Emotional well-being and adjustment to vision loss in later life: a meta-synthesis of qualitative studies.

Purpose: To review perceived emotional well-being in older people with visual impairment and perceived factors that inhibit/facilitate psychosocial adjustment to vision loss. Method: The databases of MEDLINE, EMBASE, PsycINFO and CINAHL were searched for studies published from January 1980 to December 2010, which recruited older people with irreversible vision loss, and used qualitative methods for both data collection and analysis. Results sections of the papers were synthesised using a thematic-style analysis to identify the emergent and dominant themes. Results: Seventeen qualitative papers were included in the review, and five main themes emerged from the synthesis: 1) the trauma of an ophthalmic diagnosis, 2) impact of vision loss on daily life, 3) negative impact of visual impairment on psychosocial well-being, 4) factors that inhibit social well-being, and 5) factors that facilitate psychological well-being. We found the response shift model useful for explaining our synthesis. Conclusions: Acquired visual impairment can have a significant impact on older people's well-being and make psychosocial adjustment to the condition a major challenge. Acceptance of the condition and a positive attitude facilitate successful psychosocial adjustment to vision loss as well as social support from family, friends and peers who have successfully adjusted to the condition. [Box: see text].

Can the dynamical impact of the stratosphere on the troposphere be described by large-scale adjustment to the stratospheric PV distribution?

Recent numerical experiments have demonstrated that the state of the stratosphere has a dynamical impact on the state of the troposphere. To account for such an effect, a number of mechanisms have been proposed in the literature, all of which amount to a large-scale adjustment of the troposphere to potential vorticity (PV) anomalies in the stratosphere. This paper analyses whether a simple PV adjustment suffices to explain the actual dynamical response of the troposphere to the state of the stratosphere, the actual response being determined by ensembles of numerical experiments run with an atmospheric general-circulation model. For this purpose, a new PV inverter is developed. It is shown that the simple PV adjustment hypothesis is inadequate. PV anomalies in the stratosphere induce, by inversion, flow anomalies in the troposphere that do not coincide spatially with the tropospheric changes determined by the numerical experiments. Moreover, the tropospheric anomalies induced by PV inversion are on a larger scale than the changes found in the numerical experiments, which are linked to the Atlantic and Pacific storm-tracks. These findings imply that the impact of the stratospheric state on the troposphere is manifested through the impact on individual synoptic-scale systems and their self-organization in the storm-tracks. Changes in these weather systems in the troposphere are not merely synoptic-scale noise on a larger scale tropospheric response, but an integral part of the mechanism by which the state of the stratosphere impacts that of the troposphere.

Understanding land-sea warming contrast in response to increasing greenhouse gases. Part I: Transient adjustment

Climate model simulations consistently show that surface temperature over land increases more rapidly than over sea in response to greenhouse gas forcing. The enhanced warming over land is not simply a transient effect caused by the land–sea contrast in heat capacities, since it is also present in equilibrium conditions. This paper elucidates the transient adjustment processes over time scales of days to weeks of the surface and tropospheric climate in response to a doubling of CO2 and to changes in sea surface temperature (SST), imposed separately and together, using ensembles of experiments with an atmospheric general circulation model. These adjustment processes can be grouped into three stages: immediate response of the troposphere and surface processes (day 1), fast adjustment of surface processes (days 2–5), and adjustment of the whole troposphere (days 6–20). Some land surface warming in response to doubled CO2 (with unchanged SSTs) occurs immediately because of increased downward longwave radiation. Increased CO2 also leads to reduced plant stomatal resistance and hence restricted evaporation, which increases land surface warming in the first day. Rapid reductions in cloud amount lead in the next few days to increased downward shortwave radiation and further warming, which spreads upward from the surface, and by day 5 the surface and tropospheric response is statistically consistent with the equilibrium value. Land surface warming in response to imposed SST change (with unchanged CO2) is slower. Tropospheric warming is advected inland from the sea, and over land it occurs at all levels together rather than spreading upward from the surface. The atmospheric response to prescribed SST change in about 20 days is statistically consistent with the equilibrium value, and the warming is largest in the upper troposphere over both land and sea. The land surface warming involves reduction of cloud cover and increased downward shortwave radiation, as in the experiment with CO2 change, but in this case it is due to the restriction of moisture supply to the land (indicated by reduced soil moisture), whereas in the CO2 forcing experiment it is due to restricted evaporation despite increased moisture supply (indicated by increased soil moisture). The warming over land in response to SST change is greater than over the sea and is the dominant contribution to the land–sea warming contrast under enhanced CO2 forcing.

The impact of global freshwater forcing on the thermohaline circulation: adjustment of North Atlantic convection sites in a CGCM

On the time scale of a century, the Atlantic thermohaline circulation (THC) is sensitive to the global surface salinity distribution. The advection of salinity toward the deep convection sites of the North Atlantic is one of the driving mechanisms for the THC. There is both a northward and a southward contributions. The northward salinity advection (Nsa) is related to the evaporation in the subtropics, and contributes to increased salinity in the convection sites. The southward salinity advection (Ssa) is related to the Arctic freshwater forcing and tends on the contrary to diminish salinity in the convection sites. The THC changes results from a delicate balance between these opposing mechanisms. In this study we evaluate these two effects using the IPSL-CM4 ocean-atmosphere-sea-ice coupled model (used for IPCC AR4). Perturbation experiments have been integrated for 100 years under modern insolation and trace gases. River runoff and evaporation minus precipitation are successively set to zero for the ocean during the coupling procedure. This allows the effect of processes Nsa and Ssa to be estimated with their specific time scales. It is shown that the convection sites in the North Atlantic exhibit various sensitivities to these processes. The Labrador Sea exhibits a dominant sensitivity to local forcing and Ssa with a typical time scale of 10 years, whereas the Irminger Sea is mostly sensitive to Nsa with a 15 year time scale. The GIN Seas respond to both effects with a time scale of 10 years for Ssa and 20 years for Nsa. It is concluded that, in the IPSL-CM4, the global freshwater forcing damps the THC on centennial time scales.

A covariate adjustment for zero-truncated approaches to estimating the size of hidden and elusive populations

In this paper we consider the estimation of population size from onesource capture–recapture data, that is, a list in which individuals can potentially be found repeatedly and where the question is how many individuals are missed by the list. As a typical example, we provide data from a drug user study in Bangkok from 2001 where the list consists of drug users who repeatedly contact treatment institutions. Drug users with 1, 2, 3, . . . contacts occur, but drug users with zero contacts are not present, requiring the size of this group to be estimated. Statistically, these data can be considered as stemming from a zero-truncated count distribution.We revisit an estimator for the population size suggested by Zelterman that is known to be robust under potential unobserved heterogeneity. We demonstrate that the Zelterman estimator can be viewed as a maximum likelihood estimator for a locally truncated Poisson likelihood which is equivalent to a binomial likelihood. This result allows the extension of the Zelterman estimator by means of logistic regression to include observed heterogeneity in the form of covariates. We also review an estimator proposed by Chao and explain why we are not able to obtain similar results for this estimator. The Zelterman estimator is applied in two case studies, the first a drug user study from Bangkok, the second an illegal immigrant study in the Netherlands. Our results suggest the new estimator should be used, in particular, if substantial unobserved heterogeneity is present.

Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness

Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and Subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Maternal psychosocial adversity and the longitudinal development of infant sleep

Research has identified associations between indicators of social disadvantage and the presence of child sleep problems. We examined the longitudinal development of infant sleep in families experiencing high (n = 58) or low (n = 64) levels of psychosocial adversity, and the contributions of neonatal self-regulatory capacities and maternal settling strategies to this development. Assessments of infant sleep at 4-, 7-, and 12-weeks postpartum indicated no differences in sleeping difficulties between high- and low-adversity groups. However, more infant sleep difficulties were reported in the high- versus low-adversity groups at 12- and 18-month follow-ups. Neonatal self-regulatory capacities were not related to the presence or absence of adversity, or to subsequent infant sleep quality. However, there were group differences in maternal settling strategies that did predict subsequent infant sleep difficulties. The pattern of sleep disturbance observed in association with maternal psychosocial adversity at 18-months was consistent with risk for broader impairments in child functioning.

The climate response to CO2 of the Hadley Centre coupled AOGCM with and without flux adjustment

Coupled atmosphere‐ocean general circulation models have a tendency to drift away from a realistic climatology. The modelled climate response to an increase of CO2 concentration may be incorrect if the simulation of the current climate has significant errors, so in many models, including ours, the drift is counteracted by applying prescribed fluxes of heat and fresh water at the ocean‐atmosphere interface in addition to the calculated surface exchanges. Since the additional fluxes do not have a physical basis, the use of this technique of “flux adjustment” itself introduces some uncertainty in the simulated response to increased CO2. We find that the global‐average temperature response of our model to CO2 increasing at 1% per year is about 30% less without flux adjustment than with flux adjustment. The geographical patterns of the response are similar, indicating that flux adjustment is not causing any gross distortion. The reduced size of the response is due to more effective vertical transport of heat into the ocean, and a somewhat smaller climate sensitivity. Although the response in both cases lies within the generally accepted range for the climate sensitivity, systematic uncertainties of this size are clearly undesirable, and the best strategy for future development is to improve the climate model in order to reduce the need for flux adjustment.