A case report of progressive Brown syndrome?

Aim: To report an unusual case of progressive Brown syndrome and the successful surgical treatment. Methods: A 42-year-old male with a documented 14-year history of progressive Brown syndrome is presented. To improve diplopia symptoms an ipsilateral superior oblique (SO) 7 mm silicone tendon spacer and a contralateral 3 mm superior rectus (SR) recession were performed. Results: The surgical procedure was successful in reducing the primary position deviation (preoperative 30ΔLHoT 7ΔLXT; one month post surgery 3ΔLHo; one year post surgery 7-8ΔLHo 1-2ΔE) and eliminating the abnormal head posture (AHP). Diplopia was only reported on elevation and depression following surgery. Conclusion: This case of Brown syndrome is unusual as it was progressive and had a documented history over a number of years prior to surgery. Surgical treatment of Brown syndrome is rarely required, but in this case was successful in improving the patient’s diplopia and AHP

The provision of patient information about nystagmus

Aims: The aims of this study were to evaluate the current provision of patient information about nystagmus in orthoptic clinics in the UK and Ireland and to develop a standardised information pack about nystagmus. Methods: A questionnaire was circulated to orthoptists in the UK and Ireland asking whether they had information to provide to patients with nystagmus, what was included in this information and how it could be improved. Orthoptists were also asked what should be included in a standardised information pack about nystagmus. Results: Two hundred and thirty three orthoptists completed the questionnaire. One-third of responding orthoptists did not have information to provide to patients with nystagmus. Most reported the information available to them included details of support services and physical symptoms. Including information about living with nystagmus at different ages and long-term prognosis were the most common suggestions to improve information about nystagmus. More than half of orthoptists selected all the suggested topics to be included in a standardised information pack, with support services and long-term prognosis most frequently selected. Conclusions: Only 67% of responding orthoptists had information about nystagmus to give to patients or their families. Ways to improve the current information and content considered important by orthoptists were taken into account to create a nystagmus information pack, which is now available online

Simulation of oscillopsia in virtual reality

Purpose: Nystagmus is characterised by involuntary eye movement. A proportion of those with nystagmus experience the world constantly in motion as their eyes move: a symptom known as oscillopsia. Individuals with oscillopsia can be incapacitated and often feel neglected due to limited treatment options. Effective communication of the condition is challenging and no tools to aid communication exist. This paper describes a virtual reality (VR) application that recreates the effects of oscillopsia, enabling others to appreciate the condition. Methods: Eye tracking data was incorporated into a VR oscillopsia simulator and released as a smartphone app – “Nystagmus Oscillopsia Sim VR”. When a smartphone is used in conjunction with a Google Cardboard headset, it presents an erratic image consistent with oscillopsia. The oscillopsia simulation was appraised by six participants for its representativeness. These individuals have nystagmus and had previously experienced oscillopsia but were not currently symptomatic; they were therefore uniquely placed to judge the app. The participants filled in a questionnaire to record impressions and the usefulness of the app. Results: The published app has been downloaded ~3700 times (28/02/2018) and received positive feedback from the nystagmus community. The validation study questionnaire scored the accuracy of the simulation an average of 7.8/10 while its ability to aid communication received 9.2/10. Conclusion: The evidence indicates that the simulation can effectively recreate the sensation of oscillopsia and facilitate effective communication of the symptoms associated with the condition. This has implications for communication of other visual conditions

A joint role for forced and internally-driven variability in the decadal modulation of global warming

Despite the observed monotonic increase in greenhouse-gas concentrations, global mean temperature displays important decadal fluctuations typically attributed to both external forcing and internal variability. Here, we provide a robust quantification of the relative contributions of anthropogenic, natural, and internally-driven decadal variability of global mean sea surface temperature (GMSST) by using a unique dataset consisting of 30-member large initial-condition ensembles with five Earth System Models (ESM-LE). We present evidence that a large fraction (~29–53%) of the simulated decadal-scale variance in individual timeseries of GMSST over 1950–2010 is externally forced and largely linked to the representation of volcanic aerosols. Comparison with the future (2010–2070) period suggests that external forcing provides a source of additional decadal-scale variability in the historical period. Given the unpredictable nature of future volcanic aerosol forcing, it is suggested that a large portion of decadal GMSST variability might not be predictable

Using scenarios to explore UK upland futures

Uplands around the world are facing significant social, economic and environmental changes, and decision-makers need to better understand what the future may hold if they are to adapt and maintain upland goods and services. This paper draws together all major research comprising eight studies that have used scenarios to describe possible futures for UK uplands. The paper evaluates which scenarios are perceived by stakeholders to be most likely and desirable, and assesses the benefits and drawbacks of the scenario methods used in UK uplands to date. Stakeholders agreed that the most desirable and likely scenario would be a continuation of hill farming (albeit at reduced levels) based on cross-compliance with environmental measures. The least desirable scenario is a withdrawal of government financial support for hill farming. Although this was deemed by stakeholders to be the least likely scenario, the loss of government support warrants close attention due to its potential implications for the local economy. Stakeholders noted that the environmental implications of this scenario are much less clear-cut. As such, there is an urgent need to understand the full implications of this scenario, so that upland stakeholders can adequately prepare, and policy-makers can better evaluate the likely implications of different policy options. The paper concludes that in future, upland scenario research needs to: (1) better integrate in-depth and representative participation from stakeholders during both scenario development and evaluation; and (2) make more effective use of visualisation techniques and simulation models

Evaluation of the Nystagmus Information Pack

Introduction: In response to the need for easily accessible, high-quality information about nystagmus, the Nystagmus Information Pack was created and made freely available online in 2017. This study was undertaken to evaluate the content and accessibility of the Nystagmus Information Pack. Methods: Clinicians, eye clinic liaison officers (ECLOs), teachers, patients, families, and any person with an interest in nystagmus were invited to complete an online questionnaire about the content and accessibility of the Nystagmus Information Pack. Results: One hundred and sixty respondents completed the questionnaire. Respondents who had previously accessed the Nystagmus Information Pack (n = 49, 30.6%) reported the content was appropriate (86%), of sufficient detail (94%), and easy to understand (88%). Minor suggestions were made to improve the content. Respondents who had not accessed the Nystagmus Information Pack (n = 111, 69.4%) reported not being aware of the resource (90%) but had already accessed nystagmus information from a wide range of sources. Poor vision was a barrier to accessing the resource for a small number of respondents (4.5%). Conclusion: Some improvements to the content and accessibility of the Nystagmus Information Pack should be considered, in particular the format options in which it is available, to enable access in preferred formats and with poor vision. The availability of the Nystagmus Information Pack should be promoted and shared more widely, as the majority of respondents were unaware of the resource despite having an association with or interest in nystagmus

Using VR to investigate the relationship between visual acuity and severity of simulated oscillopsia

Purpose: Oscillopsia is a debilitating symptom resulting from involuntary eye movement most commonly associated with acquired nystagmus. Investigating and documenting the efects of oscillopsia severity on visual acuity (VA) is challenging. This paper aims to further understanding of the efects of oscillopsia using a virtual reality simulation. Methods: Fifteen right-beat horizontal nystagmus waveforms, with diferent amplitude (1°, 3°, 5°, 8° and 11°) and frequency (1.25 Hz, 2.5 Hz and 5 Hz) combinations, were produced and imported into virtual reality to simulate diferent severities of oscillopsia. Fifty participants without ocular pathology were recruited to read logMAR charts in virtual reality under stationary conditions (no oscillopsia) and subsequently while experiencing simulated oscillopsia. The change in VA (logMAR) was calculated for each oscillopsia simulation (logMAR VA with oscillopsia – logMAR VA with no oscillopsia), removing the inluence of diferent baseline VAs between participants. A one-tailed paired t-test was used to assess statistical signiicance in the worsening in VA caused by the oscillopsia simulations. Results: VA worsened with each incremental increase in simulated oscillopsia intensity (frequency x amplitude), either by increasing frequency or amplitude, with the exception of statistically insigniicant changes at lower intensity simulations. Theoretical understanding predicted a linear relationship between increasing oscillopsia intensity and worsening VA. This was supported by observations at lower intensity simulations but not at higher intensities, with incremental changes in VA gradually levelling of. A potential reason for the diference at higher intensities is the inluence of frame rate when using digital simulations in virtual reality. Conclusions: The frequency and amplitude were found to equally afect VA, as predicted. These results not only consolidate the assumption that VA degrades with oscillopsia but also provide quantitative information that relates these changes to amplitude and frequency of oscillopsia

The learning sciences in Initial Teacher Education - responding to the Core Content Framework

The new ITT Core Content Framework (DfE 2019a) and the Early Career Framework (DfE 2019b) have all been informed by the ‘Learning Sciences’, particularly by cognitive neuropsychology with an emphasis on learning as memory. This provides an urgency for ITE providers to address scientific accounts of learning in their programmes. We see this as a provocation for critical thought and an opportunity to support our trainees in becoming ‘reflective professionals’ rather than ‘executive technicians’ (Winch et al. 2015). In this session, we shared the approach we are taking at Bath Spa University through our ‘Learning Sciences in ITE’ project (funded by The Wellcome Trust). We are taking a Design-Based Research (DBR) approach to the project. DBR involves cyclical processes of design, trial, feedback and reflection in a real-life context. (e.g. Anderson & Shattuck, 2012). To date, we have developed a package of open access resources to critically engage trainee teachers with ideas from the learning sciences such as challenging VAK and considering retrieval practice (available at: https://www.bathspa.ac.uk/learning-sciences). By taking this approach we reduced and unsettled trainee belief in neuromyths and successfully positioned the trainees as ‘critical consumers’ of neuroscience (McMahon, Yeh & Etchells 2019). We are maintaining this emphasis on critical research literacy and some neuromyth busting, but moving on to look at the learning sciences as another lens through which we can view learning and pedagogy. We shared how the rationale for our approach emerged from education tutors in collaboration with colleagues in biological and neuropsychology (McMahon & Etchells, 2018). We have looked within and beyond the ITT Core Content Framework to identify and select key ideas from the science of learning and map these across the primary ITE curriculum