Evaluating digital diabetic retinopathy screening in people aged 90 years and over

To evaluate the effectiveness of digital diabetic retinopathy screening in patients aged 90 years and over.MethodsThis is a retrospective analysis of 200 randomly selected patients eligible for diabetic retinopathy screening aged 90 years and over within the Birmingham, Solihull, and Black Country Screening Programme.ResultsOne hundred and seventy-nine (90%) patients attended screening at least once. 133 (74%) annual screening after their first screen, of whom 59% had no detectable diabetic retinopathy; 38 (21%) were referred for ophthalmology clinical assessment-36 for nondiabetic retinopathy reasons and two for diabetic maculopathy. Cataract accounted for 50% of all referrals for ophthalmology clinical assessment. Of the 133 patients placed on annual screening, 93 (70%) were screened at least once more. In terms of level of diabetic retinopathy, assessability or other ocular pathologies, 8 improved, 51 remained stable, and 31 deteriorated. Of the latter, 19 patients were referred for ophthalmology clinical assessment; none of these for diabetic retinopathy.ConclusionsScreening provides opportunistic identification of important nondiabetic retinopathy eye conditions. However, in view of the low identification rate of sight-threatening diabetic retinopathy in patients aged 90 years and over, and the current mission statement of the NHS Diabetic Eye Screening Programme, systematic annual diabetic retinopathy screening may not be justified in this age group of patients, but rather be performed in optometric practice.

Global trends in myopia management attitudes and strategies in clinical practice

PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

Similarities and Differences in Polish and Hungarian History

In my lecture I would like to give a general introduction to a comparative approach of Polish and Hungarian history. I am convinced it could be not only an interesting, but a relevant issue as well. This approach could be touching emotionally for average Hungarian and Polish people because both nations strongly felt last centuries that they had common historical fate in East Central Europe. There is evidence which prove that Polish-Hungarian friendship is not only a modern phenomenon, but it is originated from the historical past. Historical memory calls the attention that Polish-Hungarian friendship was rooted already in the early modern history, and it was not constructed by historians, but a special relationship between the two nations was a widespread and accepted concept for the wider public in Hungary. I can cite the well-known proverb which represents it: „Pole and Hungarian – two good friends, joint fight and drinking are their ends.” In this lecture I don’t want to give a complete list of differences and similarities, but to call the attention to some interesting aspects of two nations’ common historical fate.

The Use of the Military for Law Enforcement Activities in Central America

Faced with the violence, criminality and insecurity now threatening peace and democratic governance in Central America, the region’s governments have decided to use the Armed Forces to carry out actions in response to criminal actions, looking to improve their performance. Although public demand for including the Armed Forces in these functions takes place within a legally legitimate framework, it is motivated by tangible circumstances such as increased levels of violence, delinquency and crime. Despite being coupled with the perception of institutional weakness within the security and judicial system (particularly police) and the recognition of prestige, efficiency, discipline and severity in fulfilling the Armed Forces’ missions, these arguments are insufficient to legitimize the use of the military as a police force. Within this context, this paper reflects on the implications or consequences of the use of the Armed Forces in duties traditionally assigned to the police in the Central American region with the goal of contributing to the debate on this topic taking place in the Americas. To achieve this end, first we will focus on understanding the actual context in which a decision is made to involve the Armed Forces in security duties in the region. Second, we will examine the effects and implications of this decision on the Armed Forces’ relations within their respective societies. Third and finally, considering this is already a reality in the region, this paper will provide recommendations. The main findings of this research, resulting from the application of an analyticaldescriptive and historically based study, are organized in three dimensions: the political dimension, by implication referring to the relationship between the ultimate political authority and the Armed Forces; the social dimension, by implication the opinion of citizens; and other implications not only affecting the structural and cultural organization of armies and police but also the complementary operational framework within a context of comprehensive response by the State. As a main conclusion, it poses there is an environment conducive to the use of the Armed Forces in citizen’s security, in view of the impact of threats provoked by criminal structures of a military nature currently operating in Central America. However, this participation creates an inevitable social and political impact if implemented in isolation or given a political leading role and/or operational autonomy. This participation poses risks to the institutions of the Armed Forces and the police as well. Finally, this paper identifies an urgent need for the Armed Forces’ role to be more clearly defined with regard to security matters, limiting it to threats that impact States’ governability and existence. Nonetheless, Central American States should seek a COMPREHENSIVE response to current crime and violence, using all necessary institutions to confront these challenges, but with defined roles and responsibilities for each and dynamic coordination to complement their actions.

Capabilities of Police and Military Forces in Central America -- A Comparative Analysis of Guatemala, El Salvador, Honduras an d Nicaragua

A difficult transition to a new paradigm of Democratic Security and the subsequent process of military restructuring during the nineties led El Salvador, Honduras, Guatemala and Nicaragua to re-consider their old structures and functions of their armed forces and police agencies. This study compares the institutions in the four countries mentioned above to assess their current condition and response capacity in view of the contemporary security challenges in Central America. This report reveals that the original intention of limiting armies to defend and protect borders has been threatened by the increasing participation of armies in public security. While the strength of armies has been consolidated in terms of numbers, air and naval forces have failed to become strengthened or sufficiently developed to effectively combat organized crime and drug trafficking and are barely able to conduct air and sea operations. Honduras has been the only country that has maintained a proportional distribution of its armed forces. However, security has been in the hands of a Judicial Police, supervised by the Public Ministry. The Honduran Judicial Police has been limited to exercising preventive police duties, prohibited from carrying out criminal investigations. Nicaragua, meanwhile, possesses a successful police force, socially recognized for maintaining satisfactory levels of security surpassing the Guatemalan and El Salvadoran police, which have not achieved similar results despite of having set up a civilian police force separate from the military. El Salvador meanwhile, has excelled in promoting a Police Academy and career professional education, even while not having military attachés in other countries. Regarding budgetary issues, the four countries allocate almost twice the amount of funding on their security budgets in comparison to what is allocated to their defense budgets. However, spending in both areas is low when taking into account each country's GDP as well as their high crime rates. Regional security challenges must be accompanied by a professionalization of the regional armies focused on protecting and defending borders. Therefore, strong institutional frameworks to support the fight against crime and drug trafficking are required. It will require the strengthening of customs, greater control of illicit arms trafficking, investment in education initiatives, creating employment opportunities and facilitating significant improvements in the judicial system, as well as its accessibility to the average citizen.

The activity of the feminist online publications: challenges for the transmission of the feminist culture in Spain

Traditionally, big media corporations have contributed to hiding the women’s movement itself, as well as its main claims and topics of discussion (Marx, Myra y Hess, 1995; Rhode, 1995; Mendes, 2011). This has led the feminist movement to develop its own media generally print publications, usually, with a very specialized character and reduced audience. This is similar to what has occurred with quality main stream media, asthese publications have had to adapt themselves to a new communicatiion context, because of the financial crisis and  technological evolution. Feminist media has found in the Internet an excellent opportunity to access citizens and communicate their messages. , In view of this scene of change and renovation,  this article offers the results of a qualitative analysis focused on the experiences of four feminist online media sites edited in Spain: Pikaramagazine.com, Proyecto-kahlo.com, Mujeresenred.net and Laindependent.cat. Besides exploring the characteristics and content of these sites, the article pays attention to the virality of their contents spread through Facebook and Twitter. The onclusion estimates their social impact, insofar as they symbolize the specialization, diversification and dialogue promoted by the Web.

Optimized operations of Distributed Renewable Energy Sources in Smart Grid

The renewable energy sources (RES) will play a vital role in the future power needs in view of the increasing demand of electrical energy and depletion of fossil fuel with its environmental impact. The main constraints of renewable energy (RE) generation are high capital investment, fluctuation in generation and requirement of vast land area. Distributed RE generation on roof top of buildings will overcome these issues to some extent. Any system will be feasible only if it is economically viable and reliable. Economic viability depends on the availability of RE and requirement of energy in specific locations. This work is directed to examine the economic viability of the system at desired location and demand.

Farmers' Resilience to Climate Change in the Welsh Marshes

Climate change will exacerbate challenges facing food security in the UK. Increasing frequency and intensity of extreme weather events will further impact upon farm systems. At the heart of the impending challenges to UK agricultural production, farmers’ resilience will be tested to new limits. Research into farmers’ resilience to climate change in the UK is distinctly underdeveloped when compared to research in developing and other developed nations. This research gap is addressed through exploration of farmers’ resilience in the Welsh Marches, establishing the role of risk perceptions, local knowledge and adaptive capacity in farmers’ decision-making to limit climate shocks. Further contributions to agricultural geography are made through experimentation of a ‘cultural-behavioural approach’, seeking to revisit the behavioural approach in view of the cultural-turn. The Welsh Marches, situated on the English-Welsh border, has been selected as a focal point due to its agricultural diversity, and known experiences of extreme weather events. A phased mixed methodological approach is adopted. Phase one explores recorded and reported experiences of past extreme weather events in local meteorological records and local newspaper articles. Phase two consists of 115 survey-questionnaires, 15 in-depth semi-structured interviews, and a scenario based focus group with selected farmers from the Welsh Marches. This allows farmers’ resilience to climate change in the past, present and future to be explored. Original contributions to knowledge are made through demonstrating the value of focusing upon the culture of a specific farm community, applying a ‘bottom-up’ approach. The priority given to the weather in farmers’ decision-making is identified to be determined by individual relationships that farmers’ develop with the weather. Yet, a consensus of farmers’ observations has established recognition of considerable changes in the weather over the last 30 years, acknowledging more extremes and seasonal variations. In contrast, perceptions of future climate change are largely varied. Farmers are found to be disengaged with the communication of climate change science, as the global impacts portrayed are distant in time and place from probable impacts that may be experienced locally. Current communication of climate change information has been identified to alienate farmers from the local reality of probable future impacts. Adaptation options and responses to extreme weather and climate change are identified from measures found to be already implemented and considered for the future. A greater need to explore local knowledge and risk perception in relation to farmers’ understanding of future climate challenges is clear. There is a need to conduct comparable research in different farm communities across the UK. Progression into establishing the role of farmers’ resilience in responding effectively to future climate challenges has only just begun.

The role of nuclear physics in supernovae and the evolution of neutron stars, Neutrino Opacities, Equation of State, Transport Coefficients, and Dark Matter Production

Thesis (Ph.D.)--University of Washington, 2016-08

Die Koranschule. Eine Alternative zur öffentlichen Grundschule in einem laizistischen Staat? Ein Fallbeispiel: Die Republik Senegal

In Anbetracht der sich eher verschlechternden Lage des öffentlichen Schulwesens in den Ländern Schwarzafrikas sucht man in den internationalen und nationalen Diskussionen u.a. nach alternativen, auf traditionelle und private Bildungsformen aufbauenden Strategien zur Förderung der Grundbildung. Das sich verändernde islamische Bildungswesen in der zu über 90% muslimischen Republik Senegal könnte für einen großen Teil der Bevölkerung zu einer solchen Alternative werden, weil nur 48% der Kinder im Primarschulalter die öffentliche Schule besuchen, die sich am französischen Vorbild orientiert. (DIPF/Orig.)

Water hyacinth in Uganda: distribution cover and movement

The strategy to control the noxious water hyacinth requires reliable data base on the magnitude of the weed problem. This report which presents up to date (1997) information on distribution, coverage and movement of the weed in Uganda is intended to provide this basis as suppliment to other inputs for control planning. The report is the first in a series being prepared by FIRI from results the "Water hyacinth. research project" whose major goal is to supply information needed to define and focus the scope of the control process for water hyacinth in view of the fact that the weed is to remain a permanent feature of the aquatic landscape of Uganda. Water hyacinth is firmly established in lakes Victoria, Kyoga Albert and along the River Nile, distributed in two distinct forms namely as stationary fringes the shoreline and as mobile mats and large "fields" usually found in sheltered bays.

Testing the universality of free fall with rubidium and ytterbium in a very large baseline atom interferometer

We propose a very long baseline atom interferometer test of Einstein's equivalence principle (EEP) with ytterbium and rubidium extending over 10m of free fall. In view of existing parametrizations of EEP violations, this choice of test masses significantly broadens the scope of atom interferometric EEP tests with respect to other performed or proposed tests by comparing two elements with high atomic numbfers. In the first step, our experimental scheme will allow us to reach an accuracy in the Eotvos ratio of 7 . 10(-13). This achievement will constrain violation scenarios beyond our present knowledge and will represent an important milestone for exploring a variety of schemes for further improvements of the tests as outlined in the paper. We will discuss the technical realisation in the new infrastructure of the Hanover Institute of Technology (HITec) and give a short overview of the requirements needed to reach this accuracy. The experiment will demonstrate a variety of techniques, which will be employed in future tests of EEP, high-accuracy gravimetry and gravity gradiometry. It includes operation of a force-sensitive atom interferometer with an alkaline earth-like element in free fall, beam splitting over macroscopic distances and novel source concepts.

KANGAROO CARE: MATERNAL PERCEPTION OF THE EXPERIENCE IN THE NEONATAL INTENSIVE CARE UNIT

Objective: To investigate the maternal perception of the experience in the first phase of the Kangaroo Mother Care Method in the Neonatal Intensive Care Unit (NICU). Methods: Descriptive, exploratory and qualitative study, conducted in the period from August to October 2014, with 10 mothers of newborn preterm (NP) infants, who were admitted to the Maternity School Assis Chateaubriand (MEAC) in Fortaleza, Brazil, and had received skin-to-skin contact through the Kangaroo Care Method during hospitalization in the NICU. Data was collected by semi-structured interview, directed by guiding questions. Content analysis was used for processing the data, being established four categories: “The bond and the attachment”, “Maternal competence”, “The fear of losing the baby” and “The importance of the multidisciplinary team”. Results: The Kangaroo Care Method is a safe and pleasurable practice for mothers and relatives, in addition to providing social and psychoaffective benefits, found in the imagery of the method institutionalization and in the mothers’ experience when properly supported. The meanings of the maternal feelings of apprehension as a result of the first physical contact with the hospitalized child can be evidenced. Regarding the evaluation of its clinical practice, this method has provided better development of the newborn infant and a reduction in hospital stay. Conclusion: The study shows relevance, since the evidence of the maternal perception of this method supports its establishment as a mandatory practice in maternity hospitals, in view of the benefits to the mother and the neonate.

Chronic respiratory diseases and quality of life in elderly nursing home residents

Few studies have assessed the quality of life (QOL) related to chronic respiratory diseases in the elderly. In the framework of the geriatric study on the health effects of air quality in elderly care centers (GERIA) study, a questionnaire was completed by elderly subjects from 53 selected nursing homes. It included various sections in order to assess respiratory complaints, QOL (World Health Organization QOL (WHOQOL)-BREF), and the cognitive and depression status. The outcome variables were the presence of a score lower than 50 (<50) in each of the WHOQOL-BREF domains (physical health, psychological health, social relationships, and environmental health). Chronic bronchitis, frequent cough, current wheezing, asthma, and allergic rhinitis were considered as potential risk factors. The surveyed sample was (n = 887) 79% female, with a mean age of 84 years (SD: 7 years). In the multivariable analysis, a score of <50 in the physical domain was associated with wheezing in the previous 12 months (odds ratio (OR): 2.03, confidence interval (CI): 1.25-3.31) and asthma (OR: 1.95, CI: 1.12-3.38). The psychological domain was related with a frequent cough (OR: 1.43, CI: 0.95-2.91). A score of <50 in the environmental domain was associated with chronic bronchitis (OR: 2.89, CI: 1.34-6.23) and emphysema (OR: 3.89, CI: 1.27-11.88). In view of these findings, the presence of respiratory diseases seems to be an important risk factor for a low QOL among elderly nursing home residents.

Evaluation of the cytotoxic and genotoxic effects of benchmark multi-walled carbon nanotubes in relation to their physicochemical properties

To contribute with scientific evidence to the grouping strategy for the safety assessment of multi-walled carbon nanotubes (MWCNTs), this work describes the investigation of the cytotoxic and genotoxic effects of four benchmark MWCNTs in relation to their physicochemical characteristics, using two types of human respiratory cells. The cytotoxic effects were analysed using the clonogenic assay and replication index determination. A 48h-exposure of cells revealed that NM-401 was the only cytotoxic MWCNT in both cell lines, but after 8-days exposure, the clonogenic assay in A549 cells showed cytotoxic effects for all the tested MWCNTs. Correlation analysis suggested an association between the MWCNTs size in cell culture medium and cytotoxicity. No induction of DNA damage was observed after any MWCNTs in any cell line by the comet assay, while the micronucleus assay revealed that both NM-401 and NM-402 were genotoxic in A549 cells. NM-401 and NM-402 are the two longest MWCNTs analyzed in this work, suggesting that length may be determinant for genotoxicity. No induction of micronuclei was observed in Beas-2B cell line and the different effect in both cell lines is explained in view of the size-distribution of MWCNTs in the cell culture medium, rather than cell's specificities.