Geographical variation in certification rates of blindness and sight impairment in England, 2008-2009

To examine and interpret the variation in the incidence of blindness and sight impairment in England by PCT, as reported by the Certificate of Vision Impairment (CVI). Design: Analysis of national certification data. Setting: All Primary Care Trusts, England. Participants: 23 773 CVI certifications issued from 2008 to 2009. Main Outcome measures: Crude and Age standardised rates of CVI data for blindness and sight loss by PCT. Methods: The crude and age standardised CVI rates per 100 000 were calculated with Spearman's rank correlation used to assess whether there was any evidence of association between CVI rates with Index of Multiple Deprivation (IMD) and the Programme Spend for Vision. Results: There was high-level variation, almost 11-fold (coefficient of variation 38%) in standardised CVI blindness and sight impairment annual certification rates across PCTs. The mean rate was 43.7 and the SD 16.7. We found little evidence of an association between the rate of blindness and sight impairment with either the IMD or Programme Spend on Vision. Conclusions: The wide geographical variation we found raises questions about the quality of the data and whether there is genuine unmet need for prevention of sight loss. It is a concern for public health practitioners who will be interpreting these data locally and nationally as the CVI data will form the basis of the public health indicator ‘preventable sight loss’. Poor-quality data and inadequate interpretation will only create confusion if not addressed adequately from the outset. There is an urgent need to address the shortcomings of the current data collection system and to educate all public health practitioners

Home-based tuberculosis contact investigation in Uganda: a household randomised trial.

IntroductionThe World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries, but most contacts do not complete a full clinical and laboratory evaluation.MethodsWe performed a randomised trial of home-based, SMS-facilitated, household TB contact investigation in Kampala, Uganda. Community health workers (CHWs) visited homes of index patients with pulmonary TB to screen household contacts for TB. Entire households were randomly allocated to clinic (standard-of-care) or home (intervention) evaluation. In the intervention arm, CHWs offered HIV testing to adults; collected sputum from symptomatic contacts and persons living with HIV (PLWHs) if ≥5 years; and transported sputum for microbiologic testing. CHWs referred PLWHs, children <5 years, and anyone unable to complete sputum testing to clinic. Sputum testing results and/or follow-up instructions were returned by automated SMS texts. The primary outcome was completion of a full TB evaluation within 14 days; secondary outcomes were TB and HIV diagnoses and treatments among screened contacts.ResultsThere were 471 contacts of 190 index patients allocated to the intervention and 448 contacts of 182 index patients allocated to the standard-of-care. CHWs identified 190/471 (40%) intervention and 213/448 (48%) standard-of-care contacts requiring TB evaluation. In the intervention arm, CHWs obtained sputum from 35/91 (39%) of sputum-eligible contacts and SMSs were sent to 95/190 (50%). Completion of TB evaluation in the intervention and standard-of-care arms at 14 days (14% versus 15%; difference -1%, 95% CI -9% to 7%, p=0.81) and yields of confirmed TB (1.5% versus 1.1%, p=0.62) and new HIV (2.0% versus 1.8%, p=0.90) diagnoses were similar.ConclusionsHome-based, SMS-facilitated evaluation did not improve completion or yield of household TB contact investigation, likely due to challenges delivering the intervention components

Access to Artemisinin-Based Anti-Malarial Treatment and its Related Factors in Rural Tanzania.

Artemisinin-based combination treatment (ACT) has been widely adopted as one of the main malaria control strategies. However, its promise to save thousands of lives in sub-Saharan Africa depends on how effective the use of ACT is within the routine health system. The INESS platform evaluated effective coverage of ACT in several African countries. Timely access within 24 hours to an authorized ACT outlet is one of the determinants of effective coverage and was assessed for artemether-lumefantrine (Alu), in two district health systems in rural Tanzania. From October 2009 to June 2011we conducted continuous rolling household surveys in the Kilombero-Ulanga and the Rufiji Health and Demographic Surveillance Sites (HDSS). Surveys were linked to the routine HDSS update rounds. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data on individual treatment seeking, access to treatment, timing, source of treatment and household costs per episode were collected. Data are presented on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. In Kilombero-Ulanga, 41.8% (CI: 36.6-45.1) and in Rufiji 36.8% (33.7-40.1) of fever cases had access to an authorized ACT provider within 24 hours of fever onset. In neither of the HDSS site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. Timely access to authorized ACT providers is below 50% despite interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. To improve prompt diagnosis and treatment, access remains a major bottle neck and new more innovative interventions are needed to raise effective coverage of malaria treatment in Tanzania

Lewy Body Dementia Association\u27s Research Centers of Excellence Program: Inaugural Meeting Proceedings.

The first Lewy Body Dementia Association (LBDA) Research Centers of Excellence (RCOE) Investigator\u27s meeting was held on December 14, 2017, in New Orleans. The program was established to increase patient access to clinical experts on Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson\u27s disease dementia (PDD), and to create a clinical trials-ready network. Four working groups (WG) were created to pursue the LBDA RCOE aims: (1) increase access to high-quality clinical care, (2) increase access to support for people living with LBD and their caregivers, (3) increase knowledge of LBD among medical and allied (or other) professionals, and (4) create infrastructure for a clinical trials-ready network as well as resources to advance the study of new therapeutics

Criteria for the diagnosis of corticobasal degeneration

Current criteria for the clinical diagnosis of pathologically confirmed corticobasal degeneration (CBD) no longer reflect the expanding understanding of this disease and its clinicopathologic correlations. An international consortium of behavioral neurology, neuropsychology, and movement disorders specialists developed new criteria based on consensus and a systematic literature review. Clinical diagnoses (early or late) were identified for 267 nonoverlapping pathologically confirmed CBD cases from published reports and brain banks. Combined with consensus, 4 CBD phenotypes emerged: corticobasal syndrome (CBS), frontal behavioral-spatial syndrome (FBS), nonfluent/agrammatic variant of primary progressive aphasia (naPPA), and progressive supranuclear palsy syndrome (PSPS). Clinical features of CBD cases were extracted from descriptions of 209 brain bank and published patients, providing a comprehensive description of CBD and correcting common misconceptions. Clinical CBD phenotypes and features were combined to create 2 sets of criteria: more specific clinical research criteria for probable CBD and broader criteria for possible CBD that are more inclusive but have a higher chance to detect other tau-based pathologies. Probable CBD criteria require insidious onset and gradual progression for at least 1 year, age at onset ≥50 years, no similar family history or known tau mutations, and a clinical phenotype of probable CBS or either FBS or naPPA with at least 1 CBS feature. The possible CBD category uses similar criteria but has no restrictions on age or family history, allows tau mutations, permits less rigorous phenotype fulfillment, and includes a PSPS phenotype. Future validation and refinement of the proposed criteria are needed

Adding a Plank to the Bridge: Julia Armstrong-Zwart's Leadership at UC Santa Cruz

Julia Armstrong-Zwart was hired by Chancellor Robert Sinsheimer in 1981 as Special Assistant to the Chancellor for Matters of Informal Grievance and Affirmative Action and served as the University of California, Santa Cruz’s first ombudsman. In 1983, she stepped down as ombudsman, to assume the position of assistant academic vice chancellor for faculty relations, and continued to serve as special assistant to the chancellor for affirmative action. In addition to her work as assistant vice chancellor for faculty relations, she held the position of assistant chancellor for human resources, with responsibility for the offices of Academic Human Resources, EEO/Affirmative Action, Labor Relations, Staff Human Resources, and Title IX.  She retired from UCSC in 2001.In this oral history, conducted by the Regional History Project in the summer of 2013, Armstrong-Zwart describes how she worked with other key UCSC administrators, faculty, and staff members to transform the cultural and politics of UC Santa Cruz and the University of California system. They accomplished this through vision and much hard work, strengthening existing affirmative action policies and creating innovative programs such as the Target of Opportunity faculty recruitments, establishing retention and faculty development programs, and founding a Title IX office devoted to sexual harassment prevention

Parent-of-origin-specific allelic associations among 106 genomic loci for age at menarche.

Age at menarche is a marker of timing of puberty in females. It varies widely between individuals, is a heritable trait and is associated with risks for obesity, type 2 diabetes, cardiovascular disease, breast cancer and all-cause mortality. Studies of rare human disorders of puberty and animal models point to a complex hypothalamic-pituitary-hormonal regulation, but the mechanisms that determine pubertal timing and underlie its links to disease risk remain unclear. Here, using genome-wide and custom-genotyping arrays in up to 182,416 women of European descent from 57 studies, we found robust evidence (P < 5 × 10(-8)) for 123 signals at 106 genomic loci associated with age at menarche. Many loci were associated with other pubertal traits in both sexes, and there was substantial overlap with genes implicated in body mass index and various diseases, including rare disorders of puberty. Menarche signals were enriched in imprinted regions, with three loci (DLK1-WDR25, MKRN3-MAGEL2 and KCNK9) demonstrating parent-of-origin-specific associations concordant with known parental expression patterns. Pathway analyses implicated nuclear hormone receptors, particularly retinoic acid and γ-aminobutyric acid-B2 receptor signalling, among novel mechanisms that regulate pubertal timing in humans. Our findings suggest a genetic architecture involving at least hundreds of common variants in the coordinated timing of the pubertal transition

Formar bem as mães para criar e educar boas crianças: as revistas portuguesas de educação familiar e a difusão da maternidade científica (1945-1958)

Este artigo tem como principal objetivo contribuir para a compreensão do processo de construção da maternidade científica em Portugal. Neste sentido, foi analisado um conjunto de artigos (n=628), publicados em revistas de educação familiar, entre 1945 e 1958. A análise realizada permitiu compreender que as revistas analisadas contribuem para a difusão da maternidade científica, ou seja, da ideia de que a aquisição de conhecimento científico sobre a criação e educação das crianças é elemento indispensável ao adequado exercício da função maternal. Observou-se, ainda, a existência de diferentes estratégias de educação para a maternidade, às quais está subjacente um elemento de classe, assim como diferentes níveis de adesão, por parte das mulheres, à concepção de maternidade científica

Atmospheric and Oceanic Pathways Drive Separate Modes of Southern Hemisphere Climate in Simulations of Spontaneous Dansgaard‐Oeschger‐Type Oscillations

Dansgaard-Oeschger (DO) events are a dominant mode of millennial-scale climate variability during the last glacial period with most pronounced impacts in the North Atlantic region. In Antarctica, they manifest primarily as a muted and phase-shifted temperature signal, but recent studies suggest an additional in-phase component. Here, we analyze the Southern Hemisphere (SH) response to spontaneous DO-type oscillations in a general circulation model. The dominant Antarctic temperature mode is phase-shifted compared to Greenland temperature variations and consistent with the oceanic pathway described by the bipolar seesaw model. However, the leading SH atmospheric circulation mode varies synchronously with Greenland temperatures. A westward-shifted Walker circulation and strengthened Hadley cell during Greenland temperature maxima cause zonally heterogeneous jet stream anomalies differing from the Southern Annular Mode pattern. Comparison of simulated δ18O with speleothems and ice cores indicates a good agreement in the tropics and SH mid-latitudes but deviations in Antarctica warrant further research

The inXuence of stimulus direction and eccentricity on pro-and anti-saccades in humans

Abstract We examined the sensory and motor inXuences of stimulus eccentricity and direction on saccadic reaction times (SRTs), direction-of-movement errors, and saccade amplitude for stimulus-driven (prosaccade) and volitional (antisaccade) oculomotor responses in humans. Stimuli were presented at Wve eccentricities, ranging from 0.5° to 8°, and in eight radial directions around a central Wxation point. At 0.5° eccentricity, participants showed delayed SRT and increased direction-of-movement errors consistent with misidentiWcation of the target and Wxation points. For the remaining eccentricities, horizontal saccades had shorter mean SRT than vertical saccades. Stimuli in the upper visual Weld trigger overt shifts in gaze more easily and faster than in the lower visual Weld: prosaccades to the upper hemiWeld had shorter SRT than to the lower hemiWeld, and more anti-saccade direction-of-movement errors were made into the upper hemiWeld. With the exception of the 0.5° stimuli, SRT was independent of eccentricity. Saccade amplitude was dependent on target eccentricity for prosaccades, but not for antisaccades within the range we tested. Performance matched behavioral measures described previously for monkeys performing the same tasks, conWrming that the monkey is a good model for the human oculomotor function. We conclude that an upper hemiWeld bias lead to a decrease in SRT and an increase in direction errors