Healthcare experiences of patients with age-related macular degeneration:have things improved? Cross-sectional survey responses of Macular Society members in 2013 compared with 1999

OBJECTIVE: To investigate healthcare experiences of patients with age-related macular degeneration (AMD) and determine whether a previous survey and Royal College of Ophthalmologists (RCOphth) management guidelines brought improvements. DESIGN: Cross-sectional survey of Macular Society members in 2013 compared with previous 1999 survey. SETTING: UK Postal Questionnaires. PARTICIPANTS: 1169 respondents in 2013 (1187 in 1999). INTERVENTION: Publication of 1999 survey results (2002), and RCOphth AMD guidelines (2009). MAIN OUTCOME MEASURES: Respondents answered questions about experiences at diagnosis. Five questions were replicated from the 1999 survey for direct comparison in the 2013 survey which included additional questions based on 2009 RCOphth recommendations for information and support provision for patients with AMD. RESULTS: Most 2013 survey respondents were given the name of their macular condition (91%), felt the healthcare professional was interested in them (71%) and were satisfied overall with the diagnostic consultation (76%). These outcomes show significant improvement since 1999. Within the 2013 sample, multivariable analyses showed gradual trends of improvement over time in: provision of written information, Macular Society information and receiving appropriate help, support and advice at diagnosis. Only overall satisfaction with the diagnostic consultation (but not the other nine areas of information and support provision studied) significantly improved in the time after publication of the RCOphth 2009 guidelines. There were no significant improvements associated with the publication of the 1999 survey results. Low information and support provision remained, for example, 44% of respondents diagnosed after the RCOphth 2009 guidelines reported not receiving information on what to do if vision deteriorated. Lack of such information at diagnosis was significantly associated with registration as sight impaired (p<0.01). Reports of general practitioner (GP) knowledge of AMD remained low: 39% reported their GP was ‘not at all well informed’. The 2013 respondents reported lower levels of help and support from GPs than 1999 respondents (p<0.001). CONCLUSIONS: Patients diagnosed with AMD after 1999 (vs before 1999) reported better experiences at diagnostic consultation. However, information and support provision at diagnosis, and satisfaction with GPs remained low

Antecedent contained deletions in native and non-native sentence processing

We report the results from an eye-movement monitoring study investigating native (L1) and non-native (L2) speakers' real-time processing of antecedent-contained deletion (ACD), a type of verb phrase ellipsis in which the ellipsis gap forms part of its own antecedent. The resulting interpretation problem is traditionally thought to be solved by quantifier raising, a covert scope-shifting operation that serves to remove the gap from within its antecedent. Our L2 group comprised advanced, native German-speaking L2 learners of English. The analysis of the eye-movement data showed that both L1 and L2 English speakers tried to recover the missing verb phrase after encountering the gap. Only the native speakers showed evidence of ellipsis resolution being affected by quantification, however. No effects of quantification following gap detection were found in the L2 group, by contrast, indicating that recovery of the elided material was accomplished independently from the object's quantificational status in this group

Service Evaluation of 'Living Well with the Impact of Cancer' Courses

The aim of the Penny Brohn Cancer Care Living Well Service Evaluation was to measure the level of benefit that participants were receiving from the Penny Brohn Cancer Care(PBCC)Living Well course and to inform current and future service provision at PBCC. The Penny Brohn Whole Person Approach model(PB-WPA model), which underpins the Living Well course, was designed to support the ‘whole person’ and the course was intended to meet the needs of people with cancer, as identified by the National Cancer Survivorship Initiative (NCSI). The combined qualitative and quantitative results of the Living Well Service Evaluation have demonstrated, very clearly at times, that participants were highly satisfied with the course. The immediate benefit of attending was measurable, in terms of improved health related quality of life (HRQoL) and improved MYCaW (Measure yourself Concerns and Wellbeing) concerns and wellbeing. The evaluation results show that the Living Well course experience enabled the majority of participants to regain control over many aspects of their life, and to start taking responsibility for their health. The following aspects of the course were identified as the most helpful: -Specific units of ‘education and explanation’ about cancer and why healthy lifestyle changes to areas such as diet, exercise and relaxation are beneficial -Advice and education from medical doctors -The opportunity to share experiences with other participants For some, this empowerment led to long-term changes in exercise, food consumption,use of self-help techniques and the ability to communicate more freely and openly with family, friends and medical professionals. These improvements were reflected in the 12 month outcome data, where a sustained improvement in HRQoL and MYCaW concerns was reported by many clients. Such patient reported outcome measures (PROMs) are limited in what they can measure, thus qualitative data were also collected to ensure that participants were able to share their experiences (positive or negative) of the Living Well course, and their subsequent experiences of applying the education and techniques learnt on the course. A picture emerged that identified difficulties in sustaining lifestyle changes at around the 3-6 month follow-up. Participants who returned to PBCC within the 12 month follow-up period, however, were more likely to benefit by reporting a greater improvement in HRQoL and MYCaW scores, plus an improved understanding of how to make and maintain healthy lifestyle changes to suit their individual circumstances. In regards to the current NCSI priorities, it is hoped that the data reported in this evaluation go some way to informing the following: -Information and support from the point of diagnosis -Managing the consequences of treatment -Promoting recovery -Sustaining recovery -Supporting people with active and advanced disease -Improving survivorship intelligence Finally, this report demonstrates how a patient-centred model of support can be effectively evaluated to provide relevant, practical and evidence-based information to commissioners. Participant satisfaction: Participants were very satisfied with the course content, course delivery and resources provided which often exceeded their needs and expectations. Participant outcomes: The PB-WPA model successfully encompassed and supported all the types of concerns participants arrived with. The most frequently reported participant concerns were psychological and emotional,about their wellbeing and about their physical health. On average, participants experienced statistically and clinically significant improvements in their MYCaW concern and wellbeing scores, and total HRQoL scores,which remained improved over the 12 month follow-up. The aspects of HRQoL that were most likely to improve after attending the Living Well course were spiritual, emotional and functional wellbeing. Supporters had their own profile of concerns, namely psychological and emotional,supporter specific concerns and practical concerns. Concerns were as severely rated as those from participants with a diagnosis of cancer and also showed statistically significant average improvements throughout the 12 month follow-up. The small group of participants with metastatic disease reported significant improvements in their MYCaW concern scores, in line with the whole evaluation group,and a significantly greater improvement in HRQoL over 12 months compared to participants with primary cancer.Participants who returned for more support from PBCC were in more need of support than those who did not return. They were more likely to have poorer HRQoL at baseline and rate their concerns more severely. Participants who returned to PBCC experienced more improvement in HRQoL that was likely to be clinically significant. These participants also had a greater degree of improvement in their MYCaW concerns, compared to non-returners. Over half of the participants experienced new concerns over the 12 month follow-up period. Concerns were most frequently associated with psychological and emotional and physical issues. Furthermore, at 12 months, participants were still experiencing arange of health issues

Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed

Rapid ascent: Rocky Mountain National Park in the Great Acceleration, 1945-present

2016 Summer.Includes bibliographical references.After the Second World War's conclusion, Rocky Mountain National Park (RMNP) experienced a massive rise in visitation. Mobilized by an affluent economy and a growing, auto-centric infrastructure, Americans rushed to RMNP in droves, setting off new concerns over the need for infrastructure improvements in the park. National parks across the country experienced similar explosions in visitation, inspiring utilities- and road-building campaigns throughout the park units administered by the National Park Service. The quasi-urbanization of parks like RMNP implicated the United States' public lands in a process of global change, whereby wartime technologies, cheap fossil fuels, and a culture of techno-optimism—epitomized by the Mission 66 development program—helped foster a "Great Acceleration" of human alterations of Earth’s natural systems. This transformation culminated in worldwide turns toward mass-urbanization, industrial agriculture, and globalized markets. The Great Acceleration, part of the Anthropocene—a new geologic epoch we have likely entered, which proposes that humans have become a force of geologic change—is used as a conceptual tool for understanding the connections between local and global changes which shaped the park after World War II. The Great Acceleration and its array of novel technologies and hydrocarbon-powered infrastructures produced specific cultures of tourism and management techniques within RMNP. After World War II, the park increasingly became the product and distillation of a fossil fuel-dependent society

Professional Identity Development of Asian American & Pacific Islander AANAPISI Staff

In spite of a swiftly growing AAPI undergraduate student population, higher education staff remain predominantly White with AAPIs significantly underrepresented within the field. The underrepresentation of AAPI professional staff is a problem not only because it may represent a lack of a career pipeline for AAPIs entering the workforce, but it also negatively impacts the large population of AAPI students who struggle to access and succeed in higher education. Contrary to prevalent stereotypes and misconceptions, many AAPI undergraduates are first-generation college students, come from low-income backgrounds, and struggle to obtain bachelor’s degrees (Maramba, 2011). Although AAPIs in predominately White fields face myriad racialized barriers, those who have developed a strong sense of professional identity may be better able to persist in spite of obstacles. Professional identity is when an individual perceives themselves as valuable and competent member of their profession (Auxier et al.; 2003; Ewan, 1988; Slay & Smith 2011). Doing so allows an individual to perform better professionally and to develop feelings of well-being and belonging in their workplaces and professions overall (Roberts et al., 2014). This study uses the theoretical frameworks of Slay and Smith’s (2011) theory of professional identity development for People of Color (POC) and Museus et al.’s (2012) theory of ethnic campus subcultures to examine how and why the experience of working for AANAPISI programs may be impactful for AAPI staff and their professional identities. Initial findings suggest that during their time working for AANAPISI programs, (a) AAPI staff experienced a simultaneous redefinition of their racial and professional identities, and (b) this redefinition took place through the process of cultural integration and validation that staff experienced working for AANAPISI. Like Slay and Smith (2011) suggest, my findings suggest that AAPI staff experience identity redefinition as their self-perceptions as higher education professionals and as AAPIs shift as they engage in AANAPISI work. The fact that these twin processes of redefinition take place simultaneously is no coincidence. Instead, participants’ redefinition of their sense of self as higher education professionals and as AAPIs were mutually reinforcing processes

An Examination of the Deliberate Practice Framework in Quad Rugby

Ericsson, Krampe, and Tesch-Römer (1993) forwarded a general framework to account for the characteristics and developmental experiences of individuals who have acquired exceptional performance in any domain. This framework proposed that experts undergo an extensive acquisition period involving the accumulation of thousands of hours of deliberate practice while overcoming various constraints that serve as functional barriers to the achievement of expertise. The purpose of this study was to examine expert disability-sport athletes to determine how well their experiences and characteristics were captured by Ericsson et al.’s (1993) framework. In Part I, quad rugby players recalled the amount of time spent in individual and team practice activities, quad rugby related activities, and daily life activities at the start of their career and every two years since. In Part II, these activities were rated with respect to relevance to improving performance, effort and concentration required, and enjoyment of participation. Findings revealed that quad rugby athletes engaged in similar amounts of practice throughout their career to those observed in superior performers across domains, including Ericsson et al.’s musicians and expert performers in the able-bodied sport domain (e.g., Helsen, Starkes, & Hodges, 1998). Contrary to the original deliberate practice framework as described by Ericsson et al. (1993), results indicated that disability-sport athletes did not rate the most relevant and effortful activities as low on enjoyment.

Changes in soil physical and hydrological properties due to Bromus tectorum (cheatgrass) invasion

Introduction of Bromus tectorum (cheatgrass) into western rangelands has had a profound effect on the diversity and health of native ecosystems. Introduced in the late 19th century, B. tectorum has rapidly out-competed native species and colonized large areas of the Great Basin region (Mack, 1981). The objective of this research is to assess changes in soil physical and hydrologic properties on former A. tridentata sites now invaded by B. tectorum and to quantify the scope of the alterations through time. Study site selection was based upon a range of A. tridentata stand replacing fire histories spanning approximately 20 years and subsequent colonization of each fire site by B. tectorum. Fire sites sampled were invaded by B. tectorum following a single fire event; the earliest plot was burned in 1985 with subsequent sites having fires in 1987, 1998, and 2002. Sites characterized by A. tridentata, and not burned, were sampled as controls. To assess soil physical and hydrological properties measures of aggregate stability; hydrophobicity; bulk density; surface strength; surface roughness; and infiltration (double-ring and tension infiltrometer) were made. T-test results indicate increased silt and clay particle size fractions and a decreased sand particle size fraction with colonization by B. tectorum. B. tectorum sites exhibited increased bulk density, aggregate stability, and surface strength along with decreasing surface roughness and saturated conductivity. No significant differences in unsaturated conductivity were represented by tension infiltrometer measurements. Sand sieve fractions indicate an increase in very coarse, coarse, and medium sand fractions and a decrease in fine and very fine sand fractions on B. tectorum sites. Results suggest that B. tectorum invasion is altering soil physical properties and in turn, surface hydrology

A Drought-Induced African Slave Trade?

Historians have frequently suggested that droughts helped facilitate the African slave trade. By introducing a previously unused dataset on 19th century rainfall levels in Africa, I provide the first empirical answer to this hypothesis. I show that negative rainfall shocks and long-run shifts in the mean level of rainfall increased the number of slaves exported from a given region and may have had a persistent impact on the level of development today. Using geocoded data on 19th century African conflicts, I show that these drought conditions also increased the likelihood of conflict, but only in the slave exporting regions of Africa. I also explore the role of household desperation, the internal African slave market, and disease outbreaks in explaining the negative relationship between droughts and slave exports. I find limited evidence for for these alternative mechanism, with household desperation having the most empirical support. These results contribute to our understanding of the process of selection into the African slave trade