Relationship between socioeconomic deprivation or urban/rural residence and visual acuity before cataract surgery in Northern Scotland

Purpose: To evaluate the influence of socioeconomic factors on visual acuity before cataract surgery. ?Methods: The medical case notes of 240 consecutive patients listed for cataract surgery from January 1, 2010, at Grampian University Hospital, Aberdeen, were reviewed retrospectively. Patients with ocular comorbidity were excluded. Demographics, postal codes, and visual acuity were recorded. Scottish Index of Multiple Deprivation was used to determine the deprivation rank. Home location was classified as urban or rural. The effect of these parameters on preoperative visual acuity was investigated using chi-square tests or Fisher exact test as appropriate. ?Results: A total of 184 patients (mean 75 years) were included. A total of 127 (69%) patients had visual acuity of 6/12 or better. An association was found between affluence and preoperative visual acuity of 6/12 or better (?2trend = 4.97, p = 0.03), with a significant rising trend across quintile of deprivation. There was no evidence to suggest association between geographical region and preoperative visual acuity (p = 0.63). ?Conclusion: Affluence was associated with good visual acuity (6/12 or better) before cataract surgery. There was no difference in preoperative visual acuity between rural and urban populations.

Efficacy and safety of radium-223 dichloride in patients with castration-resistant prostate cancer and symptomatic bone metastases, with or without previous docetaxel use: A prespecified subgroup analysis from the randomised, double-blind, phase 3 ALSYMPCA trial

Background: Primary results from the phase 3 ALSYMPCA trial showed that radium-223 dichloride (radium-223), a targeted α-emitter, improved overall survival compared with placebo and was well tolerated in patients with castration-resistant prostate cancer and symptomatic bone metastases. We did a prespecified subgroup analysis from ALSYMPCA to assess the effect of previous docetaxel use on the efficacy and safety of radium-223. 

Methods: In the phase 3, randomised, double-blind ALSYMPCA trial, patients with symptomatic castration-resistant prostate cancer, at least two symptomatic bone metastases, no known visceral metastases, and who were receiving best standard of care were randomly assigned (2:1) via an interactive voice response system to receive six injections of radium-223 (50 kBq/kg intravenously) or matching placebo, with one injection given every 4 weeks. Patients had either received previous docetaxel treatment or were unsuitable for or declined docetaxel; previous docetaxel use (yes or no) was a trial stratification factor. We investigated the effect of previous docetaxel use on radium-223 treatment for the primary endpoint of overall survival, the main secondary efficacy endpoints, and safety. Efficacy analyses were done for the intention-to-treat population; safety analyses were done for the safety population. The trial has been completed and is registered with ClinicalTrials.gov, number NCT00699751. 

Findings: Randomisation took place between June 12, 2008, and Feb 1, 2011. 526 (57%) of 921 randomly assigned patients had received previous docetaxel treatment (352 in the radium-223 group and 174 in the placebo group) and 395 (43%) had not (262 in the radium-223 group and 133 in the placebo group). Radium-223 prolonged median overall survival compared with placebo, irrespective of previous docetaxel use (previous docetaxel use, hazard ratio [HR] 0·70, 95% CI 0·56-0·88; p=0·002; no previous docetaxel use, HR 0·69, 0·52-0·92; p=0·01). The benefit of radium-223 compared with placebo was seen in both docetaxel subgroups for most main secondary efficacy endpoints; risk for time to time to first symptomatic skeletal event was reduced with radium-223 versus placebo in patients with previous docetaxel use, but the difference was not significant in those with no previous docetaxel use. 322 (62%) of 518 patients previously treated with docetaxel had grade 3-4 adverse events, compared with 205 (54%) of 383 patients without docetaxel. Patients who had previously been treated with docetaxel had a higher incidence of grade 3-4 thrombocytopenia with radium-223 than with placebo (31 [9%] of 347 patients vs five [3%] of 171 patients), whereas the incidence was similar between treatment groups among patients with no previous docetaxel use (seven [3%] of 253 patients vs one [1%] of 130 patients). The incidences of grade 3-4 anaemia and neutropenia were similar between the radium-223 and placebo groups within both docetaxel subgroups. 

Interpretation: Radium-223 is effective and well tolerated in patients with castration-resistant prostate cancer and symptomatic bone metastases, irrespective of previous docetaxel use. 

Funding: Algeta ASA and Bayer HealthCare Pharmaceuticals.

Polybius’ ‘previous landslide’: Proof that Hannibal’s invasion route crossed the col de la traversette

Both Polybius and Livy described a landslide/landslip that blocked the Punic Army’s exfiltration from a high col on the water divide in the Western Alps. The landslide, more aptly termed rockfall, has been a source of contention amongst classicists for centuries despite the fact that only two cols—Clapier and Traversette—exhibit rockfall debris on the lee side of the Alps. While the Clapier rockfall is too small and too young to have provided blockage, the Traversette debris is nearly as Polybius described it when he retraced the invasion route some 60 years after the event. His ‘two-tier’ description of the deposit, a doublet of younger and older rock rubble, including measurements of width and volume are close to modern measurements and prove that he knew, in advance, the route Hannibal had followed. It would take a practiced eye to correctly identify the stratigraphic complexity inherent in the Traversette Rockfall. Here we present weathering ratios, soil stratigraphic, mineral, chemical and microbiological evidence in support of Polybius’ observations as a considerable background database for future geoarchaeological exploration.

Residential segregation, dividing walls and mental health: A population-based record linkage study

Background
Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. Whilst most previous research has relied on conceptualized measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or “peacelines”) which can be used to accurately identify residential segregation.
Methods
We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health.
Results
Using multi-level logistic regression models we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a “peaceline” increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI: 1.14, 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI: 1.32, 1.48), even after adjustment for gender, age, conurbation, deprivation and crime.
Conclusions
Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation.

Imagens do envelhecimento e da velhice: um estudo na população portuguesa

Este estudo visa identificar as imagens do processo de envelhecimento e da velhice, as imagens relacionadas com a preparação de um envelhecimento bem sucedido e compreender a relação entre as mesmas. Pretende-se ainda identificar possíveis linhas de intervenção que permitam modificar imagens da velhice e da sua preparação, capazes de promover activamente um envelhecimento bem sucedido. Optou-se por um estudo de desenho de carácter transversal, descritivocorrelacional, com recurso à técnica de análise quantitativa para correlações entre diferentes variáveis sócio-demográficas. A amostra compreende 800 sujeitos com idades compreendidas entre os 13 e os 87 anos, analisadas as seguintes variáveis sociodemográficas: idade, género, escolaridade, estado civil, ter ou não filhos, se trabalhou ou não com pessoas idosas e freguesia de residência (urbana ou rural). Os instrumentos utilizados foram duas escalas, a ImAge e a ImPreVe. Os principais resultados indicam que: a) os sujeitos que manifestam imagens positivas tendem a preocupar-se com a preparação da velhice, a viver no presente mas também a planear o seu futuro; b) os sujeitos que manifestam imagens negativas da velhice e do envelhecimento também tendem a preocupar-se com a preparação da velhice, a focalizar-se no futuro; c) os sujeitos que manifestam imagens ambivalentes (positivas e negativas, onde há ganhos e perdas em simultâneo) tendem a considerar a preparação como pouco importante; d) são os sujeitos mais velhos e com menor escolaridade quem tende a manifestar imagens negativas e a valorizar a preparação da velhice. A promoção de um envelhecimento bem sucedido deve incidir nas dimensões individual, familiar, social e institucional, com vista à alteração de imagens irreais e baseadas em estereótipos ou preconceitos (sejam positivas ou negativas), ajustadas à realidade do normal processo de envelhecimento. Impõe-se uma mudança dessas imagens, desmistificando a sua conjugação com o envelhecimento patológico e promover activamente estratégias adequadas a cada perfil para a promoção de um envelhecimento bem sucedido.

The Trembling Line

The Trembling Line is a film and multi-channel sound installation exploring the visual and acoustic echoes between decipherable musical gestures and abstract patterning, orchestral swells and extreme high-speed slow-motion close-ups of strings and percussion. It features a score by Leo Grant and a newly devised multichannel audio system by the Institute of Sound and Vibration Research, University of Southampton. The multi-channel speaker array is devised as an intimate sound spatialisation system in which each element of sound can be pried apart and reconfigured, to create a dynamically disorienting sonic experience. It becomes the inside of a musical instrument, an acoustic envelope or cage of sorts, through which viewers are invited to experience the film and generate cross-sensory connections and counterpoints between the sound and the visuals. Funded by a Leverhulme Artist-in-Residence Award and John Hansard Gallery, with support from ISVR and the Music Department, University of Southampton. The project provided a rare opportunity to work creatively with new cutting edge developments in sound distribution devised by ISVR, devising a new speaker array, a multi- channel surround listening sphere which spatialises the auditory experience. The sphere is currently used by ISVR for outreach and teaching purposes, and has enables future collaborations between music staff and students at Southampton University and staff and ISVR. Exhibitions: Solo exhibition at John Hansard Gallery, Southampton (Dec 2015-Jan 2016), across 5 rooms, including a retrospective of five previous film-works and a new series of photographic stills. Public lectures: two within the gallery. Reviews and interviews: Art Monthly, Studio International, The Quietus, The Wire Magazine.

A methodology to estimate the residence time of estuaries

The residence time has long been used as a classification parameter for estuaries and other semi- enclosed water bodies. It aims to quantify the time water remains inside the estuary, being used as an indicator both for pollution assessment and for ecological processes. Estuaries with a short residence time will export nutrients from upstream sources more rapidly then estuaries with longer residence time. On the other hand the residence time determines if micro-algae can stay long enough to generate a bloom. As a consequence, estuaries with very short residence time are expected to have much lower algae blooms, then estuaries with longer residence time. In addition, estuaries with residence times shorter than the doubling time of algae cells will inhibit formation of algae blooms (EPA, 2001). The residence time is also an important issue for processes taking place in the sediment. The fluxes of particulate matter and associated adsorbed species from the water column to the sediment depends of the particle’s vertical velocity, water depth and residence time. This is particularly important for the fine fractions with lower sinking velocities. The question is how to compute the residence time and how does it depend on the computation method adopted.

Acompanhamento de obra: optimização de soluções: técnicas de cofragem (Atlântico Estoril Residence)

Relatório de Estágio para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Edificações

Outcome and Experience from the Swiss Mammography Screening Pilot Programmes

BACKGROUND:The Swiss breast cancer screening pilot programme was conducted in 3 districts of theFrench-speaking canton of Vaud (ca. 300,000 resident women) between October 1993 and January 1999.Women aged 50 to 69 were invited by mail every 2 years for a free of charge screening mammography (doubleview, multiple reading). This first ever-organised cancer screening programme in Switzerland showed thefeasibility and acceptability of this kind of public health intervention in the liberal Swiss healthcare system, whichwas the main objective of the pilot programme. This mammographic screening programme was extended to thewhole canton in 1999, and contributed to the implementation of similar programmes in 2 neighbouring cantons. OBJECTIVE:To appraise the use, the quality and the effectiveness of the Swiss screening pilot programme. METHODS:About 15,000 women (aged 50-69) were enrolled. Logistic regression analyses were performedseparately to identify determinants of initial and subsequent attendance. Standard indicators of quality,effectiveness and impact of the programme were assessed and compared with European recommendations. Tothis intent, linkage with data from the Vaud Cancer Registry was performed. RESULTS:About half the target population was screened at least once during the pilot trial. Participation washigher among Swiss than foreigners, among widowed or married women than among single, divorced or separatedones. Attendance also increased with age and decreasing distance between residence and the dedicatedscreening centre. Apart from Swiss citizenship, socio-demographic factors were not associated with reattendance.Intensity of prior recruitment, outcome of previous screening test (positive vs. negative) and indicators of women'shealth behaviour (time of last mammography prior to initial screen, smoking status) were the main determinants ofreattendance. Programme performance and quality indicators were, overall, in line with European Guidelines. Theywere overall more favourable among 60-69 than 50-59 year-olds and improved over time. CONCLUSION:The objectives of the pilot programme were met. Even if participation should increase in order toreach European standards, performance indicators overall met quality requirements. Ways to improve screeninguse, quality and effectiveness were devised and taken into account for the generalisation of the programme.

Available evidence on re-irradiation with stereotactic ablative radiotherapy following high-dose previous thoracic radiotherapy for lung malignancies.

Patients affected with intra-thoracic recurrences of primary or secondary lung malignancies after a first course of definitive radiotherapy have limited therapeutic options, and they are often treated with a palliative intent. Re-irradiation with stereotactic ablative radiotherapy (SABR) represents an appealing approach, due to the optimized dose distribution that allows for high-dose delivery with better sparing of organs at risk. This strategy has the goal of long-term control and even cure. Aim of this review is to report and discuss published data on re-irradiation with SABR in terms of efficacy and toxicity. Results indicate that thoracic re-irradiation may offer satisfactory disease control, however the data on outcome and toxicity are derived from low quality retrospective studies, and results should be cautiously interpreted. As SABR may be associated with serious toxicity, attention should be paid for an accurate patients' selection.

Residence Model

Model layout of the 3 stage residence expansion to the university proposed in September of 1967. This was a revision of the original master plan which called for high rise residences east of the Tower rather then the sprawling residences shown here. Although modified slightly from the model, the first stage of the residence would become a reality in the form of the Decew Residence. The realization of the second stage would also eventually take place when the Gordon and Betty Vallee Residence was constructed.