The role of near adaptation in myopia development

Prolonged near work is associated with myopia development in children and young adults but the reason underlying this association is unknown. Two potentially important factors are the near work induced ocular adaptations of contrast and accommodative adaptation. This study measured the degrees of contrast and accommodative adaptation during and following reading in myopic and emmetropic children and young adults in Singapore, where myopia is highly prevalent. Reading caused significantly greater contrast and accommodative adaptations in myopic children and myopic young adults compared to that measured in emmetropes of comparable ages. The adaptations were greater in magnitude in children than young adults, suggesting that children are more susceptible to ocular changes induced by reading and thus are potentially at greater risk of adverse refractive outcomes from these adaptations. In addition to the magnitude of the adaptations the regression time of these adaptations, (i.e. their durations) are also important. Longer accommodative adaptation regression times were measured for myopic children than for emmetropic children. Although the regression of contrast adaptation was not measured, its duration may likewise be important. The refractive effects of both of these adaptations are likely to be cumulative across the day and this could promote myopia in susceptible individuals performing considerable amounts of near work. Whether the type of text read affected the magnitude of the adaptations was also explored. Given the high prevalence of myopia in Chinese children and the fact that Chinese text is more complicated to write than English text, it was hypothesized that Chinese text would induce greater adaptation. However, both Chinese and English text produced similar amounts of accommodative and contrast adaptation in young adult subjects. We propose that children who spend prolonged periods reading at a young age are most vulnerable to near work induced adaptations and hence near work induced myopia. Both Chinese and English texts produce these effects and we propose that these adaptations are likely to occur for all types of common reading texts.

‘It's the end of the university as we know it (and I feel fine)’: the Generation Y student in higher education discourse

This paper examines discussions of Generation Y within higher education discourse, arguing the sector’s use of the term to describe students is misguided for three reasons. First, portraying students as belonging to Generation Y homogenises people undertaking higher education as young, middle-class and technologically literate. Second, speaking of Generation Y students allows constructivism to be reinvented as a ‘new’ learning and teaching philosophy. Third, the Generation Y university student has become a central figure in concerns about technology’s role in learning and teaching. While the notion of the ‘Generation Y student’ creates the illusion that higher education institutions understand their constituents, ultimately, it is of little value in explaining young adults’ educational experiences.

Community beliefs about intentional injury and responsibility for prevention

Community beliefs related to intentional injury inflicted by others were examined in a population-based telephone survey (n= 1032) in Queensland, Australia. Young adults 18-24 years were nominated as the most likely to be intentionally injured. 89.1% of respondents nominating this group believed that the injury incidents occur in alcohol environments. Though respondents from this age group also identified 18-24 yo as most likely to be intentionally injured, this was at a significantly lower level than did parents or 25-64 yo respondents. Responsibility for preventing injuries was placed on proprietors of licensed premises, schools and parents/family of the victim for alcohol, school and home environments respectively. Beliefs were aligned with prevalence data on intentional injury demonstrating a high level of awareness in the community about likely victims and situations where intentional injuries occur. Interventions could target families of young adults to capitalize on high levels of awareness about young adult vulnerability.

The impact of mental health literacy on help-seeking intentions : results of a pilot study with first year psychology students

Although mental health literacy has been proposed as a factor that may facilitate help-seeking, few studies have examined this relation. This pilot study aimed to investigate the relation between mental health literacy and help-seeking intentions, and to explore which components of mental health literacy may be best able to predict help-seeking intentions. An online questionnaire was completed by a convenience sample of 150 university students enrolled in a psychology unit, aged between 17 and 26 years. A simultaneous multiple regression indicated that higher levels of mental health literacy were able to predict greater intentions to seek help from professional sources. A number of mental health literacy components made a unique and significant contribution to the prediction of help-seeking intentions. The findings of this pilot study indicate that the role of mental health literacy in facilitating help-seeking is a promising area of research.

Theraplay : staying in life's performance zone with play - Homo ludens: Man the player - Homo Cogito: Man the thinker

The paper introduces an update on a therapy originally developed by Jernberg (1979) for the American Head Start Programme for use with children and parents. Theraplay was based on John Bowlby's (1969) attachment theory and was started by Jernberg in Chicago. The present use of theraplay is for young adults to deal with negative mood and mood disorders resulting from stress, anxiety or depression. It is for the sad, lonely, sluggish, miserable or melancholic amongst us as well as the worried well.

Ocular surface changes with short-term contact lens wear

Contact lenses are a common method for the correction of refractive errors of the eye. While there have been significant advancements in contact lens designs and materials over the past few decades, the lenses still represent a foreign object in the ocular environment and may lead to physiological as well as mechanical effects on the eye. When contact lenses are placed in the eye, the ocular anatomical structures behind and in front of the lenses are directly affected. This thesis presents a series of experiments that investigate the mechanical and physiological effects of the short-term use of contact lenses on anterior and posterior corneal topography, corneal thickness, the eyelids, tarsal conjunctiva and tear film surface quality. The experimental paradigm used in these studies was a repeated measures, cross-over study design where subjects wore various types of contact lenses on different days and the lenses were varied in one or more key parameters (e.g. material or design). Both, old and newer lens materials were investigated, soft and rigid lenses were used, high and low oxygen permeability materials were tested, toric and spherical lens designs were examined, high and low powers and small and large diameter lenses were used in the studies. To establish the natural variability in the ocular measurements used in the studies, each experiment also contained at least one “baseline” day where an identical measurement protocol was followed, with no contact lenses worn. In this way, changes associated with contact lens wear were considered in relation to those changes that occurred naturally during the 8 hour period of the experiment. In the first study, the regional distribution and magnitude of change in corneal thickness and topography was investigated in the anterior and posterior cornea after short-term use of soft contact lenses in 12 young adults using the Pentacam. Four different types of contact lenses (Silicone hydrogel/ Spherical/–3D, Silicone Hydrogel/Spherical/–7D, Silicone Hydrogel/Toric/–3D and HEMA/Toric/–3D) of different materials, designs and powers were worn for 8 hours each, on 4 different days. The natural diurnal changes in corneal thickness and curvature were measured on two separate days before any contact lens wear. Significant diurnal changes in corneal thickness and curvature within the duration of the study were observed and these were taken into consideration for calculating the contact lens induced corneal changes. Corneal thickness changed significantly with lens wear and the greatest corneal swelling was seen with the hydrogel (HEMA) toric lens with a noticeable regional swelling of the cornea beneath the stabilization zones, the thickest regions of the lenses. The anterior corneal surface generally showed a slight flattening with lens wear. All contact lenses resulted in central posterior corneal steepening, which correlated with the relative degree of corneal swelling. The corneal swelling induced by the silicone hydrogel contact lenses was typically less than the natural diurnal thinning of the cornea over this same period (i.e. net thinning). This highlights why it is important to consider the natural diurnal variations in corneal thickness observed from morning to afternoon to accurately interpret contact lens induced corneal swelling. In the second experiment, the relative influence of lenses of different rigidity (polymethyl methacrylate – PMMA, rigid gas permeable – RGP and silicone hydrogel – SiHy) and diameters (9.5, 10.5 and 14.0) on corneal thickness, topography, refractive power and wavefront error were investigated. Four different types of contact lenses (PMMA/9.5, RGP/9.5, RGP/10.5, SiHy/14.0), were worn by 14 young healthy adults for a period of 8 hours on 4 different days. There was a clear association between fluorescein fitting pattern characteristics (i.e. regions of minimum clearance in the fluorescein pattern) and the resulting corneal shape changes. PMMA lenses resulted in significant corneal swelling (more in the centre than periphery) along with anterior corneal steepening and posterior flattening. RGP lenses, on the other hand, caused less corneal swelling (more in the periphery than centre) along with opposite effects on corneal curvature, anterior corneal flattening and posterior steepening. RGP lenses also resulted in a clinically and statistically significant decrease in corneal refractive power (ranging from 0.99 to 0.01 D), large enough to affect vision and require adjustment in the lens power. Wavefront analysis also showed a significant increase in higher order aberrations after PMMA lens wear, which may partly explain previous reports of "spectacle blur" following PMMA lens wear. We further explored corneal curvature, thickness and refractive changes with back surface toric and spherical RGP lenses in a group of 6 subjects with toric corneas. The lenses were worn for 8 hours and measurements were taken before and after lens wear, as in previous experiments. Both lens types caused anterior corneal flattening and a decrease in corneal refractive power but the changes were greater with the spherical lens. The spherical lens also caused a significant decrease in WTR astigmatism (WRT astigmatism defined as major axis within 30 degrees of horizontal). Both the lenses caused slight posterior corneal steepening and corneal swelling, with a greater effect in the periphery compared to the central cornea. Eyelid position, lid-wiper and tarsal conjunctival staining were also measured in Experiment 2 after short-term use of the rigid and SiHy contact lenses. Digital photos of the external eyes were captured for lid position analysis. The lid-wiper region of the marginal conjunctiva was stained using fluorescein and lissamine green dyes and digital photos were graded by an independent masked observer. A grading scale was developed in order to describe the tarsal conjunctival staining. A significant decrease in the palpebral aperture height (blepharoptosis) was found after wearing of PMMA/9.5 and RGP/10.5 lenses. All three rigid contact lenses caused a significant increase in lid-wiper and tarsal staining after 8 hours of lens wear. There was also a significant diurnal increase in tarsal staining, even without contact lens wear. These findings highlight the need for better contact lens edge design to minimise the interactions between the lid and contact lens edge during blinking and more lubricious contact lens surfaces to reduce ocular surface micro-trauma due to friction and for. Tear film surface quality (TFSQ) was measured using a high-speed videokeratoscopy technique in Experiment 2. TFSQ was worse with all the lenses compared to baseline (PMMA/9.5, RGP/9.5, RGP/10.5, and SiHy/14) in the afternoon (after 8 hours) during normal and suppressed blinking conditions. The reduction in TFSQ was similar with all the contact lenses used, irrespective of their material and diameter. An unusual pattern of change in TFSQ in suppressed blinking conditions was also found. The TFSQ with contact lens was found to decrease until a certain time after which it improved to a value even better than the bare eye. This is likely to be due to the tear film drying completely over the surface of the contact lenses. The findings of this study also show that there is still a scope for improvement in contact lens materials in terms of better wettability and hydrophilicity in order to improve TFSQ and patient comfort. These experiments showed that a variety of changes can occur in the anterior eye as a result of the short-term use of a range of commonly used contact lens types. The greatest corneal changes occurred with lenses manufactured from older HEMA and PMMA lens materials, whereas modern SiHy and rigid gas permeable materials caused more subtle changes in corneal shape and thickness. All lenses caused signs of micro-trauma to the eyelid wiper and palpebral conjunctiva, although rigid lenses appeared to cause more significant changes. Tear film surface quality was also significantly reduced with all types of contact lenses. These short-term changes in the anterior eye are potential markers for further long term changes and the relative differences between lens types that we have identified provide an indication of areas of contact lens design and manufacture that warrant further development.

Even moderate visual impairments degrade drivers’ ability to see pedestrians at night

Purpose: To determine the effect of moderate levels of refractive blur and simulated cataracts on nighttime pedestrian conspicuity in the presence and absence of headlamp glare. Methods: The ability to recognize pedestrians at night was measured in 28 young adults (M=27.6 years) under three visual conditions: normal vision, refractive blur and simulated cataracts; mean acuity was 20/40 or better in all conditions. Pedestrian recognition distances were recorded while participants drove an instrumented vehicle along a closed road course at night. Pedestrians wore one of three clothing conditions and oncoming headlamps were present for 16 participants and absent for 12 participants. Results: Simulated visual impairment and glare significantly reduced the frequency with which drivers recognized pedestrians and the distance at which the drivers first recognized them. Simulated cataracts were significantly more disruptive than blur even though photopic visual acuity levels were matched. With normal vision, drivers responded to pedestrians at 3.6x and 5.5x longer distances on average than for the blur or cataract conditions, respectively. Even in the presence of visual impairment and glare, pedestrians were recognized more often and at longer distances when they wore a “biological motion” reflective clothing configuration than when they wore a reflective vest or black clothing. Conclusions: Drivers’ ability to recognize pedestrians at night is degraded by common visual impairments even when the drivers’ mean visual acuity meets licensing requirements. To maximize drivers’ ability to see pedestrians, drivers should wear their optimum optical correction, and cataract surgery should be performed early enough to avoid potentially dangerous reductions in visual performance.

Effects of simulated cataracts on speech intelligibility

Limited research is available on how well visual cues integrate with auditory cues to improve speech intelligibility in persons with visual impairments, such as cataracts. We investigated whether simulated cataracts interfered with participants’ ability to use visual cues to help disambiguate a spoken message in the presence of spoken background noise. We tested 21 young adults with normal visual acuity and hearing sensitivity. Speech intelligibility was tested under three conditions: auditory only with no visual input, auditory-visual with normal viewing, and auditory-visual with simulated cataracts. Central Institute for the Deaf (CID) Everyday Speech Sentences were spoken by a live talker, mimicking a pre-recorded audio track, in the presence of pre-recorded four-person background babble at a signal-to-noise ratio (SNR) of -13 dB. The talker was masked to the experimental conditions to control for experimenter bias. Relative to the normal vision condition, speech intelligibility was significantly poorer, [t (20) = 4.17, p < .01, Cohen’s d =1.0], in the simulated cataract condition. These results suggest that cataracts can interfere with speech perception, which may occur through a reduction in visual cues, less effective integration or a combination of the two effects. These novel findings contribute to our understanding of the association between two common sensory problems in adults: reduced contrast sensitivity associated with cataracts and reduced face-to-face communication in noise.

Hybridized writing for scientific literacy : pedagogy and evidence

Disengagement of students in science and the scientific literacy of young adults are interrelated international concerns. One way to address these concerns is to engage students imaginatively in activities designed to improve their scientific literacy. Our ongoing program of research has focused on the effects of a sequence of activities that require students to transform scientific information on important issues for their communities from government websites into narrative text suitable for a lay reader. These hybridized stories we call BioStories. Students upload their stories for peer review to a dedicated website. Peer reviews are intended to help students refine their stories. Reviewing BioStories also gives students access to a wider range of scientific topics and writing styles. We have conducted separate studies with students from Grade 6, Grade 9 and Grade 12, involving case study and quasi-experimental designs. The results from the 6th grade study support the argument that writing the sequence of stories helped the students become more familiar with the scientific issue, develop a deeper understanding of related biological concepts, and improve their interest in science. Unlike the Grade 6 study, it was not possible to include a control group for the study conducted across eight 9th grade classes. Nevertheless, these results suggest that hybridized writing developed more positive attitudes toward science and science learning, particularly in terms of the students’ interest and enjoyment. In the most recent case study with Grade 12 students, we found that pride, strength, determination, interest and alertness were among the positive emotions most strongly elicited by the writing project. Furthermore, the students expressed enhanced feelings of self-efficacy in successfully writing hybridized scientific narratives in science. In this chapter, we describe the pedagogy of hybridized writing in science, overview the evidence to support this approach, and identify future developments.

Axial length changes with shifts of gaze direction in myopes and emmetropes

Purpose. The purpose of the study was to investigate the changes in axial length occurring with shifts in gaze direction. Methods. Axial length measurements were obtained from the left eye of 30 young adults (10 emmetropes, 10 low myopes, and 10 moderate myopes) through a rotating prism with 15° deviation, along the foveal axis, using a noncontact optical biometer in each of the nine different cardinal directions of gaze over 5 minutes. The subject's fellow eye fixated on an external distance (6 m) target to control accommodation, also with 15° deviation. Axial length measurements were also performed in 15° and 25° downward gaze with the biometer inclined on a tilting table, allowing gaze shifts to be achieved with either full head turn but no eye turn, or full eye turn with no head turn. Results. There was a significant influence of gaze angle and time on axial length (both P < 0.001), with the greatest axial elongation (+18 ± 8 μm) occurring with inferonasal gaze (P < 0.001) and a slight decrease in axial length in superior gaze (−12 ± 17 μm) compared with primary gaze (P < 0.001). In downward gaze, a significant axial elongation occurred when eye turn was used (P < 0.001), but not when head turn was used to shift gaze (P > 0.05). Conclusions. The angle of gaze has a small but significant short-term effect on axial length, with greatest elongation occurring in inferonasal gaze. The elongation of the eye appears to be due to the influence of the extraocular muscles, in particular the oblique muscles.

Monocular myopic defocus and daily changes in axial length and choroidal thickness of human eyes

Recent research indicates that brief periods (60 minutes) of monocular defocus lead to small but significant changes in human axial length. However, the effects of longer periods of defocus on the axial length of human eyes are unknown. We examined the influence of a 12 hour period of monocular myopic defocus on the natural daily variations occurring in axial length and choroidal thickness of young adult emmetropes. A series of axial length and choroidal thickness measurements (collected at ~3 hourly intervals, with the first measurement at ~9 am and the final measurement at ~9 pm) were obtained for 13 emmetropic young adults over three consecutive days. The natural daily rhythms (Day 1, baseline day, no defocus), the daily rhythms with monocular myopic defocus (Day 2, defocus day, +1.50 DS spectacle lens over the right eye), and the recovery from any defocus induced changes (Day 3, recovery day, no defocus) were all examined. Significant variations over the course of the day were observed in both axial length and choroidal thickness on each of the three measurement days (p<0.0001). The magnitude and timing of the daily variations in axial length and choroidal thickness were significantly altered with the monocular myopic defocus on day 2 (p<0.0001). Following the introduction of monocular myopic defocus, the daily peak in axial length occurred approximately 6 hours later, and the peak in choroidal thickness approximately 8.5 hours earlier in the day compared to days 1 and 3 (with no defocus). The mean amplitude (peak to trough) of change in axial length (0.030 ± 0.012 on day 1, 0.020 ± 0.010 on day 2 and 0.033 ± 0.012 mm on day 3) and choroidal thickness (0.030 ± 0.007 on day 1, 0.022 ± 0.006 on day 2 and 0.027 ± 0.009 mm on day 3) were also significantly different between the three days (both p<0.05). The introduction of monocular myopic defocus disrupts the daily variations in axial length and choroidal thickness of human eyes (in terms of both amplitude and timing) that return to normal the following day after removal of the defocus.

Have we misinterpreted the study of Hoogerheide et al. (1971)?

In 1971, Rempt et al. reported peripheral refraction patterns (skiagrams) along the horizontal visual field in 442 people. Later in the same year, Hoogerheide et al. used skiagrams in combination with medical records to relate skiagrams in emmetropes and hyperopes to progression of myopia in young adults. The two articles have spurred interest in peripheral refraction in the past decade. We challenge the understanding that their articles provide evidence that the peripheral refraction pattern along the horizontal visual field is predictive of whether or not a person develops myopia. First, although it has been generally assumed that the skiagrams were measured before the changes in refraction were monitored, Hoogerheide et al. did not state that this was the case. Second, if the skiagrams were obtained at an initial examination and given the likely rates of recruitment and successful completion of training, the study must have taken place during a period of 10 to 15 years; it is much more likely that Hoogerheide et al. measured the skiagrams in a shorter period. Third, despite there being many more emmetropes and hyperopes in the Rempt et al. article than there are in the Hoogerheide et al. article, the number of people in two types of “at risk” skiagrams is greater in the latter; this is consistent with the central refraction status being reported from an earlier time by Hoogerheide et al. than by Rempt et al. In summary, we believe that the skiagrams reported by Hoogerheide et al. were taken at a later examination, after myopia did or did not occur, and that the refraction data from the initial examination were retrieved from the medical archives. Thus, this work does not provide evidence that peripheral refraction pattern is indicative of the likely development of myopia.

An HIV epidemic is ready to emerge in the Philippines

Background: The state of the HIV epidemic in the Philippines has been described as "low and slow", which is in stark contrast to many other countries in the region. A review of the conditions for HIV spread in the Philippines is necessary. Methods: We evaluated the current epidemiology, trends in behaviour and public health response in the Philippines to identify factors that could account for the current HIV epidemic, as well as to review conditions that may be of concern for facilitating an emerging epidemic. Results: The past control of HIV in the Philippines cannot be attributed to any single factor, nor is it necessarily a result of the actions of the Filipino government or other stakeholders. Likely reasons for the epidemic's slow development include: the country's geography is complicated; injecting drug use is relatively uncommon; a culture of sexual conservatism exists; sex workers tend to have few clients; anal sex is relatively uncommon; and circumcision rates are relatively high. In contrast, there are numerous factors suggesting that HIV is increasing and ready to emerge at high rates, including: the lowest documented rates of condom use in Asia; increasing casual sexual activity; returning overseas Filipino workers from high-prevalence settings; widespread misconceptions about HIV/AIDS; and high needle-sharing rates among injecting drug users. There was a three-fold increase in the rate of HIV diagnoses in the Philippines between 2003 and 2008, and this has continued over the past year. HIV diagnoses rates have noticeably increased among men, particularly among bisexual and homosexual men (114% and 214% respective increases over 2003-2008). The average age of diagnosis has also significantly decreased, from approximately 36 to 29 years. Conclusions: Young adults, men who have sex with men, commercial sex workers, injecting drug users, overseas Filipino workers, and the sexual partners of people in these groups are particularly vulnerable to HIV infection. There is no guarantee that a large HIV epidemic will be avoided in the near future. Indeed, an expanding HIV epidemic is likely to be only a matter of time as the components for such an epidemic are already present in the Philippines.

Predicting depressive and anxiety disorders with the YASR internalising scales (empirical and DSM-oriented)

Background The Achenbach problem behaviour scales (CBCL/YSR) are widely used. The DSM-oriented anxiety and depression scales have been created to improve concordance between Achenbach’s internalising scales and DSM-IV depression and anxiety. To date no study has examined the concurrent utility of the young adult (YASR) internalising scales, either the empirical or newly developed DSM-oriented depressive or anxiety scales. Methods A sample of 2,551 young adults, aged 18–23 years, from an Australian cohort study. The association between the empirical and DSM-oriented anxiety and depression scales were individually assessed against DSMIV depression and anxiety diagnoses derived from structured interview. Odds ratios, ROC analyses and diagnostic efficiency tests (sensitivity, specificity, positive and negative predictive values) were used to report findings. Results YASR empirical internalising scale predicted DSM-IV mood disorders (depression OR = 6.9, 95% CI 5.0–9.5; anxiety OR = 5.1, 95% CI 3.8–6.7) in the previous 12 months. DSM-oriented depressive or anxiety scales did not appear to improve the concordance with DSM-IV diagnosed depression or anxiety. The internalising scales were much more effective at identifying those with comorbid depression and anxiety, with Ors between 10.1 and 21.7 depending on the internalising scale used. Conclusion DSM-oriented scales perform no better than the standard internalising in identifying young adults with DSM-IV mood or anxiety disorder.

Screening in early childhood for risk of later mental health problems : a longitudinal study

Depression in childhood or adolescence is associated with increased rates of depression in adulthood. Does this justify efforts to detect (and treat) those with symptoms of depression in early childhood or adolescence? The aim of this study was to determine how well symptoms of anxiety/depression (A-D) in early childhood and adolescence predict adult mental health. The study sample is taken from a population-based prospective birth cohort study. Of the 8556 mothers initially approached to participate 8458 agreed, of whom 7223 mothers gave birth to a live singleton baby. Children were screened using modified Child Behaviour Checklist (CBCL) scales for internalizing and total problems (T-P) at age 5 and the CBCL and Youth Self Report (YSR) A-D subscale and T-P scale at age 14. At age 21, a sub-sample of 2563 young adults in this cohort were administered the CIDI-Auto. Results indicated that screening at age 5 would detect few later cases of significant mental ill-health. Using a cut-point of 20% for internalizing at child age 5 years the CBCL had sensitivities of only 25% and 18% for major depression and anxiety disorders at 21 years, respectively. At age 14, the YSR generally performed a little better than the CBCL as a screening instrument, but neither performed at a satisfactory level. Of the children who were categorised as having YSR A-D at 14 years 30% and 37% met DSM-IV criteria for major depression and anxiety disorders, respectively, at age 21. Our findings challenge an existing movement encouraging the detection and treatment of those with symptoms of mental illness in early childhood.