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Deficits in Motion and Form Perception in Infantile Nystagmus Syndrome
Get PDFPurpose: Visual deficits in infantile nystagmus syndrome (INS) could be a result of retinal blur from excessive eye movements and/or cortical changes from visual deprivation. We measured global motion and form sensitivity in INS to compare deficits between motion and form perception and to decipher the role of internal noise (local deficit such as eye movement) and sampling efficiency (global cortical deficit).Methods: A total of 30 participants (14.40 ± 4.83 years) with INS and 30 age-matched controls discriminated the direction of motion and orientation of physically equivalent translational random dot kinematograms (RDKs) and Glass patterns. Both stimuli consisted of 240 black dots (RDKs) and 120 pairs of dipoles (Glass patterns) with a display duration of 1.0 second. Two experimental paradigms were employed: coherence threshold (random noise) and equivalent noise (at five external noise levels).Results: The mean motion coherence thresholds at 5°/s and 10°/s were higher in INS (50.55% ± 21.33% and 31.87% ± 14.69% respectively) compared to controls (24.04% ± 13.22% and 20.65% ± 12.89, respectively) (P \u3c 0.01). The mean orientation coherence thresholds were also higher in INS (12.23% ± 0.32% vs. 7.88% ± 0.33%; P \u3c 0.01). For the equivalent noise paradigm, thresholds were higher for INS at no noise and 3 lower noise levels (P \u3c 0.01), but similar at the highest noise level (P \u3e 0.01). Higher internal noise best explained the difference in performance between INS and controls for both motion and form (P \u3e 0.05).Conclusions: INS results in lower sensitivity to both motion and form perception. These deficits are due to higher internal noise, which could arise from early areas of visual processing such as primary visual cortex as a result of abnormal eye movement or effect of early visual deprivation
Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021
Get PDFBackground: Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions. Methods: Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5–14 years, typically in school and cared for by child health services) and older adolescents (aged 15–24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990–2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage. Findings: Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6–96·6) individuals aged 5–14 years and 80·6 million (78·2–83·3) aged 15–24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15–24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5–14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7–17·2) of those aged 5–14 years are forecasted to have obesity by 2050 (186 million [141–221]), compared with 14·2% (11·4–15·7) of those aged 15–24 years (175 million [136–203]). We forecasted that by 2050, there will be more young males (aged 5–14 years) living with obesity (16·5% [13·3–18·3]) than overweight (12·9% [12·2–13·6]); while for females (aged 5–24 years) and older males (aged 15–24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041–50: children and adolescents (males and females aged 5–24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5–14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5–14 years in Australasia; females aged 15–24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15–24 years in high-income North America. Interpretation: Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis. Funding: Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council
The Bionics Bus for Neurology and Neuropsychiatry: Concept Development and Validation
Get PDFHealthcare delivery in the United Kingdom is increasingly becoming a challenging issue where demand is regularly outstripping availability. This is particularly a challenge in neurology and neuropsychiatry, where delays in diagnosis and treatment are leading to worse health and social outcomes. The Darzi report, which focused on three key tenants, has been hailed as the future blueprint for National Health Service (NHS) sustainability and high-quality care delivery. These three tenants are moving from analogue to digital approaches, focusing on prevention and wellbeing, and supporting diagnosis and treatment in communities instead of hospitals. Technological interventions are relevant at all stages of these care pathways. There is an opportunity to identify an easy to use community-based mobile resource to help screen, triage and refer suspect neurology and neuropsychiatric presentations to the right support. The potential benefits to patients, clinicians, organisations and communities could be significant. To enable this vision, the concept of Bionic Bus (https://bionicsbus.org/) was developed. This study looked to understand the acceptability, utility and scope of the Bionics Bus concept among the public using mixed-methods research techniques. Results suggest high acceptability, utility and wide scope. This study gives a template for similar evidence-based innovation to be applied for other health conditions
Novel approach for women’s self-management of rectal emptying difficulty
Get PDFAim To pragmatically investigate rectal emptying difficulty in women to identify if managing their symptoms with an innovative device is more effective and satisfactory than their usual care. Background Rectal emptying difficulty has a mostly unknown influence on women and frequently a hidden issue. Self-management alternatives are underappreciated. Despite the magnitude of the problem and its influence on women’s lives and healthcare, non-surgical alternatives have received little attention. Methods This cohort study of 35 female participants, recruited via secondary care outpatient clinics, used composite questionnaires before and after an 8-week intervention using the device. The questionnaire comprised of a quality of life instrument (International Consultation on Incontinence Questionnaire-Vaginal Symptoms and obstructed defaecation syndrome questionnaires), bowel diary recordings and participant feedback on using the device. Findings The device helped participants reduce the need to use their fingers (z= −2.844; p≤0.004) and offered participants improved lifestyle. There was significant reduction in difficulties to evacuate (p≤0.004), digitation to evacuate (p≤0.018), the feeling of incomplete evacuation (p≤0.002), straining to evacuate (p≤0.008) and lifestyle alteration (p≤0.046). The sense of incomplete emptying before and after using the device was significant (z= −2.646; p≤0.008), and feeling of being blocked improved (z= −3.317; p≤0.001). Stool consistency did not change. Medication to evacuate, returning to the toilet to evacuate and time needed showed no difference. Twenty-four participants (68.5%) completed the Patient Global Impression of Improvement question postintervention. Overall, 16 participants (66.7%) reported that the device was better than not using it. The results have clinical value, suggesting the device can assist women enhance their quality of life and improve physical symptoms associated with rectal emptying difficulties. Conclusions Most women with rectal emptying difficulty in this study found the device effective when compared with their usual care. Furthermore, it offers an additional conservative measure option within healthcare provision
Data for: Thresholds of wave forcing: Implications for atoll reef dynamics under sea level rise
No full textWe investigate the response of shallow reef flow to tidal variability and wave exposure during a four-month field campaign in southern Huvadhu Atoll, Maldives. Incident waves breaking on steep fore reefs and reef crests generate a setup proportional to offshore wave height that drive a cross-reef flow. We identify a critical threshold—where the depth on the reef flat equals the depth at wave breaking—that separates two distinct reef flow regimes: one dominated by strong, unidirectional flow from the ocean into the lagoon, and another where wave breaking ceases, flow rates decrease, and occasionally reverse direction. Recognising the relative importance of water depth and wave energy, we develop a framework for interpreting shallow reef hydrodynamics in a combined tide-wave parameter space. This framework allows us to project how rising sea levels may alter reef flows - potentially leading to prolonged and more frequent periods of limited wave breaking and a decline in wave-driven transport
Balancing familiarity and novelty: the interplay of cultural familiarity and food neophilia in shaping tourists’ local food experiences
No full textCultural familiarity and food neophilia both shape tourists’ local food experiences. However, limited research has explored how these factors interact within tourists’ psychological processes. This study applies approach-avoidance motivation theory to examine how cultural familiarity influences emotional responses, destination food image, place attachment, and behavioural intentions, with food neophilia serving as a moderator. Data were collected from 401 domestic tourists in Yangzhou, China, a UNESCO City of Gastronomy. The results from Partial Least Squares Structural Equation Modelling (PLS-SEM) show that cultural familiarity enhances emotional engagement, which in turn strengthens destination evaluations and behavioural intentions. The moderating effect of food neophilia indicates that familiarity and novelty jointly shape tourists’ desire for both comfort and new experiences. These findings contribute to tourism theory by introducing a dual-motivation framework into food tourism research. From a managerial perspective, the study offers practical insights for destination marketers. Cultivating ‘unexpected familiarity’ by blending familiar cultural elements with novel experiences can help reduce travel anxiety, strengthen emotional engagement, and increase destination appeal and revisit intentions
But who is it for? Introducing a framework for critical reflection on design and delivery of ethical participatory research
Get PDFDelivering ethical collaborative research is challenging, requiring disruption of assumptions, academic norms, and ways of working–including long-standing power dynamics. This article proposes a framework to support critical reflection on participatory practice; an adaptation of the wheel of consent. The adapted ‘ILBR’ framework explores the balance of who Initiates (makes requests/offers), does Labour (the action), gets Benefits, and takes on Risks (ILBR) in the conduct of research. This aims to support reflexive design and delivery of ethical participation, including a shift towards consent becoming an ongoing multi-way negotiation of agreements. Particularly it aims to support ‘interpersonal reflexivity’, and navigation of the ‘micro-ethics’ present during everyday-level interactions. The framework was tested for individual reflection and as an educational role-play exercise. Explorations indicate managing power and positionality need consideration, and future research should explore how to make space for more requests
A Spatiotemporal Machine Learning Framework for the Prediction of Metocean Conditions in the Gulf of Mexico: Application to Loop Current and Loop Current Eddy Forecasting
Get PDFWe are entering an exciting new era of data-driven weather prediction, where forecast models trained on historical data (including observations and reanalyses) offer an alternative to directly solving the governing equations of fluid dynamics. By capitalizing on a vast amount of available information – and capturing their inherent patterns that are not represented explicitly – such machine learning-based techniques have the potential to increase forecast accuracy, augmenting traditional physics-based equivalents. Here, we adapt and apply a promising machine learning framework – originally proposed by the present authors for regional prediction of ocean waves – to the operational forecasting of the Loop Current and Loop Current Eddies (LC/LCEs) in the Gulf of Mexico (GoM). The approach consists of using an attention-based long short-term memory recurrent neural network to learn the temporal patterns from a network of available observations, that is then combined with a random forest based spatial nowcasting model, trained on high-resolution regional reanalysis data, to develop a complete spatiotemporal prediction for the basin. Since machine learning approaches are typically physics-agnostic, an identical framework to that developed for the prediction of ocean waves can be used for the prediction of surface currents, with the only difference being the training datasets to which this is exposed. This is illustrated here using a period of three months of training data from October 2022 to December 2022, with the model driven by only three observation sites in the northern GoM. As such, it is unrealistic to expect performance for an unseen week in January 2023 to be equivalent to smaller/simpler domains with a more favorable quantity, quality and coverage/distribution of input observations but, despite these severe constraints, the ability of the model to forecast a plausible structure of the LC/LCE system is nonetheless impressive. The architecture of the MaLCOM framework allows for easy interrogation of the temporal and spatial behavior of the model which allows us to better unpick and explain its characteristics – thus providing a path to inform further enhancements. While still at an early stage of refinement, the extension of the framework from waves to currents demonstrates encouraging potential for a fundamentally different approach to the way that metocean data in general, and LC/LCE forecasts in particular, can be generated and used by the offshore energy sector, by directly leveraging sparse sensor networks as the basis for these predictions (further extending the value of the observations, when collected with this additional purpose in mind). Provided a suitable coverage, quality and quantity of observations are available, the advent of these very low cost, data-driven predictions – able to be run on-demand, in-house, using standard laptop or desktop computers – herald new opportunities for improving real-time decision-making to support offshore planning and workability
Using Diagrams in Place-Based Performances
No full textThis chapter addresses certain problems for a poetics of experience of landscape and how a diagrammatical reading of the text of a place, as part of ‘being there’, might help avoid our experiencing it as a literary landscape and, instead, enter a corporeal entanglement with it. This chapter describes how we might embody, and not simply ‘tell of’ (or tell of the telling of) landscape experience, using diagrammatical performance to draw others into a sensorial re-imagining of space and its place-stories. By seeking an intersection where bodies and the imaginal meet, this chapter explores the parts that the stories, substances, colours and codes might play in such a poetics. The author presents a response to these possibilities partly by describing Crab & Bee’s performance-making in response to particular landscapes in Plymouth. For the past two years, the author, with Helen Billinghurst, as Crab & Bee, has been visiting these areas regularly, tracking deer, keeping abreast of local news stories and monitoring the phenomenological and ecological effects of large-scale traffic infrastructure and house-building. Then making diagrammatical performances in response to our findings. It describes how, in making such performances, they have found help in Fernand Deligny’s arachnid paths, the diagrams of Simon O’Sullivan, the visceral approach of Alkistis Dimech to the moving body in space and Ursula Le Guin’s carrier bag theory of fiction
A 3-week pause versus continued Bruton tyrosine kinase inhibitor use during COVID-19 vaccination in individuals with chronic lymphocytic leukaemia (IMPROVE trial): a randomised, open-label, superiority trial
Get PDFBackground: Chronic lymphocytic leukaemia is the commonest leukaemia and is associated with profound immunosuppression. Bruton tyrosine kinase inhibitors (BTKi) have revolutionised chronic lymphocytic leukaemia management; however, therapy impairs vaccine-induced immunity. We evaluated whether a 3-week pause of BTKi treatment improved spike protein receptor binding domain (RBD) immunity to SARS-CoV-2 booster vaccination while maintaining disease control. Methods: We performed an open-label, two-arm, parallel-group, randomised trial in secondary-care haematology clinics in 11 UK hospitals. Participants aged 18 years or older, diagnosed with chronic lymphocytic leukaemia, and currently taking BTKi therapy (frontline or relapsed setting) for at least 12 months were eligible. Participants were randomly allocated (1:1, by a centralised computer randomisation program, stratified by BTKi therapy line) to pause BTKi for 3 weeks, starting 6 days before their SARS-CoV-2 vaccination booster date, or to continue therapy as usual. Neither participants nor clinical staff were blinded but laboratory staff were. Intramuscular injection of either original BA.1 or original BA.4/5 bivalent mRNA vaccine (50 μg mRNA-1273 or 30 μg BNT162b2), or 5 μg protein-based Vidprevtyn Beta (Sanofi Pasteur, Lyon, France) were received according to the national vaccination programme schedule. The primary outcome measure was anti-spike-RBD-specific antibody titre 3 weeks after vaccination and analysis performed by intention to treat (as randomly allocated, irrespective of compliance) following trial completion. This trial is registered with ISRCTN, 14197181, and has been completed. Findings: Between Oct 10, 2022, and June 8, 2023, 99 individuals (71 [72%] male and 28 [28%] female, with 89 [90%] of White ethnicity) were randomly allocated to groups pausing (n=50 [51%]) or continuing (n=49 [49%]) their BTKi therapy, and followed up for 12 weeks. At 3 weeks after vaccination, the geometric mean anti-spike-RBD-specific antibody titre was 218·8 U/mL (SD 122·9) in the continue group and 153·4 U/mL (103·2) in the pause group, with geometric mean ratio 1·104 (95% CI 0·565–2·158, p=0·77) using a mixed-effects model. The only serious adverse event during the 12-week follow-up was the death of one participant in the pause group due to COVID-19 infection 2 months after randomisation. Interpretation: Although the study was slightly underpowered, the results suggest that pausing BTKi around the time of vaccination is not beneficial for immunity and should not be recommended in clinical practice. Funding: National Institute for Health and Care Research