based assessment designed for this age group. Key assessment alterations included the substitution of letter stimuli with black and white symbols and the reduction of assessment duration. The suitability of the assessment for the target age group was subsequently tested in two consecutive studies (Study I: N = 43; Study II: N = 24). Study results show that measuring visual attention based on a simplified TVA-based assessment appears feasible in such a young age group, provided that the study design takes into account the capabilities of these young children. The authors argue that by adopting this kind of visual attention assessment the relationship between visual attention development and early learning could be better understood