Vision screening occurs once in United Kingdom (UK) children on school entry, but has recently been withdrawn in some areas. Consequently, significant refractive error and/or vision problems may go undetected. School-led vision checking, where school staff assess vision, is increasingly advocated by the International Agency for the Prevention of Blindness. This study investigates the accuracy of school-led vision checking in UK school students. School personnel were trained to conduct vision checks on their students. These involved external observation of the eyes for obvious abnormalities, as well as monocular distance (3 m) and near vision assessments (33 cm), equivalent to 0.2 logMAR. Equipment required to complete the checks was provided to schools. Optometrists repeated the assessments on average within 3 weeks to determine the accuracy of the school-led checks. Failure criteria were habitual vision >0.20 logMAR (<4 of 5 letters correct) in one or both eyes, at distance or near, and/or the presence of any ocular abnormality. One thousand and one children (45.7% female) from eight primary (6-8 years n = 233) and three secondary (11-13 years n = 768) schools participated. Overall sensitivity and specificity of distance vision and ocular abnormality checks were 87.2% and 88.9%, respectively. Corresponding values for sensitivity and specificity were 95.8% and 88.1% for primary schoolchildren and 84.3% and 89.2% for secondary schoolchildren. High negative predictive values in both primary (99.3%) and secondary (97.4%) schools indicate school staff correctly identified most children with distance vision problems. With near vision results included, sensitivity and specificity reduced to 80.6% and 82.2%, respectively, in the whole cohort (87.1% and 83.2% in primary schoolchildren and 78.5% and 81.6% for secondary schoolchildren) because of an increase in false positives. The vision screening assessment battery utilized within this study requires refinement; however, school-led vision screening is feasible and can correctly identify UK school children with and without vision problems with sensitivity and specificity of >80%.
The Kingdom of Saudi Arabia (KSA) has a mixed health financing system consisting of governmental health coverage (GHC) and private health insurance (PHI). In 2016, KSA launched Vision 2030, which aims to reduce government spending and increase reliance on employer-sponsored PHI. This reform may affect the utilization of health services based on citizenship and the type of health coverage (PHI compared with GHC). The current study aimed to identify the characteristics of private health insurance enrollees and the association between different types of health coverage (GHC and PHI) and outpatient service utilization in the KSA. This study used data from the 2018 Saudi Family Health Survey (SFHS), which included 8,276 respondents aged 18 years and above and collected information on outpatient utilization during the previous 12 months. Statistical analyses were conducted using SPSS version 26. Bivariate analyses (chi-square and t-tests) were used to assess differences by nationality and coverage type. Binary logistic regression was used to examine the characteristics of PHI enrollment, and Poisson regression was used to evaluate the association between coverage type and outpatient utilization. This dataset provides a pre-reform baseline for assessing PHI enrollment and outpatient utilization prior to the implementation of the first phase of the reform in 2019. Most respondents were Saudi nationals (76.8%), and 54.9% were male. About 26.2% of respondents had PHI. Among non-Saudis, 72.8% were enrolled in PHI, compared with only 12.1% of Saudis. The logistic regression analysis revealed that having PHI was associated with factors such as a high monthly income, non-Saudi, male, being married, a high level of education, and a perception of good health. We found that having PHI was negatively associated with the utilization of outpatient services (coefficient -0.107; P < 0.001) compared with GHC. This finding may reflect barriers to access, a lower perceived need, or limitations in awareness of PHI benefits. In addition, this finding suggests that PHI may be associated with disparities in healthcare access, based on the observed lower utilization of outpatient services among its enrollees compared with those covered by GHC. Other factors associated with the utilization of outpatient services were being female, having a high monthly income, being never married, having chronic diseases, and the perception of poor health. The results of this study may inform future health reform efforts to enhance access to healthcare. These findings should be considered when planning the implementation and evaluation of the health system in KSA.
Healthy aging and community well-being are the priorities of Egypt Vision 2030; hence, the need to promote non-pharmacological approaches to mental health among the older adults. This paper examines how physical activity can be used as a form of therapy in improving the mental health and quality of life of older adults who attend sports clubs in EL Minya, Arab Republic of Egypt, using the notion of movement as therapy. A cross-sectional, quantitative research design was used, and a sample of 422 older adults (aged ≥60 years) was used. The participants took a questionnaire in a structured form (Arabic version of DASS-21 to evaluate depression, anxiety, and stress) and the Rapid Assessment of Physical Activity (RAPA). The data were reviewed on descriptive statistics, chi-square tests, and multiple linear regression to determine the relation between the level of physical activity and mental health outcomes, and the results were adjusted by age. It was found that almost one-third (31) of the respondents did not have any physical activity, and the remaining 69.2% participated in different levels of physical activity weekly. The most common was walking (92.4%). The level of mental health symptoms was also much lower in the highly active group; that is, individuals who exercised 10 h/week or more had a mean DASS-21 of 12.3 (normal) versus 34.2 among inactive ones (clinically significant distress). The relationship between dose and response was evident (all p < 0.001). The level of exercise was the strongest negative predictor of psychological distress (β = 0.41, p < 0.001) and could predict 23 percent of the variance of the DASS-21 scores (F = 31.28, p < 0.001). The results justify the inclusion of customized and socially entrenched movement initiatives, especially walking and light aerobic activities, in national aging and mental health policies. This initiative can make physical activity not a personal habit but a civic intervention, both dignified, resilient, and mentally healthy aging, in accordance with Egypt Vision 2030.
This study aims to examine the impact of applying green accounting on the quality of sustainability reports at the Central Bank of Iraq within the framework of the Sustainable Development Goals 2030, It examined the moderating effect of environmental awareness on this relationship. A structured questionnaire was used to survey 320 senior officials and accountants regarding green accounting practices, environmental awareness, and reporting quality. Quantitative models using structural equation modeling (SEM) employed to analyze direct and indirect relationships between variables. The results showed that green accounting practices had a direct negative impact on the quality of sustainability reports, indicating a discrepancy between objectives and implementation. However, the presence of environmental awareness among leaders reduced the organizational confusion resulting from the new systems represented by green accounting. The results also indicate factors, such as the legal framework and technological maturity, enhancing the effectiveness of green accounting initiatives. Adopting green accounting without the necessary infrastructure weakens the quality of sustainability reports. A key factor in this is environmental awareness among officials, which promotes transparency and sustainability. Therefore, organizations must understand that the successful implementation of green accounting begins with raising environmental awareness among leaders and employees, training and developing human resources to use these systems, and improving existing technological systems and regulations to align with them and enhance the chances of successful green accounting implementation. This study makes a pivotal contribution to the academic literature, adding to the limited body of research on the dynamic links between green accounting, sustainability reporting and environmental awareness in banks.
Hearing, vision and cognitive impairments are common yet frequently underrecognized among older adults. Although these impairments affect quality of life, functional independence and psychological well-being, there are no published data on the prevalence and consequences of these impairments in relation to Australian home care populations. This protocol outlines a cross-sectional investigation into the prevalence of hearing, vision and cognitive impairments and their associations with quality of life, functional ability and psychosocial well-being among older Australians receiving home care services. A total of 369 participants aged 65 years and older will be recruited from home care services across Australia. Standardized assessment tools will be used to assess hearing, vision and cognitive function, quality of life, daily living activities, mental health and social participation. Multi-variable regression models will explore the impact of sensory and cognitive impairments on health and well-being outcomes. With ageing populations, it is increasingly important to support older people to live independently in their own homes rather than needing to move into residential aged care. This study will facilitate understanding of the prevalence and impact of sensory and cognitive impairments among the older Australian home care population. Findings may inform strategies to support health ageing in place, including service planning, care coordination and workforce training. Older adults receiving home care services and individuals with lived experience of sensory and cognitive impairments contributed to the study design. A Patient and Public Involvement advisory group and a stakeholder steering group will guide study implementation.
The aim of this study was to examine the degree to which known lawful relationships in saccadic eye movements hold when visual acuity is artificially degraded. If lawful relationships still hold, then violations during the vision assessment could indicate that individuals are not performing with their maximum effort in an effort to exaggerate their impairment. Twelve healthy participants performed saccades between targets of different sizes and at different separations from each other. Each participant completed the task with habitual vision and with three levels of simulated impairment. Saccade duration and fixation dispersion both increased with target separation, irrespective of the simulated visual impairment (R values of 0.78 for duration and 0.27 for dispersion). Some eye movement measures retained lawful relationships with task constraints even when visual input was degraded. Although the present study does not assess the ability of these measures to detect intentional misrepresentation, the dependency of saccade duration and fixation dispersion on target separation under simulated vision impairment identifies them as candidate variables for future work aimed at improving confidence in vision assessments. Future work should examine whether saccade duration and fixation dispersion show the same lawful relationship in actual vision impairment.
A minority (13 of 91) of patient-reported outcome measures for adult glaucoma meet rigorous quality standards for development. Others, despite limited evidence describing development, have been validated in glaucoma populations and should be used judiciously. To identify, characterize and assess the quality of existing patient-reported outcome measures (PROMs) relevant to adult glaucoma patients, focusing on development and validation. We searched multiple databases for studies reporting development, validation, adaptation, or extension of vision-related PROMs in adults with glaucoma. Eligible reports were grouped by instrument for assessment using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias checklist's "Standards for evaluating the quality of PROM development." Among 91 instruments represented by 140 reports, 57 were developed for use in glaucoma patients; the remainder were validated in glaucoma patients. The instruments vary in length and complexity and evaluate domains within several constructs: vision-related QoL, health-related QoL, glaucoma knowledge, disease symptoms, vision-related activity limitation, treatment preferences, treatment side effects, patient satisfaction, and psychological status. According to COSMIN criteria, "adequate" development was documented for just 17 of 91 instruments, with descriptions of constructs, population(s) and context(s) for use, and published studies in the target population. Among these 17, concept elicitation was described for 13, of which 7 were developed since 2021. Thirteen instruments stand out in rigorous quality analysis based on the COSMIN Risk of Bias checklist. Other instruments without evidence of sound development have nevertheless been rigorously validated. PROMs we commonly use should be understood in the context of what they were designed to do, what they do well, their efficiency and limitations. It behooves us to follow and document best practices for developing and validating novel instruments.
In this study, eye movement technology was used to explore the lateralization characteristics of Han and Tibetan individuals when they recognized faces of individuals of their own and other ethnicities. In Experiment 1, the faces were divided into two areas of interest: the left and right sides. The results revealed that left lateralization occurred when participants of both ethnicities recognized faces of individuals of their own and other nationalities. In Experiment 2, the faces were divided into six areas of interest: the left and right eyes, the left and right sides of the nose, and the left and right sides of the mouth. The results revealed that the focus of left lateralization was the nose and mouth for the faces of Han individuals, whereas that for the faces of Tibetan individuals was the mouth. The results indicate that left visual lateralization occurs when the faces of Tibetan and Han individuals are recognized and that this lateralization differs across different ethnicities.
Retinitis pigmentosa (RP) is a progressive inherited retinal disorder that leads to severe visual impairment, even blindness. This condition significantly compromises quality of life and imposes substantial socioeconomic burdens. Currently, most cases of RP have no effective treatment, and therapies aimed at slowing the decline of patients' vision and improving their quality of life remain the main clinical tasks. Identifying key factors influencing visual outcomes is crucial for optimizing patient management. To bridge this gap, we conducted a study to explore these determinants. This study aimed to investigate the determinants of better-eye visual acuity in RP patients, focusing particularly on disease duration, age of onset, and a positive family history. In this cross-sectional study, 285 participants with clinically confirmed RP were enrolled. Comprehensive demographic and clinical data were collected, including a positive family history, age of onset, disease duration, and best-corrected visual acuity measuring in LogMAR units. Both simple and multiple linear regression analyses were employed to assess the associations between the clinical factors and visual outcomes. The study population had a mean age of onset of 13.61 ± 14.36 years and a mean disease duration of 26.36 ± 16.12 years, with 53.71% having a positive family history. Multiple linear regression analysis revealed that disease duration was significantly associated with lower visual acuity (β = 0.012, P < .001), while age of onset showed no significant association (β = -0.005, P = .149) after adjustment for all potential confounding factors. Based on these findings, disease duration emerges as a significant predictor of visual acuity in RP patients, highlighting its value as a prognostic indicator for clinical assessment. These findings underscore the importance of considering disease duration when developing personalized management strategies for RP patients. Further investigations to explore the underlying mechanisms linking disease duration and visual deterioration are warranted.
Ocular injury is a significant public health concern, which may threaten vision and impose a heavy burden on healthcare systems. In South Korea, understanding the epidemiology of ocular injury is critical for developing effective prevention strategies. This study utilized data from the National Emergency Department Information System from 2016 to 2022. Patients presenting with ocular injury to emergency departments (EDs) nationwide were analyzed. We categorized ED visits based on the types of injury and the risk of vision loss by a modified Delphi process. Multivariate logistic regression was performed to identify factors associated with a high risk of vision loss. A total of 581,264 cases of ocular injury were analyzed. Majority of cases occurred in males (72.3%) and individuals aged 40-64 years (37.02%). The elderly (≥ 65 years) exhibited an increasing trend in ocular injury, rising from 9.41% in 2016 to 17.82% in 2022. Individuals covered by industrial accident compensation insurance showed a significantly higher risk of vision loss, particularly among males aged 20-39 years (adjusted odds ratio [aOR], 5.55; 95% confidence interval [CI], 4.25-7.26) and 40-64 years (aOR, 2.94; 95% CI, 2.41-3.59). Machinery-related injuries were also identified as a major risk factor for severe vision loss, with an aOR of 4.83 (95% CI, 3.27-7.14) in males aged 40-64 years. Residents in low-populated areas showed significantly greater risks of severe vision loss compared to those in high-populated areas. This study provides a comprehensive epidemiological overview of ocular injury in South Korea, suggesting the need for a more detailed understanding of the mechanisms underlying these injuries, promoting the use of appropriate eye protective gear, and improving access to emergency care in low population density areas.
To evaluate the quality of existing patient-reported outcome measures (PROMs) used to assess the impact of keratitis on the quality of life (QoL). A literature search was conducted using Embase, PubMed, Scopus, Web of Science, CINAHL, and PsycINFO. The review included PROMs used to assess the impact of keratitis on QoL. Data on the content development and psychometric properties were extracted. Quality assessment was performed using the established criteria for ophthalmic PROMs. A total of seven articles met our inclusion criteria. The study populations in the reviewed articles consist of individuals diagnosed with different types of microbial keratitis. Ten unique PROMs were reviewed. Nine were ophthalmic and one was generic. Only the impact of vision impairment PROM has undergone psychometric validation in keratitis. Although the validation indicated acceptable unidimensionality (grade B), both the eigenvalue and item-person targeting demonstrated misfit to the Rasch model. Psychometric appraisal showed that keratitis patients were not involved in PROM content development, leading to misalignment and inconsistencies between the constructs outlined by the instruments and evaluation findings. Limited available literature constrains the depth of this review. Initiating psychometric validation of the PROM in keratitis conditions is a good starting point. All evaluated PROMs lack psychometric validation and are not specific to keratitis. The findings of this review underscore the need to create a psychometrically robust, keratitis-specific PROM. The systematic review registration number is CRD42023449213.
To validate a custom smartphone application for at-home visual acuity (VA) measurement in children. A total of 452 children aged 3-17.5 years participated. Certified examiners measured in-office test-retest VA (logMAR) using gold-standard Amblyopia Treatment Study HOTV (3-to-6-year-olds, younger cohort) or electronic Early Treatment of Diabetic Retinopathy Study (7-to-17.5-year-olds, older cohort) protocols at 3-4.5 m and app-based VA at 1.5 m. Caregivers measured at-home app-based VA at 1.5 m. Comparing at-home app-based with gold-standard VA, in eyes 20/40 or better, 95% (143/151) and 93% (91/98) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.04; 95% limits-of-agreement half-width (LOA): younger = ±0.26, older = ±0.22). In eyes 20/50 or worse, 66% (42/64) and 75% (76/101) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.11, older = 0.13, LOA: younger = ±0.50, older = ±0.51). Comparing in-office app-based VA with gold-standard VA, in eyes 20/40 or better, 98% (160/164) and 94% (99/105) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.03; LOA: younger = ±0.22; older = ±0.24). In eyes 20/50 or worse, 85% (60/71) and 91% (101/111) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.04; older = 0.04; LOA: younger = ±0.39; older = ±0.24). For gold-standard test-retest, in eyes 20/40 or better, 99% (163/164) and 99% (104/105) of the younger and older cohorts had retest within 2 lines, respectively (mean differences: younger = 0.00; older = 0.01; LOA: younger = ±0.17; older = ±0.11). For 20/50 or worse, 92% (66/72) and 100% (111/111) in the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.01; older = 0.02; LOA: younger = ±0.35; older = ±0.15). Our app demonstrated good concordance with the gold standard at home and in the office for eyes with VA of 20/40 or better. However, concordance decreased considerably for eyes with VA 20/50 or worse, particularly at home.
This study explored in a mouse model whether activation or upregulation of the two-pore domain potassium channel tandem pore domain acid-sensitive potassium channel 3 (TASK-3) in retinal ganglion cells (RGCs) could protect RGCs and reverse the vision loss arising through optic nerve injury. TASK-3 activity was assessed using patch-clamp electrophysiology. The optic nerve of each mouse was crushed, and the selective TASK-3 agonist CHET3 was applied to the surface of the eye once daily for 1 week or TASK-3 was overexpressed specifically in RGCs through infection with recombinant adeno-associated virus 1 week after optic nerve crushing. Numbers of RGCs and of intrinsic photosensitive RGCs were determined through fluorescence microscopy. Image-forming activity of RGCs in mice was assessed using flash visual evoked potentials, the visual cliff test, and the visual water maze task. The non-image-forming activity of intrinsic photosensitive RGCs was assessed using the pupillary light reflex test. CHET3 treatment increased the number of RGCs surviving after optic nerve injury, and it improved their electrophysiological response, visual acuity, contrast sensitivity, and the sensitivity of pupillary light reflex. These effects were associated with decreased RGC excitability. TASK-3 overexpression in sparse RGCs surviving long-term optic nerve injury restored their image- and non-image-forming activities. These results suggest that pharmacological activation or upregulation of TASK-3 may be a promising therapeutic strategy to promote vision recovery after optic nerve injury or in eye disorders associated with RGC degeneration.
To examine if clusters of colocated damaged locations repeatedly found during prior SITA-Standard (SS) visual field tests are not replicated in a subsequent SITA-Faster (SFR) test. Visual field series from the Lions Eye Institute, Perth, Australia were extracted if they had at least 4 SS fields followed by a SFR field and all fields had false positive rates and fixation losses less than 15%. Clusters of damaged locations were defined as either an isolated location with no damaged neighbors or a group of connected 24-2 points (not crossing the horizontal) that all had Pattern Deviation (PD) probability values below 1% of normal in all 3 SS tests immediately preceding the SFR test. For each cluster, the number of locations that were damaged in the SFR field that overlapped the established and repeatable SS clusters was computed and reported. We compare this proportion of overlap against the same calculations using the last SS as the final field. We also examine the effect of relaxing the PD criteria for damage in the final field on the proportion of overlap. 2519 eyes were included. For established, repeatable, and clusters of size 1, 2, 3, and 4 locations, the follow-up SFR field completely missed 46%, 26%, 11%, and 14% of the clusters whereas SS missed significantly less 26%, 11%, 4% and 1% (t-test with mixed paired and unpaired observations and p < 0.05). Relaxing the criteria for damage in the final field to PD < 5% reduced the miss rates for both methods, but SFR was still significantly worse than SS (SFR: 24%, 8%, 3%, and 6% vs. SS: 13%, 3%, 1%, and 1%). SITA-Faster tends to miss established clusters of damaged locations of size 4 or fewer locations in follow up visits at a higher rate than SITA-Standard.
Pre-procedural anxiety in patients with intravitreal injections shows a significant negative association with vision-related quality of life. This study determines the effect of telenursing with self-care education podcasts on anxiety and quality of life in patients with diabetes undergoing intravitreal injections. A randomized clinical trial was conducted in 2022 in Mashhad, Iran on 68 patients assigned to two groups. After informed consent were obtained, patients completed a demographic questionnaire, the Spielberger State-Trait Anxiety Inventory, and the SF-36 quality of life questionnaire. Relevant podcasts were delivered individually via WhatsApp once a week over an 8-week period to the intervention group (n=34), while the control group (n=34) received routine education via pamphlets. Anxiety levels were measured before the commencement of the intervention and each injection; the quality-of-life questionnaire was administered before and after the completion of the intervention. Data were analyzed using SPSS version 26. The statistical tests included the t-test, Chi square, repeated measures ANOVA, ANCOVA, and Mann-Whitney U test. The intervention group demonstrated a significantly greater reduction in both state anxiety (P<0.001) and trait anxiety (P<0.001) over the eight-week study period compared to the control group. Furthermore, the intervention group comparison with the control group showed statistically significant improvement in the total score of quality-of-life (P<0.001). A telenursing program delivered via self-care podcasts, a feasible task for community nurses, significantly reduced anxiety and improved quality of life in patients with diabetic retinopathy undergoing intravitreal injections.Trial Registration Number: IRCT20220611055134N.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
Clinicians often view exposure to supplementary oxygen in preterm infants as a simple reciprocal trade-off between mortality and the risk of vision-threatening retinopathy, but this perspective oversimplifies the underlying physiology. Oxygen moves through a series of spatially distinct compartments without intrinsic regulation, with Fick's law governing the entire process. We suggest that retinopathy of prematurity and cerebral palsy represent opposite ends of a shared continuum of oxygen diffusion injury. Several physiological concepts define this risk matrix. The spatial critical threshold indicates the structural limits of immature microvasculature that impact the diffusion radius. The extinction gradient marks the point at which the capillary-to-cell gradient becomes flat, leading to flux collapse and intracellular hypoxia. Conversely, the hyperoxic injury threshold identifies the point at which intracellular oxygen tension becomes harmful. Lastly, buffering capacity refers to the oxygen bound to haemoglobin in the venous circulation, downstream of metabolism, which is available to buffer temporary mismatches between delivery and consumption. These thresholds explain how hyperoxia and hypoxia can coexist within the same capillary, clarifying distinct clinical phenotypes. Framing oxygen injury this way clarifies contradictions in neonatal trials and offers a physiological model relevant to other diffusion-limited conditions.
This study examined motion segmentation and spatial suppression of motion in central versus peripheral vision, their relationship, and whether scaling peripheral stimuli to match larger middle temporal receptive fields reduces eccentricity effects. Ten adults (mean 27.5 years) completed motion segmentation and motion discrimination tasks across five contrast levels (12%-92%), three eccentricities (0°, 10°, 20°), and two stimulus conditions (scaled, unscaled). In the segmentation task, participants identified the tilt of a motion-defined ellipse within an oppositely moving background; segmentation thresholds were minimum stimulus exposure duration required for accurate tilt discrimination. Participants also judged motion direction of the ellipse in isolation. Segmentation efficiency was the log10 threshold difference between ellipse motion and segmentation thresholds. The motion discrimination task involved identifying the motion direction of the moving background patch in isolation, with a suppression index calculated as the log10 threshold difference between highest and lowest contrasts. In the unscaled condition, eccentricity reduced segmentation efficiency (p < 0.01) and suppression index (p = 0.003), with a significant interaction among suppression, segmentation, and eccentricity (p < 0.001). Correlations between segmentation efficiency and suppression index weakened with eccentricity (Pearson's r = 0.81, p = 0.003 at 0°, r = 0.69, p = 0.26 at 10°, r = 0.48, p = 0.16). Scaling improved segmentation efficiency (p = 0.003) and suppression index (p = 0.043) but did not remove eccentricity effects. Thus our ability to segment moving foreground objects declines with eccentricity, even when accounting for receptive field scaling.
Spinal cerebrospinal fluid (CSF) leak is a disabling and often misdiagnosed condition characterised by CSF hypovolemia. Associated neurological symptoms are diverse and often leave individuals bed-bound due to their orthostatic nature. Prior literature describing the difficulties in diagnosis, treatment, and ongoing impact of CSF leak is, thus far, confined to Europe and North America. This study provides a novel account of lived experiences of spinal CSF leak in Australia and Aotearoa New Zealand (NZ). An online survey exploring symptoms, diagnosis, treatment, and effect on daily life of a person's "first" CSF leak was designed with consumer involvement. Responses were received from May to August 2025. Open-text responses were analysed using thematic analysis. In total, 106 surveys were completed. Over 70 symptoms were reported; the most common were orthostatic headache (95.3%), neck pain (85.8%), and brain fog (79.2%). Most people considered their diagnosis (73.6%) and treatment (65.3%) difficult, underscored by limited clinician awareness and access to care, leaving individuals to self-advocate. Amongst symptomatic participants (73.6%), median EuroQol Visual Analogue Scale score was 40 (interquartile range 25-64; indicating low health-related quality-of-life) and mean Headache Impact Test-6 score was 69 ± 5 (indicating severe impact). Other challenges identified included navigating change to social identity and daily functioning. The spinal CSF leak experience in Australia and NZ is comparable to reports from other high-income countries, highlighting the global need to increase awareness of spinal CSF leak, support timely diagnostic, referral and treatment pathways, and mitigate its impact on quality of life.
The same dataset can be analysed in different justifiable ways to answer the same research question, potentially challenging the robustness of empirical science1-3. In this crowd initiative, we investigated the degree to which research findings in the social and behavioural sciences are contingent on analysts' choices. We examined a stratified random sample of 100 studies published between 2009 and 2018, in which, for one claim per study, at least five reanalysts independently reanalysed the original data. The statistical appropriateness of the reanalyses was assessed in peer evaluations, and the robustness indicators were inspected along a range of research characteristics and study designs. We found that 34% of the independent reanalyses yielded the same result (within a tolerance region of ±0.05 Cohen's d) as the original report; with a four times broader tolerance region, this indicator increased to 57%. Of the reanalyses conducted, 74% reached the same conclusion as the original investigation, 24% yielded no effects or inconclusive results and 2% reported the opposite effect. This exploratory study indicates that the common single-path analyses in social and behavioural research should not be simply assumed to be robust to alternative analyses4. Therefore, we recommend the development and use of practices to explore and communicate this neglected source of uncertainty.