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Status and weapon dogs are easily visible on social housing estates throughout the UK, providing acquired authority, respect, power and control. This book contextualises the phenomenon in terms of sociology, criminology and public policy.

Our application concerns the automated detection of vessels in retinal images to improve understanding of the disease mechanism, diagnosis and treatment of retinal and a number of systemic diseases. We propose a new framework for segmenting retinal vasculatures with much improved accuracy and efficiency. The proposed framework consists of three technical components: Retinex-based image inhomogeneity correction, local phase-based vessel enhancement and graph cut-based active contour segmentation. These procedures are applied in the following order. Underpinned by the Retinex theory, the inhomogeneity correction step aims to address challenges presented by the image intensity inhomogeneities, and the relatively low contrast of thin vessels compared to the background. The local phase enhancement technique is employed to enhance vessels for its superiority in preserving the vessel edges. The graph cut-based active contour method is used for its efficiency and effectiveness in segmenting the vessels from the enhanced images using the local phase filter. We have demonstrated its performance by applying it to four public retinal image datasets (3 datasets of color fundus photography and 1 of fluorescein angiography). Statistical analysis demonstrates that each component of the framework can provide the level of performance expected. The proposed framework is compared with widely used unsupervised and supervised methods, showing that the overall framework outperforms its competitors. For example, the achieved sensitivity (0:744), specificity (0:978) and accuracy (0:953) for the DRIVE dataset are very close to those of the manual annotations obtained by the second observer.

\"Simon Harding proposes a unique theoretical perspective on survival in violent street gangs which offers new evidence on gang behaviour, dynamics, affiliation and risks in inner city areas.\"--Provided by publisher.

Bevacizumab has been suggested to have similar effectiveness to ranibizumab for treatment of neovascular age-related macular degeneration. The Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) trial was designed to compare these drugs and different regimens. Here, we report the findings at the prespecified 2-year timepoint. In a multicentre, 2×2 factorial, non-inferiority randomised trial, we enrolled adults aged at least 50 years with active, previously untreated neovascular age-related macular degeneration and a best corrected distance visual acuity (BCVA) of at least 25 letters from 23 hospitals in the UK. Participants were randomly assigned (1:1:1:1) to intravitreal injections of ranibizumab (0·5 mg) or bevacizumab (1·25 mg) in continuous (every month) or discontinuous (as needed) regimens, with monthly review. Study participants and clinical assessors were masked to drug allocation. Allocation to continuous or discontinuous treatment was masked up to 3 months, at which point investigators and participants were unmasked. The primary outcome was BCVA at 2 years, with a prespecified non-inferiority limit of 3·5 letters. The primary safety outcome was arterial thrombotic event or hospital admission for heart failure. Analyses were by modified intention to treat. This trial is registered, number ISRCTN92166560. Between March 27, 2008, and Oct 15, 2010, 628 patients underwent randomisation. 18 were withdrawn; 610 received study drugs (314 ranibizumab; 296 bevacizumab) and were included in analyses. 525 participants reached the visit at 2 years: 134 ranibizumab in continuous regimen, 137 ranibizumab in discontinuous regimen, 127 bevacizumab in continuous regimen, and 127 bevacizumab in discontinuous regimen. For BCVA, bevacizumab was neither non-inferior nor inferior to ranibizumab (mean difference −1·37 letters, 95% CI −3·75 to 1·01; p=0·26). Discontinuous treatment was neither non-inferior nor inferior to continuous treatment (−1·63 letters, −4·01 to 0·75; p=0·18). Frequency of arterial thrombotic events or hospital admission for heart failure did not differ between groups given ranibizumab (20 [6%] of 314 participants) and bevacizumab (12 [4%] of 296; odds ratio [OR] 1·69, 95% CI 0·80–3·57; p=0·16), or those given continuous (12 [4%] of 308) and discontinuous treatment (20 [7%] of 302; 0·56, 0·27–1·19; p=0·13). Mortality was lower with continuous than discontinuous treatment (OR 0·47, 95% CI 0·22–1·03; p=0·05), but did not differ by drug group (0·96, 0·46–2·02; p=0·91). Ranibizumab and bevacizumab have similar efficacy. Reduction in the frequency of retreatment resulted in a small loss of efficacy irrespective of drug. Safety was worse when treatment was administered discontinuously. These findings highlight that the choice of anti-VEGF treatment strategy is less straightforward than previously thought. UK National Institute for Health Research Health Technology Assessment programme.

Background Falls are the second leading  cause of accidental deaths worldwide mainly in older people. Older people have poor vision and published evidence suggests that it is a risk factor for falls. Less than half of falls clinics assess vision as part of the multi-factorial assessment of older adults at risk of falls despite vision being an essential input for postural stability. The aim of our study was to investigate the relationship between all clinically assessed visual functions and falls amongst older adults in a prospective observational individually age-matched case control study. Methods Visual acuity (VA), contrast sensitivity (CS), depth perception, binocular vision and binocular visual field were measured using routinely used clinical methods in falls participants (N = 83) and non-falls participants (N = 83). Data were also collected on socio-demographic factors, general health, number of medications, health quality, fear of falling and physical activity. Logistic regression analysis was carried out to determine key visual and non-visual risk factors for falls whilst adjusting for confounding covariates. Results Older adults have an increased risk of experiencing a fall if they have reduced visual function (odds ratio (OR): 3.49, 1.64-7.45, p = 0.001), specifically impaired stereoacuity worse than 85” of arc (OR: 3.4, 1.20-9.69, p = 0.02) and reduced (by 0.15 log unit) high spatial frequency CS (18 cpd) (OR:1.40, 1.12-1.80, p = 0.003). Older adults with a hearing impairment are also at higher risk of falls (OR: 3.18, 95% CI: 1.36-7.40, p = 0.007). The risk decreases with living in a less deprived area (OR: 0.74, 0.64-0.86, <0.001), or socialising more out of the home (OR: 0.75, 0.60-0.93, p = 0.01). Conclusions The combination of social, behavioural and biological determinants are significant predictors of a fall. The non-visual risk factors include older adults, living in deprived neighbourhoods, socialising less outside of the home and those who have a hearing impairment. Impaired functional visual measures; depth perception and contrast are significant visual risk factors for falls above visual acuity.

Previous work has identified that malarial retinopathy has diagnostic value in paediatric cerebral malaria (CM). To improve our understanding of malarial retinopathy as a predictor of cerebral parasite sequestration in paediatric CM we reviewed data from the Blantyre autopsy study, to test the hypothesis that malarial retinopathy is an accurate predictor of cerebral parasite sequestration in an autopsy cohort. We performed a retrospective analysis of data collected from a consecutive series of patients presenting to the Pediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi between 1996 and 2010. We determined the diagnostic accuracy of malarial retinopathy as a predictor of cerebral parasite sequestration in a cohort of children with fatal CM. Of 84 children included in the study, 65 met the World Health Organization clinical diagnostic criteria for CM during life. Eighteen (28%) of 65 did not have evidence of cerebral parasite sequestration at autopsy and 17 had an alternative cause of death. Malarial retinopathy had a sensitivity of 89.4% (95% CI [77.6%, 95.6%]) and specificity of 73.0% (95% CI [57.2%, 84.8%]) to predict cerebral parasite sequestration. In a subset of patients with graded retinal assessments, this was improved to 94.3% (95% CI [81.7%, 98.7%]) and 88.0% (95% CI [70.4%, 96.2%]) by reclassifying patients in whom the only retinal sign was 1-5 haemorrhages in a single eye as retinopathy negative. This study is limited by its retrospective nature and the inherent selection bias associated with autopsy studies. Malarial retinopathy remains the most specific point-of-care test for CM in endemic areas. Its specificity may be improved, without sacrificing sensitivity, by reclassifying patients in whom the only retinal sign is fewer than 5 haemorrhages in a single eye as malarial retinopathy negative. A management algorithm is proposed for integration of malarial retinopathy into clinical care in both well-resourced and resource-limited environments.

This is the first book in the UK or US to set on record the recent cultural phenomenon of the use of certain dog breeds - both legal and illegal - to 'convey status' upon their owners. Such dogs are easily visible on social housing estates throughout the UK and in projects in the USA and provide acquired authority, respect, power and control. However they are increasingly linked to urban street gangs as 'Weapon Dogs' and present a danger to the ordinary public especially those using parks and open spaces with increased injuries being presented at UK hospitals. Though initially slow to react, local and statutory authorities are now seeking to address the issue through action plans and interventions. Written in a fresh, engaging and accessible style, this unique book contextualizes the phenomenon in terms of sociology, criminology and public policy. It considers a complex mix of urban and social deprivation, social control of public space and the influence of contemporary media imagery and 'gangsta' culture. It will make essential reading for academics and policy makers in criminology and criminal justice and those working with animal rights/animal welfare groups.

Aims Neurodegeneration and glial activation are primary events in the pathogenesis of diabetic retinopathy. Serum glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) are biomarkers of underlying neuroinflammatory and neurodegenerative disease processes. The aim of the present study was to assess the usefulness of these serum biomarkers for the identification and monitoring of retinal neurodysfunction in subjects with type 2 diabetes. Methods A case–control study was designed including 38 patients from the placebo arm of the EUROCONDOR clinical trial: 19 with and 19 without retinal neurodysfunction assessed by multifocal electroretinography. GFAP and NfL were measured by Simoa. Results Serum levels of GFAP and NfL directly correlated with age ( r  = 0.37, p  = 0.023 and r  = 0.54, p  < 0.001, respectively). In addition, a direct correlation between GFAP and NfL was observed ( r  = 0.495, p  = 0.002). Serum levels of GFAP were significantly higher at baseline in those subjects in whom neurodysfunction progressed after the 2 years of follow-up (139.1 ± 52.5 pg/mL vs. 100.2 ± 54.6 pg/mL; p  = 0.04). Conclusions GFAP could be a useful serum biomarker for retinal neurodysfunction. Monitoring retinal neurodysfunction using blood samples would be of benefit in clinical decision-making. However, further research is needed to validate this result as well as to establish the best cutoff values.

Street gangs, by definition, enjoy a special relationship with the street. Prior research shows that some communities are synonymous with gangs and that turf holds a combination of expressive and instrumental value for gang members. As gangs evolve over time and through different levels of organization, however, gangs’ relationship with the street changes. This shifting street dynamic is underexplored in prior research, thus, drawing on qualitative data from Scotland and Bourdieu’s theory of social field, the current study presents three cases of gangs at different stages of evolution and examines how levels of gang organization affect spatial relationships. As gangs accumulate sufficient street capital to evolve, we find territory is defined less physically and more relationally, with implications for gang research and practice.

OBJECTIVE: The expression of vascular endothelial growth factor (VEGF) is elevated in diabetic macular edema (DME). Ranibizumab binds to and inhibits multiple VEGF variants. We investigated the safety and efficacy of ranibizumab in DME involving the foveal center. RESEARCH DESIGN AND METHODS: This was a 12-month, multicenter, sham-controlled, double-masked study with eyes (age >18 years, type 1 or 2 diabetes, central retinal thickness [CRT] ≥300 μm, and best corrected visual acuity [BCVA] of 73-39 ETDRS letters [Early Treatment Diabetic Retinopathy Study]) randomly assigned to intravitreal ranibizumab (0.3 or 0.5 mg; n = 51 each) or sham (n = 49). The treatment schedule comprised three monthly injections, after which treatment could be stopped/reinitiated with an opportunity for rescue laser photocoagulation (protocol-defined criteria). After month 1, dose-doubling was permitted (protocol-defined criteria, injection volume increased from 0.05 to 0.1 ml and remained at 0.1 ml thereafter). Efficacy (BCVA and CRT) and safety were compared between pooled ranibizumab and sham arms using the full analysis set (n = 151, patients receiving ≥1 injection). RESULTS: At month 12, mean ± SD BCVA improved from baseline by 10.3 ± 9.1 letters with ranibizumab and declined by 1.4 ± 14.2 letters with sham (P < 0.0001). Mean CRT reduction was 194.2 ± 135.1 μm with ranibizumab and 48.4 ± 153.4 μm with sham (P < 0.0001). Gain of ≥10 letters BCVA from baseline occurred in 60.8% of ranibizumab and 18.4% of sham eyes (P < 0.0001). Safety data were consistent with previous studies of intravitreal ranibizumab. CONCLUSIONS: Ranibizumab is effective in improving BCVA and is well tolerated in DME. Future clinical trials are required to confirm its long-term efficacy and safety.